1. Reduced Quality of Life
Self-reported symptom severity and physical activity, sedentary time and
physical function in COPD patients with mild-moderate airflow obstruction
Mark Orme 1; Dale Esliger 1; Sally Singh 1, 2; Michael Steiner 1, 2; Mike Morgan 2; Andrew Kingsnorth 1; Lauren Sherar SSEHS, NCSEM, Loughborough University, UK University Hospitals of Leicester, UK
INTRODUCTION
METHODS
RESULTS
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally (1).
Large heterogeneity in COPD patient symptoms exists, including dyspnea and exacerbations (2).
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 multidimensional system for COPD assessment (3) (Fig 1) stratifies patients based on symptom severity using two methods (Figs 2 and 3).
COPD patients are less physically active compared with healthy counterparts (4). Leading a less active and sedentary lifestyle, even in the early stages of COPD progression, may have a detrimental effect on symptoms and quality of life (5) (Fig 4)
Study Sample
Group A and B Comparisons
Analysis of covariance (age, gender, wear time) revealed that patients in CAT-A achieved higher ISWT distances (Fig 6 A) and were less sedentary compared with CAT-B patients (Fig 6 B).
ISWT distance and time sedentary did not differ significantly between mMRC groups (Table 3).
Physical activity did not differ between A and B groups, for both symptom assessment tools.
A cross-section of primary care recruited COPD patients from Leicestershire, UK as part of the Physical Activity and Respiratory Health (PhARaoH) Study. The sample comprised 96 mild-moderate COPD patients (66.3±6.8 years, 62.5% male, 66.7% retired)
Patient Stratification
Data Collection
Fig 5 – Distribution of patients across groups A (low symptoms; blue) and B (high symptoms; red), by CAT and mMRC
Table 1 – List of measures
Outcome
Measure(s)
Symptoms
CAT scores
mMRC score
Exacerbations history
Physical Activity and Sedentary Behaviour
Wrist-worn accelerometry
ActiGraph wGT3X-BT
7 days of wear
Physical Function
Incremental Shuttle Walk Test (ISWT)
Grip strength (kg)
Leg strength (kg)
Lung Function
Forced spirometry
Body Composition
Body mass index (kg/m2)
Fig 6 – Adjusted means (age, gender, wear time) (SE) for physical function (Panel A) and sedentary behaviour (Panel B) { * ** A B
CAT-A and CAT-B
mMRC-A and mMRC-B C A D B
CAT Score
0 - 9
Respiratory GOLD
1 - 2
3 - 4
mMRC Score
0 - 1
2 - 4
Fig 1 – GOLD groups
Fig 2 – CAT form
Individual Symptom Assessment
Linear regressions (Table 4) showed that total CAT was significantly related with ISWT distance and time sedentary.
The mMRC score was associated with ISWT distance, time sedentary and counts per minute.
Breathless, limited activities, confidence leaving the home and energy scores were significantly associated with physical behaviours and/or ISWT distance.
Breathless score was the only symptom indicator to be significantly related to all outcomes.
Group B had a higher number of previous exacerbations compared with group A. This difference was greatest between mMRC groups (Table 2).
Table 2 - Patient characteristics by CAT and mMRC groups A and B, median (IQR)
CAT-A (n=33)
CAT-B (n=63)
mMRC-A (n=79)
mMRC-B (n=17)
Age (years)
69.0 (7.5)
67.0 (10.0)
69.0 (9.0)
67.0 (13.0)
Gender (% male)
23 (69.7)
37 (58.7)
49 (62.0)
11 (64.7)
FEV1/FVC
56.0 (11.0)
52.5 (16.0)
55.0 (14.0)
44.0 (15.0)
FEV1%pred
78.0 (23.5)
70.5 (22.3)
76.0 (23.8)
63.0 (20.0)
Body Mass Index (kg/m2)
27.4 (4.6)
27.5 (6.6)
28.0 (5.3)
28.6 (10.0)
Exacerbations
0 (1)
0 (3)*
3 (4)**
Grip Strength (kg)
38.0 (16.5)
33.3 (19.6)
35.5 (19.0)
36.0 (23.3)
Leg Strength (kg)
36.0 (18.5)
34.0 (20.0)
32.0 (21.0)
38.0 (14.5)
Table 4 – Associations of individual symptoms with physical behaviours and function, controlling for age, gender and wear time
ISWT Distance
Counts per minute
PA ≥4000
Time Sedentary β R2
Total CAT Score (0-40)
-6.2**
0.22
2.0*
0.33
Breathless (0-5)
-29.0**
0.21
-61.4**
0.09
-3.6**
0.20
15.9***
0.40
Limited Activities (0-5)
-41.5***
0.27
-52.4*
0.05
 -3.8**
 0.19
Leave the Home (0-5)
-33.1*
Energy (0-5)
-51.8***
0.30
12.8*
0.34
mMRC Score (0-4)
-99.2**
-111.9**
0.08
33.1*
Exacerbations (0-8)
-29.3**
0.24
-2.5*
0.17
Fig 3 – mMRC form
Symptoms
Inactivity
Reduced Quality of Life
Deconditioning
Sedentariness
Anxiety
Depression
Fig 4 – Conceptual model: activity and symptoms
*p<0.05; **p<0.01
Table 3 – Adjusted means (age, gender, wear time) (SE) for physical behaviour and function by CAT and mMRC groups A and B
CAT-A
CAT-B
mMRC-A
mMRC-B
ISWT Distance (m)
455 (25)
364 (19)**
409 (17)
341 (39)
Counts Per Minute
1203 (53)
1076 (38)
1129 (35)
1078 (79)
PA >2000cpm (mins)
174 (10)
149 (7)
158 (7)
152 (15)
PA >5000cpm (mins)
9 (1)
6 (1)
7 (1)
7 (2)
Time Sedentary (mins)
514 (11)
541 (8)*
531 (7)
538 (16)
Wear Time (mins)
697 (9)
710 (7)
703 (6)
714 (13)
*p<0.05; **p<0.01; ***p<0.001
AIMS
CONCLUSIONS
To compare physical activity, sedentary behaviour and physical function between GOLD 2011 symptom groups A and B.
Choice of symptom assessment (CAT or mMRC) impacts the characteristics of resulting groups in relation to physical function and behaviours.
*p<0.05; **p<0.01
To investigate the associations of physical activity, sedentary behaviour and physical function with individual symptoms in primary care COPD patients.
References
Symptoms are better related to physical function than physical activity. Individual CAT scores such as energy provide additional insight into the relationship between symptoms and both physical function and behaviours.
(1) Soriano et al. (2012) Med Clin North Am 96: ; (2) Agusti et al. (2010) Respir Res 11: 122; (3) Global Initiative for Chronic Obstructive Lung Disease (2014); (4) Tudor-Locke et al. (2009) Prev Med 49: 3-11; (5) Aguilaniu & Roche (2014) Prim Care Respir Med 24: 14014
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