Chest
Volume 144, Issue 1, July 2013, Pages 145-151
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Original Research
COPD
Patients With COPD With Higher Levels of Anxiety Are More Physically Active

https://doi.org/10.1378/chest.12-1873Get rights and content

Background

Physical activity (PA) has been found to be an excellent predictor of mortality beyond traditional measures in COPD. We aimed to determine the association between depression and anxiety with accelerometry-based PA in patients with COPD.

Methods

We performed a cross-sectional analysis of baseline data from 148 stable patients with COPD enrolled in an ongoing, longitudinal, observational study. We measured PA (total daily step count) with a Stepwatch Activity Monitor over 7 days, depression and anxiety with the Hospital Anxiety and Depression Scales (HADSs), dyspnea with the Shortness of Breath Questionnaire, and functional capacity with the 6-min walk test.

Results

Increased anxiety was associated with higher levels of PA such that for every one-point increase in the HADS-Anxiety score there was a corresponding increase of 288 step counts per day (β = 288 steps, P < .001), after adjusting for all other variables. Higher levels of depressive symptoms were associated with lower PA (β= −176 steps, P = .02) only when anxiety was in the model. The interaction term for anxiety and depression approached significance (β = 26, P = .10), suggesting that higher levels of anxiety mitigate the negative effects of depression on PA.

Conclusions

The increased PA associated with anxiety in COPD is, to our knowledge, a novel finding. However, it is unclear whether anxious patients with COPD are more restless, and use increased psychomotor activity as a coping mechanism, or whether those with COPD who push themselves to be more physically active experience more anxiety symptoms. Future studies should evaluate for anxiety and PA to better inform how to improve clinical outcomes.

Section snippets

Study Design and Settings

The COPD Activity: Serotonin Transporter, Cytokine, and Depression Study (CASCADE) is an ongoing, multisite, prospective, observational study of subjects with COPD who are being followed for 2 years to study the biologic causes and functional consequences of depression. This manuscript is a cross-sectional, descriptive analysis of data from 148 subjects collected at entry to CASCADE. This study was approved by the respective institutional review boards at three clinical sites: the University of

Patient Characteristics

Table 1 includes the summary of the demographic and baseline characteristics of the 148 patients included in the analysis. The cohort (78% men) had a mean FEV1 % predicted of 42% and few comorbidities. Overall, participants were relatively high functioning and had relatively low depressive and anxiety symptoms. Approximately 32% and 29% of patients scored higher than 8 points on the HADS-A and HADS-D, respectively. Mean SAM wear time did not differ between subjects who had high- or low-anxiety

Discussion

A key novel finding of this study is that anxiety was significantly and independently associated with increased ambulatory PA in patients with severe COPD, even after adjusting for relevant covariates including demographics, disease severity, functional capacity, dyspnea, and depression. To our knowledge, this finding has not been published elsewhere. We performed a number of diagnostic tests to ensure that the models met the assumptions for linear regression, and, thus, we believe these

Conclusions

We conclude that anxiety is associated with increased daily PA in a selected sample of patients with COPD. It is unclear whether patients with COPD who have higher levels of anxiety are more restless and use increased psychomotor activity as a coping mechanism, or whether those with COPD who push themselves to be more physically active experience more anxiety symptoms. The clinical implications of these observations are interesting because anxiety as a comorbid disorder is associated with

Acknowledgments

Author contributions: Dr Nguyen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Nguyen: contributed to the study design, data analysis and interpretation, and preparation of the manuscript and served as principal author.

Dr Fan: contributed to the study design, data analysis and interpretation, and preparation of the manuscript.

Dr Herting: contributed to the study design, data analysis and

References (43)

  • AA Thorp et al.

    Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011

    Am J Prev Med

    (2011)
  • J Garcia-Aymerich et al.

    Risk factors of readmission to hospital for a COPD exacerbation: a prospective study

    Thorax

    (2003)
  • J Garcia-Aymerich et al.

    Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

    Thorax

    (2006)
  • J Garcia-Aymerich et al.

    Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study

    Am J Respir Crit Care Med

    (2007)
  • NK Leidy

    Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework

    Nurs Res

    (1994)
  • A Yohannes et al.

    Mood disorders in elderly patients with chronic obstructive pulmonary disease

    Rev Clin Gerontol

    (2000)
  • GA Brenes

    Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment

    Psychosom Med

    (2003)
  • MP Wall

    Predictors of functional performance in community-dwelling people with COPD

    J Nurs Scholarsh

    (2007)
  • TE Weaver et al.

    Physiological and psychological variables related to functional status in chronic obstructive pulmonary disease

    Nurs Res

    (1992)
  • ML Yeh et al.

    Testing the functional status model in patients with chronic obstructive pulmonary disease

    J Adv Nurs

    (2004)
  • TP Ng et al.

    Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life

    Arch Intern Med

    (2007)
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    Funding/Support: This work was supported in part by grants from the US National Institutes of Health (NIH) National Heart, Lung, and Blood Institute [5R01HL093146] and the NIH National Center for Research Resources [UL1RR025014]. Dr Fan has funding through the Department of Veterans Affairs.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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