Living with Others Associated with Higher Levels of Physical Activity

Physical Activity Benefits of Living with Others 

Background: There is limited information on the effects of social support on activity behaviors in those with COPD.

Dr. Chen is author of study of living with others

Zijing Chen, Ph.D., is Research Coordinator at U.S. Department of Veterans Affairs,
University of Washington, in Seattle

Study: Dr. Chen and colleagues at the University of Washington in Seattle examined the association between a person’s social support and smoking, physical activity, participating in pulmonary rehabilitation, and using inhalers as prescribed in patients with COPD. The researchers collected information at the start of the study (called baseline) and one and two years later. Participants were recruited from one academic medical center and two Veterans Affairs (VA) health care systems.

Subjects answered questions and wore an activity monitor on the ankle during waking hours for 7 days at each time period.

The study was published in the September 2017 issue of the journal Annals of the American Thoracic Society, volume 14; pages 1419-1427.

family and living with others can provide social support

Daughter provides social support for her mother

Results: Information was collected on 282 subjects at baseline and on 225 subjects after two years. Average age was 68 years, and 80% of subjects were men. Total steps per day at baseline were 6,002, and at two years were 5,528.

Main findings were: 1. Those with COPD who were living with others walked 903 more steps per day compared with those who lived alone. 2. The odds of participating in pulmonary rehabilitation were more than 11 times higher if an individual with COPD had a spouse or partner caregiver compared with not having a caregiver. 3. Social support was not associated with receiving the flu shot or taking inhaler medications as prescribed.

Conclusions: The authors concluded that the social environment (such as living with others) was critical in shaping success with physical activity, including steps walked per day and participating in a pulmonary rehabilitation program.

My Comments: Having a spouse/partner or living with others has  direct benefits as shown in this study. Other studies have demonstrated that having a network of supportive relationships contributes to psychological well-being. When you have a social support network, you benefit in the following ways:

  • Sense of belonging. Spending time with people helps ward off loneliness. Whether it’s family members, dog lovers, fishing buddies, or playing cards with a group  – you know that you are not alone. This can help to cope with stress.
  • Increased sense of self-worth. Having people who call you a friend reinforces the idea that you’re a good person to be around.
  • Feeling of security. Your social network gives you access to information, advice, guidance and other types of assistance should you need them. It’s comforting to know that you have people you can turn to in a time of need.

 

 

Home-based Pulmonary Rehabilitation: Benefits Similar to a Standard Program

Home-based Pulmonary Rehabilitation: An Alternative Approach

Background: Unfortunately, overall participation in standard pulmonary rehabilitation programs is low. The many reasons include no interest, “I am too busy,” travel time, inconvenience, and cost, depending on the individual’s medical insurance.

Although home-based pulmonary rehabilitation offers an alternative, there is little information about its benefits. Does it work as well as a person going to the hospital or facility with an experienced nurse, respiratory therapist, and/or an exercise specialist?

Dr. Elizabeth Horton

Dr. Elizabeth Horton is Senior Lecturer in Exercise and Health at Coventry University

Study: Dr. Elizabeth Horton and colleagues from the Faculty of Health and Life Sciences, Coventry University, and the Centre for Exercise and Rehabilitation Science, University Hospitals Leicester NHS Trust, in the United Kingdom performed the study. 187 patients with COPD referred to their hospitals for pulmonary rehabilitation were assigned to either a standard program supervised by trained professionals OR to a structured unsupervised home-based pulmonary rehabilitation program. Shortness of breath with activities was selected as the main outcome to compare whether the home-based program was “as good as” the hospital-based program.

The home-based pulmonary rehabilitation program included one hospital visit with a health care professional trained in motivational interviewing, a self-management manual, instructions on exercise, and two telephone calls over the 7 weeks.

Different exercises as part of a home-based pulmonary rehabilitation program

Different types of exercises can be performed as part of a home-based pulmonary rehabilitation program

The study was published on-line on July 29, 2017, in the journal Thorax (doi: 10.1136/thoraxjnl-2016-208506).

Results: Both groups of patients had significant, but similar, gains in shortness of breath measured on the Chronic Respiratory Questionnaire Self-Report after 7 weeks. The authors did not report on changes in other outcomes such as exercise ability or albuterol rescue use.

Conclusions: The authors concluded that a structured home-based pulmonary rehabilitation program was “as good as” the standard hospital-based program for improving daily shortness of  breath.

My Comments: Not everyone with COPD is interested or able to perform physical activities for a variety of reasons. For almost all patients with COPD whom I see in my practice, I recommend participation in a standard pulmonary rehabilitation program . Major benefits include: better breathing; better quality of life; less frequent flare-ups (exacerbations); and the ability to do more physical activities.

Water exercise may be part of a home-based pulmonary rehabilitation program

Water Aerobics may be part of a home-based pulmonary rehabilitation program

If this is not possible, then I encourage the person to “do more” on their own. This may using a treadmill or exercise bike in their apartment or home, going to a community fitness center, and/or using an available swimming pool. I ask the person to write down these activities on paper or on the computer and bring this information at their next appointment.

Physical Activity Reduces Risk of Death in COPD

150 Minutes or More of Physical Activity per Week Lowers Risk of Death by 47% in the Year Following Hospitalization

Study: Dr. Nguyen analyzed the risk of dying among those with COPD who were hospitalized for a worsening of breathing symptoms (called an exacerbation). The study included 2,370 individuals (55% were female; average age = 73 years) hospitalized at one of 14 hospitals in the Kaiser Permanente Southern California health system.  Patients were hospitalized between January 1, 2011, to December 31, 2011. 

Each person provided an estimate of physical activity in minutes of moderate to vigorous activity. Patients were then categorized as: Inactive – 0 minutes per week; Insufficiency Active – 1 – 149 minutes per week;  Active – 150 or more minutes per week                                                                                                                                                                            

Seniors participating in physical activity such as walking, biking, and swimming

Seniors Exercising

Results: The study was published online in the European Respiratory Journal Open Research on  March 16, 2016.

♦ 73% were inactive; 17% were insufficiently active; and 10% were active. There were a total of 464 deaths (20%) in the year following hospitalization.

♦ Those who were active had a 47% lower risk of death in the 12 months compared with inactive patients.

♦ Other lifestyle factors such as active cigarette smoking, failure to participate in pulmonary rehabilitation, and poor nutrition also predicted the risk of death.

My Comments:  It may take weeks to a few months for some to recover from a flare-up of COPD that is severe enough to require hospitalization. However, once you are feeling better, it is important to gradually increase activities to regain fitness. 

The good news of this study is that those who pursue an active life style that includes 150 minutes or more of moderate to vigorous activity have a reduced risk of dying.  This translates into 30 minutes five times a week and allows for 2 days a week for rest and recovery.

Physical Activity includes Water Aerobics

Seniors doing Water Aerobics

Moderate to vigorous activities may include brisk walking, riding a stationary cycle, water exercises, and any other things that you like to do. Doing different activities provides variety.

 

For many, participation in a pulmonary rehabilitation program is the best way to achieve the target of 150 minutes of activity each week.

 

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:

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  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

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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.