Validity and responsiveness of the Daily- and Clinical visit-PROactive Physical Activity in COPD (D-PPAC and C-PPAC) instruments

BackgroundThe Daily-PROactive and Clinical visit-PROactive Physical Activity (D-PPAC and C-PPAC) instruments in chronic obstructive pulmonary disease (COPD) combines questionnaire with activity monitor data to measure patients’ experience of physical activity. Their amount, difficulty and total scores range from 0 (worst) to 100 (best) but require further psychometric evaluation.ObjectiveTo test reliability, validity and responsiveness, and to define minimal important difference (MID), of the D-PPAC and C-PPAC instruments, in a large population of patients with stable COPD from diverse severities, settings and countries.MethodsWe used data from seven randomised controlled trials to evaluate D-PPAC and C-PPAC internal consistency and construct validity by sex, age groups, COPD severity, country and language as well as responsiveness to interventions, ability to detect change and MID.ResultsWe included 1324 patients (mean (SD) age 66 (8) years, forced expiratory volume in 1 s 55 (17)% predicted). Scores covered almost the full range from 0 to 100, showed strong internal consistency after stratification and correlated as a priori hypothesised with dyspnoea, health-related quality of life and exercise capacity. Difficulty scores improved after pharmacological treatment and pulmonary rehabilitation, while amount scores improved after behavioural physical activity interventions. All scores were responsive to changes in self-reported physical activity experience (both worsening and improvement) and to the occurrence of COPD exacerbations during follow-up. The MID was estimated to 6 for amount and difficulty scores and 4 for total score.ConclusionsThe D-PPAC and C-PPAC instruments are reliable and valid across diverse COPD populations and responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables.

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Impact of feedback on physical activity levels of individuals with chronic obstructive pulmonary disease during pulmonary rehabilitation

Chronic Respiratory Disease ◽

10.1177/1479972314552280 ◽

2014 ◽

Vol 11 (4) ◽

pp. 191-198 ◽

Cited By ~ 6

Author(s):

Joana Cruz ◽

Dina Brooks ◽

Alda Marques

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Pulmonary Rehabilitation ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Activity Monitors ◽

Standing Time ◽

The Impact

This study aimed at investigating whether providing feedback on physical activity (PA) levels to patients with chronic obstructive pulmonary disease (COPD) is feasible and enhances daily PA during pulmonary rehabilitation (PR). Patients with COPD participated in a 12-week PR program. Daily PA was measured using activity monitors on weeks 1, 7, and 12, and feedback was given in the following weeks on the number of steps, time spent in sedentary, light, and moderate-to-vigorous intensity activities, and time spent standing, sitting, and lying. Compliance with PA monitoring was collected. Two focus groups were conducted to obtain patients’ perspectives on the use of activity monitors and on the feedback given. Differences in PA data were also assessed. Sixteen patients (65.63 ± 10.57 years; forced expiratory volume in one second (FEV1) 70.31 ± 22.74% predicted) completed the study. From those, only eleven participants used the activity monitors during all monitoring days. Participants identified several problems regarding the use of activity monitors and monitoring duration. Daily steps ( p = 0.026) and standing time ( p = 0.030) were improved from week 1 to week 7; however, the former declined from week 7 to week 12. Findings suggest that using feedback to improve PA during PR is feasible and results in improved daily steps and standing time on week 7. The subsequent decline suggests that additional strategies may be needed to stimulate/maintain PA improvements. Further research with more robust designs is needed to investigate the impact of feedback on patients’ daily PA.

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Benefits of physical activity on COPD hospitalisation depend on intensity

European Respiratory Journal ◽

10.1183/13993003.01699-2014 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1281-1289 ◽

Cited By ~ 27

Author(s):

David Donaire-Gonzalez ◽

Elena Gimeno-Santos ◽

Eva Balcells ◽

Jordi de Batlle ◽

Maria A. Ramon ◽

...

Keyword(s):

Physical Activity ◽

Risk Reduction ◽

Cox Regression ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Average Intensity ◽

Physically Active ◽

Obstructive Pulmonary Disease ◽

Intensity Physical Activity

The present study aims to disentangle the independent effects of the quantity and the intensity of physical activity on the risk reduction of chronic obstructive pulmonary disease (COPD) hospitalisations.177 patients from the Phenotype Characterization and Course of COPD (PAC-COPD) cohort (mean±sd age 71±8 years, forced expiratory volume in 1 s 52±16% predicted) wore the SenseWear Pro 2 Armband accelerometer (BodyMedia, Pittsburgh, PA, USA) for eight consecutive days, providing data on quantity (steps per day, physically active days and daily active time) and intensity (average metabolic equivalent tasks) of physical activity. Information on COPD hospitalisations during follow-up (2.5±0.8 years) was obtained from validated centralised datasets.During follow-up 67 (38%) patients were hospitalised. There was an interaction between quantity and intensity of physical activity in their effects on COPD hospitalisation risk. After adjusting for potential confounders in the Cox regression model, the risk of COPD hospitalisation was reduced by 20% (hazard ratio (HR) 0.79, 95% CI 0.67–0.93; p=0.005) for every additional 1000 daily steps at low average intensity. A greater quantity of daily steps at high average intensity did not influence the risk of COPD hospitalisations (HR 1.01, p=0.919). Similar results were found for the other measures of quantity of physical activity.Greater quantity of low-intensity physical activity reduces the risk of COPD hospitalisation, but high-intensity physical activity does not produce any risk reduction.

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Physical Activity in Older Cancer Survivors: What Role Do Multimorbidity and Perceived Disability Play?

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0086 ◽

2020 ◽

Vol 28 (2) ◽

pp. 311-319 ◽

Cited By ~ 1

Author(s):

Shirley M. Bluethmann ◽

Wayne Foo ◽

Renate M. Winkels ◽

Scherezade K. Mama ◽

Kathryn H. Schmitz

Keyword(s):

Physical Activity ◽

Confidence Interval ◽

Cancer Survivors ◽

Odds Ratio ◽

Age Groups ◽

Chronic Obstructive ◽

Behavioral Risk ◽

Obstructive Pulmonary Disease ◽

Exercise Interventions ◽

Perceived Disability

Purpose: (a) To describe the relationship of multimorbidity and physical activity (PA) in cancer survivors and (b) to explore perceived disability and PA in middle-aged and older survivors. Methods: The authors analyzed the data from cancer survivors (N = 566), identified using the Pennsylvania Cancer Registry, who responded to a Behavioral Risk Factor Surveillance System-derived questionnaire. They created age groups (e.g., 45–54 years, 55–64 years, 65–74 years, and 75 years and older) and calculated a composite score of eight common comorbidities (e.g., chronic obstructive pulmonary disease, heart disease) to assess multimorbidity. Logistic regression was used to estimate the association of demographic and behavioral/clinical risk factors (e.g., multimorbidity, perceived disability, body mass index) with PA. Results: Most respondents were females (62%), older (mean age = 68 years) and represented diverse cancer sites, including breast (n = 132), colorectal (n = 102), gynecologic (n = 106), prostate (n = 111), and lung (n = 80). PA participation was mixed; 44% of survivors reported achieving >150 min of aerobic PA, but half of lung and 37% of gynecologic survivors reported no PA (0 min/week). Higher multimorbidity (odds ratio = 0.82, confidence interval [0.69, 0.98], p < .05), obesity (odds ratio = 0.51, confidence interval [0.30, 0.86], p < .05), and perceived disability (odds ratio = 0.49, confidence interval [0.32, 0.77], p < .001) were negatively associated with PA participation. Strength training was suboptimal across all survivors. Conclusion: Most older survivors experienced comorbid conditions, and this was associated with less PA. Survivors who perceived themselves as disabled or who were obese were half as likely as others to participate in PA. This suggests an increasing need to address both physical and psychological limitations in designing PA interventions for real-world needs. Exercise interventions that address the unique needs of older survivors for multimorbidity, obesity, and perceived disability may strengthen opportunities for PA.

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The minimal important difference for the St George's Respiratory Questionnaire in patients with severe COPD

European Respiratory Journal ◽

10.1183/13993003.00535-2015 ◽

2015 ◽

Vol 46 (6) ◽

pp. 1598-1604 ◽

Cited By ~ 24

Author(s):

Jorrit B.A. Welling ◽

Jorine E. Hartman ◽

Nick H.T. Ten Hacken ◽

Karin Klooster ◽

Dirk-Jan Slebos

Keyword(s):

Clinical Trials ◽

Minimal Important Difference ◽

Forced Expiratory Volume ◽

Sample Size Determination ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

St George's Respiratory Questionnaire ◽

Severe Copd

The St George's Respiratory Questionnaire (SGRQ) is a validated, commonly used questionnaire for measuring quality of life in patients with chronic obstructive pulmonary disease (COPD). The current established minimal important difference (MID) for SGRQ scores in an average COPD population is −4 units. However, for patients with severe COPD, the MID has not been thoroughly validated. We re-determined the SGRQ MID for this patient group.115 severe COPD patients (forced expiratory volume in 1 s (FEV1) 26±9% of predicted, SGRQ score 62±11 units; mean±sd,) who participated in seven different bronchoscopic lung volume reduction clinical trials were included in the analysis. Anchor- and distribution-based methods were used to define the MID for SGRQ scores. FEV1, 6-min walk distance and residual volume were used as anchors.Combining both anchor- and distribution-based methods, we identified a SGRQ MID of −8.3 units at 1 month and −7.1 units at 6 months.This study proposes an alternative SGRQ MID for patients with severe COPD of −8.3 units at 1 month and −7.1 units at 6 months follow-up after intervention. Our new MID estimates could be applied for both interpreting SGRQ outcomes as well as sample size determination in future clinical trials investigating interventions in severe COPD patients.

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Pedometers to enhance physical activity in COPD: a randomised controlled trial

European Respiratory Journal ◽

10.1183/09031936.00084514 ◽

2014 ◽

Vol 45 (2) ◽

pp. 347-354 ◽

Cited By ~ 90

Author(s):

Laura Mendoza ◽

Paula Horta ◽

José Espinoza ◽

Miguel Aguilera ◽

Nicolás Balmaceda ◽

...

Keyword(s):

Physical Activity ◽

Controlled Trial ◽

Forced Expiratory Volume ◽

Activity Level ◽

Walking Distance ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Randomised Controlled

Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease (COPD), and is associated with increased morbidity and mortality. Pedometers, which have been used in healthy populations, might also increase physical activity in patients with COPD.COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were randomised to either a standard programme of physical activity encouragement alone, or a pedometer-based programme. Assessments were performed by investigators blinded to treatment allocation. Change in average 1-week daily step count, 6-min walking distance (6MWD), modified Medical Research Council scale, St George’s respiratory questionnaire (SGRQ) and COPD assessment test (CAT) were compared between groups.102 patients were recruited, of whom 97 completed the programme (pedometer group: n=50; control group: n=47); 60.8% were male with a mean±sd age of 68.7±8.5 years, and forced expiratory volume in 1 s (FEV1) 66.1±19.4% and FEV1/forced vital capacity 55.2±9.5%. Both groups had comparable characteristics at baseline. The pedometer group had significantly greater improvements in: physical activity 3080±3254 steps·day−1versus 138.3±1950 steps·day−1 (p<0.001); SGRQ −8.8±12.2 versus −3.8±10.9 (p=0.01); CAT score −3.5±5.5 versus −0.6±6.6 (p=0.001); and 6MWD 12.4±34.6 versus −0.7±24.4 m (p=0.02) than patients receiving activity encouragement only.A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients.

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Bronchodilator reversibility in asthma and COPD: findings from three large population studies

European Respiratory Journal ◽

10.1183/13993003.00561-2019 ◽

2019 ◽

Vol 54 (3) ◽

pp. 1900561 ◽

Cited By ~ 10

Author(s):

Christer Janson ◽

Andrei Malinovschi ◽

Andre F.S. Amaral ◽

Simone Accordini ◽

Jean Bousquet ◽

...

Keyword(s):

Population Studies ◽

Large Population ◽

Symptom Burden ◽

Airway Disease ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Phenotypic Marker ◽

Obstructive Pulmonary Disease ◽

Bronchodilator Response ◽

Obstructive Airway Diseases

Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged ≥16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used.The prevalence of bronchodilator reversibility expressed as increase FEV1 ≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04–1.79), atopy (OR 1.36, 95% CI 1.04–1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1.Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.

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Physical activity patterns and clusters in 1001 patients with COPD

Chronic Respiratory Disease ◽

10.1177/1479972316687207 ◽

2017 ◽

Vol 14 (3) ◽

pp. 256-269 ◽

Cited By ~ 22

Author(s):

Rafael Mesquita ◽

Gabriele Spina ◽

Fabio Pitta ◽

David Donaire-Gonzalez ◽

Brenda M Deering ◽

...

Keyword(s):

Physical Activity ◽

Activity Patterns ◽

Airflow Obstruction ◽

Principal Component ◽

Forced Expiratory Volume ◽

Daily Physical Activity ◽

Chronic Obstructive ◽

Activity Data ◽

Obstructive Pulmonary Disease ◽

Activity Measures

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters ( p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.

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Prospective validation of the endurance shuttle walking test in the context of bronchodilation in COPD

European Respiratory Journal ◽

10.1183/09031936.00024314 ◽

2014 ◽

Vol 44 (5) ◽

pp. 1166-1176 ◽

Cited By ~ 10

Author(s):

Benoit Borel ◽

Véronique Pepin ◽

Donald A. Mahler ◽

Éric Nadreau ◽

François Maltais

Keyword(s):

Arterial Oxygen Saturation ◽

Intraclass Correlation ◽

Minimal Important Difference ◽

Forced Expiratory Volume ◽

Walking Distance ◽

Arterial Oxygen ◽

Chronic Obstructive ◽

Metabolic System ◽

Endurance Time ◽

Walking Test

This study focused on repeatability data and minimal important difference (MID) estimates of the endurance shuttle walking test (ESWT).255 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s 54.7±13.2% predicted) completed four ESWTs at different times during the 8-week study: two under baseline conditions with tiotropium (1 week apart), one after a single dose and one after 4 weeks of either fluticasone propionate/salmeterol combination or placebo in addition to tiotropium. 97 patients performed all the tests with a portable metabolic system. Reproducibility of test performance and cardiorespiratory response was investigated with the data obtained on the first two ESWTs.The mean differences between the first two ESWT performances (-6.7±72.2 s and -7.3±113.1 m for endurance time and walking distance, respectively) were not statistically significant. The between-test end-exercise and isotime values for each cardiorespiratory parameter were not significantly different from each other. With the exception of arterial oxygen saturation by pulse oximetry, the repeatability of cardiorespiratory adaptations to ESWT was also confirmed with strong Pearson and intraclass correlation coefficients. Finally, changes of 56–61 s and 70–82 m in endurance time and distance walked, respectively, were perceived by patients.This study provides methodological information supporting the reliability of the ESWT and suggests MID estimates for this test.

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The prevalence of diagnosed α1-antitrypsin deficiency and its comorbidities: results from a large population-based database

European Respiratory Journal ◽

10.1183/13993003.00154-2016 ◽

2016 ◽

Vol 49 (1) ◽

pp. 1600154 ◽

Cited By ~ 29

Author(s):

Timm Greulich ◽

Christoph Nell ◽

David Hohmann ◽

Marco Grebe ◽

Sabina Janciauskiene ◽

...

Keyword(s):

Large Population ◽

Age Groups ◽

Clinical Manifestations ◽

Healthcare Utilisation ◽

International Classification Of Diseases ◽

Population Based ◽

Chronic Obstructive ◽

Healthcare Database ◽

Obstructive Pulmonary Disease ◽

Antitrypsin Deficiency

α1-Antitrypsin deficiency (AATD) is a genetically determined disorder that is associated with different clinical manifestations. We aimed to assess the prevalence of diagnosed AATD and its comorbidities using a large healthcare database.In this retrospective longitudinal observational study, we analysed data from 4 million insurants. Using International Classification of Diseases revision 10 (ICD-10) codes, we assessed the prevalence, comorbidities and healthcare utilisation of AATD patients (E88.0 repeatedly coded) relative to non-AATD patients with chronic obstructive pulmonary disease (COPD), emphysema or asthma.In our study population, we identified 673 AATD patients (590 aged ≥30 years), corresponding to a prevalence of 23.73 per 100 000 in all age groups and 29.36 per 100 000 in those ≥30 years. Based on the number of AATD cases detected in the sample size (673 out of 2 836 585), we extrapolated that there were 19 162 AATD cases in Germany during the years studied. AATD patients had a higher prevalence of arterial hypertension, chronic kidney disease and diabetes relative to non-AATD asthma or emphysema patients. When compared to non-AATD COPD patients, AATD patients had significantly more consultations and more frequent and longer hospitalisations.Our data strengthen the assumption that AATD is associated with a variety of other diseases. Healthcare utilisation appears to be higher among AATD patients as compared to patients with non-AATD-related obstructive lung diseases.

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The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease

European Respiratory Journal ◽

10.1183/09031936.00183014 ◽

2015 ◽

Vol 46 (4) ◽

pp. 988-1000 ◽

Cited By ~ 62

Author(s):

Elena Gimeno-Santos ◽

Yogini Raste ◽

Heleen Demeyer ◽

Zafeiris Louvaris ◽

Corina de Jong ◽

...

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Intraclass Correlation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Item Reduction ◽

Clinical Visit ◽

Copd Patients ◽

Patient Reported

No current patient-centred instrument captures all dimensions of physical activity in chronic obstructive pulmonary disease (COPD). Our objective was item reduction and initial validation of two instruments to measure physical activity in COPD.Physical activity was assessed in a 6-week, randomised, two-way cross-over, multicentre study using PROactive draft questionnaires (daily and clinical visit versions) and two activity monitors. Item reduction followed an iterative process including classical and Rasch model analyses, and input from patients and clinical experts.236 COPD patients from five European centres were included. Results indicated the concept of physical activity in COPD had two domains, labelled “amount” and “difficulty”. After item reduction, the daily PROactive instrument comprised nine items and the clinical visit contained 14. Both demonstrated good model fit (person separation index >0.7). Confirmatory factor analysis supported the bidimensional structure. Both instruments had good internal consistency (Cronbach's α>0.8), test–retest reliability (intraclass correlation coefficient ≥0.9) and exhibited moderate-to-high correlations (r>0.6) with related constructs and very low correlations (r<0.3) with unrelated constructs, providing evidence for construct validity.Daily and clinical visit “PROactive physical activity in COPD” instruments are hybrid tools combining a short patient-reported outcome questionnaire and two activity monitor variables which provide simple, valid and reliable measures of physical activity in COPD patients.

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