Are indoor and outdoor opportunities for physical activity related to active behaviours in patients with copd?

Abstract

Introduction: Persistent respiratory symptoms at rest and during exertion (e.g., dyspnea, fatigue) play a role on the low physical activity (PA) levels found in people with chronic obstructive pulmonary disease (COPD), but other factors may also be involved. Environmental factors have been shown to impact PA levels in other patient populations, but evidence regarding people with COPD is still scarce. Investigations have been focused mostly on outdoor factors, such as air pollution or population density, disregarding the patients’ perception of their surroundings, both indoor and outdoor milieus. Objectives: This study explored the relationship between self-reported indoor and outdoor physical environmental opportunities for PA and actual PA levels in patients with COPD. Methods: Patients with COPD completed the Physical Activity Neighbourhood Environment Survey (PANES; total score 0-6, higher scores indicating a more supportive PA environment; 11 subscales: Residential Density, Land Use Mix, Access to Transportation, Infrastructure for Pedestrians, Infrastructure for Bicycles, Recreation Facilities, Street Connectivity, Security – Crimes, Security – Traffic, Security – Pedestrians, Aesthetics) and questions regarding their indoor and outdoor home environment (car ownership; having a dog, corridor, elevator, stairs and/or exercise equipment). An accelerometer was used for 7 days to assess daily PA: steps (steps/day); time in moderate and vigorous PA (MVPA; min/day); total PA (TPA; light PA+MVPA; min/day). Mann-Whitney-U and Spearman’s correlations (r) tests were conducted. Results: Ninety-four patients [78 males (83%), 67 ± 8 years, 48 ± 19 FEV1% predicted] participated in this study. PANES total score (n = 75) was 3 [1;4] (median [Q1;Q3]). Forty-three patients had a dog (13 walked it regularly); 63 had stairs, 12 had an elevator, 71 had a corridor, 45 had exercise equipment (stationary bicycle, n = 21) and 84 owned a car. Participants performed 4,428 [2,761;6,886] steps/ day, 19 [9;41] min/day of MVPA and 144 [103;208] min/day of TPA. Patients walking the dog presented a significantly higher daily step count (4,895 [2,644;7,780] vs. 4,422 [2,850;6,775] steps/day, p = 0.01) and time in TPA (154 [100;256] vs. 144 [103;177] min/day, p =.03) than those not walking the dog. No other significant differences were observed in the indoor and outdoor home environment (p > 0.05). No significant correlations were found between any of the PANES subscales and the different PA outcomes (-0.210 ≤ r ≤ 0.181, p > 0.05). Conclusions: A minimal influence of neighbourhood environmental factors on PA levels of patients with COPD was found in this observational study. Findings support previous research, as walking the dog impacted patients’ daily step counts. Longitudinal research is needed to more definitely evaluate potential environmental opportunities to promote PA in people with COPD.