Editorial
Pulmonary rehabilitation and long-term physical activity in the chronic obstructive pulmonary disease patient
Rehabilitación pulmonar y actividad física a largo plazo en el paciente con enfermedad pulmonar obstructiva crónica
Elena Gimeno-Santos
Centro de Diagnóstico Respiratorio, Instituto Clínic Respiratorio, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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"<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Impact of Physical Activity and Exercise on Chronic Obstructive Pulmonary Disease Phenotypes: The Relevance of Muscle Adaptation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "614" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de la actividad física y el ejercico en los fenotipos de enfermedad pulmonar obstructiva crónica: la importancia de la adaptación muscular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esther Barreiro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Esther" "apellidos" => "Barreiro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289619302522" "doi" => "10.1016/j.arbres.2019.04.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302522?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919303593?idApp=UINPBA00003Z" "url" => "/15792129/0000005500000012/v2_201912171000/S1579212919303593/v2_201912171000/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Pulmonary rehabilitation and long-term physical activity in the chronic obstructive pulmonary disease patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "615" "paginaFinal" => "616" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Elena Gimeno-Santos" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Elena" "apellidos" => "Gimeno-Santos" "email" => array:1 [ 0 => "elenagimeno@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Diagnóstico Respiratorio, Instituto Clínic Respiratorio, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rehabilitación pulmonar y actividad física a largo plazo en el paciente con enfermedad pulmonar obstructiva crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Research on physical activity in patients with chronic obstructive pulmonary disease (COPD) has increased exponentially in the last decade. COPD patients have reduced levels of physical activity, they spend more time sitting and lying down than standing or walking, and the intensity of their activity is significantly lower than that of healthy subjects.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It should be noted that physical activity is a key factor in the prognosis and progress of COPD. Current evidence consistently confirms that reduced levels of physical activity are associated with an increased risk of mortality and hospitalization for disease exacerbations, regardless of whether physical activity is measured by questionnaire or accelerometer.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Interest in sedentary behavior and its effects on patients with COPD has also increased recently. Current data show that the risk of mortality is 4 times higher in subjects who spend more than 8 and a half hours in activities that require less than 1.5 metabolic equivalents (MET), which basically corresponds to sitting or lying down.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although there is still scope for a better understanding of the relationship between the effects of activity and inactivity in COPD, evidence (and common sense) suggests that increasing and maintaining physical activity in COPD patients is a top priority therapeutic goal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this respect, the most current definition of pulmonary rehabilitation (PR) incorporates the objective of promoting long-term adherence to behaviors that benefit health, along with improving the physical condition and psychological status of patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The exercise training component is currently the best approach for improving exercise tolerance (or physical condition) in patients with COPD. However, this improvement does not necessarily mean an increase in the patient’s daily physical activity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This shows us that in PR programs, exercise training and the promotion of physical activity should be complementary interventions, with each meeting a specific objective: the first, to improve functional ability, and the second, to change physical (in)activity behavior. In this line, implementing interventions to promote physical activity in PR programs (with a duration of more than 12 weeks) could be the ideal opportunity to modify behavior in COPD patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although little evidence is available, experts in the field argue that the combination of exercise training and programs to change behavior should be proposed at different times during the PR program. For example, behavioral change intervention should begin in the final phase of the PR program, when patients have already completed their adaptation to exercise training and are experiencing the improvements that this offers (greater exercise capacity and fewer symptoms).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is also important to note that exercise capacity can be a predictor of response to changes in physical activity in COPD patients. Recent data show that patients with a better baseline functional capacity (>350<span class="elsevierStyleHsp" style=""></span>m in the 6-min walk test) are more likely to increase physical activity after a 3-month PR program.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite this, PR is only offered and implemented in a small proportion of COPD patients, compared with the (almost) universal availability of drug therapy. The reasons for this discrepancy are difficult to comprehend, because both therapies receive a strong international recommendation as the standard of care in these patients. So, is long-term adherence to an active life (outside PR programs) possible in our COPD patients?</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several studies have now reported on the combination of different motivational elements, such as pedometers, mobile phones, and websites associated with the promotion of physical activity – telecoaching, as it is known, used to efficiently increase (and the most individualized way possible) daily physical activity in this group of patients.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> Outcomes in all of these studies were successful, even if behavior change was only maintained in the short term (3–4 months). One could hypothesize that most of these studies were not designed with the understanding of physical activity as a complex and multifactorial behavior.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this respect, taking into account psychological factors and behavioral science, theoretical models can help explain why some people (both the general population and subjects with chronic diseases, such as COPD) are physically active and others are not.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> We should not forget that knowledge of the determinants of physical activity in COPD is currently restricted to mainly biological, clinical, and functional factors.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Moreover, little evidence has been generated on factors more closely associated with motivation and socio-environmental factors that may influence physical activity and behavior change. Thus, the determinants that contribute to physical activity (both in the general population and in patients with COPD) must be identified at different levels, i.e., the individual, social, environmental, and political.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Two recent studies have demonstrated the importance of socio-environmental determinants in COPD patients with regard to their physical activity. For example, walking the dog or caring for grandchildren is related to the amount and intensity of physical activity, regardless of the airflow limitation and other clinical parameters.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Similarly, COPD patients with an active partner are more active and are more likely to be so.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">As a result, it can be observed that only by planning interventions that take into account individual factors, interpersonal and environmental determinants of physical activity,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and the barriers and facilitators to this conduct,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> can the effects of behavior change be maintained in the long term.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this line, the Urban Training® study<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> was designed as a multicomponent intervention that combined behavioral strategies (such as the motivational interview) in physical training with an increase in daily physical activity using walking routes adapted to the social environment of the COPD patient. This clinical trial was the first to demonstrate effectiveness, as it managed to increase and maintain physical activity after 12 months of follow-up, without no serious safety issues. However, this program was not effective in improving the distance walked in the 6-min walk test, which may be more closely related to specific intense supervised exercise training interventions within the PR framework.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In summary, therapeutic strategies such as Urban Training® may be a solution for (or a possible way of) promoting physical activity in the long term in patients with respiratory diseases. Interventions of this type depend on the setting, and must be adapted to the cultural, geographic, and environmental environment in order to achieve the appropriate design and implementation. In addition, these strategies should be complementary to physical training in PR programs, that (to date) remain the best treatment for increasing the functional capacity of patients with COPD.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gimeno-Santos E. Rehabilitación pulmonar y actividad física a largo plazo en el paciente con enfermedad pulmonar obstructiva crónica. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 47 | 19 | 66 |
| 2024 September | 42 | 16 | 58 |
| 2024 August | 60 | 36 | 96 |
| 2024 July | 36 | 22 | 58 |
| 2024 June | 58 | 42 | 100 |
| 2024 May | 80 | 27 | 107 |
| 2024 April | 28 | 34 | 62 |
| 2024 March | 36 | 18 | 54 |
| 2024 February | 36 | 23 | 59 |
| 2023 March | 7 | 5 | 12 |
| 2023 February | 28 | 14 | 42 |
| 2023 January | 32 | 25 | 57 |
| 2022 December | 38 | 33 | 71 |
| 2022 November | 51 | 25 | 76 |
| 2022 October | 43 | 43 | 86 |
| 2022 September | 43 | 48 | 91 |
| 2022 August | 40 | 75 | 115 |
| 2022 July | 44 | 40 | 84 |
| 2022 June | 39 | 38 | 77 |
| 2022 May | 32 | 37 | 69 |
| 2022 April | 37 | 30 | 67 |
| 2022 March | 34 | 44 | 78 |
| 2022 February | 31 | 33 | 64 |
| 2022 January | 34 | 36 | 70 |
| 2021 December | 34 | 38 | 72 |
| 2021 January | 1 | 2 | 3 |
| 2020 July | 1 | 2 | 3 |
| 2020 June | 2 | 2 | 4 |
| 2020 April | 1 | 0 | 1 |
| 2020 March | 3 | 0 | 3 |
| 2019 November | 3 | 2 | 5 |
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