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.
- 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)
- 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)
- 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)
- 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)
- 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)
- 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)
- 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)