O6. Non-pharmacological interventions
There is strong evidence for the benefits of regular exercise in individuals with COPD (McCarthy 2015, Ries 2003, Spruit 2013, Alison 2017) [evidence level I]. All individuals with COPD should be encouraged to engage in physical activity consistent with the recommendations for ‘healthy’ adults. The current Australian and New Zealand guidelines for physical activity for adults at: www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult and www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-for-new-zealand-adults-oct15_0.pdf recommend:
- Doing any physical activity is better than doing none;
- Be active on most, preferably all, days every week;
- Accumulate 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week;
- Do muscle strengthening activities on at least 2 days each week.
Meeting current guidelines for physical activity is challenging for people with COPD due to exertional dyspnoea and symptoms of fatigue. A large cohort study of 2,398 individuals with COPD (mean age 52.1 [11.5] years, 52.1% male) recruited as part of Health Surveys in England and Scotland (Cheng 2018) provide data demonstrating a reduction in mortality at a level of physical activity significantly below that recommended by the current Australian and New Zealand guidelines for physical activity for adults. Please refer to the Department of Health’s Australia’s Physical Activity and Sedentary Behaviour Guidelines at: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines and the Ministry of Health’s Eating and Activity Guidelines for New Zealand Adults at: https://www.health.govt.nz/publication/eating-and-activity-guidelines-new-zealand-adults.
Specifically, compared to those who reported no physical activity, over a mean follow up period of 8.5 ± 3.9 years, individuals who reported a level of physical activity below at least half that recommended (i.e. 75 min/week of moderate or 32.5 min/week of vigorous physical activity or equivalent combination) had a reduced risk of all-cause (hazard ratio [HR] 0.75, 95% CI 0.56 to 1.00) and cardiovascular disease (CVD) mortality (HR 0.48, 95% CI 0.26 to 0.88). Individuals who met the physical activity guidelines demonstrated the greatest reductions in all-cause (HR 0.56, 95% CI 0.45 to 0.69), CVD (HR 0.48, 95% CI 0.32 to 0.71) and respiratory mortality risk (HR 0.40, 95% CI 0.24 to 0.67). Dose response associations with mortality risk were found for walking and sport/exercise but not for domestic physical activity. The majority of the study cohort (80.2%) had an FEV1 >50% predicted limiting the generalisability of the findings. These findings provide further support for encouraging walking and structured exercise in people with COPD with the aim of reducing mortality risk.< Prev Next >