Determinant | N studies | Direction established | Control for confounding | Directness | Consistency | Strength | Low precision | Other | Confidence rating |
---|---|---|---|---|---|---|---|---|---|
(A) Quality of evidence for socio-demographic, lifestyle and environmental determinants of physical activity | |||||||||
AgeS30 S33 S34 S57 S71 S81 | 6 | na | na | Yes | −11 | No | No | No | +++ (moderate) |
Alcohol consumptionS30 S34 | 2 | −22 | −14 | Yes | −11 | No | −16 | No | + (very low) |
Cultural groupS14 S59 S71 | 3 | −12 | na | −13 | −11 | No | No | No | + (very low) |
Day of the weekS45 S49 S82 | 3 | −22 | −14 | Yes | −11 | No | No | No | + (very low) |
EducationS30 S33 S34 | 3 | −22 | −14 | Yes | −11 | No | No | No | + (very low) |
Marital statusS30 S33 | 2 | −22 | −14 | Yes | −11 | No | No | No | + (very low) |
SexS30 S33 S34 S57 S68 S81 | 6 | na | na | Yes | −11 | No | No | No | +++ (moderate) |
Smoking habitS30 S33 S34 | 3 | −22 | −14 | Yes | −11 | No | −16 | No | + (very low) |
Socioeconomic statusS30 S33 | 2 | −22 | −15 | Yes | −11 | No | No | No | + (very low) |
Working statusS30 S33 S34 | 3 | −22 | −14 | Yes | −11 | No | No | No | + (very low) |
(B) Quality of evidence for functional and clinical determinants of physical activity | |||||||||
BODE indexS34 S49 S57 S81 S83 | 5 | −22 | −15 | Yes | −11 | No | No | No | + (very low) |
Body mass indexS30 S34 S48 S57 S81 | 5 | −22 | −15 | Yes | −11 | No | No | No | + (very low) |
CardiovascularS30 S81 | 2 | −22 | −15 | Yes | −11 | No | −16 | −17 | + (very low) |
DyspnoeaS8 S41 S30 S34 S52 S57 S83 | 7 | −22 | −15 | Yes | yes | No | No | No | + (very low) |
Emotional statusS30 S52 | 2 | −22 | Yes | Yes | −11 | No | No | No | + (very low) |
Exercise capacity (VO2 max, 6MWD)S1 S6 S34 S37 S49 S52 S57 S74 S83 | 9 | −22 | −15 | Yes | yes | No | No | No | + (very low) |
FEV1S6 S22 S30 S34 S41 S42 S49 S57 S58 S71 S81 S82 S83 S86 | 14 | −12 | −15 | Yes | −11 | No | No | No | + (very low) |
FVCS34 S57 | 2 | −12 | Yes | Yes | −11 | No | No | −112 | + (very low) |
Gas exchange (DLco)S34 S74 | 2 | −22 | −14 | Yes | yes | No | No | No | + (very low) |
Gas exchange (PCO2)S30 S34 | 2 | −22 | −14 | Yes | yes | No | No | No | + (very low) |
Gas exchange (PO2)S30 S34 | 2 | −22 | −14 | Yes | yes | No | No | No | + (very low) |
HyperinflationS34 S37 S42 S57 S58 | 5 | −22 | Yes | Yes | yes | No | No | No | ++ (low) |
Osteoarticular conditionS30 S49 | 2 | −22 | −14 | Yes | −11 | No | −16 | No | + (very low) |
Previous exacerbationS11 S30 S56 | 3 | −12 | −14 | Yes | yes | No | No | −17 | + (very low) |
Quality of life/health-related quality of lifeS1 S30 S34 S49 S57 | 5 | −22 | −14 | Yes | yes | No | No | No | + (very low) |
Self-efficacyS1 S37 | 2 | −22 | Yes | Yes | yes | No | No | −17 | + (very low) |
Systemic inflammationS34 S81 | 2 | −22 | −15 | Yes | yes | No | No | −17 | + (very low) |
(C) Quality of evidence for interventions to modify levels of physical activity | |||||||||
Dietary interventionS16 S84 | 2 | Yes | Yes | Yes | −11 | No | No | −112 | ++ (low) |
Exercise trainingS3 S4 S7 S12 S15 S17 S18 S20 S21 S27 S28 S46 S53 S60 S61 S64 S65 S66 S69 S70 S79 | 21 | Yes | −18 | Yes | −11 | No | No | No | ++ (low) |
Long-acting β2 agonist/corticosteroidsS30 S34 S38 | 3 | −22 | −18 | Yes | −11 | No | −16 | No | + (very low) |
Long-term oxygen therapyS30 S34 S54 S63 S72 S75 | 6 | Yes | Yes | Yes | −11 | No | No | −110,11 | ++ (low) |
Physical activity adviceS19 S51 S85 | 3 | Yes | −18 | Yes | −11 | No | −19 | No | + (very low) |
Outcome | |||||||||
(D) Quality of evidence for outcomes as a result of different levels of physical activity | |||||||||
BalanceS2 S62 | 2 | −12 | −18 | Yes | −11 | No | No | −112,13 | + (very low) |
Bone mineral densityS9 S67 | 2 | −22 | −18 | Yes | −11 | No | No | −113 | + (very low) |
DyspnoeaS33 S44 | 2 | −12 | Yes | Yes | Yes | No | No | −113 | ++ (low) |
ExacerbationsS5 S14 S29 S31 S32 S35 S50 S56 | 8 | Yes | Yes | Yes | Yes | No | No | −113 | +++ (moderate) |
Exercise capacity (6MWD)S13 S23 S33 S76 | 4 | −12 | Yes | Yes | Yes | No | No | −113 | ++ (low) |
FEV1S33 S44 | 2 | −22 | Yes | Yes | Yes | No | No | −113 | + (very low) |
MortalityS24 S26 S31 S32 S35 S55 S80 | 7 | Yes | Yes | Yes | Yes | No | No | −113 | +++ (moderate) |
Quality of life/health-related quality of lifeS24 S25 S40 S44 | 4 | Yes | Yes | Yes | −11 | No | No | −113 | ++ (low) |
Interpretation of the categories of the quality of evidence: + (very low), there is a little confidence in the effect estimate, the true effect is likely to be substantially different from the estimate of effect; ++ (low), the confidence in the effect estimated is limited, the true effect may be substantially different from the estimate of the effect; +++ (moderate), there is a moderate confidence that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; and ++++ (high), there is high confidence that the true effect lies close to that of the estimate of the effect.
Reasons for upgrading or downgrading:
1Inconsistent effects (eg, different direction of effects) across and/or within studies with statistically significant and/or non-significant results.
2Direction could not be established because the majority (–1) or all (–2) studies were cross-sectional studies.
3The majority of studies included some sources of highly selected population (patients candidates for lung volume reduction surgery, patients with very severe COPD or patients included in a rehabilitation programme).
4No control for confounding.
5Only some studies had some control for confounding.
6Determinant was self-reported in most/all studies.
7The measures of exposure were so different that results could not be compared.
8The majority of studies without control group.
995% CIs too wide to interpret the effect estimates.
10Measures of physical activity too different to allow comparison of results across studies.
11Potential confounding by indication.
12Studies with small to moderate sample size.
13Too few measures of physical activity (eg, only indirect and no activity monitor) to judge association with physical activity.
DLCO, Diffusing Lung capacity for carbon monoxide; FEV1, Forced Expiratory Volume in the first second; FVC, Forced Vital Capacity; PCO2, Partial Pressure of Carbon Dioxide; PO2, Partial Pressure of Oxygen; VO2 max, Maximal Oxygen Uptake; 6MWD, 6 min walk distance.