Consequences of Physical Inactivity in Chronic Obstructive Pulmonary Disease

Jorine E Hartman; H Marike Boezen; Mathieu HG de Greef; Linda Bossenbroek; Nick HT ten Hacken


Expert Rev Resp Med. 2010;4(6):735-745. 

In This Article

Abstract and Introduction


The many health benefits of regular physical activity underline the importance of this topic, especially in this period of time when the prevalence of a sedentary lifestyle in the population is increasing. Physical activity levels are especially low in patients with chronic obstructive pulmonary disease (COPD). Regular physical activity and an active lifestyle has shown to be positively associated with outcomes such as exercise capacity and health-related quality of life, and therefore could be beneficial for the individual COPD patient. An adequate level of physical activity needs to be integrated into daily life, and stimulation of physical activity when absent is important. This article aims to discuss in more detail the possible role of regular physical activity for a number of well-known outcome parameters in COPD.


Chronic obstructive pulmonary disease (COPD) is a disease characterized by a usually progressive airflow limitation that is not fully reversible, and has potential significant extrapulmonary effects.[1] The symptoms of this debilitating disease may have huge impact on a patient's daily life.

Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. Exercise, on the other hand, is physical activity done on purpose, and carried out in a more structured manner with the aim of improving cardiorespiratory or muscular fitness.[101] It is important to distinguish physical activity from physical fitness, functional or exercise capacity. The latter three indicate what a person is capable of doing while physical activity reflects what someone actually does. The measurement of physical activity is therefore different from the measurement of physical fitness, functional or exercise capacity. Physical activity can be measured by direct observation, assessment of energy expenditure (e.g., doubly labeled water technique), diaries, questionnaires and performance-based motion sensors (e.g., pedometers and accelerometers).[2] The first two are time consuming and expensive and are therefore used less frequently. Performance-based motion sensors objectively quantify the amount of daily physical activity performed and is therefore more accurate as compared with questionnaires and diaries, which depend on a person's memory and interpretation.

Regular physical activity improves body composition, autonomic tone, coronary blood flow, psychological wellbeing, glucose homeostasis and insulin sensitivity, enhances lipid lipoprotein profiles and endothelial function, reduces blood pressure and systemic inflammation, decreases blood coagulation and augments cardiac function.[3] Physical inactivity is therefore a modifiable risk factor for cardiovascular disease and a variety of other diseases such as diabetes mellitus, cancer, hypertension and dementia.[3,4] The recommended minimum amount of physical activity for adults to promote and maintain physical health is 30 min of moderately intense aerobic physical activity at least 5 days a week or 20 min of vigorously intense aerobic physical activity at least 3 days a week, or an equivalent combination. Every adult should also perform muscular strength and endurance exercises at least 2 days each week.[5] For elderly adults (age ≥65, or ≥50 years with clinically significant chronic conditions and/or functional limitations) it is necessary to adjust the recommended intensity of aerobic activity to the elderly adult's aerobic fitness. Moreover, activities that maintain or increase flexibility are recommended next to balance exercises for elderly adults at risk to fall.[6] The latter would be adequate for the majority of COPD patients. To our knowledge, there are no COPD-specific recommendations for an adequate physical activity level. Most guidelines on the management of COPD mention the importance of increasing the level of physical activity, however, this is often related to treatment with pulmonary rehabilitation. The American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation provides practice guidelines for exercise training during pulmonary rehabilitation and emphasizes the need for the transference of exercise adherence to the home setting.[7] Unfortunately, the recommended amount of physical activity in daily life is not specified in these guidelines.

Several studies have shown that the level of physical activity in COPD patients is low, especially compared with that of healthy controls. A selection of these studies is shown in Table 1. Moreover, a recent study from Sweden[8] has reported that the number of COPD patients who do not reach the recommended amount of physical activity according to the earlier stated guidelines[6] was significantly higher than in patients with rheumatoid arthritis, diabetes mellitus and healthy subjects (COPD 84%, rheumatoid arthritis 74%, diabetes mellitus 72% and healthy 60%, respectively). This indicates that the level of physical activity in COPD patients is also lower than in other diseases.

From the literature we can conclude that being physically active has many health benefits in general, and that many COPD patients lack an adequate level of physical activity. Consequently, a reduced level of physical activity may contribute to a lower physical fitness and wellbeing. The aim of this article is to discuss in more detail the possible role of regular physical activity in a number of well-known outcome parameters in COPD.


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