Background The updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recognise the limitations of using grading systems based on spirometry alone. Understanding the impact of COPD on an individual patient should combine symptomatic assessment (using MRC Dyspnoea scale or COPD Assessment Test), spirometric classification and/or risk of exacerbations. GOLD recommends classifying patients into four groups: A (Low Risk, Less Symptoms), B (Low Risk, More Symptoms), C (High Risk, Less Symptoms) and D (High Risk, More Symptoms). Physical inactivity level is an important predictor for hospital admissions and mortality in patients with COPD. The aim of the study was to document objective physical activity parameters according to GOLD grouping. We hypothesised that physical activity levels would be highest in Group A and lowest in Group D.
Methods 220 patients with COPD (mean age 69 years, 81F:139M, mean FEV1 51%predicted) were classified into GOLD groups A-D. Physical activity (PA) was measured for seven days using an accelerometer (Sensewear®) as previously described (Watz et al., 2009). Physical activity parameters were analysed by researcher blinded to GOLD grouping, and included physical activity level (PAL: Total energy expenditure / resting energy expenditure), step count (steps per day) and time spent in at least moderate activity, defined as greater than 3 METS. Kruskal-Wallis was used to compare physical activity parameters across groups and Dunn’s multiple comparison post-hoc test to compare between individual groups.
Results Parameters of physical activity according to GOLD group are shown in Figure 1. Although multiple group comparison showed significant differences in physical activity (PAL: p = 0.04, Step Count: p = 0.005, 3METS: p = 0.02), post-hoc tests revealed no significant differences in PAL or 3METS between individual groups. For step count, there was a significant difference in rank sum between groups B and D (p < 0.05), but not between any other individual group comparisons.
Conclusions There are complex and multifactorial determinants of physical activity levels in patients with COPD which cannot be distinguished by new GOLD grouping.
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