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A recent review outlines the factors influencing activity and exercise capacity in COPD, and offers clinicians practical recommendations for improved care.

A recent review published online in Breathe explored the multifaceted factors affecting exercise capacity, physical activity levels, and sedentary behavior in patients with chronic obstructive pulmonary disease (COPD) and offered practical recommendations for clinicians to better address these factors.

Exercise limitation and physical inactivity are critical yet challenging treatable traits in COPD management, explained the authors of the study. Maximizing exercise capacity and maintaining physical activity can significantly enhance health status and survival rates.

The authors of the review highlighted the novel concept of categorizing individual patients into “can do/can’t do” and “do do/don’t do” groups to better understand and manage treatable traits. The concept of treatable traits in COPD aims to advance precision medicine by targeting specific phenotypic or endotypic characteristics to improve clinical outcomes. A treatable trait must be clinically relevant, detectable, and treatable, and these traits can be categorized into pulmonary, extrapulmonary, and behavior/lifestyle domains.

The “can do/can’t do” paradigm in COPD refers to exercise capacity, assessed through tests like the 6-minute walk test, defining physiological limits of daily functioning. In contrast, the “do do/don’t do” paradigm relates to actual physical activity, measured by diaries, questionnaires, or remote monitoring devices like pedometers.

Patients with COPD are categorized into four groups:

1. “can do/do do,”
2. “can do/don’t do,”
3. “can’t do/do do,”
4. “can’t do/don’t do.”

Those in the “can do/do do” group have the lowest mortality risk. Factors such as intrapulmonary issues, larger waist circumference, overweight, and psychological conditions contribute to reduced physical activity.

Sedentary behavior, defined as low-energy expenditure while sitting or reclining, is distinct from physical inactivity but strongly correlated and independently predicts mortality in COPD. Notably, people can be physically active yet still fall into the sedentary category, with combined high inactivity and sedentary behavior posing significant health risks.

To improve exercise capacity, increase physical activity, and reduce sedentary behavior in COPD patients, the authors recommend a spectrum of tailored interventions be integrated into clinical practice.

A crucial first step is a thorough assessment of each patient’s pulmonary, extrapulmonary, and behavioral treatable traits early in the disease’s progression. This personalized approach goes beyond a “one-size-fits-all” principle and allows for the identification and targeting of the key features unique to each patient.

Pulmonary rehabilitation, guided by a core outcome set, should be recommended to objectively analyze and address these treatable traits, as it is highly effective in managing multiple aspects of COPD, according to the findings of the study.

The authors noted that clinicians must also consider the broader factors influencing physical activity, including psychological, societal, cultural, and environmental elements. Conducting collaborative discussions with patients to identify barriers and formulate strategies to overcome them are essential. Engaging family members can further support patients in becoming more active.

Additionally, healthcare professionals should promote public health strategies like “move more and sit less” to encourage increased light-intensity activities.

By adopting a multidimensional approach, including the co-design of implementation strategies with both healthcare professionals and patients, and ensuring clear, patient-centered communication, clinicians can significantly enhance engagement in physical activity and improve overall health outcomes for patients with COPD.

“As exercise limitation and physical inactivity have detrimental effects on health outcomes, increasing exercise capacity and physical activity needs to be a focus in the treatment of patients with COPD,” the study authors concluded.

“A collaborative approach in which patients and clinicians work in partnership to identify factors that negatively impact exercise limitation and physical inactivity, and devise strategies to address these treatable traits (including timely referral to pulmonary rehabilitation) offers a promising path towards improving health outcomes in COPD.”