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Vol. 57. Issue 3.
Pages 214-223 (March 2021)
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Vol. 57. Issue 3.
Pages 214-223 (March 2021)
Original article
Patterns of Physical Activity Progression in Patients With COPD
Patrones de progresión de la actividad física en pacientes con EPOC
Maria Korenya,b,c, Heleen Demeyerd,e,f, Marta Beneta,b,c, Ane Arbillaga-Etxarrig, Eva Balcellsb,h,i, Anael Barberan-Garciaj, Elena Gimeno-Santosj, Nicholas S. Hopkinsonk, Corina De Jongl,m, Niklas Karlssonn, Zafeiris Louvarisd,o, Michael I. Polkeyk, Milo A. Puhanp, Roberto A. Rabinovichq, Robert Rodríguez-Roisinj, Pere Vall-Casasr, Ioannis Vogiatziso,s, Thierry Troostersd,e, Judith Garcia-Aymericha,b,c,
Corresponding author

Corresponding author.
, The Urban Training Study Group and PROactive Consortium members
a ISGlobal, Barcelona, Spain
b Pompeu Fabra University (UPF), Barcelona, Spain
c CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
d Department of Rehabilitation Sciences, KU Leuven • University of Leuven, Leuven, Belgium
e Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
f Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
g Physical Activity and Sports Sciences, Faculty of Psychology and Education, University of Deusto, Donostia-San Sebastián, Spain
h CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
i Pneumology Department, Institut Hospital del Mar d
tm)Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain
j University of Barcelona, Institut d
tm)Investigació Biomèdica August Pi i Sunyer (IDIBAPS), CIBER Enfermedades Respiratorias (CIBERES), Hospital Clínic, Barcelona, Spain
k National Heart and Lung Institute, Imperial College, Royal Brompton Hospital Campus, London UK
l Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
m Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
n Patient Centered Science, BioPharmaceuticals, AstraZeneca R&D, Gothenburg, Sweden
o First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece
p Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
q ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
r Universitat Internacional de Catalunya (UIC), Barcelona, Spain
s Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle UK
The Urban Training Study Group
The PROactive Consortium members
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Figures (3)
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Tables (3)
Table 1. Patient Characteristics at Baseline and at 12-month Follow-up for All Patients (n=291) and by Study Group (Urban Training and PROactive study).
Table 2. Patient Characteristics by Physical Activity Progression Pattern (Inactive, Active Improvers and Active Decliners) in 291 COPD Patients.
Table 3. Adjusted Predictive Factors for Inactive and Active Improvers vs Active Decliners in 291 COPD Patients.
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Additional material (2)

Although mean physical activity in COPD patients declines by 400•500steps/day annually, it is unknown whether the natural progression is the same for all patients. We aimed to identify distinct physical activity progression patterns using a hypothesis-free approach and to assess their determinants.


We pooled data from two cohorts (usual care arm of Urban Training [NCT01897298] and PROactive initial validation [NCT01388218] studies) measuring physical activity at baseline and 12 months (Dynaport MoveMonitor). We identified clusters (patterns) of physical activity progression (based on levels and changes of steps/day) using k-means, and compared baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics across patterns.


In 291 COPD patients (mean±SD 68±8 years, 81% male, FEV1 59±19%pred) we identified three distinct physical activity progression patterns: Inactive (n=173 [59%], baseline: 4621±1757 steps/day, 12-month change (΢): ∧487±1201 steps/day), ActiveImprovers (n=49 [17%], baseline: 7727±3275 steps/day, ΢:+3378±2203 steps/day) and ActiveDecliners (n=69 [24%], baseline: 11 267±3009 steps/day, ΢: ∧2217±2085 steps/day). After adjustment in a mixed multinomial logistic regression model using Active Decliners as reference pattern, a lower 6-min walking distance (RRR [95% CI] 0.94 [0.90•0.98] per 10m, P=.001) and a higher mMRC dyspnea score (1.71 [1.12•2.60] per 1 point, P=.012) were independently related with being Inactive. No baseline variable was independently associated with being an Active Improver.


The natural progression in physical activity over time in COPD patients is heterogeneous. While Inactive patients relate to worse scores for clinical COPD characteristics, Active Improvers and Decliners cannot be predicted at baseline.

Physical activity
Patterns of progression
Cluster analysis

Aunque la actividad física en pacientes con EPOC declina una media anual de 400-500 pasos/día, se desconoce si esta progresión es igual en todos los pacientes. Este estudio pretendió identificar los patrones de progresión de la actividad física mediante mèc)todos libres de hipótesis y evaluar sus determinantes.


Se estudiaron 291 pacientes con EPOC estable (media±DE: 68±8años, 81% hombres, VEMS 59±19%pred) de dos cohortes europeas con actividad física basal y a 12meses (acelerómetro Dynaport MoveMonitor). Se identificaron conglomerados (patrones) de progresión de actividad física basados en los niveles y cambios de pasos/día usando k-means, y se compararon entre patrones las características sociodemográficas, interpersonales, ambientales, clínicas y psicosociales basales.


Se identificaron tres patrones: inactivo (n=173 [59%], basal: 4.621±1.757 pasos/día, cambio en 12meses (΢): ∧487±1.201 pasos/día), activo que aumenta (n=49 [17%], basal: 7.727±3.275 pasos/día, ΢: +3.378±2.203 pasos/día) y activo que reduce (n=69 [24%], basal: 11.267±3.009 pasos/día, ΢: ∧2.217±2.085 pasos/día). La distancia en la prueba de la marcha de 6minutos (6MWD) y la disnea se asociaron independientemente con ser inactivo: RRR [IC95%] 0,94 [0,90-0,98] por cada 10m de 6MWD (p=0,001) y 1,71 [1,12-2,60] por cada punto en la escala mMRC (p=0,012), respectivamente, en comparación con el patrón activo que reduce. No se encontraron variables basales independientemente asociadas con ser activo que aumenta.


La progresión natural de la actividad física en pacientes con EPOC es heterogèc)nea. Mientras que el patrón de pacientes inactivo se relaciona con peores características clínicas de EPOC, no se pudo predecir la evolución de los activos a aumentar o reducir.

Palabras clave:
Actividad física
Patrones de progresión
Análisis de conglomerados


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