Seasonal variations in objectively assessed physical activity among people with COPD in two Nordic countries and Australia: a cross-sectional study

Hanne Hoaas, Paolo Zanaboni, Audhild Hjalmarsen, Bente Morseth, Birthe Dinesen, Angela T Burge, Narelle S Cox, Anne E Holland, Hanne Hoaas, Paolo Zanaboni, Audhild Hjalmarsen, Bente Morseth, Birthe Dinesen, Angela T Burge, Narelle S Cox, Anne E Holland

Abstract

Purpose: Seasons and weather conditions might influence participation in physical activity and contribute to differences between countries. This study aimed at investigating whether there were differences in physical activity levels between Norwegian, Danish and Australian people with chronic obstructive pulmonary disease (COPD), and establishing if any variations in physical activity were attributable to seasons. Patients and methods: A cross-sectional study where study subjects were people with COPD who participated in two separate clinical trials: the iTrain study (Norway, Denmark, and Australia) and the HomeBase study (Australia). Physical activity was objectively assessed with an activity monitor; variables were total energy expenditure, number of daily steps, awake sedentary time, light, and moderate-to-vigorous intensity physical activity. Differences in physical activity between countries and seasons were compared, with adjustment for disease severity. Results: In total, 168 participants were included from Norway (N=38), Denmark (N=36) and Australia (N=94). After controlling for disease severity, time spent in awake sedentary time was greater in Danish participants compared to the other countries (median 784 minutes/day [660-952] vs 775 minutes/day [626-877] for Norwegians vs 703 minutes/day [613-802] for Australians, P=0.013), whilst time spent in moderate to vigorous physical activity was lower (median 21 minutes/day [4-73] vs 30 minutes/day [7-93] for Norwegians vs 48 minutes/day [19-98] for Australians, P=0.024). Participants walked more during summer (median 3502 [1253-5407] steps/day) than in spring (median 2698 [1613-5207] steps/day), winter (median 2373 [1145-4206] steps/day) and autumn (median 1603 [738-4040] steps/day), regardless of geography. The median difference between summer and other seasons exceeded the minimal clinically important difference of 600 steps/day. However, the differences were not statistically significant (P=0.101). Conclusion: After controlling for disease severity, Danish participants spent more time in an awake sedentary state and less time in moderate to vigorous physical activity than their counterparts in Norway and Australia. People with COPD increased their physical activity in summer compared to other seasons. Weather conditions and seasonal variations may influence outcomes in clinical trials and health registries measuring physical activity over time, irrespective of the interventions delivered, and should be taken into account when interpreting results.

Trial registration: ClinicalTrials.gov NCT02258646 NCT01423227.

Keywords: activity monitoring; chronic obstructive pulmonary disease; population comparison; seasons; weather.

Conflict of interest statement

The authors declare that they have no competing interests. Dr Narelle Cox reports honorarium paid by Boehringer Ingelheim for workshop delivery regarding pulmonary rehabilitation and exercise in COPD. The authors report no other conflicts of interest in this work.

References

    1. Kohl HW 3rd, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.
    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(9):972–977. doi:10.1164/rccm.200407-855OC
    1. Park SK, Richardson CR, Holleman RG, Larson JL. Physical activity in people with COPD, using the National health and nutrition evaluation survey dataset (2003–2006). Heart Lung. 2013;42(4):235–240. doi:10.1016/j.hrtlng.2013.04.005
    1. Troosters T, van der Molen T, Polkey M, et al. Improving physical activity in COPD: towards a new paradigm. Respir Res. 2013;14:115. doi:10.1186/1465-9921-14-19
    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. 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(2):331–342. doi:10.1378/chest.10-2521
    1. Furlanetto KC, Donária L, Schneider LP, et al. Sedentary behavior is an independent predictor of mortality in subjects with COPD. Respir Care. 2017;62(5):579–587. doi:10.4187/respcare.05306
    1. Van Remoortel H, Hornikx M, Demeyer H, et al. Daily physical activity in subjects with newly diagnosed COPD. Thorax. 2013;68(10):962–963. doi:10.1136/thoraxjnl-2013-203534
    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(3):295–306. doi:10.1164/rccm.201501-0081OC
    1. [homepage on the Internet]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2018 Report; 2018. Available from: . Accessed August14, 2018.
    1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247–257. doi:10.1016/S0140-6736(12)60646-1
    1. Pitta F, Breyer M-K, Hernandes NA, et al. Comparison of daily physical activity between COPD patients from Central Europe and South America. Respir Med. 2009;103(3):421–426. doi:10.1016/j.rmed.2008.09.019
    1. Demeyer H, Burtin C, Van Remoortel H, et al. Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest. 2014;146(2):318. doi:10.1378/chest.13-1968
    1. Sewell L, Singh SJ, Williams JEA, Morgan MD. Seasonal variations affect physical activity and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev. 2010;30(5):329–333. doi:10.1097/HCR.0b013e3181e175f2
    1. Sumukadas D, Witham M, Struthers A, McMurdo M. Day length and weather conditions profoundly affect physical activity levels in older functionally impaired people. J Epidemiol Community Health. 2009;63(4):305–309. doi:10.1136/jech.2008.080838
    1. Balish SM, Dechman G, Hernandez P, et al. The relationship between weather and objectively measured physical activity among individuals with COPD. J Cardiopulm Rehabil Prev. 2017;37(6):445–449. doi:10.1097/HCR.0000000000000244
    1. Furlanetto KC, Demeyer H, Sant‘Anna T, et al. Physical activity of patients with COPD from regions with different climatic variations. Copd. 2017;14(3):276–283. doi:10.1080/15412555.2017.1303039
    1. Koskela HO. Cold air-provoked respiratory symptoms: the mechanisms and management. Int J Circumpolar Health. 2007;66(2):91–100.
    1. Hansel NN, McCormack MC, Kim V. The effects of air pollution and temperature on COPD. Copd. 2016;13(3):372–379. doi:10.3109/15412555.2015.1089846
    1. Zanaboni P, Dinesen B, Hjalmarsen A, et al. Long-term integrated telerehabilitation of COPD patients: a multicentre randomised controlled trial (iTrain). BMC Pulm Med. 2016;16(1):126. doi:10.1186/s12890-016-0276-3
    1. Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017;72(1):57–65. doi:10.1136/thoraxjnl-2016-208514
    1. [homepage on the Internet]. San Francisco, United States: cedar Lake Ventures: average weather for Tromsø, Norway. Available from: . Accessed October1, 2016
    1. [homepage on the Internet]. San Francisco, United States: cedar Lake Ventures: average weather for Esbjerg, Denmark. Available from: . Accessed October 1, 2016.
    1. [homepage on the Internet]. San Francisco, United States: cedar Lake Ventures: average weather for Melbourne, Australia. Available from: . Accessed: October1, 2016.
    1. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–338. doi:10.1183/09031936.05.00034805
    1. Stenton C. The MRC breathlessness scale. Occup Med. 2008;58(3):226–227. doi:10.1093/occmed/kqm162
    1. Holland AE, Spruit MA, Troosters T, et al. An official European respiratory Society/American thoracic society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–1446. doi:10.1183/09031936.00150314
    1. Patel SA, Benzo RP, Slivka WA, Sciurba FC. Activity monitoring and energy expenditure in COPD patients: a validation study. Copd. 2007;4(2):107–112. doi:10.1080/15412550701246658
    1. Byrom B, Rowe DA. Measuring free-living physical activity in COPD patients: deriving methodology standards for clinical trials through a review of research studies. Contemp Clin Trials. 2016;47:172–184. doi:10.1016/j.cct.2016.01.006
    1. Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport. 2010;13(5):496–502. doi:10.1016/j.jsams.2009.09.008
    1. Demeyer H, Burtin C, Hornikx M, et al. The minimal important difference in physical activity in patients with COPD. PLoS One. 2016;11(4):e0154587. doi:10.1016/j.rmed.2017.07.057
    1. [homepage on the Internet]. London, United Kingdom: legatum Institute Foundation: legatum prosperity index TM; 2016. Available form: . Accessed March23, 2017.
    1. Troosters T, Sciurba F, Battaglia S, et al. Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir Med. 2010;104(7):1005–1011. doi:10.1016/j.rmed.2010.01.012
    1. [homepage on the Internet]. Global observatory for physical activity: country cards; 2017. Available from: . Accessed June22, 2017.
    1. Dyrstad SM, Hansen BH, Holme IM, Anderssen SA. Comparison of self-reported versus accelerometer-measured physical activity. Med Sci Sports Exerc. 2014;46(1):99–106. doi:10.1249/MSS.0b013e3182a0595f
    1. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American college of sports medicine and the American heart association. Med Sci Sports Exerc. 2007;39(8):1423–1434.
    1. Thorpe O, Kumar S, Johnston K. Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study. Int J Chron Obstruct Pulmon Dis. 2014;9(1):115–128. doi:10.2147/COPD.S54457
    1. Burtin C, Langer D, Van Remoortel H, et al. Physical activity counselling during pulmonary rehabilitation in patients with COPD: a randomised controlled trial. PLoS One. 2015;10(12):e0144989. doi:10.1371/journal.pone.0144989
    1. Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–2905. doi:10.1007/s00125-012-2677-z
    1. Maclay JD, McAllister DA, MacNee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology. 2007;12(5):634–641. doi:10.1111/j.1440-1843.2007.01136.x
    1. Lahham A, McDonald CF, Holland AE. Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials. Int J Chron Obstruct Pulmon Dis. 2016;11:3121–3136. doi:10.2147/COPD.S121263
    1. Gibbs BB, Brach JS, Byard T, et al. Reducing sedentary behavior versus increasing moderate-to-vigorous intensity physical activity in older adults. J Aging Health. 2017;29(2):247–267. doi:10.1177/0898264316635564
    1. Togo F, Watanabe E, Park H, Shephard RJ, Aoyagi Y. Meteorology and the physical activity of the elderly: the Nakanojo study. Int J Biometeorol. 2005;50(2):83–89. doi:10.1007/s00484-005-0277-z
    1. Alahmari AD, Mackay AJ, Patel AR, et al. Influence of weather and atmospheric pollution on physical activity in patients with COPD. Respir Res. 2015;16(1):71. doi:10.1186/s12931-015-0229-z
    1. Wan ES, Kantorowski A, Homsy D, et al. Promoting physical activity in COPD: insights from a randomized trial of a web-based intervention and pedometer use. Respir Med. 2017;130:102–110. doi:10.1016/j.rmed.2017.07.057

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