Intensity and safety of community-based physical activities for people with COPD

Abstract

Background: long-term maintenance of the benefits obtained with pulmonary rehabilitation (PR) in people with COPD is of upmost importance, yet highly challenging. Integrating these people in community-based physical activities (PAs), after PR, can be a promising strategy to maintain achieved benefits. Nevertheless, to confidently advise people with COPD to enrol these community-based PAs, clinicians must ensure those are safe and ideally are of at least moderate intensity (following PAs guidelines). This study aimed to explore safety and intensity level of community-based PAs (cardiofitness room, senior gymnastics, and aquatic gymnastics) in people with COPD, after PR.

Methods: an observational cross-sectional study, part of a larger trial (NCT04223362) was conducted. People with COPD that had finished a community-based PR programme, conducted in the Respiratory Research and Rehabilitation Laboratory (Lab3R) or in four primary health care centres (Aveiro, Estarreja, Oliveira do Bairro and Montemor-o-Velho), and that had a positive risk-benefit analysis regarding their inclusion on community-based PAs were included. Participants were given the opportunity to choose among the available community-based PAs (previously identified as adequate), the one(s), they wanted to try, and were then accompanied by a physiotherapist. During the community-based PAs, dyspnoea and fatigue perception were assessed every 20 minutes using the modified Borg 0-10 scale; and heart rate (HR) and percentage of peripheral oxygen saturation (SpO2) were constantly monitored. Participants wore the SenseWear Armband on the left triceps to estimate the Metabolic Equivalent Task (METs) of each community-based PA. The final community-based PAs intensity level was obtained by summing the intensity levels yielded by: dyspnoea and fatigue Borg scores, maximal HR percentage predicted (HRmax%predicted) (where HRmaxpredicted=220-age), and METs; with 3-6 Borg scores, 64-76% of HRmax%predicted, and 3-6 METs identifying moderate intensities. For security standards, SpO2 below 88% and HRmax%predicted above 85% were considered. The occurrence of any adverse event during the PAs was registered.

Results: three community-based PAs were included, cardiofitness room (9 people with COPD, 68±9 years, 100% men, 58±21 FEV1 %predicted), senior gymnastics (8 people with COPD, 70±9 years, 75% men, 53±11 FEV1 %predicted), and aquatic gymnastics (6 people with COPD, 68±10 years, 100% men, 49±16 FEV1 %predicted). Overall, the explored community-based PAs were classified as of moderate intensity (Figure 1 – a, b, c). Only one participant presented a SpO2 below 88% on the cardiofitness room (lowest SpO2 registered was 86%) and the HRmax%predicted was below 85% in all participants. Mean values of SpO2 and HRmax%predicted are presented in Figure 1 (d, e, f). No adverse event was registered.

Conclusion: Cardiofitness room, senior gymnastics, and aquatic gymnastics seem safe and of moderate intensity for people with COPD. Enrolment of people with COPD on these community-based PAs, following PR, should be advised, as these may facilitate the long-term maintenance of PR benefits, while promoting a more physically active lifestyle in this population. Nevertheless, caution is needed when interpreting these results, since intensity of PA is highly influenced by individual factors and patients’ enrolment must be preceded by a careful patient selection to ensure their safety.