Care of Patients with Chronic Pulmonary DisordersPhysical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003–2006)
Introduction
In 2008, chronic obstructive pulmonary disease (COPD) was reported to be the third leading cause of death in the United States.1 By 2020, it is predicted to become the fifth largest contributor to disability.2 People with COPD are notably inactive in daily life.3 This inactivity leads to deconditioning and muscle weakness.4 Further, growing evidence shows that an inactive lifestyle is associated with negative outcomes, such as increased disability, increased risk of hospital admission due to COPD, and increased risk of death associated with respiratory disease.5, 6, 7, 8, 9 Increasing overall levels of physical activity is an important goal of COPD disease management.10 To accomplish this, a better understanding of the patterns of physical activity is needed.
Previous studies4, 8, 11, 12 have established that people with COPD do not meet guidelines for moderate to vigorous physical activity (MVPA), but less is known about sedentary time and light physical activity (LPA). LPA is important because it is a major source of 24-h energy expenditure and is known to affect health-related outcomes in healthy older adults and people with other chronic diseases.13, 14, 15 The negative effect of sedentary time on adverse health-related outcomes, independent of physical activity, has also been reported in the general population.16, 17 In addition, most of what is known about PA in COPD comes from research in other countries.4, 11, 18 Differences in cultures and socioeconomic status influence PA,19 making it difficult to generalize to the United States (U.S.) population. Thus, this study describes sedentary time and different levels of physical activity based on data from a representative sample of the U.S. population.
The purposes of this study were two: (1) to compare sedentary time and levels of physical activity in a representative sample of people with COPD with a control group without COPD, using actigraphy; and (2) to examine the relative contributions of demographic and clinical characteristics to sedentary time and time spent in LPA and MVPA in people with COPD.
Researchers have used a variety of activity-monitoring devices and self-reported questionnaires to measure physical activity in people with COPD.4, 11, 18, 20, 21 Population-based studies from Spain used self-reported measures and provided strong evidence that people with COPD are very sedentary8, 12 and less active than people with other chronic diseases.3 In studies of objectively measured physical activity, people with COPD spent less time walking and standing4, 11 and had decreased movement intensity while walking,4 compared with healthy controls. It was also reported that time spent in MVPA differed significantly between people with moderate and severe COPD and healthy subjects.22 Specifically, the duration, intensity, and counts of physical activity were significantly reduced in people with COPD compared with healthy subjects.23 From the existing research it is established that people with COPD have reduced physical activity, but the extent of the problem in the U. S. is not clear because there are no population-based studies with objectively measured physical activity.
The following factors have been generally associated with total physical activity. Variables independently associated with a low total physical activity in people with COPD include female sex,24 older age,21, 24 marital status,21 unemployed status,21 and lower social economic status.24 Conflicting findings have been reported on the relationship between smoking and the level of physical activity. One study6 reported that former smokers and those who never smoked were more physically active; another21 found that current smokers were associated with a higher level of physical activity. Dyspnea was negatively associated with total physical activity.21, 24, 25, 26 However, little is known about the factors that are related to different levels of physical activity (i.e., LPA vs. MVPA) in people with COPD.
Sedentary time is defined as prolonged sitting time and the absence of whole-body movement that results in an energy expenditure of no more than 1.5 times resting energy expenditure.27, 28 Recently, the importance of decreasing sedentary time has been emphasized in studies of the general population and older adults with cancer.14, 17 Sugiyama et al29 noted that decreasing sedentary time in the general population reduces their risk of obesity to the same degree as getting sufficient physical activity. Few studies have described sedentary time in people with COPD, but it has been reported that people with COPD spend more time sitting and lying down than healthy controls.4, 11 These findings, however, were based on only two days of monitoring. Another study of objectively measured physical activity22 reported differences in physical activity, but no difference in time spent in sedentary activity between people with COPD and healthy subjects. Further studies are needed to examine sedentary time in people with COPD.
Section snippets
Design
This secondary cross-sectional study used data from the National Health and Nutrition Evaluation Survey (NHANES). NHANES is a cross-sectional, multistage, stratified, clustered probability sample of civilian, noninstitutionalized, U.S. populations conducted by the National Center for Health Statistics.30 African Americans, low-income persons, Mexican-Americans, and those aged 60 or older were oversampled in NHANES.
Sample, settings, and procedures
Participants (n = 21,470) completed an NHANES interview between 2003 and 2006. Of
Sample characteristics
The COPD group and the comparison group numbered 224 and 1386, respectively. The mean age of the COPD group was 70.05; the mean age of the comparison group was 69.21. Men comprised 50.9% of the COPD group and 64.3% of the comparison group. People with COPD were mainly non-Hispanic Whites, and few were working (Table 1). Significant differences were found in the proportion of men, working status, marital status, pack years of smoking, shortness of breath, self-reported health, and number of
Discussion
In this study of the United States population, people with COPD were less physically active than people without COPD. When physically active, they spent most of that time in LPA. By contrast, they spent an average of 6.4 min a day in MVPA, far below the recommended duration of 30 min a day, five days a week. They also spent more time in sedentary activities than the comparison group. Age, gender, self-reported health, BMI, and shortness of breath were associated with physical activity.
Conclusion
The findings of this study provide additional confirmation that people with COPD in the United States are extremely sedentary and have low levels of LPA and MVPA. This highlights the need to assess patients' physical activity level in clinical settings and further emphasizes the need to assess their sedentary time and to detail their patterns of physical activity, so that more individualized goals for physical activity could be set in people with COPD. Several demographic and clinical
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This study is supported by T32 Post Doctoral Fellowship; Health Promotion/ Risk Reduction Interventions with Vulnerable Populations Training Grant in University of Michigan, Ann Arbor.