Publications by authors named "Heleen Demeyer"

45 Publications

Objectively Measured Physical Activity in Patients with COPD: Recommendations from an International Task Force on Physical Activity.

Chronic Obstr Pulm Dis 2021 08 25. Epub 2021 Aug 25.

Reval Rehabilitation Research Center, Biomed Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.

Physical activity (PA) is of key importance for health among healthy persons and individuals with COPD. PA has multiple dimensions that can be assessed and quantified objectively using activity monitors. Moreover, as shown in the published literature, variable methodologies have been used to date to quantify PA among individuals with COPD, precluding clear comparisons of outcomes across studies. The present paper aims to provide a summary of the available literature for the rationale behind using objectively measured PA and proposes a standardized methodology for assessment, including standard operating procedures for future research. The present paper therefore describes the concept of PA, reports on the importance of PA, summarizes the dimensions of PA, provides a standard operating procedure how to monitor PA using objective assessments and describes the psychometric properties of objectively measured PA. The present international task force recommends implementation of the standard operating procedure for PA data collection and reporting in the future. This should allow to further clarify the relationship between PA and clinical outcomes, to test the impact of treatment interventions on PA in individuals with COPD and to successfully propose a PA endpoint for regulatory qualification in the future.
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http://dx.doi.org/10.15326/jcopdf.2021.0213DOI Listing
August 2021

Objectively Measured Physical Activity as a COPD Clinical Trial Outcome.

Chest 2021 Jul 1. Epub 2021 Jul 1.

Department of Research and Development, CIRO, Horn, The Netherlands.

Background: Reduced physical activity is common in COPD and is associated with poor outcomes. Physical activity is therefore a worthy target for intervention in clinical trials; however, trials evaluating physical activity have used heterogeneous methods.

Research Question: What is the available evidence on the efficacy and/or effectiveness of various interventions to enhance objectively measured physical activity in patients with COPD, taking into account the minimal preferred methodologic quality of physical activity assessment?

Study Design And Methods: In this narrative review, the COPD Biomarker Qualification Consortium (CBQC) task force searched three scientific databases for articles that reported the effect of an intervention on objectively measured physical activity in COPD. Based on scientific literature and expert consensus, only studies with ≥ 7 measurement days and ≥ 4 valid days of ≥ 8 h of monitoring were included in the primary analysis.

Results: Thirty-seven of 110 (34%) identified studies fulfilled the criteria, investigating the efficacy and/or effectiveness of physical activity behavior change programs (n = 7), mobile or electronic-health interventions (n = 9), rehabilitative exercise (n = 9), bronchodilation (n = 6), lung volume reduction procedures (n = 3), and other interventions (n = 3). Results are generally variable, reflecting the large differences in study characteristics and outcomes. Few studies show an increase beyond the proposed minimal important change of 600 to 1100 daily steps, indicating that enhancing physical activity levels is a challenge.

Interpretation: Only one-third of clinical trials measuring objective physical activity in people with COPD fulfilled the preset criteria regarding physical activity assessment. Studies showed variable effects on physical activity even when investigating similar interventions.
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http://dx.doi.org/10.1016/j.chest.2021.06.044DOI Listing
July 2021

Lung volume reduction in emphysema: a pragmatic prospective cohort study.

ERJ Open Res 2021 Apr 31;7(2). Epub 2021 May 31.

Clinical Dept of Respiratory Diseases, University Hospitals Leuven, BREATHE, Dept CHROMETA, KU Leuven, Leuven, Belgium.

Limited guidance exists for the implementation of lung volume reduction interventions in routine clinical care. We designed a pragmatic study to evaluate a strategy including endoscopic lung volume reduction (ELVR) and lung volume reduction surgery (LVRS) in heterogeneous emphysema. This prospective monocentre cohort study evaluated ELVR no-ELVR, followed by a cohort study evaluating LVRS. Primary outcome was the proportion of subjects with a forced expiratory volume in 1 s (FEV) improvement of ⩾100 mL at 3-month follow-up. Changes in FEV, residual volume (RV), 6-min walk distance (6MWD) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were evaluated at 6-month follow-up. Hospital stay and treatment-related serious adverse events were monitored. From 106 subjects screened, 38 subjects were enrolled comparing ELVR (n=20) with no-ELVR (n=18). After 6 months' follow-up, eligible patients were referred for LVRS (n=16) with another 6-month follow-up. At 3-month follow-up, 70% of ELVR compared to 11% of no-ELVR (p<0.001) and 69% of LVRS had an FEV improvement of ⩾100 mL. Between-group differences (mean±sem) for ELVR no-ELVR at 6-month follow-up were FEV +0.21±0.05 L; RV -0.95±0.21 L; 6MWD 58±17 m and SGRQ -18±5 points. At 6-month follow-up, within-group differences (mean±sem) for LVRS showed FEV +0.27±0.06 L; RV -1.49±0.22 L and 6MWD +75±18 m. Serious adverse events in 81% 45% of subjects (p=0.04) and a median hospital stay of 15 5 days (p<0.001) were observed for LVRS ELVR, respectively. This pragmatic prospective cohort study supports a clinical approach with ELVR as a less invasive first option and LVRS as powerful alternative in severe heterogeneous emphysema.
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http://dx.doi.org/10.1183/23120541.00877-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165372PMC
April 2021

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

Thorax 2021 03 21;76(3):228-238. Epub 2021 Jan 21.

Department of Respiratory Diseases, University Hospital Leuven, Leuven, Belgium.

Background: The 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.

Objective: To 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.

Methods: We 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.

Results: We 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.

Conclusions: The 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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http://dx.doi.org/10.1136/thoraxjnl-2020-214554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892393PMC
March 2021

Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial.

Eur Heart J 2021 06;42(23):2284-2295

Department of Cardiology, Antonio Carderelli Hospital, Naples, Italy.

Aims: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods And Results: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group.

Conclusion: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.
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http://dx.doi.org/10.1093/eurheartj/ehaa696DOI Listing
June 2021

Patterns of Physical Activity Progression in Patients With COPD.

Arch Bronconeumol (Engl Ed) 2021 Mar 8;57(3):214-223. Epub 2020 Oct 8.

ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address:

Introduction: Although mean physical activity in COPD patients declines by 400-500steps/day annually, it is unknown whether the natural progression is the same for all patients. We aimed to identify distinct physical activity progression patterns using a hypothesis-free approach and to assess their determinants.

Methods: We pooled data from two cohorts (usual care arm of Urban Training [NCT01897298] and PROactive initial validation [NCT01388218] studies) measuring physical activity at baseline and 12 months (Dynaport MoveMonitor). We identified clusters (patterns) of physical activity progression (based on levels and changes of steps/day) using k-means, and compared baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics across patterns.

Results: In 291 COPD patients (mean±SD 68±8 years, 81% male, FEV 59±19%) we identified three distinct physical activity progression patterns: Inactive (n=173 [59%], baseline: 4621±1757 steps/day, 12-month change (Δ): -487±1201 steps/day), ActiveImprovers (n=49 [17%], baseline: 7727±3275 steps/day, Δ:+3378±2203 steps/day) and ActiveDecliners (n=69 [24%], baseline: 11 267±3009 steps/day, Δ: -2217±2085 steps/day). After adjustment in a mixed multinomial logistic regression model using Active Decliners as reference pattern, a lower 6-min walking distance (RRR [95% CI] 0.94 [0.90-0.98] per 10m, P=.001) and a higher mMRC dyspnea score (1.71 [1.12-2.60] per 1 point, P=.012) were independently related with being Inactive. No baseline variable was independently associated with being an Active Improver.

Conclusions: The natural progression in physical activity over time in COPD patients is heterogeneous. While Inactive patients relate to worse scores for clinical COPD characteristics, Active Improvers and Decliners cannot be predicted at baseline.
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http://dx.doi.org/10.1016/j.arbres.2020.08.001DOI Listing
March 2021

Accuracy of consumer-based activity trackers as measuring tool and coaching device in patients with COPD and healthy controls.

PLoS One 2020 4;15(8):e0236676. Epub 2020 Aug 4.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Background: Consumer-based activity trackers are used to measure and improve physical activity. However, the accuracy of these devices as clinical endpoint or coaching tool is unclear. We investigated the use of two activity trackers as measuring and coaching tool in patients with Chronic Obstructive Pulmonary Disease (COPD) and healthy age-matched controls.

Methods: Daily steps were measured by two consumer-based activity trackers (Fitbit Zip, worn at the hip and Fitbit Alta, worn at the wrist) and a validated activity monitor (Dynaport Movemonitor) in 28 patients with COPD and 14 healthy age-matched controls for 14 consecutive days. To investigate the accuracy of the activity trackers as a clinical endpoint, mean step count per patient were compared with the reference activity monitor and agreement was investigated by Bland-Altman plots. To evaluate the accuracy of activity trackers as coaching tool, day-by-day differences within patients were calculated for all three devices. Additionally, consistency of ranking daily steps between the activity trackers and accelerometer was investigated by Kendall correlation coefficient.

Results: As a measuring tool, the hip worn activity tracker significantly underestimates daily step count in patients with COPD as compared to DAM (mean±SD Δ-1112±872 steps/day; p<0.0001). This underestimation is less prominent in healthy subjects (p = 0.21). The wrist worn activity tracker showed a non-significant overestimation of step count (p = 0.13) in patients with COPD, and a significant overestimation of daily steps in healthy controls (mean±SD Δ+1907±2147 steps/day; p = 0.006). As a coaching tool, both hip and wrist worn activity tracker were able to pick up the day-by-day variability as measured by Dynaport (consistency of ranking resp. r = 0.80; r = 0.68 in COPD).

Conclusion: Although the accuracy of hip worn consumer-based activity trackers in patients with COPD and wrist worn activity trackers in healthy subjects as clinical endpoints is unsatisfactory, these devices are valid to use as a coaching tool.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236676PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402478PMC
October 2020

Walking-related digital mobility outcomes as clinical trial endpoint measures: protocol for a scoping review.

BMJ Open 2020 07 19;10(7):e038704. Epub 2020 Jul 19.

Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Introduction: Advances in wearable sensor technology now enable frequent, objective monitoring of real-world walking. Walking-related digital mobility outcomes (DMOs), such as real-world walking speed, have the potential to be more sensitive to mobility changes than traditional clinical assessments. However, it is not yet clear which DMOs are most suitable for formal validation. In this review, we will explore the evidence on discriminant ability, construct validity, prognostic value and responsiveness of walking-related DMOs in four disease areas: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease and proximal femoral fracture.

Methods And Analysis: Arksey and O'Malley's methodological framework for scoping reviews will guide study conduct. We will search seven databases (Medline, CINAHL, Scopus, Web of Science, EMBASE, IEEE Digital Library and Cochrane Library) and grey literature for studies which (1) measure differences in DMOs between healthy and pathological walking, (2) assess relationships between DMOs and traditional clinical measures, (3) assess the prognostic value of DMOs and (4) use DMOs as endpoints in interventional clinical trials. Two reviewers will screen each abstract and full-text manuscript according to predefined eligibility criteria. We will then chart extracted data, map the literature, perform a narrative synthesis and identify gaps.

Ethics And Dissemination: As this review is limited to publicly available materials, it does not require ethical approval. This work is part of Mobilise-D, an Innovative Medicines Initiative Joint Undertaking which aims to deliver, validate and obtain regulatory approval for DMOs. Results will be shared with the scientific community and general public in cooperation with the Mobilise-D communication team.

Registration: Study materials and updates will be made available through the Center for Open Science's OSFRegistry (https://osf.io/k7395).
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http://dx.doi.org/10.1136/bmjopen-2020-038704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371223PMC
July 2020

Effects of downhill walking in pulmonary rehabilitation for patients with COPD: a randomised controlled trial.

Eur Respir J 2020 09 17;56(3). Epub 2020 Sep 17.

Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium

The development of contractile muscle fatigue (CMF) affects training responses in patients with chronic obstructive pulmonary disease (COPD). Downhill walking induces CMF with lower dyspnoea and fatigue than level walking. This study compared the effect of pulmonary rehabilitation (PR) comprising downhill walking training (DT) to PR comprising level walking (conventional training (CT)) in patients with COPD.In this randomised controlled trial, 35 patients (62±8 years; forced expiratory volume in 1 s (FEV) 50±17% predicted) were randomised to DT or CT. Exercise tolerance (6-minute walk test distance (6MWD); primary outcome), muscle function, symptoms, quality-of-life and physical activity levels were assessed before and after PR. Absolute training changes and the proportion of patients exceeding the 30 m 6MWD minimally important difference (MID) were compared between groups. Quadriceps muscle biopsies were collected after PR in a subset of patients to examine physiological responses to long-term eccentric training.No between-group differences were observed in absolute 6MWD improvement (mean 6MWD change 77±46 m DT 56±47 m CT; p=0.45), however 94% of patients in DT exceeded the 6MWD MID compared to 65% in CT (p=0.03). Patients in DT tended to have larger improvements than CT in other outcomes. Muscle biopsy analyses did not differ between groups.PR incorporating downhill walking confers similar magnitudes of effects to PR with conventional walking across clinical outcomes in patients with COPD, however, offers a more reliable stimulus to maximise the achievement of clinically relevant gains in functional exercise tolerance in people with COPD.
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http://dx.doi.org/10.1183/13993003.00639-2020DOI Listing
September 2020

Progression of physical inactivity in COPD patients: the effect of time and climate conditions - a multicenter prospective cohort study.

Int J Chron Obstruct Pulmon Dis 2019 3;14:1979-1992. Epub 2019 Sep 3.

National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.

Purpose: Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients.

Patients And Methods: This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months).

Results: At 12 months (n=157; FEV% predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs 3533±293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters.

Conclusion: COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.
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http://dx.doi.org/10.2147/COPD.S208826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732558PMC
March 2020

Determinants of study completion and response to a 12-month behavioral physical activity intervention in chronic obstructive pulmonary disease: A cohort study.

PLoS One 2019 20;14(5):e0217157. Epub 2019 May 20.

ISGlobal, Barcelona, Spain.

Objectives: Physical activity is key to improve the prognosis of chronic obstructive pulmonary disease (COPD). To help to tailor future interventions we aimed to identify the baseline characteristics of COPD patients which predict 12-month completion and response to a behavioral physical activity intervention.

Methods: This is a 12-month cohort study of the intervention arm of the Urban Training randomized controlled trial (NCT01897298), an intervention proven to be efficacious to increase physical activity. We considered baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics as potential determinants of completion and response. We defined completion as attending the 12-month study visit. Among completers, we defined response as increasing physical activity ≥1100 steps/day from baseline to 12 months, measured by accelerometer. We estimated the factors independently for completion and response using multivariable logistic regression models.

Results: Of a total of 202 patients (m (SD) 69 (9) years, 84% male), 132 (65%) completed the study. Among those, 37 (28%) qualified as responders. Higher numbers of baseline steps/day (OR [95% CI] 1.11 [1.02-1.21] per increase of 1000 steps, p<0.05) and living with a partner (2.77 [1.41-5.48], p<0.01) were related to a higher probability of completion while more neighborhood vulnerability (0.70 [0.57-0.86] per increase of 0.1 units in urban vulnerability index, p<0.01) was related to a lower probability. Among the completers, working (3.14 [1.05-9.33], p<0.05) and having an endocrino-metabolic disease (4.36 [1.49-12.80], p<0.01) were related to a higher probability of response while unwillingness to follow the intervention (0.21 [0.05-0.98], p<0.05) was related to a lower probability.

Conclusions: This study found that 12-month completion of a behavioral physical activity intervention was generally determined by previous physical activity habits as well as interpersonal and environmental physical activity facilitators while response was related to diverse factors thought to modify the individual motivation to change to an active lifestyle.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217157PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527234PMC
January 2020

Health status deterioration in subjects with mild to moderate airflow obstruction, a six years observational study.

Respir Res 2019 May 18;20(1):93. Epub 2019 May 18.

Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.

Background: Patients with COPD need to cope with a disabling disease, which leads to health status impairment.

Aim: To investigate the long term change of health status in subjects with mild to moderate airflow obstruction and to compare this to subjects without airflow obstruction, with and without a smoking history. Second, to investigate the factors potentially associated to rapid health status decline in our total cohort.

Methods: Two hundred and one subjects were included. Generic [Short form 36 health survey (SF36) and EuroQol - 5 dimensions (EQ-5D)] and disease specific [Clinical COPD questionnaire (CCQ) and COPD Assessment Test (CAT)] health status questionnaires were regularly repeated over a six years period. Other functional outcomes comprised measures of lung function, physical fitness, physical activity and emotional state.

Results: On average, health status decline did not differ between groups with the exception of the EQ-5D index, which deteriorated faster in subjects with airflow obstruction compared to the never smoking control group [- 0.018(0.008) versus 0.00006(0.003), p = 0.03]. Subjects presenting at least one exacerbation had faster rate of deterioration measured with CAT [0.91(0.21) versus - 0.26(0.25), p < 0.01]. Characteristics of the fast declining group were older age, worse lung function, physical fitness, physical activity and disease specific baseline health status. Subjects with airflow obstruction had a 2.5 (95% CI 1.36-4.71) higher risk of presenting fast overall health status decline. Fast overall decline was associated with the presence of acute exacerbation(s) (44% of the subjects with exacerbation(s) versus 17% of subjects without exacerbation, p = 0.03). Changes in fat free mass, functional exercise capacity and in symptoms of anxiety and depression correlated weakly to changes in health status measured with all questionnaires.

Conclusion: Subjects with mild airflow obstruction present a significant deterioration of health status, which is generally not much faster compared to smoking and never smoking controls. Subjects with fast decline in overall health status are older and more likely to have airflow obstruction, acute respiratory exacerbation(s), reduced physical fitness, physical activity and impaired COPD specific health status at baseline.

Trial Registration: NCT01314807 - retrospectively registered on March 2011.
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http://dx.doi.org/10.1186/s12931-019-1061-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525445PMC
May 2019

Strategies to Increase Physical Activity in Chronic Respiratory Diseases.

Clin Chest Med 2019 06;40(2):397-404

Department of Rehabilitation Sciences, Laboratory of Pneumology, University Hospitals Leuven, KU Leuven-University of Leuven, Herestraat 49, Onderwijs en Navorsing 1, PO Box 706, Leuven 3000, Belgium; Respiratory Division, University Hospitals Leuven, Leuven, Belgium.

Physical activity is important to maintain health. Patients who reduce their physical activity are at increased risk of developing comorbidities and faster decline in health. Interventions to enhance physical activity require a behavior change from patients and these interventions have become increasingly popular in chronic obstructive pulmonary disease. However, few interventions have shown long-term effects and all focused on enhancing physical activity rather than the maintenance thereof. In patients with very low exercise tolerance or with significant symptom burden, enhancing physical activity be difficult and interventions should first focus on enhancing exercise tolerance.
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http://dx.doi.org/10.1016/j.ccm.2019.02.017DOI Listing
June 2019

The past, present and future of pulmonary rehabilitation.

Respirology 2019 09 13;24(9):830-837. Epub 2019 Mar 13.

Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.

Abundant evidence supports the use of pulmonary rehabilitation as a treatment for stable and exacerbated chronic obstructive pulmonary disease. Several questions around the science base of rehabilitation in other patient groups as well as the role of rehabilitation as a component in other comprehensive care trajectories remain to be addressed. The impact of a rehabilitation programme could also perhaps be enhanced if clear guidance would be available on how to individualize the components of a rehabilitation programme in individual patients. The rehabilitation community, in an attempt to increase access to programmes, has developed less rigorous interventions. These may serve specific patients (e.g. less severe patients or may be used as a maintenance programme), but in order to have conceptual clarity they should not be called substitutes for rehabilitation if they do not meet the definition of rehabilitation. Reaching clarity on the best format for maintenance programmes in order to achieve long-lasting health benefits for patients is another challenge. Furthermore, as many patients as possible should be referred to adequate rehabilitation programmes within their reach with fair reimbursement. Programmes should take into account the burden of the disease of a patient, the required components to tackle the problems, adequate assessment to document the outcome and the patient's preference. In summary, pulmonary rehabilitation is one of the most potent evidence-based therapies for patients with respiratory diseases. Researchers should continue to fine tune the interventions, get clarity on terminology as well as the ultimate outcomes for rehabilitation to ensure sustainable health effects.
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http://dx.doi.org/10.1111/resp.13517DOI Listing
September 2019

The role of physical activity in the context of pulmonary rehabilitation.

COPD 2018 12 4;15(6):632-639. Epub 2019 Feb 4.

a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium.

Pulmonary rehabilitation is an important treatment for patients with chronic obstructive pulmonary disease (COPD). Although this intervention leads to large and clinically meaningful improvements in exercise capacity and quality of life, the effect of pulmonary rehabilitation on physical activity is controversial. Physical activity is lower in patients with COPD as compared to healthy age-matched controls and it is related to important health outcomes (e.g. increased risk of mortality and hospitalization). It is an important goal for rehabilitation programs to enhance physical activity to more normal levels in order to achieve the ultimate goal of rehabilitation 'to improve adherence to health enhancing behaviors'. This review discusses the role of physical activity in the context of pulmonary rehabilitation and possible ways to embed interventions geared to behavior change (i.e. to enhance physical activity) and exercise training (i.e. to enhance physical fitness) into comprehensive rehabilitation programs for patients with COPD.
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http://dx.doi.org/10.1080/15412555.2018.1563060DOI Listing
December 2018

Six years progression of exercise capacity in subjects with mild to moderate airflow obstruction, smoking and never smoking controls.

PLoS One 2018 26;13(12):e0208841. Epub 2018 Dec 26.

Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.

Background: Exercise capacity is an important feature in patients with COPD. Its impairment drives disability and dependency for daily activities performance. This study evaluated the six years change in exercise capacity in subjects with airflow obstruction and compared this to subjects without airflow obstruction, with and without a smoking history.

Methods: Cardiopulmonary exercise tests (CPET) were repeatedly performed during a six years follow up period. Peak oxygen uptake (VO2peak), work rate (WRpeak), heart rate (HRpeak), minute ventilation (VEpeak), respiratory exchange ratio (RERpeak) and ventilatory reserve (VE/MVV) were collected as effort dependent outcomes. The slopes of oxygen uptake, ventilatory and mechanical efficiency (OUES, ΔVE/ΔVCO2 and ΔVO2/ΔWR) were collected as effort independent outcomes.

Results: One hundred and thirty-eight subjects were included. Thirty-eight presented airflow obstruction (63±6 years, 74% men, FEV1 90±15%pred), 44 had a smoking history but no airflow obstruction (61±5 years, 61% men, FEV1 105±15%pred) and 56 had never smoked (61±7 years, 57% men, FEV1 117±18%pred). At baseline, the airflow obstruction group had slightly worse exercise capacity in comparison to the never smoking control group, in absolute terms and expressed as percentage of the predicted value (VO2peak = 27±5 versus 32±8 ml/min/kg, p<0.01; 112±29 versus 130±33%pred, p = 0.04). Most exercise variables showed a statistically significant yearly deterioration, with exception of VE/MVV, ΔVE/ΔVCO2 and ΔVO2/ΔWR. The yearly decline in VO2peak and OUES was not faster in subjects with airflow obstruction than in smoking and never smoking controls (VO2peak -67 (9) versus -76 (9) ml/min, p = 0.44 and versus -58 (9), p = 0.47; OUES -32 (11) versus -68 (10), p = 0.03 and versus -68 (13), p = 0.03).

Conclusions: With exception of VO2peak, effort dependent variables deteriorated faster in subjects with airflow obstruction compared to never smoking controls. The deterioration of effort independent variables, however, was not accelerated in the airflow obstruction group compared to controls.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208841PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306213PMC
May 2019

Smartphone-Based Physical Activity Telecoaching in Chronic Obstructive Pulmonary Disease: Mixed-Methods Study on Patient Experiences and Lessons for Implementation.

JMIR Mhealth Uhealth 2018 Dec 21;6(12):e200. Epub 2018 Dec 21.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Background: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics.

Objective: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention.

Methods: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA.

Results: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P<.001). Patients needing more contact time had a smaller increase in PA, with mean (SD) of +193 (SD 2375) steps per day, +907 (SD 2306) steps per day, and +1489 (SD 2310) steps per day in high, medium, and low contact time groups, respectively; P for-trend=.01. The overall actual usage of the different components of the intervention was not associated with change in step count in the total group (P=.63).

Conclusions: The 12-week semiautomated PA telecoaching intervention was well accepted and feasible for patients with COPD and their coaches. The actual usage of the step counter was excellent, whereas actual usage of the smartphone tasks was lower and decreased over time. Patients who required more contact experienced less PA benefits.

Trial Registration: ClinicalTrials.gov NCT02158065; http://clinicaltrials.gov/ct2/show/NCT02158065 (Archived by WebCite at http://www.webcitation.org/73bsaudy9).
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http://dx.doi.org/10.2196/mhealth.9774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320438PMC
December 2018

Physical Activity Is Associated with Attenuated Disease Progression in Chronic Obstructive Pulmonary Disease.

Med Sci Sports Exerc 2019 05;51(5):833-840

ISGlobal, Barcelona, SPAIN.

Introduction: Chronic obstructive pulmonary disease (COPD) progression is variable and affects several disease domains, including decline in lung function, exercise capacity, muscle strength, and health status as well as changes in body composition. We aimed to assess the longitudinal association of physical activity (PA) with these a priori selected components of disease progression.

Methods: We studied 114 COPD patients from the PAC-COPD cohort (94% male, mean [SD], 70 yr [8 yr] of age, 54 [16] forced expiratory volume in 1 s % predicted) at baseline and 2.6 yr (0.6 yr) later. Baseline PA was assessed by accelerometry. Multivariable general linear models were built to assess the association between PA and changes in lung function, functional exercise capacity, muscle strength, health status, and body composition. All models were adjusted for confounders and the respective baseline value of each measure.

Results: Per each 1000 steps higher baseline PA, forced expiratory volume in 1 s declined 7 mL less (P < 0.01), forced vital capacity 9 mL less (P = 0.03) and carbon monoxide diffusing capacity 0.10 mL·min·mm Hg less (P = 0.04), while the St George's Respiratory Questionnaire symptom domain deteriorated 0.4 points less (P = 0.03), per year follow-up. Physical activity was not associated with changes in functional exercise capacity, muscle strength, other domains of health status or body composition.

Conclusions: Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
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http://dx.doi.org/10.1249/MSS.0000000000001859DOI Listing
May 2019

The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

Int J Chron Obstruct Pulmon Dis 2018;13:3515-3527. Epub 2018 Oct 24.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium,

Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.

Materials And Methods: Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008-2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day ("PA responders") after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses.

Results: Two hundred thirty-six patients with COPD (median [IQR] FEV 44 [33-59] % predicted, age 65±8 years, 6MWDi 416 [332-486] m) were included. The proportion of "PA responders" after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; <0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51-6.36).

Conclusion: The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field.
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http://dx.doi.org/10.2147/COPD.S174827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207410PMC
April 2019

Short and long-term effects of pulmonary rehabilitation in interstitial lung diseases: a randomised controlled trial.

Respir Res 2018 Sep 20;19(1):182. Epub 2018 Sep 20.

University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium.

Background: Few data are available on the long-term effect of pulmonary rehabilitation (PR) and on long PR programs in interstitial lung diseases (ILD). We aimed to evaluate the effects of PR on exercise capacity (6-Minute Walking Distance, 6MWD; Peak Work Rate, W), quality of life (St George's Respiratory Questionnaire, SGRQ), quadriceps force (QF) and objectively measured physical activity in ILD after the 6-month PR-program and after 1 year.

Methods: 60 patients (64 ± 11 years; 62% males; 23% with IPF) were randomly assigned to receive a 6 month-PR program or usual medical care.

Results: Exercise capacity, quality of life and muscle force increased significantly after the program as compared to control (mean,95%CI[ll to ul]; 6MWD + 72,[36 to 108] m; W 19, [8 to 29]%pred; SGRQ - 12,[- 19 to - 6] points; QF 10, [1 to 18] %pred). The gain was sustained after 1 year (6MWD 73,[28 to 118] m; Wmax 23, [10 to 35]%pred; SGRQ - 11,[- 18 to - 4] points; QF 9.5, [1 to 18] %pred). Physical activity did not change.

Conclusions: PR improves exercise tolerance, health status and muscle force in ILD. The benefits are maintained at 1-year follow-up. The intervention did not change physical activity.

Trial Registration: Clinicaltrials.gov NCT00882817 .
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http://dx.doi.org/10.1186/s12931-018-0884-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149060PMC
September 2018

Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD.

Thorax 2018 10 18;73(10):942-950. Epub 2018 Jun 18.

Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.

Background: This study aimed to investigate whether adjunctive inspiratory muscle training (IMT) can enhance the well-established benefits of pulmonary rehabilitation (PR) in patients with COPD.

Methods: 219 patients with COPD (FEV: 42%±16% predicted) with inspiratory muscle weakness (PImax: 51±15 cm HO) were randomised into an intervention group (IMT+PR; n=110) or a control group (Sham-IMT+PR; n=109) in this double-blind, multicentre randomised controlled trial between February 2012 and October 2016 (ClinicalTrials.gov NCT01397396). Improvement in 6 min walking distance (6MWD) was a priori defined as the primary outcome. Prespecified secondary outcomes included respiratory muscle function and endurance cycling time.

Findings: No significant differences between the intervention group (n=89) and the control group (n=85) in improvements in 6MWD were observed (0.3 m, 95% CI -13 to 14, p=0.967). Patients who completed assessments in the intervention group achieved larger gains in inspiratory muscle strength (effect size: 1.07, p<0.001) and endurance (effect size: 0.79, p<0.001) than patients in the control group. 75 s additional improvement in endurance cycling time (95% CI 1 to 149, p=0.048) and significant reductions in Borg dyspnoea score at isotime during the cycling test (95% CI -1.5 to -0.01, p=0.049) were observed in the intervention group.

Interpretation: Improvements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome) TRIAL REGISTRATION NUMBER: NCT01397396; Results.
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http://dx.doi.org/10.1136/thoraxjnl-2017-211417DOI Listing
October 2018

Physical activity levels after treatment for breast cancer: Two-year follow-up.

Breast 2018 Aug 16;40:23-28. Epub 2018 Apr 16.

KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium; University Hospitals Leuven, Department of Vascular Surgery, Leuven, Belgium.

Objectives: Breast cancer treatment can have a considerable large and prolonged impact on activity levels of breast cancer survivors. Therefore, the aim of the present study was to investigate the change in total physical activity level and occupational, sport and household activity levels of breast cancer survivors from preoperatively up to 24 months after breast cancer surgery. Additionally, predictive factors for this change were investigated.

Methods: Patients with primary breast cancer (n = 267) filled in the Flemish Physical Activity Computerized Questionnaire (FPACQ) before surgery and 1, 3, 6, 12 and 24 months after surgery. Patient-, disease- and treatment-related factors were analyzed as predictive factors for change in physical activity.

Results: Two years after surgery, all activity levels (total, occupational, sport and household) were still significantly lower compared to preoperative values. After the first 12 months, no significant improvements were seen for none of the activity levels, except for the occupational activity.

Conclusions: Two years after breast cancer surgery, physical activity levels are still significantly lower compared to pre-operative values. Based on this limited recovery, it seems important to monitor physical activity levels in breast cancer patients and advice these patients to stay active after surgery and return to pre-operative activity levels in the long term as well. This study indicates the importance of long term monitoring and subsequently coaching of physical activity after breast cancer surgery.
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http://dx.doi.org/10.1016/j.breast.2018.04.009DOI Listing
August 2018

Montelukast for bronchiolitis obliterans syndrome after lung transplantation: A randomized controlled trial.

PLoS One 2018 6;13(4):e0193564. Epub 2018 Apr 6.

KULeuven and UZ Leuven, Dept. of Clinical and Experimental Medicine, Division of Respiratory Diseases, Lung Transplant Unit, Leuven, Belgium.

Bronchiolitis obliterans syndrome (BOS) remains the major problem which precludes long-term survival after lung transplantation. Previously, an open label pilot study from our group demonstrated a possible beneficial effect of montelukast in progressive BOS patients with low airway neutrophilia (<15%), and already on azithromycin treatment, in whom the further decline in pulmonary function was attenuated. This was, however, a non-randomized and non-placebo controlled trial. The study design is a single center, prospective, interventional, randomized, double blind, placebo-controlled trial, with a two arm parallel group design and an allocation ratio of 1:1. Randomization to additional montelukast (10 mg/day, n = 15) or placebo (n = 15) was performed from 2010 to 2014 at the University Hospitals Leuven (Leuven, Belgium) in all consecutive patients with late-onset (>2years posttransplant) BOS ≥1. Primary end-point was freedom from graft loss 1 year after randomization; secondary end-points were acute rejection, lymphocytic bronchiolitis, respiratory infection rate; and change in FEV1, airway and systemic inflammation during the study period. Graft loss at 1 y and 2y was similar in both groups (respectively p = 0. 981 and p = 0.230). Montelukast had no effect on lung function decline in the overall cohort. However, in a post-hoc subanalysis of BOS stage 1 patients, montelukast attenuated further decline of FEV1 during the study period, both in absolute (L) (p = 0.008) and % predicted value (p = 0.0180). A linear mixed model confirmed this association. Acute rejection, lymphocytic bronchiolitis, respiratory infections, systemic and airway inflammation were comparable between groups over the study period. This randomized controlled trial showed no additional survival benefit with montelukast compared to placebo, although the study was underpowered. The administration of montelukast was associated with an attenuation of the rate of FEV1 decline, however, only in recipients with late-onset BOS stage 1.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193564PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889063PMC
July 2018

Validity and reliability of strain gauge measurement of volitional quadriceps force in patients with COPD.

Chron Respir Dis 2017 Aug 24;14(3):289-297. Epub 2017 Feb 24.

1 Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.

This study investigated the validity and reliability of fixed strain gauge measurements of isometric quadriceps force in patients with chronic obstructive pulmonary disease (COPD). A total cohort of 138 patients with COPD were assessed. To determine validity, maximal volitional quadriceps force was evaluated during isometric maximal voluntary contraction (MVC) manoeuvre via a fixed strain gauge dynamometer and compared to (a) potentiated non-volitional quadriceps force obtained via magnetic stimulation of the femoral nerve (twitch (Tw); n = 92) and (b) volitional computerized dynamometry (Biodex; n = 46) and analysed via correlation coefficients. Test-retest and absolute reliability were determined via calculations of intra-class correlation coefficients (ICCs), smallest real differences (SRDs) and standard errors of measurement (SEMs). For this, MVC recordings in each device were performed across two test sessions separated by a period of 7 days ( n = 46). Strain gauge measures of MVC demonstrated very large correlation with Tw and Biodex results ( r = 0.86 and 0.88, respectively, both p < 0.0001). ICC, SEM and SRD were numerically comparable between strain gauge and Biodex devices (ICC = 0.96 vs. 0.93; SEM = 8.50 vs. 10.54 N·m and SRD = 23.59 vs. 29.22 N·m, respectively). The results support that strain gauge measures of quadriceps force are valid and reliable in patients with COPD.
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http://dx.doi.org/10.1177/1479972316687210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720235PMC
August 2017

Physical Activity of Patients with COPD from Regions with Different Climatic Variations.

COPD 2017 Jun 7;14(3):276-283. Epub 2017 Apr 7.

a Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy , State University of Londrina , Londrina , Brazil.

Seasonal changes in physical activity in daily life (PADL) of patients with Chronic Obstructive Pulmonary Disease (COPD) living in regions of the world with contrasting (i.e., mild or marked) weather variations have not been yet investigated. We aimed to quantify PADL and compare its variability caused by seasonality in patients with COPD who live in world regions with different summer-winter climatic variations (i.e. Londrina, Brazil and Leuven, Belgium). In a longitudinal, prospective and observational study, patients with COPD from Brazil and Belgium wore the SenseWear Armband for 7 days in summer and 7 days in winter. Active time (≥2METs) was the primary outcome. PADL data were matched day-by-day with weather information. Regarding the two assessment moments, median (min;max) temperatures were 11 (-5.5;27.2)°C in Leuven and 21 (7;27)°C in Londrina. Patients in Brazil (n = 19, 69 ± 7 years, FEV 47 ± 15%) and Belgium (n = 18, 69 ± 6 years, FEV 50 ± 15%) decreased their active time in winter compared to summer (p < 0.05), and this reduction was more pronounced in Brazil (p = 0.01, between group). Mean, minimum and maximum temperature, daylight duration and relative humidity were significantly related to active time. Patients with COPD decrease their PADL in winter even in a region with milder climatic variation.
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http://dx.doi.org/10.1080/15412555.2017.1303039DOI Listing
June 2017

Survival after pulmonary rehabilitation in patients with COPD: impact of functional exercise capacity and its changes.

Int J Chron Obstruct Pulmon Dis 2016 26;11:2671-2679. Epub 2016 Oct 26.

KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium.

The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan-Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, <0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30-0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51-0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92-2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28-2.84]; =0.001), and Group 4 (HR 3.28 [95% CI 2.02-5.33]; <0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.
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http://dx.doi.org/10.2147/COPD.S113450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087703PMC
August 2017

Interventions to modify physical activity in patients with COPD: where do we go from here?

Eur Respir J 2016 07;48(1):14-7

KU Leuven-University of Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium University Hospitals Leuven, Respiratory Rehabilitation and Respiratory Division, Leuven, Belgium Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.

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http://dx.doi.org/10.1183/13993003.00762-2016DOI Listing
July 2016

Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study.

Int J Chron Obstruct Pulmon Dis 2016 10;11:1287-95. Epub 2016 Jun 10.

ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBEREpidemiología y Salud Pública (CIBERESP), Barcelona, Spain.

Background: The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients.

Methods: We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport(®) accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0-7), suggested (8-10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach.

Results: Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, -149 to -12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA.

Conclusion: In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later.
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http://dx.doi.org/10.2147/COPD.S101459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910613PMC
August 2017

The Minimal Important Difference in Physical Activity in Patients with COPD.

PLoS One 2016 28;11(4):e0154587. Epub 2016 Apr 28.

KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium.

Background: Changes in physical activity (PA) are difficult to interpret because no framework of minimal important difference (MID) exists. We aimed to determine the minimal important difference (MID) in physical activity (PA) in patients with Chronic Obstructive Pulmonary Disease and to clinically validate this MID by evaluating its impact on time to first COPD-related hospitalization.

Methods: PA was objectively measured for one week in 74 patients before and after three months of rehabilitation (rehabilitation sample). In addition the intraclass correlation coefficient was measured in 30 patients (test-retest sample), by measuring PA for two consecutive weeks. Daily number of steps was chosen as outcome measurement. Different distribution and anchor based methods were chosen to calculate the MID. Time to first hospitalization due to an exacerbation was compared between patients exceeding the MID and those who did not.

Results: Calculation of the MID resulted in 599 (Standard Error of Measurement), 1029 (empirical rule effect size), 1072 (Cohen's effect size) and 1131 (0.5SD) steps.day-1. An anchor based estimation could not be obtained because of the lack of a sufficiently related anchor. The time to the first hospital admission was significantly different between patients exceeding the MID and patients who did not, using the Standard Error of Measurement as cutoff.

Conclusions: The MID after pulmonary rehabilitation lies between 600 and 1100 steps.day-1. The clinical importance of this change is supported by a reduced risk for hospital admission in those patients with more than 600 steps improvement.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154587PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849755PMC
April 2017
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