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COPD – Reduced number of exacerbations

Evidence Summary

A large body of good quality observational data shows a reduction in hospital admissions due to COPD exacerbations.

Quality of Evidence

Grade C – low quality. Evidence comes from observational studies

Strength of recommendation

Grade 1 – strong recommendation. Clinical and patient consensus is that physical activity can reduce the number of exacerbations. 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. Benzo, RP. 2010, Respiration8

No hospital admission during 12-month period, Mean (SD) self-reported time of physical activity per week (minutes) 109 (62) in patients with no hospital admission during 12-month period vs. 94(65) in patients with at least one hospital admission during 12-month period; p=0.01

Mean self-reported time of ≥2 h of physical activity per week (%): 42 in patients with no hospital admission during 12-month period vs. 30 in patients with at least one hospital admission during 12-month period; p=0.003

Adjusted OR (95% CI) of hospitalization: 0.6 (0.41 to 0.88) in self-reported time of ≥2 h of physical activity per week; p=0.01

(Observational study 12-month follow-up, self-reported physical activity in minutes of any endurance activity, 597 subjects)

  1. Chen, Y. 2006, Western journal nursing research9

Readmission at 14 days Adjusted OR (95% CI) of daily functioning: 0.99 (0.53 to 1.85); p<0.05

Readmission at 90 days Adjusted OR (95% CI) of daily functioning: 0.56 (0.33 to 0.97); p<0.05

(Observational study, 14 and 90 days, daily functioning – likert scale, subsection of PFSS, 145 participants)

  1. Garcia-Aymerich, J. 2003, Thorax10

Readmission to hospital for COPD exacerbation Adjusted HR (95% CI): 0.85 (0.59 to 1.24) usual physical activity 79-232 kcal/day; p=0.400; 0.49 (0.31 to 0.79) usual physical activity >232 kcal/day; p=0.003 Adjusted HR (95% CI): 0.87 (0.60 to 1.27) usual physical activity 79-232 kcal/day; p=0.469; 0.54 (0.34 to 0.86) usual physical activity >232 kcal/day; p=0.010

(Observational study, self-reported physical activity with calculated energy expenditure, 340 participants)

  1. Garcia-Aymerich, J. 2006, Thorax11

COPD admissions Adjusted IRR (95% CI): 0.72 (0.53 to 0.97) in low/moderate/high physical activity; p=0.033

(Observational study, 9 – 19 years follow up, self-reported physical activity, 2386 subjects)

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

COPD admissions Weighted IRR (95% CI): 1.10 (0.82 to 1.49) in moderate physical activity; p=0.522; 0.68 (0.47 to 0.99) in high physical activity; p=0.044

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

  1. Garcia-Rio, F. 2012, Chest13

COPD admissions Adjusted IRR (95% CI): 0.099 (0.033 to 0.293) 35 in quartile 4 (Q4) of physical activity; p<0.0001;0.529 (0.291 to 0.962) in Q3; p=0.0369; and0.537 (0.285 to 1.013) in Q2; p=0.0547

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

  1. Moy, M. 2013, PLoS ONE14

Acute exacerbations Adjusted RR (95% CI): 1.07 (1.003 to 1.15) in mean daily step count (per 1000 step

decrease); p=0.04

COPD-Related hospitalisations Adjusted RR (95% CI): 1.24 (1.08 to 1.42) in mean daily step count (per 1000 step decrease); p=0.003

(Observational study, median 16 months, step count, 169 subjects)

  1. Pitta, F. 2006, Chest15

Readmission in the year following discharge, Median (P25-P75) walking time per day at 1 month 12 (9-27) min/d in patients readmitted in the year following discharge vs. 30 (21-100) min/d in patients not readmitted; p=0.03

(Observational study, 1 year follow-up for admissions/death, objective physical activity monitor, 17 patients)

  1. Moy (ERJ, 2016)14 (not included in review)

Observational study: 12 months post discharge following exacerbation. 2370 patients.

Patients with >150mins self-reported MVPA per week had a HR of 0.53 (95%CI: 0.34 – 0.85, p<0.01) vs inactive patients (0 mins MVPA/wk)

  1. Chawla (Ann Am Thorac Soc, 2014)16

Observational study: 54 patients post discharge for AECOPD: 30 day readmission was lower in those with higher physical activity (OR 6.7, p=0.02)

  1. Nguyen (Ann Am Thorac Soc, 2014)17

Observational study: 4596 patients post AECOPD: 30 day readmission rate was lower in those reporting performing any amount of MVPA vs none and OR 0.66 (0.51-0.87) for >150mins MVPA /week vs none)