BACKGROUND:Cardiac autonomic dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). Although exercise training improves cardiac autonomic function, the effects of changing physical activity on cardiac autonomic function remain unknown. OBJECTIVE:This study aimed to (1) investigate the association between cardiac autonomic function, exercise capacity and physical activity cross-sectionally and (2) relate changes in physical activity, as a result of a 6-month coaching program, to changes in cardiac autonomic function. METHODS:Autonomic function was assessed objectively using the Polar H10 sensor, measuring (1) resting heart rate during sleep; (2) heart rate variability (SDNN, RMSSD, LF/HF ratio and SD2/SD1 ratio) during sleep and (3) heart rate recovery following the 6-minute walking test (6MWT), and subjectively using the COMPASS 31 questionnaire at baseline and 6-months follow-up. Physical activity (steps per day and movement intensity during walking) was measured using accelerometery. Cross-sectional and longitudinal associations were evaluated. RESULTS:In 36 patients with COPD (69% male, mean ± SD age 69 ± 7 years, FEV1 53 ± 13%pred, 28% taking β-blockers), baseline cross-sectional analyses showed weak to moderate associations between heart rate recovery and movement intensity during walking (rs = 0.45) and distance covered during 6MWT (rs = 0.55). Longitudinal analyses over 6-months follow-up showed that changes in daily step count were inversely associated with changes in resting heart rate (rs = -0.48), LF/HF ratio (rs = -0.35) and SD2/SD1 ratio (rs = -0.28) and that changes in movement intensity during walking were inversely associated with changes in SD2/SD1 ratio (rs = -0.51) in patients not taking β-blockers. CONCLUSION:Weak cross-sectional associations were observed between certain parameters of cardiac autonomic function, exercise capacity and physical activity. Increasing the amount of physical activity showed a weak relation with lowering resting heart rate over 6 months in patients not taking influencing medication.

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Rationale: Disability and loss of function are acknowledged as important problems for people living with chronic obstructive pulmonary disease (COPD), but there is a need for validated tools to assess them. Objectives: The Late-Life Function and Disability Instrument (LLFDI) was originally validated for community-dwelling older adults. The full instrument has not been validated to assess disability and loss of function in people with COPD. Methods: People with COPD from six European countries completed the LLFDI as part of an observational study. Its validity was assessed in terms of 1) levels and distribution of LLFDI domain and subdomain scores; 2) floor and ceiling effects; 3) instrument structure (three domains, seven subdomains) by confirmatory factor analysis; and 4) construct validity by convergent validity, which is based on Spearman correlation with COPD-relevant and related constructs (functional exercise capacity, severity of dyspnea, and COPD-related health status), and known-groups validity, which is based on the distribution of LLFDI scores according to COPD-meaningful groups (disease severity, age groups, and use of a walking aid). Results: The study included 605 participants (ages 68 ± 8 yr, 37% female; FEV1 = 54 ± 20 % predicted). Most had impaired disability and function levels. We observed no floor effects and a ceiling effect in only two subdomains. Confirmatory factor analysis showed a moderate model fit for all LLFDI domains. Most of the correlations met our hypotheses (73%), with moderate to strong correlations for the function domain (rmin-max = 0.25-0.70), followed by the disability limitation domain (rmin-max = 0.15-0.54), and weakest correlations in the disability frequency domain (rmin-max = 0.04-0.41). The disability limitation and function domains differed by disease severity, age group, and use of a walking aid. The disability frequency domain differed by disease severity and use of a walking aid, but not by age groups. Conclusions: The LLFDI, a valid patient-reported outcome to investigate disability and function, has proven good construct validity in people with COPD. Clinical trial registered with the ISRCTN registry (ISRCTN no. 12051706); https://www.isrctn.com/ISRCTN12051706.

Background:Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBV) is a minimally invasive treatment for patients with advanced emphysema and severe hyperinflation. While several randomized controlled trials have demonstrated improvements in lung function, exercise performance, and quality of life, information on long-term outcomes of BLVR outside clinical trial settings are limited. Objective:This study provides real-world data with a follow-up of up to two years, incorporating the BODE index (Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index), as part of the follow-up assessments. Methods:Data were collected for all patients treated with BLVR at the University Hospitals of Leuven, Belgium, including lung function parameters, 6-minute walking distance, respiratory questionnaires, and the BODE index at intervals of 3, 6, 12, and 24 months. A composite outcome combining FEV1 (forced expiratory volume in 1 second), 6MWD (6-minute walk distance), and SGRQ (St. George's Respiratory Questionnaire) was used to evaluate the overall impact of BLVR. Mixed model analyses were performed. Results:All outcome parameters, including FEV1, residual volume (RV), 6MWD, modified Medical Research Council (mMRC) and SGRQ exhibited significant improvement up to 1 year of treatment. RV and mMRC maintained statistical significance compared to baseline at the 2-year follow-up. The BODE index as well, revealed a significant improvement persisting up to 2 years of treatment. Response rate for the composite outcome was 86% (44/51) at one year and 71% (17/24) at 2 years follow-up. Conclusion:Follow-up data of a real-world setting show maintained benefits of bronchoscopic lung volume reduction with endobronchial valves up to 2 years after treatment, for patients of whom the valves are still in situ. A potential survival benefit of BLVR, based on BODE, and high response rate on the composite outcome was present, in patients who remained in follow-up.

INTRODUCTION:Most lung transplant (LTX) recipients do not meet physical activity (PA) guidelines. Interventions are needed as long-term inactivity is related to morbidity and mortality. We investigated the effect of a telecoaching programme on objectively measured PA in LTX recipients. METHODS:Inactive patients (<7500 steps/day, n=90) were randomised into a light or intensive version of a 1-year PA telecoaching programme. The light intervention consisted of a step counter and a minimal version of the smartphone application. Patients randomised to the intensive intervention discussed PA barriers and goals, received a step counter, a patient-tailored smartphone application and supportive coaching calls. PA (primary outcome, assessed by an accelerometer), physical function, quality of life and symptoms were measured at baseline, after 3 months (primary endpoint) and 1 year. Mixed model analyses were used to investigate the effectiveness of the intervention compared with the light intervention. RESULTS:Between-group difference in change after 3 months and 1 year was observed as mean (CI) 750 (-96 to 1596) (p=0.08) and 680 (-244 to 1605) steps per day (p=0.15), 10 (-0.5 to 20) and 10 (-1 to 22) min of total moving time (walking, taking stairs and cycling) (both p=0.07) and -3 (-6 to 0) (p=0.07) and -6 (-10 to -2) (p=0.002) of sedentary time, all in favour of the intervention group. Other outcomes did not differ between groups. CONCLUSION:PA tends to improve in LTX recipients by following an intensive telecoaching programme compared with a light programme. TRIAL REGISTRATION NUMBER:NCT04122768.

Rationale: Physical activity (PA) is decreased in patients with chronic obstructive pulmonary disease (COPD). PA coaching interventions are effective to improve PA in the short term, yet long-term effects are lacking. Providing an individualized step goal, feedback, and regular contact with a coach might be important aspects to obtain a long-term effect. Objectives: To investigate the effectiveness of a 12-month fully deployed PA coaching intervention to improve and maintain PA in patients with COPD, compared with a light coaching intervention. Methods: In this multicenter, single-blind randomized controlled trial, participants were randomized to either a full coaching intervention (including an activity tracker and a smartphone application with dynamic goal setting, regular feedback, and contact with a coach) or a light PA coaching group (including an activity tracker, a fixed step goal, and limited feedback or contact with a coach). Outcomes were assessed at baseline and at 6- and 12-month follow-up. Measurements and Main Results: One hundred fifty participants with COPD were randomized to the full (n = 77) and light (n = 73) coaching groups. No between-group differences were observed for objectively measured PA and perceived amount of PA measured with the Clinical Visit-PROactive Physical Activity instrument at 6-month follow-up (172 ± 367 steps/d [P = 0.64] and 2.5 ± 2.2 points [P = 0.26], respectively) and at 12-month follow-up (-43 ± 372 steps/d [P = 0.91] and 2.1 ± 2.2 points [P = 0.34], respectively). Responder rates were similar for the full and light coaching groups at 12 months (19% and 22%, respectively). Conclusions: A full coaching intervention providing dynamic individualized step goals, adequate feedback, and regular contact with a coach did not have additional effects on PA at 12 months compared with a light coaching intervention. Clinical trial registered with www.clinicaltrials.gov (NCT04139200).

Background:Randomized controlled trials with lung volume reduction surgery (LVRS) or endobronchial valves (EBVs) have shown clinically significant benefits for specific patients with emphysema. Research Question:What is the impact of a comprehensive lung volume reduction (LVR) program, with both LVRS and EBVs as treatment options, on patient selection and short- and long-term outcomes in real life? Study Design and Methods:This study summarizes the results of a prospective comprehensive LVR program in tertiary care, based on 5-year inclusions and follow-up over 1 to 3 years. Results:A total of 429 cases were discussed at a multidisciplinary emphysema board; of these, 131 (30%) were referred for LVRS, 73 (17%) were referred for EBV, 25 (6%) were referred for lung transplantation, and 200 (47%) were referred for usual care. A total of 38 (52%) of the EBV interventions were followed by a second to fourth intervention, including LVRS in 25 (34%). For LVRS first, 72 (55%) and 37 (38%) of patients had a single 1-stage bilateral or unilateral LVRS procedure, and 22 (17%) had a staged procedure. Clinically significant improvements between baseline and follow-up visits were obtained on all outcome dimensions in all LVRS and EBV groups for most of the visits. Responder rates varied between 50% and 80% at 3 months to 1 year and slowly declined in the second year. Transplant-free survival over 2.5 years, adjusted for age and BODE Index at baseline, was significantly better for the EBV intervention (hazard ratio, 0.14; 95% CI, 0.04-0.44) and borderline significant for LVRS (hazard ratio, 0.7; 95% CI, 0.45-1.2) compared with the nonintervention group. Interpretation:LVR programs should cover both surgical and bronchoscopic interventions to maximize eligibility and to improve outcome and prognosis of highly symptomatic patients with severe emphysema.

BackgroundFunctional status is a marker for evaluating fall risk and predicting mortality and hospitalisations in elderly and patients with COPD. Acute exacerbations of COPD result in sudden declines in exercise capacity, quadriceps force (QF) and physical activity (PA), but their impact on functional status remains unclear. This study aimed to (i) compare the functional status of patients with COPD to healthy controls and (ii) assess prospectively the impact of an exacerbation on functional status.MethodsHealthy controls and patients were assessed. Patients were followed up every 6 months and were tested again immediately if they reported an exacerbation. The short physical performance battery (SPPB), timed up and go test (TUG), 1-minute sit-to-stand test (1MSTS), 6-minute walking distance (6MWD), QF and PA (accelerometery) were measured.ResultsThirty-six patients (69 ± 7 years, 69% male) and 25 matched healthy controls (68 ± 7 years, 80% male) were included. Functional status was decreased in patients compared to healthy controls. Twelve patients were retested 10 ± 7 days after a moderate (n = 11) or severe (n = 1) exacerbation. The 1MSTS (∆-3 ± 3repetitions, p < 0.0001), 6MWD (∆-34 ± 46m, p < 0.0001) and QF (∆-9 ± 13Nm, p = 0.05) decreased after exacerbation onset. No changes in SPPB and PA were observed.ConclusionAn exacerbation negatively impacts the already reduced functional status in patients with COPD. The SPPB is not able to capture this decline.

Background Consumer-based wearables are becoming more popular and provide opportunities to track individual’s clinical parameters remotely. However, literature about their criterion and known-groups validity is scarce. Objective This study aimed to assess the validity of the Fitbit Charge 4, a wrist-worn consumer-based wearable, to measure clinical parameters (ie, daily step count, resting heart rate [RHR], heart rate variability [HRV], respiratory rate [RR], and oxygen saturation) in patients with chronic obstructive pulmonary disease (COPD) and healthy controls in free-living conditions in Belgium by comparing it with medical-grade devices. Methods Participants wore the Fitbit Charge 4 along with three medical-grade devices: (1) Dynaport MoveMonitor for 7 days, retrieving daily step count; (2) Polar H10 for 5 days, retrieving RHR, HRV, and RR; and (3) Nonin WristOX2 3150 for 4 nights, retrieving oxygen saturation. Criterion validity was assessed by investigating the agreement between day-by-day measures of the Fitbit Charge 4 and the corresponding reference devices. Known-groups validity was assessed by comparing patients with COPD and healthy controls. Results Data of 30 patients with COPD and 25 age- and gender-matched healthy controls resulted in good agreement between the Fitbit Charge 4 and the corresponding reference device for measuring daily step count (intraclass correlation coefficient [ICC2,1]=0.79 and ICC2,1=0.85, respectively), RHR (ICC2,1=0.80 and ICC2,1=0.79, respectively), and RR (ICC2,1=0.84 and ICC2,1=0.77, respectively). The agreement for HRV was moderate (healthy controls: ICC2,1=0.69) to strong (COPD: ICC2,1=0.87). The agreement in measuring oxygen saturation in patients with COPD was poor (ICC2,1=0.32). The Fitbit device overestimated the daily step count and underestimated HRV in both groups. While RHR and RR were overestimated in healthy controls, no difference was observed in patients with COPD. Oxygen saturation was overestimated in patients with COPD. The Fitbit Charge 4 detected significant differences in daily step count, RHR, and RR between patients with COPD and healthy controls, similar to those identified by the reference devices, supporting known-groups validity. Conclusions Although the Fitbit Charge 4 shows mainly moderate to good agreement, measures of clinical parameters deviated from the reference devices, indicating that monitoring patients remotely and interpreting parameters requires caution. Differences in clinical parameters between patients with COPD and healthy controls that were measured by the reference devices were all detected by the Fitbit Charge 4.

Objectives Physical activity is reduced in patients with interstitial lung disease (ILD) and physical inactivity is related to poor health outcomes. We investigated the effect of a telecoaching intervention to improve physical activity in patients with ILD. Methods Eighty patients with ILD were randomized into the intervention or control group. Patients in the intervention group received a 12-week telecoaching program including a step counter, a patient-tailored smartphone application, and coaching calls. Patients in the control group received usual care. Physical activity (primary outcome), physical fitness and quality of life were measured at baseline and 12 weeks later with an accelerometer, 6-min walking test and quadriceps muscle force and the King’s Brief Interstitial Lung Disease questionnaire (K-BILD). Results Participation in telecoaching did not improve physical activity: between-group differences for step count: 386 ± 590 steps/day, p = .52; sedentary time: 4 ± 18 min/day, p = .81; movement intensity: 0.04 ± 0.05 m/s2, p = .45). Between-group differences for the 6-min walking test, quadriceps muscle force and K-BILD were 14 ± 10 m, p = .16; 2 ± 3% predicted, p = .61; 0.8 ± 1.7 points, p = .62 respectively. Conclusions Twelve weeks of telecoaching did not improve physical activity, physical fitness or quality of life in patients with ILD. Future physical or behavioural interventions are needed for these patients to improve physical activity.

Background: Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. Objectives: To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. Methods: Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after three months of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. Results: The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, p = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, p < .0001), VO2max (r = 0.50, p = .0006) and maximal work rate (r = 0.52, p = .0003). Weak correlations were observed with QF (r = 0.33, p = .03) and step count (r = 0.38, p = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, p = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, p = .002), QF (r = 0.48, p = .003) and VO2max (r = 0.41, p = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. Conclusion: The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.

Background Pulmonary rehabilitation (PR) is a well-established intervention for patients with COPD, but access, uptake and completion are low. This retrospective propensity-matched study aimed to analyse equivalence from a hybrid PR modality against conventional PR. Methods Between 2013 and 2019, 214 patients with COPD with valid baseline physical activity assessments enrolled in conventional PR for three times per week for 3 months. In 2021-2022, 44 patients with COPD enrolled in 3 months of hybrid PR, introducing two providers: once per week in the outpatient centre and two times per week in a primary care setting near the patient's home. All sessions were supervised. Propensity score matching (1:1) was performed. Equivalence between both programmes was analysed for exercise capacity with the equivalence margins of +/- 30 m on the 6-min walk distance (6MWD). Clinical outcomes, accessibility and adherence were compared using t-tests. Results 44 patients (mean +/- SD age 67 +/- 8 years; forced expiratory volume in 1 s (FEV1) 47 +/- 15% predicted; 6MWD 355 +/- 122 m) in the hybrid PR group were matched to 44 patients (mean +/- SD age 66 +/- 8 years; FEV1 46 +/- 17% predicted; 6MWD 354 +/- 103 m) in the conventional PR group. Equivalence on the increase in 6MWD could not be confirmed; nevertheless, both groups improved their 6MWD clinically significantly (hybrid PR change 63 m (90% CI 43-83 m); conventional PR change 39 m (90% CI 26-52 m)). Changes in quality of life and symptoms were similar. Dropout in hybrid PR (23%) was comparable to conventional PR (27%) (p=0.24). Adherence in both groups was high and accessibility was better for patients following hybrid PR. Conclusion Hybrid PR can be offered as an effective alternative to conventional PR, if patients are willing to take up the offer.