Exercise as it relates to Disease/COPD and Exercise - more activity = less mortality

Does regular physical activity reduce the likelihood of mortality in patients with chronic obstructive pulmonary disease?

The wiki fact sheet below has been created by student U3115411 for the unit Health, Disease and Exercise as an assessment item. It will focus on the benefits of exercise and how it relates to Chronic Obstructive Pulmonary Disease based on the information found in this study Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

What is the background for this research?

COPD is a widely used umbrella term for long-term diseases that affect the lungs and cause shortness of breath. Some of these conditions include emphysema, chronic bronchitis and chronic asthma which are irreversible conditions.

COPD occurs in more than 1 in 20 people over the age of 55, that's over 300,000 people, and in 2013, it was the fifth leading cause of death in Australia, with over 6,000 people dying from the disease. COPD mainly occurs in the older populations and is mainly caused by smoking or passive smoking, however, not all cases are the same and some patients presenting with COPD can be non-smokers (for example, those with asthma). With our lungs being one of the most important organs in our bodies, its fair to say that they need to be taken care of and its been proven many times that exercise or physical activity helps improve lung function in multiple ages groups and populations. As the particular study mentioned above suggest, the benefits of exercise on COPD has not been widely investigated and could be a leading factor as to why this study was conducted.

Where is the research from?

Authors of the study; J Garcia-Aymerich and M Benet are from the Respiratory and Environmental Health Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain and fellow authors; J M Antó, P Lange and P Shcnohr have ties to the following institutions: the Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain, The Department of Cardiology and Respiratory Diseases, Hvidovre University Hospital, Denmark and the Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, Copenhagen, also in Denmark where the study was conducted form 1981 till 2000.

What kind of study was it?

This is a population-based cohort study involving data collection via self-reported questionnaires and electronic spirometers.

What did the research involve?

A total of 2386 participants with COPD were included in the study, and had no special parameters or guidelines they had to follow whilst participating. They simply answered a questionnaire about their physical activity and lifestyle habits every 5 to 10 years and followed with a lung function test using electric spirometry. The questionnaire was self-administered and health questions relating to hospital admissions and co-morbidities were checked against public health records. The physical acitivty was categorised into three levels:

(1) Low: light physical activity such as walking/biking for less than 2 hours per week

(2) Moderate: Light physical actiivty for 2–4 hours per week

(3) High: Light physical activity for more than 4 hours per week or a more vigorous activity for any frequency.

What were the basic results?

The preliminary findings of the study showed that subjects who participated in low, moderate or high frequency physical activity were less likely to be admitted to hospital, but those who did not participate in any physical activity or very low amounts were more likely to be admitted to hospital and reached death in a shorter time period than those who did physical activity. the very low subjects also reported more severe COPD. During the follow-up period around 60% of the subjects had died as a result of COPD. The results from this study that lead to the breakthrough conclusion showed that up to a 40% reduction in the risk of hospital admissions due to CPOD, could be seen within individuals who performed at least 2 hours of light physical activity per week. The deceased population were mainly older subjects who did very little to no physical activity and had severe COPD often with a co-mobidity present.

How did the researchers interpret the results?

The researches who conducted the study, interpreted their results and concluded that most guidelines for COPD should be reviewed following more longitudinal studies that show the long-term benefits that also investigate the specific mechanisms that result in the risk-reduction.

What conclusions can we take from this research?

At the time the study was conducted only the british guidelines stated that COPD patients should do light exercise to aid in their recovery, however using the results from this study, its clear to see that even small amounts of physical activity can postpone hospital admissions and slow the acceleration of the disease. we can conclude that all COPD guidelines should contain recommendations that physical activity (no matter how small), should be maintained through diagnosis of COPD. The type of activity to be administered does not require any special skill sets or qualified supervision and can be achieved without specialised equipment or facilities and is therefore simple and easy to participate in and can benefit the participant in a multitude of ways. The two life and death statistics compared earlier in the results section show that even the smallest amount of exercise can reduce the risk of death in COPD patients, and because the amount and type of activity is so easy to achieve, it should be recommended in all cases.

What implications does this research have?

Given that COPD is such a prevalent issue around the world and the fact that it puts such strain on the health systems, providing these simple guidelines to reduce the load even slightly would be beneficial for public health in most developed societies. However, without further, more detailed longitudinal studies always seek medical advice before exercising.

Further readings on COPD

1. About COPD - Chronic Obstructive Pulmonary Disease: http://www.aihw.gov.au/copd/
2. Living with a lung condition - Patient support: http://lungfoundation.com.au/patient-support/living-with-a-lung-condition/
3. What is COPD?: http://www.copdfoundation.org