Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study

Abstract

Background

The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients.

Methods

We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport^® accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0–7), suggested (8–10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach.

Results

Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, −149 to −12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA.

Conclusion

In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later.

Keywords:

• COPD
• anxiety
• depression
• HADS
• physical activity
• prospective study

Acknowledgments

Authors thank the input from the PROactive project Ethics Board, Advisory Board and Patient Input Platform (www.proactivecopd.com/about/advisory-boards). PROactive consortium: Almirall: Nathalie Ivanoff; AstraZeneca AB: Niklas Karlsson, Solange Corriol-Rohou; British Lung Foundation, UK: Ian Jarrod; Boehringer Ingelheim: Damijen Erzen; Chiesi Farmaceutici S.A.: Caterina Brindicci, Tim Higenbottam, Mario Scuri; Choice Healthcare Solution, UK: Paul McBride; European Respiratory Society, Lausanne: Nadia Kamel; GlaxoSmithKline: Margaret Tabberer; Katholieke Universiteit Leuven: Thierry Troosters, Fabienne Dobbels; Municipal Institute of Medical Research, Barcelona: Judith Garcia-Aymerich; the Netherlands Asthma Foundation, Amersfoort: Pim de Boer; Novartis: Karoly Kulich, Alastair Glendenning; Pfizer: Katja Rudell, Frederick J Wilson; Royal Brompton and Harefield NHS Foundation Trust: Michael I Polkey, Nick S Hopkinson; Thorax Research Foundation, Athens: Ioannis Vogiatzis; UCB: Enkeleida Nikai; University Medical Center, Groningen: Thys van der Molen, Corina De Jong; University of Edinburgh, Old College South Bridge: Roberto A Rabinovich, Bill MacNee; University of Zurich, Zurich: Milo A Puhan, Anja Frei.

Supported by the European Commission Innovative Medicines Initiative Joint Undertaking (IMI JU number 115011). No involvement of funding source in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Work at the Brompton was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London which part-fund Michael I Polkey’s salary. The views expressed in this publication are those of the authors and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health. The PROactive consortium approved the final version of the manuscript.

Author contributions

JGA takes responsibility for (is the guarantor of) the content of the manuscript, including the data and analysis. IDE and JGA led the study, performed the statistical analysis, and drafted the manuscript. All authors contributed to conception, hypotheses delineation, design of the study, acquisition of the data or analysis and interpretation of results; critically revising the article; approved the final version to be published; and agree to be accountable for all aspects of the work.

Disclosure

Michael I Polkey’s institution received payment (<$5,000) for the participation in an advisory board organized by Boehringer Ingelheim. Thierry Troosters has provided consultancy or given sponsored talks around the topic to Boehringer Ingelheim, Novartis, and GSK (amounts paid to the institution <5,000 €). Niklas Karlsson is employed by AstraZeneca. Iván Dueñas-Espín, Heleen Demeyer, Elena Gimeno-Santos, Nicholas S Hopkinson, Roberto A Rabinovich, Fabienne Dobbels, and Judith Garcia-Aymerich have no conflicts of interest to disclose.