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Determinants and outcomes of physical activity in patients with COPD: a systematic review
  1. Elena Gimeno-Santos1,2,3,4,
  2. Anja Frei5,6,
  3. Claudia Steurer-Stey6,
  4. Jordi de Batlle1,2,7,
  5. Roberto A Rabinovich8,
  6. Yogini Raste9,
  7. Nicholas S Hopkinson9,
  8. Michael I Polkey9,
  9. Hans van Remoortel10,
  10. Thierry Troosters10,
  11. Karoly Kulich11,
  12. Niklas Karlsson12,
  13. Milo A Puhan5,13,
  14. Judith Garcia-Aymerich1,2,3,
  15. on behalf of PROactive consortium
  1. 1Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  2. 2CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  3. 3Universitat Pompeu Fabra (UPF), Barcelona, Spain
  4. 4FCS Blanquerna, Research Group in Physiotherapy (GReFis), Universitat Ramon Llull, Barcelona, Spain
  5. 5Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  6. 6Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
  7. 7Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
  8. 8ELEGI/Colt Laboratory, UoE/MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  9. 9NIHR Respiratory Biomedical Research Unit of the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
  10. 10Respiratory Division, Katholieke University of Leuven, Leuven, Belgium
  11. 11Respiratory Department, Novartis, Basel, Switzerland
  12. 12R&D, AstraZeneca, Södertälje, Sweden
  13. 13Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Judith Garcia-Aymerich, Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, Barcelona 08003, Spain; jgarcia{at}


Background The relationship between physical activity, disease severity, health status and prognosis in patients with COPD has not been systematically assessed. Our aim was to identify and summarise studies assessing associations between physical activity and its determinants and/or outcomes in patients with COPD and to develop a conceptual model for physical activity in COPD.

Methods We conducted a systematic search of four databases (Medline, Embase, CINAHL and Psychinfo) prior to November 2012. Teams of two reviewers independently selected articles, extracted data and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess quality of evidence.

Results 86 studies were included: 59 were focused on determinants, 23 on outcomes and 4 on both. Hyperinflation, exercise capacity, dyspnoea, previous exacerbations, gas exchange, systemic inflammation, quality of life and self-efficacy were consistently related to physical activity, but often based on cross-sectional studies and low-quality evidence. Results from studies of pharmacological and non-pharmacological treatments were inconsistent and the quality of evidence was low to very low. As outcomes, COPD exacerbations and mortality were consistently associated with low levels of physical activity based on moderate quality evidence. Physical activity was associated with other outcomes such as dyspnoea, health-related quality of life, exercise capacity and FEV1 but based on cross-sectional studies and low to very low quality evidence.

Conclusions Physical activity level in COPD is consistently associated with mortality and exacerbations, but there is poor evidence about determinants of physical activity, including the impact of treatment.

  • COPD epidemiology
  • Exercise
  • COPD Exacerbations

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  • Correction
    Caterina Brindicci Tim Higenbottam Thierry Trooster Fabienne Dobbels Margaret X. Tabberer Roberto Rabinovich Bill McNee Ioannis Vogiatzis Michael Polkey Nick Hopkinson Judith Garcia-Aymerich Milo Puhan Anja Frei Thys van der Molen Corina De Jong Pim de Boer Ian Jarrod Paul McBride Nadia Kamel Katja Rudell Frederick J Wilson Nathalie Ivanoff Karoly Kulich Alistair Glendenning Niklas X Karlsson Solange Corriol-Rohou Enkeleida Nikai Damijen Erzen