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The relationship between physical function and experience of fatigue in patients with chronic obstructive pulmonary disease
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Chronic Obstructive Pulmonary Disease (COPD) is increasing throughout the world and most rapidly among women. COPD is characterized by a progressive loss of physical functions. The reason for this is multi-factorial and include not only lung related deficiencies but also several systemic consequences and symptoms of which several are potential restrictors of physical function. The relationship between physical function and symptoms are not clear, especially not among women with COPD.

Aim

The overall aim of this thesis was to illuminate the relationship between two dimensions of physical function (physical activity and physical capacity) and experience of fatigue. The specific aims were to explore factors associated with low physical activity and to examine experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD.

Methods

A cross-sectional study was conducted including 121 patients (67 women) with stable COPD and mean age of 67 (+/-7) years. Physical activity was measured with the International Physical Activity  Questionnaire short form. Physical capacity included assessment of lung function (dynamic spirometry), exercise capacity (the 6-minute walk distance [perceived dyspnoea and leg fatigue in connection to the test]) and muscle strength (the Timed Stands Test and grip strength). Fatigue was assessed with structured questions covering the frequency, duration and severity of fatigue the previous month and patients were categorized as those with no fatigue, moderate fatigue or severe fatigue. Data about other symptoms (dyspnoea, anxiety and depression), symptom burden (Memorial Symptom Assessment Scale), fat and fat free mass (bio-impedance analysis) and smoking history was collected.

Results

Forty-two percent of the patients reported a low physical activity level. A majority of the patients reported experience of fatigue the previous month, 52% moderate fatigue and 25% severe fatigue. Low physical activity was associated with severe fatigue, worse exercise capacity and a higher amount of smoking. There were no differences in experience of fatigue between men and women. Men with fatigue had worse physical capacity and disease severity compared to men without fatigue. Women with fatigue had comparable physical capacity and disease severity to women without fatigue except for a higher perceived leg fatigue after the exercise capacity test. Multiple logistic regression analysis showed that exercise capacity and disease severity were associated with fatigue in both men and women but in women, leg fatigue was also strongly associated with the presence of fatigue.

Conclusions

Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. This result suggests that patients with severe fatigue might need specific strategies to become more physically active. Presence of fatigue was associated with exercise capacity and disease severity in both men and women. In addition, in women leg fatigue was strongly associated with fatigue. Muscle endurance training might be extra important in the rehabilitation of women with COPD experiencing fatigue. However the association between fatigue and exercised induced leg fatigue among the women warrant further investigation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 66 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 127
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-105195DOI: 10.3384/lic.diva-105195ISBN: 978-91-7519-425-7 (print)OAI: oai:DiVA.org:liu-105195DiVA: diva2:704503
Presentation
2014-04-11, K3, Kåkenhus, Campus Norrköping, Linköpings universitet, Norrköping, 09:00 (Swedish)
Supervisors
Note

The author belong to the Department of Mecical and Health Science and is Ph.D. student at the Department of Social and Welfare Studies.

Available from: 2014-03-12 Created: 2014-03-12 Last updated: 2014-03-13Bibliographically approved
List of papers
1. Factors associated with low physical activity in patients with Chronic Obstructive Pulmonary Disease: A cross-sectional study
Open this publication in new window or tab >>Factors associated with low physical activity in patients with Chronic Obstructive Pulmonary Disease: A cross-sectional study
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2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, 697-707 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

Low physical activity (PA) in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. In addition physical activity seems to be low early in the disease. The aim in this study was to describe the level of PA in patients with stable COPD, and to explore factors associated with low PA, with a focus on fatigue, symptom burden and body composition.

Methods

In a cross-sectional study 101 patients (52 women) with COPD  were classified having low, moderate or high PA according to the International Physical Activity Questionnaire – Short. Fatigue, dyspnoea, depression and anxiety, symptom burden, body composition, physical capacity (lung function, exercise capacity, muscle strength), exacerbation rate and systemic inflammation were assessed. A multiple logistic regression was used to identify independent associations with low PA.

Results

Mean age was 68 (+/- 7) years and mean percentage of predicted forced expiratory volume in one second was 50 (+/-16.5). Forty-two patients reported a low PA level, while 34 moderate and 25 reported high levels. Factors independently associated with low PA, presented as odds ratio (95% confidence interval), were severe fatigue 5.87 (1.23 – 28.12), exercise capacity 0.99 (0.99 – 1.0) and the number of pack years 1.04 (1.01 – 1.07). No relationship was found between depression, anxiety, body composition, exacerbation rate or systemic inflammation and PA.

Conclusions

Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. Promoting physical activity is important in all patients with COPD. Our result suggests that patients with severe fatigue might need specific strategies to become more physically active.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105194 (URN)10.1111/scs.12200 (DOI)000368345900010 ()
Note

The author belong to the Department of Mecical and Health Science and is Ph.D. student at the Department of Social and Welfare Studies.

Vid tiden för disputationen förelåg publikationen endast som manuskript

Funding agencies: Swedish Heart and Lung foundation; Medical Research Council of Southeast Sweden; County Council of Ostergotland

Available from: 2014-03-12 Created: 2014-03-12 Last updated: 2016-03-23Bibliographically approved
2. Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD
Open this publication in new window or tab >>Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD
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2014 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 9, 17-25 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Several differences have been reported in the clinical characteristics of chronic obstructive pulmonary disease (COPD) between men and women. Differences have been found in the association between respiratory symptoms and lung function, and in the factors associated with dyspnea. This raises the question of whether there are differences between the sexes in the relationship between fatigue, the second most prevalent symptom, and the variables of physical capacity and disease severity. Objectives: To examine the experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD. Methods: In a cross-sectional study 121 patients with COPD (54 men and 67 women), the experience of fatigue (frequency, duration, and severity) and physical capacity (lung function, 6-minute walk distance [6MWD], grip strength, and timed-stand test) were assessed. Disease severity was graded according to the Body mass index, airway Obstruction, Dyspnoea and Exercise capacity (BODE) index. Two multiple logistic regression models were tested, both of which were performed separately in men and women, to examine the association between the experience of fatigue and variables of physical capacity and the BODE index. Results: Eighty-nine (73.6%) patients experienced fatigue, with similar proportions in men and women. The men with fatigue had worse physical capacity and more severe disease than did the men without fatigue: for men with and without fatigue, respectively, the percent of predicted forced expiratory volume in 1 second (FEV1) (mean [standard deviation]) was 47 (14) vs 64 (17); the 6MWD (mean [standard deviation]) was 398 (138) vs 539 (105) m; and the BODE index (median [quartile 1-3]) was 3 (2-5) vs 1 (0-1) (Pless than0.01). In women, only higher leg fatigue post-6MWD was seen among those experiencing fatigue compared with women without fatigue: for women with and without fatigue, respectively, leg fatigue (median [quartile 1-3]) was 4 (3-5) vs 2 (0-3) (Pless than0.001). The regression models showed that the 6MWD and the BODE index were associated with fatigue in both men and women, but in women, leg fatigue remained an independent associate in both models. Conclusion: Exercise capacity and disease severity were associated with fatigue in both men and women. In women, leg fatigue was strongly associated with fatigue, which warrants further investigation.

Place, publisher, year, edition, pages
Dove Medical Press, 2014
Keyword
chronic obstructive pulmonary disease; disease state; functional capacity; sex differences; symptom experience; leg fatigue
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-103279 (URN)10.2147/COPD.S52506 (DOI)000328463500001 ()
Note

The author belong to the Department of Mecical and Health Science and is Ph.D. student at the Department of Social and Welfare Studies.

Available from: 2014-01-17 Created: 2014-01-16 Last updated: 2015-04-09Bibliographically approved

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