Greater Activity Levels in Those with COPD are Related to Active Loved Ones

Greater Activity Levels in COPD If Loved Ones Are Active

Background: Patients with COPD are less active compared with healthy subjects. This may be due to symptoms of

Greater activity levels possible with loved ones

Man pedaling stationary cycle being supervised by daughter

breathlessness and fatigue. Adopting a healthy lifestyle with more physical activity is one of the main goals of a COPD management plan. Family members and loved ones may play an important role in helping patients with COPD achieve greater activity levels.

Study: Mr. Mesquita, a physical therapist, and colleagues at the Department of Respiratory Medicine in Maastrict, the Netherlands, studied light and moderate to vigorous physical activity in 125 patients with COPD and a loved one over 5 days. The findings were published in the May 2017 issue of the journal CHEST, volume 151, pages 1028-1038.

Woman with COPD with greater activity levels.

Woman with COPD walking with grandson

Results: Patients with COPD spent more sedentary time (being inactive) than their loved ones. However, those patients with an active loved one spent more time in moderate to vigorous activities than did those with an inactive loved one after controlling for age, body mass, and severity of COPD.

Conclusions: The authors concluded that in general patients with COPD are less active than their loved one despite similar exercise motivation. Those with an active loved one have greater activity levels.

My Comments:  It is very common for those with COPD to reduce activities to avoid the unpleasant feeling of breathing difficulty or shortness or breath. This can lead to a downward spiral as shown below.

Greater activity levels

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).

 

Getting started in a pulmonary rehabilitation program is one of the best ways to reverse this downward spiral. Studies clearly show that regular exercise provides greater benefits for those with COPD than any inhaler. I encourage you to be as active as possible.

Arm Exercise Training Reduces Shortness of Breath in COPD

Studies Show that Arm Exercise Improves Breathlessness 

Background: Many individuals with COPD have difficulty performing arm activities due to shortness of breath and arm fatigue. As a result, upper limb exercise training is typically included in pulmonary rehabilitation programs.

Study: Dr. Zoe McKeough and colleagues from the University of Sydney in Australia reviewed all published studies on upper limb exercise training for at least four weeks. They examined: arm exercise (AE) compared with either no or sham (pretend) training; and combined arm and leg exercise compared with only arm exercise. The study was published in the November 15, 2016, issue of the Cochrane Database Systematic Reviews.

Arm crack machine used for arm exercise

Man performing arm exercise using arm crank machine

Findings: A total of twelve studies were included in the analysis. When AE training was compared with either no or sham training, there was a significant improvement in breathing difficulty (four studies of 129 subjects). When upper limb exercise combined with lower limb exercise was compared with AE alone, there was no difference in shortness of breath (2 studies of 55 subjects). There was no improvement in health-related quality of life with AE training.

When AE endurance training was compared with no or sham training OR with combined arm and leg exercise training, there was a large significant improvement in unsupported endurance arm capacity.

Conclusion: Some form of upper limb exercise training when compared with no training or a sham intervention improves breathing difficulty in those with COPD.

My Comments: Arm exercises are important for those with COPD who note breathing difficulty when performing arm activities such as lifting objects (like a grandchild), carrying a grocery package, and moving dishes from the washer and placing them in a cabinet. Also, arm exercise can substitute if someone can not perform leg exercises for whatever reason. This might include those with knee, hip, or back problems or those who use a wheelchair.

Stretch or resistance band for arm exercise

Using stretch or resistance bands at home is the easiest and least expensive way to do upper limb exercise. Ask a physical therapist to show you simple arm exercises to increase strength as well as endurance.

 

Fraility Reduced by Pulmonary Rehabilitation in Older COPD Patients

Fraility is Common in Elderly

Background: Frailty is common as people age.  It is defined as a person having at least three of the following characteristics:

  • Low physical activityelderly-man

  • Muscle weakness

  • Slowed performance

  • Fatigue or poor endurance

  • Unintentional weight loss

In a press release, Dr. Matthew Maddocks, of King’s College London said: “Frailty affects one in ten over-65s, and one in four over-80s. We now have a good understanding of how to measure frailty through various tests.” Dr. Maddocks is the first author of the article published online in the journal Thorax. 2016 Jun 12. pii: thoraxjnl-2016-208460. doi: 10.1136/thoraxjnl-2016-208460.

Study: Researchers recruited 816 outpatients with COPD between 2011 and 2015. The mean age of participants was 70 years old.  To assess frailty, measurements in weight loss, exhaustion, low physical activity, slowness and weakness were measured before and after pulmonary rehabilitation.

The 8-week program consisted of exercise and multidisciplinary education, comprising topics such as physical activity and exercise, medication use, diet, smoking cessation, and coping strategies.

Results: More than 25% of the participants with COPD referred for rehabilitation were frail. The frail participants had double the odds of not finishing the rehabilitation program because of  worsened condition or admission to hospital.

The frail participants who completed the rehabilitation program scored consistently better in measures of breathlessness, exercise performance, physical activity and health status compared to those not classified as frail.

61% of the frail participants were no longer classified as frail at the end of the program.

Conclusions: The authors concluded that people with COPD respond favorably to pulmonary rehabilitation, and such programs could reverse their frailty.

My Comments: COPD can speed health decline and lead to frailty especially if those with COPD are inactive.  Fraility can cause a greater risk for falls, disability, hospitalization and death. This study provides additional support for participation in pulmonary rehabilitation if you have COPD. You should search online or ask your health care provider about a program in your area.

Electrical Stimulation of Muscles

Neuromuscular Electrical Stimulation (NMES) Increases Walking Distance

In a December 14, 2015, on-line article in the Lancet Respiratory Journal, doctors at King’s College in London reported their findings of electrical stimulation of muscles as a home-based exercise program. (Lancet Respir Med. 2015 Dec 14. pii: S2213-2600(15)00503-2. doi: 10.1016/S2213-2600(15)00503-2).

The Reason for the Study: Some individuals with advanced COPD are too short of breath to begin an exercise program. In addition,

White pads are placed on the quadricep muscle. The wires are connected to a machine that provides electrical stimulation.

White pads are placed on the quadricep muscle. The wires are connected to a machine that provides electrical stimulation.

their leg and arm muscles may be weak as a result of physical inactivity (called deconditioning). The weakness may occur over a long time period or be a result of a COPD exacerbation that limits activities

What was the Study?: Adults with COPD who had (1) lung function less than 50% of predicted and (2) incapacitating breathlessness were studied over a 6 week period. 25 received NMES and 27 received placebo (sham or ineffective therapy). The distance walked in 6 minutes after 6 weeks was the main outcome. NMES was self-administered at home every day for 30 minutes to each quadriceps muscle (large muscle in front of thigh).

A battery powered unit was used to produce a controlled contraction of the muscle. For the placebo group, a low intensity of stimulation was used and individuals could detect the electrical stimulus, but it was too low to cause actual muscle contraction (shortening).

Main Findings: The change the 6 minute walking distance over 6 weeks was + 30 meters in the NMES group and – 6 meters in the placebo group. This difference was considered significant. Two participants, one from each group, had persistent redness of the skin over the muscle.

Conclusions: The authors concluded that NMES improves the ability to walk farther  in those with severe COPD who are very breathless by strengthening the quadriceps muscle of the legs. They suggest that the use of NMES may be considered for those with severe COPD who are unable to participate in pulmonary rehabilitation.

My Comment: This is an interesting study particularly for those who are so short of breath that it is difficulty to do very much. It is reasonable to me that someone with severe COPD could receive NMES for 6 weeks and than transition to a standard pulmonary rehabilitation program.

Where is NMES available?  Electrical muscle stimulation is used commonly for athletes before and/or after knee surgery especially for repair of the anterior cruciate ligament (ACL). The equipment is typically available and can be performed by a physical therapist (PT) or  by a physiatrist (a doctor who specializes in rehabilitation and treats injuries or illnesses that affect how you move). You should ask your health care provider about a possible referral to one of these specialties. Since the use of NMES is considered as a new treatment for those with COPD who have major weakness of the muscles, you may wish to bring information about the study for the appointment.

 

 

What’s New About Breathlessness

Dr. Denis O’Donnell (Kingston, Ontario, Canada) and I wrote a review called Recent Advances in Dyspnea (medical word for breathlessness) in the January 2015 issue of the journal CHEST (pages 232-241). The review covered new research information about breathing difficulty over the past 4 years.

Here is information about how breathlessness affects daily life.

Dr. Denis O'Donnell, Professor of Medicine at Queen's University, in Kingston, Ontario, Canada

Dr. Denis O’Donnell, Professor of Medicine at Queen’s University, in Kingston, Ontario,

  1. Of 2,258 individuals with severe COPD, breathlessness was worse upon awakening in the morning.
  2. Most individuals reported that their breathing varied from day to day and from week to week.
  3. Treatment with a long-acting bronchodilator reduced the variability in breathing difficulty.
  4. Women generally report more breathlessness than men.
  5. In the United Kingdom, 20% of menopausal women reported breathing difficulty. This may be related to low levels of estrogen and progesterone which could affect mood.
  6. Obesity is associated with an increase in breathlessness.
  7. Anxiety and depression are more common in those with heart and lung diseases.

Here are some of the key findings about treatment.

  1. Most long-acting bronchodilators inhaled once or twice daily improve breathing difficulty in those with COPD.
  2. In general. the improvement in breathlessness is greater with two different bronchodilators in a single inhaler compared with one bronchodilator in an inhaler.
  3. Individuals with COPD reported less breathlessness related to anxiety after 8 weeks in a pulmonary rehabilitation program compared with “usual care.”

Here is information on new therapies not yet approved to relieve breathing difficulty. These therapies require more testing before use.

  1. Those with COPD had less breathlessness after acupuncture compared with a sham, or pretend, treatment.
  2. Placement of valves or coils into breathing tubes through a scope can deflate the lung and improve breathing difficulty.
  3. Using a breathing machine connected to plastic tubes in the nose (nasal cannula) to assist breathing during walking improves breathing by allowing the breathing muscles to work less.