A comprehensive investigation into COPD management: Understanding physical function and motivation to change behaviour as determinants of physical activity

• Grant number: 24/05641-9
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• Start date: September 02, 2024
• End date: September 01, 2025
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Renata Gonçalves Mendes
• Grantee: Débora Mayumi de Oliveira Kawakami
• Supervisor: Heleen Demeyer
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Institution abroad: Ghent University (UGent), Belgium
• Associated to the scholarship: 22/02397-4 - EFFECTIVENESS OF AN EARLY BEHAVIORAL CHANGE STRATEGY AFTER ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON CARDIOVASCULAR PROFILE, PHYSICAL ACTIVITY LEVEL AND FUNCTIONALITY: RANDOMIZED CLINICAL TRIAL WITH FOLLOW-UP, BP.DR

Abstract

Background: Chronic respiratory diseases (CRDs) pose a significant burden globally, leading to distressing symptoms like shortness of breath, exercise limitation, and impaired quality of life. Among CRDs, Chronic Obstructive Pulmonary Disease (COPD) is characterized by impaired physical capacity and low levels of daily physical activity. Pulmonary rehabilitation, including aerobic exercises and education, is a recommended part of COPD management. Despite its benefits, sustaining adequate levels of physical activity post-rehabilitation has proven to be a challenge. Assessing and interpreting the physical activity levels taking into account the patient's exercise capacity is crucial for designing the most effective and personalized COPD care. In addition, and related to physical activity, one of the important characteristics is the patient's motivation to be physically active. However, there is still a lack of consensus on which assessment tools are most appropriate to measure this. Conducting a review of the tools able to assess motivation to be physically active can enhance understanding and treatment.Aims: The overall objective is to characterize patients in terms of their real (objectively measured) physical activity in relation to their exercise capacity, both in a stable and exacerbated phase of the disease. And identify the existent tools to assess patient's motivation for physical activity in patients living with CRDs and describe their measurement properties.Methods: To characterise stable patients with COPD, we will include 1) patients included in an RCT testing the long-term effectiveness of physical activity coaching on physical activity (multicenter study Ghent University - KU Leuven) and 2) data from the European Mobilise-D observational study, including patients included in Belgium. Patients will be characterised in percentiles (P5, P25, P50, P75, and P95) of step count (physical activity) in relation to the distance walked during a 6 minute walk test, (as a measure of exercise capacity) using the categories proposed before (Demeyer, H., et al ). Next, we will compare the groups (P5, P25, P50, P75, P95) for different outcomes, including spirometric test results (FEV1), muscle strength (isometric quadriceps force), symptom experience (dyspnea, fatigue), socioeconomic characteristics (social support, loneliness), psychological factors (anxiety and depression), medication usage, medical history including exacerbations, presence of comorbidities. This analysis will be conducted on a sample of patients in a stable state of the disease.Moreover, we will characterise the physical activity of patients with an acute exacerbation of COPD using the same percentile scale and compare this to matched patients with stable disease in the same centre (Belgium) and to patients experiencing an exacerbation in another country (Brazil).For identify the existent tools to assess patient's motivation for physical activity in patients living with CRDs and describe their measurement properties we are propose a systematic review. This systematic review will be conducted in accordance to COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments). The search will include PubMed, EMBASE, PEDro, and COCHRANE databases, in languages English, Portuguese and Spanish. The population will be chronic respiratory disease patients: asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, lung cancer, cystic fibrosis, pneumoconiosis (including silicosis, asbestosis, coal-worker pneumoconiosis, and other pneumoconiosis). Each measurement property (reliability, validity, responsiveness) studies result will be assessed according to updated criteria for good measurement properties. The classification of each property will be determined as sufficient (+), insufficient (-), or indeterminate (?) based on consensus.