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Factors associated with low-level physical activity in elderly patients with chronic obstructive pulmonary disease

  • Lee, Sang Hee (Department of Internal Medicine, Wonkwang University Sanbon Hospital) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Haejung (Department of Nursing, Pusan National University College of Nursing) ;
  • Kim, Yun Seong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2016.03.18
  • Accepted : 2016.10.26
  • Published : 2018.01.01

Abstract

Background/Aims: In patients with chronic obstructive pulmonary disease (COPD), the extent of physical activity (PA) is correlated with disease severity and prognosis. However, factors associated with low-level PA in elderly COPD patients are not known. We assessed the levels of PA and clinical factors associated with low-level of PA in elderly COPD patients. Methods: This was a secondary analysis of a multicenter, prospective study of 245 patients with COPD. Among them, 160 patients with 65 years or more were included. Three PA groups were defined with respect to daily activity time (low, moderate, and high). Health related quality of life (HRQL) was measured using St. George's respiratory questionnaire (SGRQ) and 36-item short-form health survey. Anxiety and depression status were assessed employing the hospital anxiety and depression scale (HADS). Multivariate logistic regression was performed to identify independent predictors of low-level PA in elderly COPD patients. Results: Of all the 160 patients, 103 (64.4%) engaged in low-level PA. Upon univariate analysis, a decreased exercise capacity (6-minute walk test < 250 m), an increased dyspnea (the modified medical research council [MMRC] dyspnea scale ${\geq}2$), a decreased HRQL (total SGRQ score), and a presence of depression (HADS-D ${\geq}8$) were significantly associated with low-level PA. Upon multivariate analysis, an MMRC grade ${\geq}2$ (hazard ratio [HR], 2.550; p = 0.034), and HADS-D ${\geq}8$ (HR, 2.076; p = 0.045) were independently associated with low-level PA in elderly COPD patients. Conclusions: Two-thirds of elderly patients with COPD reported low-level of PA. More severe dyspnea and a presence of depression were independently associated with low-level PA in elderly COPD patients.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Rennemark M, Lindwall M, Halling A, Berglund J. Relationships between physical activity and perceived qualities of life in old age: results of the SNAC study. Aging Ment Health 2009;13:1-8. https://doi.org/10.1080/13607860802154416
  2. Aalami OO, Fang TD, Song HM, Nacamuli RP. Physiological features of aging persons. Arch Surg 2003;138:1068-1076. https://doi.org/10.1001/archsurg.138.10.1068
  3. Franceschi C, Capri M, Monti D, et al. Inflammaging and anti-inflammaging: a systemic perspective on aging and longevity emerged from studies in humans. Mech Ageing Dev 2007;128:92-105. https://doi.org/10.1016/j.mad.2006.11.016
  4. Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006;27:397-412. https://doi.org/10.1183/09031936.06.00025805
  5. Belman MJ. Exercise in patients with chronic obstructive pulmonary disease. Thorax 1993;48:936-946. https://doi.org/10.1136/thx.48.9.936
  6. Yohannes AM, Roomi J, Waters K, Connolly MJ. Quality of life in elderly patients with COPD: measurement and predictive factors. Respir Med 1998;92:1231-1236. https://doi.org/10.1016/S0954-6111(98)90426-7
  7. Gosker HR, Lencer NH, Franssen FM, van der Vusse GJ, Wouters EF, Schols AM. Striking similarities in systemic factors contributing to decreased exercise capacity in patients with severe chronic heart failure or COPD. Chest 2003;123:1416-1424. https://doi.org/10.1378/chest.123.5.1416
  8. Garcia-Aymerich J, Serra I, Gomez FP, et al. Physical activity and clinical and functional status in COPD. Chest 2009;136:62-70. https://doi.org/10.1378/chest.08-2532
  9. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006;61:772-778. https://doi.org/10.1136/thx.2006.060145
  10. Garcia-Aymerich J, Felez MA, Escarrabill J, et al. Physical activity and its determinants in severe chronic obstructive pulmonary disease. Med Sci Sports Exerc 2004;36:1667-1673. https://doi.org/10.1249/01.MSS.0000142378.98039.58
  11. Miravitlles M, Cantoni J, Naberan K. Factors associated with a low level of physical activity in patients with chronic obstructive pulmonary disease. Lung 2014;192:259-265. https://doi.org/10.1007/s00408-014-9557-x
  12. Watz H, Pitta F, Rochester CL, et al. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J 2014;44:1521-1537. https://doi.org/10.1183/09031936.00046814
  13. Kim KU, Park HK, Jung HY, et al. Association of depression with disease severity in patients with chronic obstructive pulmonary disease. Lung 2014;192:243-249. https://doi.org/10.1007/s00408-013-9547-4
  14. Jones PW, Quirk FH, Baveystock CM. The St George's respiratory questionnaire. Respir Med 1991;85 Suppl B:25-31. https://doi.org/10.1016/S0954-6111(06)80166-6
  15. Kim YS, Byun MK, Jung WY, et al. Validation of the Korean version of the St. George's respiratory questionnaire for patients with chronic respiratory disease. Tuberc Respir Dis 2006;61:121-128. https://doi.org/10.4046/trd.2006.61.2.121
  16. Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160-164. https://doi.org/10.1136/bmj.305.6846.160
  17. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-483. https://doi.org/10.1097/00005650-199206000-00002
  18. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc 1999;38:289-296.
  19. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  20. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 2002;52:69-77. https://doi.org/10.1016/S0022-3999(01)00296-3
  21. O'Donnell DE, Laveneziana P. Dyspnea and activity limitation in COPD: mechanical factors. COPD 2007;4:225-236. https://doi.org/10.1080/15412550701480455
  22. Reishtein JL. Relationship between symptoms and functional performance in COPD. Res Nurs Health 2005;28:39-47. https://doi.org/10.1002/nur.20054
  23. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest 1985;87:35-38. https://doi.org/10.1378/chest.87.1.35
  24. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry 2000;15:1090-1096. https://doi.org/10.1002/1099-1166(200012)15:12<1090::AID-GPS249>3.0.CO;2-L
  25. Yohannes AM, Baldwin RC, Connolly MJ. Prevalence of sub-threshold depression in elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry 2003;18:412-416. https://doi.org/10.1002/gps.851
  26. Zhang H, Wang X, Lin J, et al. Grey and white matter abnormalities in chronic obstructive pulmonary disease: a case-control study. BMJ Open 2012;2:e000844. https://doi.org/10.1136/bmjopen-2012-000844
  27. Alexopoulos GS. Depression in the elderly. Lancet 2005; 365:1961-1970. https://doi.org/10.1016/S0140-6736(05)66665-2
  28. Keil DC, Stenzel NM, Kuhl K, et al. The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability. Chron Respir Dis 2014;11:31-40. https://doi.org/10.1177/1479972313516881
  29. Duenas-Espin I, Demeyer H, Gimeno-Santos E, et al. Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study. Int J Chron Obstruct Pulmon Dis 2016;11:1287-1295.
  30. Bosley CM, Corden ZM, Rees PJ, Cochrane GM. Psychological factors associated with use of home nebulized therapy for COPD. Eur Respir J 1996;9:2346-2350. https://doi.org/10.1183/09031936.96.09112346
  31. Pulska T, Pahkala K, Laippala P, Kivela SL. Follow up study of longstanding depression as predictor of mortality in elderly people living in the community. BMJ 1999;318:432-433. https://doi.org/10.1136/bmj.318.7181.432
  32. Bartels SJ, Dums AR, Oxman TE, et al. Evidence-based practices in geriatric mental health care: an overview of systematic reviews and meta-analyses. Psychiatr Clin North Am 2003;26:971-990. https://doi.org/10.1016/S0193-953X(03)00072-8
  33. Alexopoulos GS, Katz IR, Reynolds CF 3rd, Carpenter D, Docherty JP; Expert Consensus Panel for Pharmacotherapy of Depressive Disorders in Older Patients. The expert consensus guideline series: pharmacotherapy of depressive disorders in older patients. Postgrad Med 2001;Spec No Pharmacotherapy:1-86.
  34. Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol 2007;21:217-230. https://doi.org/10.1111/j.1472-8206.2007.00473.x

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