The relationship between symptom
experience and
the level of daily physical activity
in patients with COPD
Hans VAN REMOORTEL
Turkish Thoracic Society Congress
April 3-7, 2013
Belek - Antalya
Academic partners
Small Medium Enterprise
Patient / Scientific organizations
EFPIA members
The PROactive project is funded by the Innovative Medicines Initiative Joint Undertaking (IMI JU) # 115011; and matching funds at each academic institution
www.proactivecopd.com
Rationale• Functional performance (Kocks PCRJ 2011)
• = activities people actually do Reduces risk hospitalization due to exacerbation (Garcia-AymerichThorax 2003)
Related to quality of life (Arne IJCOPD 2011)
Predictor all-cause mortality (Garcia-rio Chest 2012)
Time (months)
0.4
0.6
0.8
1.0
Prob
abili
ty o
f sur
viva
l
0 20 40 60 80
Q1
Q2
Q3Q4
Rationale• Measurement (Kocks PCRJ 2011)
Field assessment Energy expenditurePedometerAccelerometerHeart rate monitoring
Patient report Activity Self Efficacy questionnaireCOPD Activity Rating ScaleClinical COPD Questionnaire functional status domainCapacity of Daily Living during the Morning questionnaireCanadian Occupational Performance MeasureCRQ – dyspnea domainDaily record cardsNottingham Extended Activities of Daily Living QuestionnaireFunctional Performance InventoryFunctional Status QuestionnaireGeneral Practive Physical Activity QuestionnaireLondon Chest Activity of Daily Living ScaleModified Activity Record Questionnaire Manchester Respiratory Activities of Daily Living QuestionnaireMedical Research Council dyspnea questionnairePulmonary Functional Status and Dyspnea QuestionnairePulmonary Functional Status ScaleSGRQ – activity domain
Van Remoortel et al.; Plos One; 2012 Rabinovich et al.; European Respiratory Journal; 2013
Lab Field Usability
Activity Monitor Minute- by-
Minute
Mean Slowvs
Fast
Mean Inactivity on
Sunday?
R with 6MWD?
User-Friendly?
Actiwatch
Kenz
RT3
Actigraph
Minimod
SenseWear
RationaleField assessment: Activity monitors (accelerometry (+ other sensors))
RationalePatient report: Clinical COPD Questionnaire (CCQ) functional status domain
Adapted from T. van der Molen, Department of General Practice, University Medical Center, Groningen, The Netherlands
Rationale
Liu SWJ 2012Shrikrishna ERJ 2012
Objective measurements CCQ functional status domain
I II III IVC
5000
10000
15000
20000
25000
Step
s.da
y-1
GOLD stage
6
5
4
3
2
1
0
I II III IV
CCQ
func
tiona
l sta
tus
dom
ain
GOLD stage
RationaleObjective measurements CCQ functional status domain
Garcia-rio, Chest, 2012 Sundh, IJCOPD, 2012
0.4
0.6
0.8
1.0
0.4
0.6
0.8
1.0
Prob
abili
ty o
f sur
viva
l
Prob
abili
ty o
f sur
viva
l
Time (months) Time (months)
0 20 40 60 80 0 20 40 60
Q1
Q2
Q3Q4
<11 & <22 & <3
3
MethodsAim = Identify the relation between functional performance
measured by PRO and physical activity monitoring at the individual patient level
Inclusion + 40y FEV1/FVC < 70% +10 pack years
Exclusion Impairment of normal movement pattern unrelated to
respiratory disease Other respiratory disease
Methods
Spirometry6MWD
mMRCCATCCQ
CRQ-SAS
PA monitoring PA monitoring
V1 V2 V3 V4
14 days 14 days 14 days
mMRCCATCCQ
CRQ-SAS
mMRCCATCCQ
CRQ-SAS
mMRCCATCCQ
CRQ-SAS
Design
Results
N=54 Mean ± SD
Age (years) 66 ± 7
Fev1 (%pred) 62 ± 22
M/F (n) 42 / 12
Gold (I,II,III,IV) 12 / 27 / 12 / 3
6MWD (m) 495 ± 138
BMI (kg·m-2) 26 ± 5
Exacerbation <4w (n) 5
Baseline characteristics
ResultsPhysical activity monitoring
Patient Reported Outcome
Mean ± SD
Steps (n.day-1) 5222 ± 2708
Walk intensity (m.s-2) 1.82 ± 0.25
Walking time (min) 74 ± 31
Median Range (worst-best)
mMRC 1 3.25 - 0
CCQ functionality 1.5 4.13 - 0
CRQ-SAS dyspnea 28.31 13.00 - 34.25
CAT 12.63 34.25 - 2.75
ResultsUnivariate correlations STEPS (amount)
0 5000 10000 15000
0
1
2
3
4
Mean Steps
mM
RC
0 5000 10000 15000
0
10
20
30
40
Mean Steps
CAT
0 5000 10000 15000
0
1
2
3
4
5
6
Mean Steps
CCQ
func
tiona
lity
0 5000 10000 15000
0
10
20
30
40
Mean Steps
CRQ
dys
pnea
r= -0.51 r= -0.33
r= -0.50 r= -0.45
ResultsUnivariate correlations INTENSITY DURING WALKING
r= -0.49 r= -0.31
r= -0.49 r= -0.45
1.0 1.5 2.0 2.5
0
1
2
3
4
Intensity (m/s2)
mM
RC
1.0 1.5 2.0 2.5
0
10
20
30
40
Intensity (m/s2)
CAT
1.0 1.5 2.0 2.5
0
1
2
3
4
5
6
Intensity (m/s2)
CCQ
func
tiona
lity
1.0 1.5 2.0 2.5
0
10
20
30
40
Intensity (m/s2)
CRQ
dys
pnea
Conclusion
• Functional performance measured with a PRO is modestly related to the
amount and intensity of PA.
• Information obtained with a PRO does not provide an insight in the physical
activity level of patients with COPD and can therefore not be used as a
surrogate for objective PA measurement.
• PROactive tool = capturing physical activity by an objective assessment
(activity monitoring) AND symptom experience of the patients (PRO).
Prof. Dr. M. Decramer Prof. Dr. W. Janssens Prof. Dr. T. Troosters Prof. Dr. R. Gosselink
