COPD: Walking to Better Health

Although many COPD patients avoid exercise due to their breath-robbing condition, a new study finds that those who reported the most exercise and did not reduce their exercise level over time had the fewest hospitalizations for exacerbations.

Chronic obstructive pulmonary disease (COPD) is notoriously hard to manage. Its progression can be relentless unless patients make lifestyle changes, with smoking cessation the most important. Progression can also be slowed by avoiding episodes of acute exacerbation. Approximately 70% of exacerbations are caused by infections or pollution, but no cause can be identified in the remaining cases. Many COPD patients have significant comorbidities (ie, heart failure or diabetes) that complicate differential diagnosis. They also tend to avoid regular exercise because of their breath-robbing COPD. Lifestyle changes remain the cornerstone of exacerbation prevention. Might going for lengthy walks each day improve health despite compromised respiratory capacity?

In the April 2014 issue of Respirology, a team of researchers has published its evaluation of physical activity’s effect on exacerbations. They included 543 patients with COPD in a prospective study to determine whether regular physical activity would decrease hospitalizations for exacerbations. Patients self-reported the daily distance they walked at least 3 days per week for at least 2 years. The researchers followed patients for an additional 3 years.

At 5 years, the researchers analyzed data from 391 survivors. The results indicated that patients who reported the most exercise and maintained their exercise level after the study period had the fewest hospitalizations for exacerbations. They also tended to be younger. Patients who reported exercising the least had almost twice the number of hospitalizations as those who exercised more. Additionally, patients who reported the highest level of physical exercise in the study period and then decreased their exercise in the follow-up period were more than 2 times as likely to be hospitalized as those who maintained their high level of exercise.

This study demonstrates an inverse dose-dependent relationship between exercise and COPD exacerbations. Patients with COPD who had a low level of physical activity or who reduced their level of physical activity over time were more likely to experience an exacerbation requiring hospitalization. Patients who increased their level of exercise and maintained a moderate- to high-intensity routine had lower hospitalization rates. The researchers recommend encouraging COPD patients to engage in moderate- or high-intensity physical activity routines—such as walking at least 3 to 6 km/day—to reduce exacerbations.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.