User:DominikTurner/sandbox

What is the background to this research?
Chronic Obstructive Pulmonary Disease (COPD) is a describes a variety of chronic diseases causing breathing difficulties of the lung. COPD-induced breathing difficulties are likely to arise from diseases causing airflow limitations through the narrowing or partial blockages leading to the lungs. These may include but are not restrained to; Asthma, Emphysema, and Chronic Bronchitis. The disease may be genetically inherited or be developed via an unhealthy lifestyle. Not only correlated with respiratory impairments, people suffering from COPD are strongly linked to extrapulmonary diseases, such as systemic inflammation. The primary purpose of this study was to identify how such extrapulmonary diseases can cause reductions in physical activity amongst patients diagnosed with COPD<.ref name=Watz, H."/>.

Whilst there is no cure for COPD, treatment is available to moderate the development of the disease. Similar to other chronic diseases, early detection of COPD is key for effective treatment and prevention of developing potential extrapulmonary diseases. Studies have indicated a positive correlation associated with low-intensity PA of a high quantity, however, no major benefits were found involving more strenuous forms of PA. Within the study, physical acitivity status was not previously measured, hence making previous physcial status an unknown contributor to the results.

Where is the research from?
The leading author of the study, Henrik Watz, is employed by the Pulmonary Research Institute and has largely been involved with research encompassing pulmonary and systemic areas. This particular research article was based at the ‘Pulmonary Research Institute’ at Hospital Grosshansdorf (Schleswig-Holstein, Germany), – between February and November 2006, and published by the American Journal of Respiratory and Critical Care Medicine. The findings developed in the article are likely to be accurate at the time of publication due to the researcher's experience, however, may have a potential level of bias as not all extrapulmonary factors were taken into account when finalising the results.

What kind of research was this?
The study was conducted in the form of an observational study, more specifically as a cross-sectional study. A cross-sectional study is cost-effective and has the ability to draw conclusions of a particular topic based upon a portion from a specific population group, hereby being ideal when determining aspects such as risk factors or contributing elements. Since only a certain amount of participants take part in a cross-sectional study, the results may not be truly reflective on the whole target population and hence will not reflect the major severity of the issue associated with any outliers found in the study. Furthermore, a cross-sectional study will group various findings together to determine an overall outcome of a particular study. Where some participants may experience reductions in physical activity resulting from extrapulmonary effects, it is not confirmed that these will have the same impact on other participants, hence adding further bias to the study findings.

What did the research involve?
Patients with clinically stable levels of COPD expressing interest in the study were collected from the Institute's database and categorised into areas of concern relating to their COPD (i.e. signs of acute heart failure, severe pain syndromes). The study consisted of 170 patients (male n=128, female n=42) with a mean age of 62 years. An array of assessments were undertaken to determine whether extrapulmonary diseases had a major impact on the amount of physical activity performed by each COPD patient. Participants were graded against the GOLD (Global Initiative for Chronic Obstructive Lung Disease - stages I-IV) and BODE (body mass index, airway obstruction, dyspnea, and exercise capacity) scoring systems. The GOLD system is comprised of 4 stages with COPD symptoms being categorized depending on their severity (1= very mild, 4= very severe). Participants were assessed over 5-6 days using discrete equipment (specified next) on various components such as the quantity of PA (accelerometer), muscular status (grip strength test) and cardiovascular status (various; including echocardiography). Alcohol consumption, current smoking and educational status were also evaluated. Based upon the physical status of the patients involved, a cross-sectional study approach was suitable for this research, however, the methodology is susceptible to reliability errors as there is likely to be a strong chance of bias regarding the selection of participants - through which only those patients who were willing to participate in clinical procedures were selected.

Limitations to the study can be noted as no control group was included in the study, therefore making collected data difficult to interpret in terms of severity amongst various COPD populations. There is a strong chance for potential unnatural collected data as participants may have altered lifestyle engagements to decrease the severity of their individual results.

What were the basic results?
The article hypothesised that reductions in PA could be explained due to the co-morbidities of COPD and their related consequences on physical status. The results had matched the presented hypothesis in that greater systemic comorbidities were closely affiliated in COPD patients experiencing reduced PA levels. It was discovered, however, that there was a limited correlation between airway obstruction and reduced levels of PA, suggesting a potential reasoning that reduced systemic inflammation may result in greater capacities for COPD patients to participate in PA. Socioeconomic status, history of extrapulmonary diseases and the individual's lifestyle were all directly related to a reduction in PA.

Additionally, it was hypothesised anaemia was responsible for reduced PA levels and an increased mortality rate in COPD patients. This, however, was not reflected in the results as few patients with anaemia had experienced PA reductions during the course of the 5-day study.

The basic findings presented in the article are similar to those expressed amongst other studies. An increased sedentary lifestyle is strongly linked to COPD patients and an increased mortality rate, with an increased risk of developing further chronic diseases. Regardless of physical status, breaking up prolonged sedentary durations is strongly linked to a decreased mortality rate and may further reduce the likelihood of COPD patients developing additional extrapulmonary diseases.

What conclusions can we take from this research?
In accordance with the article's findings, physical inactivity prevalence demonstrated a strong correlation in patients with COPD suffering from extrapulmonary cofactors, such as systemic inflammation. With this in consideration, the lack of PA among patients suffering from COPD is also likely to encourage the onset of additional extrapulmonary diseases, and further increase the risk of mortality in the individual. Watz has since released additional articles relating to COPD in which more detailed findings were presented using similar methods - indicating the validity of the methodology detailed in this particular study. Being a dated study, more research is recommended to quantify the reason as to why there may be potential differences in PA levels between patients diagnosed with similar levels of COPD.

Practical advice
The relative findings from this research article should be carefully interpreted considering only patients diagnosed with stable COPD were used to conduct the research. PA consisting predominantly of lower-intensive aerobic exercise is found to be most beneficial in reducing the risks of extrapulmonary diseases leading to a COPD-induced hospitalisation. Strength training has previously been shown to benefit patients with stable COPD by encouraging muscular regeneration previously affected by prolonged durations of physical inactivity. The incorporation of whole-body resistance training will also improve systemic blood flow and positively influence the body’s ability to deliver oxygenated blood more efficiently to the working muscles. COPD patients should take caution when initiating an exercise routine to help minimise the risk of potential injury. This can be achieved through areas such as clinical guidance, seeking professional-trainer assistance and the use of a Pre-Exercise Screening Tool.

Useful Rescources
https://lungfoundation.com.au/patient-support/copd/

https://www.nhlbi.nih.gov/health-topics/copd

https://lunginstitute.com/blog/gold-copd-stages/

https://www.nejm.org/doi/pdf/10.1056/NEJMoa021322