Decline in Physical Activity

Over Time, Physical Activity Decreases in COPD

Little is know about the role of physical activity over time in those with COPD. In the August 1, 2015, issue of the American Journal of Respiratory and Critical Care Medicine (commonly called the Blue journal), Dr. Waschki and others from Grosshansdorf, Germany, described the changes in physical activity (measured by an armband sensor), results of breathing tests, 6 minute walking distance, muscle mass, and  blood tests to assess inflammation in the body. Results At the start there were 170 patients with COPD tested; 3 years later, 137 were retested. The average age was 64 years and 74% were men. Changes were observed in all stages of COPD. The following numbers are the mean changes: ______________________________________________________
  1. total daily energy expenditure:  – 200 kcal
  2. steps per day: – 957
  3. amount of air exhaled in one second (FEV1): – 168 milliliters
  4. distance walked in 6 minutes:  – 60 meters
______________________________________________________ However, not everyone got worse over the 3 years. Physical activity level went down in 71% and went up in 29%. My Comment Most healthy people are less active when they reach their 60s and 70s than when they were younger. However, the authors of the study stated that the decline in activity level observed in those with COPD averaged about 5 -6 % for the group. This decline is about 2 – 4 times what typically occurs in healthy individuals. An important question is WHY? One possibility is that breathing difficulty has worsened. This
Downward Cycle of Breathing Difficulty Leading to Reduced Physical Activity and Deconditioning ("out of shape"). Taken from page 70 of COPD: Answers to Your Questions (with permission).

Downward Cycle of Breathing Difficulty Leading to Reduced Physical Activity and Deconditioning (“out of shape”). Taken from page 70 of COPD: Answers to Your Questions (with permission).

problem, breathlessness with activities,  is unpleasant and usually causes those with COPD to reduce or limit their physical activities as shown in this figure. Another important question is WHETHER the declines observed in the study can be slowed down or even reversed. Although there is no clear answer to this at the present time, daily physical activities provide one approach. If you aren’t a daily walker or aren’t doing daily gardening or whatever, you should ask you doctor about a referral to nearby pulmonary rehabilitation program. These supervised exercise programs offer the opportunity to exercise in a safe place with appropriate monitoring. Everyone whom I see in my practice who goes to pulmonary rehabilitation has told me that, “it has changed my life.”
Individuals at Pulmonary Rehabilitation  performing resistance training

Individuals at Pulmonary Rehabilitation performing resistance training

Man pedaling stationary cycle being supervised by rehabilitation specialist.

Man pedaling stationary cycle being supervised by rehabilitation specialist.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.