Exercise reduces risk of dying in COPD patients

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Any amount of moderate to vigorous physical activity can effectively reduce the risk of dying after hospitalisation for chronic obstructive pulmonary disease (COPD), according to a new study.

The research significantly adds to the mounting evidence that physical activity should be used to monitor and treat patients with COPD.

Patients with COPD can be hospitalised if they experience an acute exacerbation of their symptoms. Re-hospitalisation and death rates are high following any initial hospitalisation and in addition, hospitalisations due to severe exacerbations of COPD account for up to 70% of the healthcare costs associated with COPD. It is crucial that healthcare professionals can identify patients at a high-risk of readmission.

Researchers studied health records of 2,370 patients from Kaiser Permanente Southern California who were hospitalised for COPD for one year, looking at exercise as a vital sign which was self-reported in the clinic as a measure of physical activity and monitoring deaths from all causes within that time frame.

The results found that patients who were active had a 47% lower risk of death in the 12 months following a COPD hospitalisation, compared to inactive patients. Patients who were active but at insufficient levels still maintained a 28% lower risk of death, compared to inactive patients.

The authors concluded that monitoring levels of physical activity with a simple exercise “vital sign” could help healthcare professionals identify, monitor and treat those patients at a high risk of death following hospitalisation.

Lead author, Dr Marilyn Moy, assistant professor at Harvard Medical School, commented: “We know that physical activity can have a positive benefit for people with COPD and these findings confirm that it may reduce the risk of dying following hospitalisation for an acute exacerbation. The results also demonstrate the importance of routinely assessing physical activity in clinical care to identify high-risk patients as part of a larger strategy to promote physical activity in this highly sedentary population.”

Abstract
The independent relationship between physical inactivity and risk of death after an index chronic obstructive pulmonary disease (COPD) hospitalisation is unknown.
We conducted a retrospective cohort study in a large integrated healthcare system. Patients were included if they were hospitalised for COPD between January 1, 2011 and December 31, 2011. All-cause mortality in the 12 months after discharge was the primary outcome. Physical activity, expressed as self-reported minutes of moderate to vigorous physical activity (MVPA), was routinely assessed at outpatient visits prior to hospitalisation. 1727 (73%) patients were inactive (0 min of MVPA per week), 412 (17%) were insufficiently active (1–149 min of MVPA per week) and 231 (10%) were active (≥150 min of MVPA per week). Adjusted Cox regression models assessed risk of death across the MVPA categories.
Among 2370 patients (55% females and mean age 73±11 years), there were 464 (20%) deaths. Patients who were insufficiently active or active had a 28% (adjusted HR 0.72 (95% CI 0.54–0.97), p=0.03) and 47% (adjusted HR 0.53 (95% CI 0.34–0.84), p<0.01) lower risk of death, respectively, in the 12 months following an index COPD hospitalisation compared to inactive patients.
Any level of MVPA is associated with lower risk of all-cause mortality after a COPD hospitalisation. Routine assessment of physical activity in clinical care would identify persons at high risk for dying after COPD hospitalisation.

European Lung Organisation material
ERJ Open Research journal


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