A Non-Interventional, Cross-Sectional Study to Evaluate Factors Relating to Daily Step Counts and Physical Activity in Japanese Patients with Chronic Obstructive Pulmonary Disease: STEP COPD

Masakazu Ichinose, Yoshiaki Minakata, Takashi Motegi, Tsuneyuki Takahashi, Munehiro Seki, Satoko Sugaya, Nobuya Hayashi, Ichiro Kuwahira, Masakazu Ichinose, Yoshiaki Minakata, Takashi Motegi, Tsuneyuki Takahashi, Munehiro Seki, Satoko Sugaya, Nobuya Hayashi, Ichiro Kuwahira

Abstract

Purpose: Patients with chronic obstructive pulmonary disease (COPD) have decreased physical activity (PA) compared with healthy adults. As lower PA is associated with increased mortality, improving PA is an important objective for COPD management. This large-scale, multicenter, non-interventional, cross-sectional study examined the activity status of COPD patients in Japan and explored factors related to PA.

Patients and methods: Outpatients aged ≥40 years with confirmed COPD diagnosis and pulmonary function test data were enrolled. Primary study outcomes were measurement of daily steps (over 14 consecutive days, using an activity monitor), assessment of activity time by activity intensity (using metabolic equivalents [METs]), and evaluation of correlation between PA and patient characteristics. Secondary outcomes included further investigation of the influence of patient characteristics on PA.

Results: Data from 417 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I (29.5%), II (43.9%), III (23.5%), and IV (3.1%) were evaluated. Median (Q1, Q3) daily step count was 3440.8 (1831.3, 5709.3). Median (Q1, Q3) durations of PA at ≥3 (moderate-to-vigorous) and ≥2 METs (light-to-vigorous) were 18.7 (6.5, 41.3) and 186.9 (126.9, 259.2) minutes, respectively. For >30% of patients, time spent in ≥3 METs activity was ≤10 minutes. Unemployment was significantly correlated with reduced activity time (≥3 and ≥2 METs) and step count. Severe GOLD stage was significantly correlated with reduced activity time (≥3 and ≥2 METs). High modified Medical Research Council (mMRC) dyspnea score was significantly correlated with reduced activity time (≥3 METs) and step count. Patients tended to overestimate the time spent in activities requiring ≥2 METs in their subjective reports compared with activity monitor measurements.

Conclusion: Reduced PA was observed in the Japanese COPD patients with the majority of them being GOLD stage I/II. Employment status, GOLD stage, and mMRC dyspnea score could help identify patients at risk of reduced PA.

Clinical trial registration: NCT03642613 (ClinicalTrials.gov); UMIN000032962 (UMIN-CTR, umin.ac.jp).

Keywords: COPD; activity monitor; physical activity; pulmonary function; step counts.

Conflict of interest statement

Masakazu Ichinose has received honoraria for speaking from AstraZeneca, GSK, and Nippon Boehringer Ingelheim. Yoshiaki Minakata has received personal fees from AstraZeneca K.K. and Nippon Boehringer Ingelheim outside the submitted work. Takashi Motegi has received personal fees from AstraZeneca K.K. for the submitted work, and personal fees from Nippon Boehringer Ingelheim outside the submitted work. Ichiro Kuwahira has received honoraria for speaking from AstraZeneca, GSK, Nippon Boehringer Ingelheim, and Meiji Seika Pharma. Munehiro Seki, Satoko Sugaya, and Nobuya Hayashi are employees of AstraZeneca K.K. The authors report no other conflicts of interest in this work.

© 2020 Ichinose et al.

Figures

Figure 1
Figure 1
Patient disposition.
Figure 2
Figure 2
Daily activity. (A) The frequency of steps for the AMC-FAS population. (B) Activity time for physical activity at ≥3.0 METs. (C) Activity time for physical activity at ≥2.0 METs.
Figure 3
Figure 3
Correlations between the total activity time in patients achieving ≥2 METs and patient-reported durations of activities equivalent to ≥2 METs.

References

    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2019 report); 2019. Available from: . Accessed November25, 2020.
    1. Lowe KE, Regan EA, Anzueto A, et al. COPDGene(R) 2019: redefining the diagnosis of chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2019;6:384–399. doi:10.15326/jcopdf.6.5.2019.0149
    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi:10.1016/S0140-6736(12)61728-0
    1. Japan Ministry of Health, Labour and Welfare. Health statistics; 2016. Available from: . Accessed November25, 2020.
    1. Omori H, Kaise T, Suzuki T, Hagan G. Prevalence of airflow limitation in subjects undergoing comprehensive health examination in Japan: survey of chronic obstructive pulmonary disease patients epidemiology in Japan. Int J Chron Obstruct Pulmon Dis. 2016;11:873–880. doi:10.2147/COPD.S99935
    1. Woo L, Smith HE, Sullivan SD. The economic burden of chronic obstructive pulmonary disease in the Asia-Pacific region: a systematic review. Value Health Reg Issues. 2019;18:121–131. doi:10.1016/j.vhri.2019.02.002
    1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.
    1. Watz H, Pitta F, Rochester CL, et al. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J. 2014;44(6):1521–1537. doi:10.1183/09031936.00046814
    1. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–1581. doi:10.1249/MSS.0b013e31821ece12
    1. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504. doi:10.1097/00005768-200009001-00009
    1. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171:972–977. doi:10.1164/rccm.200407-855OC
    1. Vorrink SN, Kort HS, Troosters T, Lammers JW. Level of daily physical activity in individuals with COPD compared with healthy controls. Respir Res. 2011;12:33. doi:10.1186/1465-9921-12-33
    1. Gimeno-Santos E, Frei A, Steurer-Stey C, et al. Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax. 2014;69:731–739. doi:10.1136/thoraxjnl-2013-204763
    1. Vaes AW, Garcia-Aymerich J, Marott JL, et al. Changes in physical activity and all-cause mortality in COPD. Eur Respir J. 2014;44:1199–1209. doi:10.1183/09031936.00023214
    1. Waschki B, Kirsten A, Holz O, et al. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest. 2011;140:331–342. doi:10.1378/chest.10-2521
    1. The Japanese Respiratory Society. Guidelines for Diagnosis and Treatment of COPD (Chronic Obstructive Pulmonary Disease). 5th edition Tokyo: Medical Review Co., Ltd; 2018.
    1. Minakata Y, Sugino A, Kanda M, et al. Reduced level of physical activity in Japanese patients with chronic obstructive pulmonary disease. Respir Investig. 2014;52:41–48. doi:10.1016/j.resinv.2013.06.002
    1. Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380:258–271. doi:10.1016/S0140-6736(12)60735-1
    1. Wshah A, Selzler AM, Hill K, Brooks D, Goldstein R. Determinants of sedentary behaviour in individuals with COPD: a qualitative exploration guided by the theoretical domains framework. COPD. 2020;17:65–73. doi:10.1080/15412555.2019.1708883
    1. Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009;33:262–272. doi:10.1183/09031936.00024608
    1. Paneroni M, Ambrosino N, Simonelli C, Bertacchini L, Venturelli M, Vitacca M. Physical activity in patients with chronic obstructive pulmonary disease on long-term oxygen therapy: a cross-sectional study. Int J Chron Obstruct Pulmon Dis. 2019;14:2815–2823. doi:10.2147/COPD.S228465
    1. Waschki B, Kirsten AM, Holz O, et al. Disease progression and changes in physical activity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015;192:295–306. doi:10.1164/rccm.201501-0081OC
    1. Yu T, Frei A, Ter Riet G, Puhan MA. Determinants of physical activity in patients with chronic obstructive pulmonary disease: a 5-year prospective follow-up study. Respiration. 2016;92:72–79. doi:10.1159/000447975
    1. Miyamoto S, Minakata Y, Azuma Y, et al. Verification of a motion sensor for evaluating physical activity in COPD patients. Can Respir J. 2018;2018:8343705. doi:10.1155/2018/8343705
    1. GOLD Japan Committee. The Japanese COPD Assessment Test, revised; 2012. Available from: . Accessed February23, 2012.
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34:648–654. doi:10.1183/09031936.00102509
    1. Maxwell SE. Sample size and multiple regression analysis. Psychol Methods. 2000;5:434–458. doi:10.1037/1082-989X.5.4.434
    1. Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37:S531–543. doi:10.1249/01.mss.0000185657.86065.98
    1. Sugino A, Minakata Y, Kanda M, et al. Validation of a compact motion sensor for the measurement of physical activity in patients with chronic obstructive pulmonary disease. Respiration. 2012;83:300–307. doi:10.1159/000330046
    1. Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioral Sciences. 5th edition. Boston, MA: Houghton Mifflin Harcourt; 2003.
    1. Rabinovich RA. Physical activity in COPD. Significance, prognosis, measurement and therapeutic interventions. Arch Bronconeumol. 2018;54:449–450. doi:10.1016/j.arbres.2018.01.011
    1. Japan Ministry of Health, Labour and Welfare. National health and nutrition survey 2015. Table 59: Average value and standard deviation of the number of steps-By age group, average value, standard deviation-Total number, male, female, 20 years old or older. [In Japanese]; 2015. Available from: . Accessed November25, 2020.
    1. Watz H, Waschki B, Boehme C, Claussen M, Meyer T, Magnussen H. Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study. Am J Respir Crit Care Med. 2008;177:743–751. doi:10.1164/rccm.200707-1011OC
    1. van Gestel AJ, Clarenbach CF, Stowhas AC, et al. Predicting daily physical activity in patients with chronic obstructive pulmonary disease. PLoS One. 2012;7:e48081. doi:10.1371/journal.pone.0048081
    1. Moy ML, Teylan M, Weston NA, Gagnon DR, Danilack VA, Garshick E. Daily step count is associated with plasma C-reactive protein and IL-6 in a US cohort with COPD. Chest. 2014;145:542–550. doi:10.1378/chest.13-1052
    1. Waschki B, Spruit MA, Watz H, et al. Physical activity monitoring in COPD: compliance and associations with clinical characteristics in a multicenter study. Respir Med. 2012;106:522–530. doi:10.1016/j.rmed.2011.10.022
    1. Ministry of Health, Labour and Welfare, Kenko Nippon, 21. Targets for improving lifestyle and social environment in relation to nutrition/eating habits, physical activity/exercise, rest, drinking habits, smoking habits, and oral health; 2015. Available from: . Accessed October22, 2020.
    1. Ministry of Health, Labour and Welfare. Physical activity standards for health promotion; 2013. Available from: . Accessed October22, 2020.
    1. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006;27:1040–1055. doi:10.1183/09031936.06.00064105
    1. Pleguezuelos E, Pérez ME, Guirao L, et al. Improving physical activity in patients with COPD with urban walking circuits. Respir Med. 2013;107:1948–1956. doi:10.1016/j.rmed.2013.07.008
    1. Hayata A, Minakata Y, Matsunaga K, Nakanishi M, Yamamoto N. Differences in physical activity according to mMRC grade in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2203–2208. doi:10.2147/COPD.S109694
    1. Nakanishi M, Minakata Y, Tanaka R, et al. Simple standard equation for daily step count in Japanese patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2019;14:1967–1977. doi:10.2147/COPD.S218705
    1. Rabe KF, Martinez FJ, Ferguson GT, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med. 2020;383:35–48. doi:10.1056/NEJMoa1916046
    1. Ferguson GT, Rabe KF, Martinez FJ, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, Phase 3 randomised controlled trial. Lancet Respir Med. 2018;6:747–758. doi:10.1016/S2213-2600(18)30327-8
    1. Ishii T, Nishimura M, Akimoto A, James MH, Jones P. Understanding low COPD exacerbation rates in Japan: a review and comparison with other countries. Int J Chron Obstruct Pulmon Dis. 2018;13:3459–3471. doi:10.2147/COPD.S165187

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