Why Are COPD Patients Afraid to Exercise?

Patients with chronic obstructive pulmonary disease (COPD) have reductions in their brains’ gray matter related to the processing of dyspnea, fear, and sensitivity to painful stimuli.

Researchers recently compared 30 patients with moderate to severe COPD with 30 control subjects using voxel-based morphometric analysis of magnetic resonance imaging (MRI).

In the study, MRI was used to measure differences in generalized cortical degeneration and regional gray matter, while a COPD anxiety questionnaire was used to identify disease-specific fears.

Those with COPD did not have generalized cortical degeneration, but there was evidence of them having decreased gray matter in the following areas: posterior cingulate cortex, anterior and midcingulate cortex, hippocampus, and amygdala.

“Patients with COPD demonstrated gray matter decreases in brain areas relevant for the processing of dyspnea, fear, and antinociception,” the researchers concluded. “These structural brain changes were partly related to longer disease duration and greater disease-specific fears, which might contribute to a less favorable course of the disease.”

Study author Andreas von Leupoldt, PhD, told Pharmacy Times that a takeaway pharmacists can glean from this research on structural brain changes is that they may be able to improve clinical interventions for COPD such as pulmonary rehabilitations if they target patients’ disease-specific fears. First, however, comorbid symptoms such as anxiety or depression should be treated in order to eliminate interference from prescribed exercise treatments.

“One needs to detect whether a patient fears dyspnea or fears physical activity in order to discuss these fears with the patient and treat these fears,” Dr. Leupoldt said. “If not detected or treated, a clinician can prescribe whatever exercise program he/she thinks is beneficial, but the patient would most likely avoid these exercise programs or only participate in a suboptimal way.”

Another tip derived from the study results is to continually encourage patients to be physically active at every pharmacy visit while emphasizing the positive outcomes of exercise on both physical and mental health—especially in terms of reduced mortality risk. Pharmacists can and should explain the highly negative outcomes of sedentary lifestyles to COPD patients.

In addition, pharmacists can work to overcome barriers to exercise. By determining which barriers a patient faces in order to exercise or increase physical activity, a pharmacist may be able to offer alternatives or suggest workarounds.

Examples of barriers that a COPD patient may face include no facilities in the neighborhood, difficulties with transportation, and a lack of support systems.

Finally, pharmacists can encourage patients to join a sporting group where they can be active together with other patients, Dr. Leopoldt said.

“COPD patients show changes in their brain structure over the course of disease, which is related to greater fear of dyspnea and fear of physical activity,” Dr. Leopoldt concluded. “Via behavioral mechanisms, this might negatively influence the course of disease. Targeting these disease-specific fears in patients with COPD might improve outcomes of clinical interventions.”

The study findings were published in Chest.