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Improving physical activity in COPD: towards a new paradigm
Open accessAbstract
Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.
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![Figure 2 Regular physical activity reduces hospital admissions (upper panel A) and all-cause death (lower panel B) [50]. Kaplan-Meier curves according to level of regular physical activity during follow-up. Patients with COPD from the Copenhagen City Heart Study (n=2386), recruited from 1981 and followed to 2000. Reproduced from [50] with permission from BMJ Publishing Group Ltd.](/paper-figures/3a7f6f694c304cf4bd18df91e36808a4/improving-physical-activity-in-copd-towards-a-new-paradigm-figure-2.jpg)
![Figure 3 Change in morning activities (absolute scores) over treatment period with budesonide/formoterol plus tiotropium versus placebo plus tiotropium [74]. CDLM: Capacity of Daily Living during the Morning questionnaire; dotted line represents budesonide/formoterol plus tiotropium; solid line represents placebo plus tiotropium; CDLM score at run-in budesonide/formoterol plus tiotropium: 4.09, placebo plus tiotropium: 4.13; †treatment comparison from randomization to first week of treatment; ‡treatment comparison from randomization to last week of treatment. Reprinted with permission of the American Thoracic Society. Copyright © 2013 American Thoracic Society. Welte T, Miravitlles M, Hernandez P, Eriksson G, Peterson S, Polanowski T, et al: Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients withchronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009, 180:741–750. Official journal of the American Thoracic Society.](/paper-figures/0eed9be14348409d9c60ec340027ef58/improving-physical-activity-in-copd-towards-a-new-paradigm-figure-3.jpg)
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“There is limited and inconsistent evidence on the effectiveness of interventions for improving physical activity (45, 46).”
From Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study (2016) · cites this paper as [46]
In the citing paper
“there is a knowledge gap on how to improve physical activity in COPD.”
From Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study (2016) · cites this paper as [46]
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Cites
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
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(1985) · Europe PMC (PubMed Central) · Cited by 9,143
Rabe, K. F., Hurd, S., Anzueto, A., Barnes, P. J., Buist, S. A., Calverley, P., Fukuchi, Y., Jenkins, C., Rodriguez-Roisin, R., van Weel, C., et al. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200703-456so · Cited by 4,925
Correlates of physical activity: why are some people physically active and others not?
Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60735-1 · Cited by 4,151
A short questionnaire for the measurement of habitual physical activity in epidemiological studies
Baecke, J. A. H., BUREMA, J., & Frijters, J. E. R. (1982) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/36.5.936 · Cited by 3,950
The physical activity scale for the elderly (PASE): Development and evaluation
Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(93)90053-4 · Cited by 3,256
Pulmonary rehabilitation for chronic obstructive pulmonary disease
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003793.pub3 · Cited by 2,643
American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation
Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., et al. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200508-1211st · Cited by 1,966
Self-citationA questionnaire for the assessment of leisure time physical activities
Taylor, H. L., Jacobs, D. R., Schucker, B., Knudsen, J., Leon, A. S., & Debacker, G. (1978) · Journal of Chronic Diseases · doi:10.1016/0021-9681(78)90058-9 · Cited by 1,848
Cited by
Sorted by citations
Understanding the impact of symptoms on the burden of COPD
Miravitlles, M., & Ribera, A. (2017) · Respiratory Research · doi:10.1186/s12931-017-0548-3 · Cited by 465
Vasilopoulou, M., Papaioannou, A. Ι., Kaltsakas, G., Louvaris, Z., Chynkiamis, N., Spetsioti, S., Kortianou, E. A., Gennimata, S. A., Palamidas, A. F., Κostikas, Κ., et al. (2017) · European Respiratory Journal · doi:10.1183/13993003.02129-2016 · Cited by 233
Self-citationHealth Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study
Benzo, R., Vickers, K., Novotny, P. J., Tucker, S., Hoult, J., Neuenfeldt, P., Connett, J., Lorig, K., & McEvoy, C. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201512-2503oc · Cited by 176
Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review
Lee, A. L., Hill, C. J., McDonald, C. F., & Holland, A. E. (2016) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2016.05.017 · Cited by 151
Hanania, N. A., & O’Donnell, D. E. (2019) · International Journal of COPD · doi:10.2147/copd.s188141 · Cited by 156
Metadata
- Authors
- Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Royal Brompton Hospital (GB)
- Centre for Inflammation Research (GB)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Troosters, Thierry
- Venue
- Respiratory Research
- Published
- 2013
- Volume
- 14
- Issue
- 1
- Pages
- 115
- ISSN
- 1465-9921 (ISSN-L)
- PMC
- PMC4176094
- OpenAlex
- W2111189556
- Cited by
- 158
- References
- 96
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 8 · 2021: 16 · 2020: 10 · 2019: 18 · 2018: 14 · 2017: 22 · 2016: 13 · 2015: 15 · 2014: 14 · 2013: 1
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Respiratory Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- Royal Brompton and Harefield NHS Foundation Trust
- National Institute for Health and Care Research
- Imperial College London
- Novartis Pharma
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Keywords
- chronic obstructive pulmonary disease, physical activity, physical inactivity, exercise intolerance, pulmonary rehabilitation, bronchodilators, physical activity measurement, multimodal intervention, behavioral interventions, health status
- MeSH terms
- Counseling, Drug Therapy, Health Status, Humans, Motor Activity, Exercise Tolerance, Pulmonary Disease, Chronic Obstructive
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