Models of Physical Activity: Active Lifestyle Promotion for adults and elderly people affected by Chronic Obstruction Pulmonary Disease

Background and aims Exercise intolerance, symptoms and extra-pulmonary effects may increase patients disabilities, affecting quality of life (QoL) and reducing maintenance of an active lifestyle. Exercise training (ExT) is considered the most effective non-pharmacological intervention to improve COPD patients health and exercise capacity. Unfortunately, there are few available health-care structured programs of physical activity (PA) and a considerable proportion of eligible patients decline participation or drop out. Reasons for decline and drop-out from ExT programs have seldom been investigated. Moreover, a considerable debate continues about what kind of model of PA and ExT intervention is more effective to improve COPD patients’ health related parameters (HRQL), and to maintain long-term active lifestyle. Finally, evidences support notions that daily physical activity (DPA), HRQL, muscle strength and performance are likely intimately interlinked. Although, muscle wasting is common in COPD patients across all disease stages, it has been observed that eccentric contraction (ECC) results greater compared to healthy control subjects. Majority of COPD leg muscle function’s research has used isometric or concentric (CON) quadriceps torque, but there is lack of knowledge about associa¬tion between ECC muscle strength and fast-velocity muscle contractions in COPD patients. Therefore, we would to outline motivation and barriers which reduced COPD patients recruitment in ExT program and hindered an active lifestyle acquisition. Secondly, it would be verify short and long-term modifications of several HRQL provided by two different and easily applied-field models of adapted fitness activity (APA) for COPD patients to evaluate long-term active-lifestyle maintenance. Finally, we would to investigate COPD patients lower limb strength performances as a function of contraction modalities and velocities comparing with healthy control (HC). Methods Fist study: single-centre, multi-practice, randomized, parallel-group clinical trial. 269 COPD males were screened to establish 132 eligible patients. 38 recruited COPD patients were administrated by EMI-2 questionnaire. Recruitment steps were recorded in order to assess patients’ motivation of decline or drop out. Second study: longitudinal randomized controlled trial, in which baseline (T1), 3 months (T2), 6 months (T3) and 3 months of follow up (T4) evaluations were performed. Body composition and bone mass content, i.e. BMC (DXA scanner), functional health-related (6MWT, Leg press, leg extension, chest press and biceps curl 1RM, shoulder and lower back flexibility and balance), lifestyle (IPAQ questionnaire and SenseWear PRO-2 assessment) and quality of life (MRF-26 questionnaire) parameters were administrated. 38 COPD patients were randomized and assigned to one of the three evaluation groups: Fitness Center based group (FC=13), Educational PA group (EDU=12) and Control group (CG=13). Third study: case/control research, cross over and observational trial. Architectural muscle measurements, CON and ECC quadriceps contractions at different velocities (30deg/sec, 210 deg/sec), lifestyle and health-related parameters of COPD patients (N=35) and HC (N=25) subjects were recorded. Results First study: major cause of not-participation was mismatched inclusion criteria (65.53%). No-interest in exercise training (8.94%), lack of available time (6.81%) and inability to access at the PA structures (1.7%) were most commonly cited reasons to drop out. Recruitment showed higher adherence (25.7%) compared to literature, also confirmed by lower number of drop out (10.52%). Low score of intrinsic motivation towards PA were recorded (mean 81.69pt ±48.08) and significant improvements in EMI-2 were observed after 3 months (+43.99%, p<0.05) and 6 months of ExT (+47.42%, p<0.05) by FC group. Significant increases in Socio/Emotional (p<0.01), Weight management (p<0.05) and Enjoyment items (p<0.01) were recorded after 3 months. Socio/Emotional aspects (p<0.01) and Enjoyment items (p<0.05) improved after 6 months. Second study: 7 patients dropped out. At short term, FC group shows significant improvement in %BMC (0.112 ±0.029, p<0.01), Biceps curl 1RM (1.9kg ±0.6, p<0.05), Chest press 1RM (8.1kg ±1.7, p<0.001) and Balance test (48.5sec ±14.2, p<0.05). EDU group shows significant modification in Fat (-736.4g ±240.0, p<0.05), BMI (-0.332 ±0.106, p<0.05), Leg Extension 1RM (7.2kg ±2.4, p<0.05), Chest Press 1RM (6.1kg±1.7, p<0.05) and Shoulder flexibility (2.7cm ±0.7, p<0.01). The CG group shows significant differences in BMI (-0.588 ±0.157, p<0.01), Fat (-1086.4g ±365, p<0.05), and Total Body Mass (-1849.8g ±494.1 p<0.01). At long-term, FC modified significantly %BMC (0.071 ±0.024 p<0.05), Chest Press 1RM (9.8kg ±2.4, p<0.01), Balance (57.0sec±13.3, p<0.01), IPAQ moderate activity (1024 ±272, p<0.01), IPAQ sedentary hours (-3.3 ±0.7, p<0.01) and MRF-26 (-2.3 ±0.7, p<0.05). EDU group recorded modifications in 6MWT Borg scale (-1.37 ±0.41 p<0.05), IPAQ walking activity (618 ±208, p<0.05), IPAQ sedentary hours (-3.6 ±0.7, p=0.000) and MRF-26 (-2.1 ±0.7, p<0.05). CG group did not shows significant differences. At follow up, FC shows significant changes in %BMC (-0.069 ±0.020 p<0.05), 6MWD (-48.2 ±14.8, p<0.05), Leg Extension 1RM (-9.3 ±2.8, p<0.05), Chest Press 1RM (-11.6 ±2.1, p=0.000), Sit & Reach (-3.8 ±0.9, p<0.01), Balance (-21.0 ±7 p<0.05). EDU group shows significant modification in 6MWT Borg score (-1.36 ±0.41 p<0.05), Leg Press 1RM (-32.6 ±9.1, p<0.05), Leg Extension 1RM (-10+5 ±1.9, p<0.001), Chest Press 1RM (-14.3 ±1.3, p=0.000), Back Scratch (-4.3 ±1.3, p<0.05), IPAQ sedentary hours (-3.5 ±0.9, p<0.01) and MRF-26 (-2.9 ±0.8, p<0.05). CG group shows significant difference in Chest Press 1RM (-10.9 ±2.6, p<0.01). No significant modification were observed in SenseWear PRO-2 administration. Third study: HC subjects were significantly different in exercise capacity, i.e. 6MWT (p<0.001) and 1RM Leg Press (p<0.05), than COPD patients. Only CON 30deg/s peak torque was significantly higher in HC compared to COPD (p<0.05). No differences in muscle architecture, fast CON and/or e ECC torque were observed between groups. Significant differences were found between groups in ECC/CON torque ratio (30 deg/sec p<0.001; 210 deg/sec p<0.01). Finally, significant correlations were found between FEV1 and 6MWT (0.719 p<0.001), 1RM Leg Press (0.449 p<0.001), peak torque contraction at 30 deg/sec (0.427 p<0.01; 0.280 p<0.05), at 210 deg/sec (0.285 p<0.05; 0.276 p<0.05) and ECC/CON peak torque ratio at both velocities (-0.562 p<0.001; -0.292 p<0.05). Same results were observed between FEV1/FVC and parameters assessed. Conclusions Recruit COPD patients becomes very challenging. Cause of not-participation was related to mismatched inclusion criteria. Great effort practice of recruitment, managed by only one person, seems to be more effective. Supervision of ExT specialist and incresed level of liaison between specialist physicians and healthcare professionals could be useful to increase participation. An easily applied-field models of COPD specific APA training could be efficient in order to improve some of COPD-specific HRQL. These improvements seem to be better provide by a “well rounded” APA program. APA exercise specialist support is necessary to maintain long-term significant health’s gains. Whereas, improvement in functional exercise capacity does not automatically turn into a more active lifestyle. COPD patients are characterized by lower health related parameters and lifestyle. Also COPD performed lower CON contraction compared to HC. COPD preserved ECC contractions and fast concentric torque. We hypothesize that COPD males develop a favorable profile to minimize strength loss likely due to neural-muscular modification. Further studies are aimed.