Evidence Summary

A large body of good quality case-control and observational data shows a reduction in mortality.

Quality of Evidence

Grade C – low quality. Evidence comes from case-control and observational studies

Strength of recommendation

Grade 1 – strong recommendation. Clinical and patient consensus is that physical activity can reduce mortality. On the basis of the existing evidence, clinical opinion is that all or most patients will be best served by following this piece of evidence. The vast majority of patients would choose to follow this evidence when given the choice

Conclusion

This is a strong recommendation that this explanation is appropriate for most patients, but the supporting evidence base is of low quality.

1. Esteban, C. 2006, QJM²¹

Deaths N (%) 11 (28) in activity level 0; 25 (22) inactivity level 1; 54 (16) in activity level 2; 4 (4)

in activity level 3; p=0.0007

Mortality: Adjusted HR: 1.12 in activity level 1, p=0.78; 0.94 in activity level 2, p=0.88; 0.38 in activity level 3, p=0.12. (Observational study, up to 3 years, self-reported physical activity, 611 participants)

1. Esteban, C. 2011, Respir Med²²

Mortality Unadjusted coefficient 1.0540 for very low physical activity level, p=0.0021; 0.7228 for low physical activity level, p=0.0303; 0.6786 for medium physical activity level, p=0.0172

(Observational study, 5 years follow-up, self-reported physical activity, 611 participants)

1. Garcia-Aymerich, J. 2006, Thorax¹¹

All-cause mortality Adjusted HR (95% CI): 0.76 (0.65 to 0.90) in low/moderate/high physical activity; p=0.001. Adjusted HR (95% CI): 1.04 (0.84 to 1.27) in low physical activity; 0.73 (0.61 to 0.86) in moderate physical activity; 0.72 (0.59 to 0.86) in high physical activity; p for trend<0.001

Respiratory mortality: Adjusted HR (95% CI): 0.70 (0.48 to 1.02) in low/moderate/high physical activity; p=0.060

Adjusted HR (95% CI): 0.89 (0.55 to 1.44) in low physical activity; 0.64 (0.43 to 0.95) in

moderate physical activity; 0.72 (0.46 to 1.12) in high physical activity; p for trend=0.072

Cardiovascular mortality:  Adjusted HR (95% CI): 0.77 (0.58 to 1.02) in  low/moderate/high physical activity; p=0.065

Adjusted HR (95% CI): 0.84 (0.58 to 1.23) in low physical activity; 0.73 (0.54 to 0.98) in

moderate physical activity; 0.81 (0.59 to 1.11) in high physical activity; p for trend=0.195

(Observational study, mean 12 years follow-up, self-reported physical activity, 2386 subjects)

1. Garcia-Aymerich, J. 2008, Ann Epidemiol¹²

All-cause mortality Adjusted HR (95% CI): 0.83 (0.74 to 0.94) in moderate physical activity; 0.80 (0.69 to 0.91) in high physical activity; p for trend=0.002

Weighted HR (95% CI): 0.88 (0.76 to 1.01) in moderate physical activity; 0.81 (0.69 to 0.95) in high physical activity; p for trend=0.009

(Observational study, 1976 – 2004, self-reported physical activity, 6568 subjects)

1. Garcia-Rio, F. 2012, Chest¹³

All-cause mortality Adjusted HR (95% CI) 0.986 (0.981 to 0.992) for every 10 VMUs increased; p=0.002

(Observational study, 5 to 8 years, accelerometry measurement, 173 subjects)

1. Palop Cervera, M. 2010, Rev Clin Esp²³

Death after ECOPD hospital readmission, N (%) 30 (68) of dead vs. 22 (27) of alive in none outside activity group; 14 (32) of dead vs. 38 (47) of alive in 1-6h outside activity group; 0 (0) of dead vs. 21 (25) of alive in >6h outside activity group; p<0.01

Mortality Adjusted OR (95% CI): 2.97 (1.2 to 7.3) in low or lack of physical activity; p<0.05

(Case-control study, 6 months retrospectively, 125 subjects)

1. Waschki, B. 2011, Chest²⁴

All-cause mortality Adjusted HR (95 %CI): 0.009 (0.001 to 0.085) in physical activity level; p<0.001

(Observational study, median 48 months follow up, objective physical activity, 170 subjects)