Factors Associated with Reduction of Sedentary Time Following Tiotropium/Olodaterol Therapy in Treatment-Naïve Chronic Obstructive Pulmonary Disease

Figures & data

Table 1 Characteristics of the Patients at the Baseline

	Tio	Tio/Olo	p
n	34	35
Age, years, mean (SD)	70.6 (6.8)	69.7 (5.8)	0.54
Male, (%)	30 (88.2)	34 (97.1)	0.34
Height, cm, mean (SD)	164.1 (9.0)	165.2 (6.6)	0.58
Weight, kg, mean (SD)	61.3 (12.6)	62.3 (11.8)	0.72
BMI, kg/m^2, mean (SD)	22.7 (3.9)	22.8 (3.9)	0.87
Smoking status, n (%)			0.40
Ex-smoker	16 (47.1)	21 (60.0)
Current smoker	18 (52.9)	14 (40.0)
Smoking, year, mean (SD)	45.2 (10.0)	45.3 (10.5)	0.97
Comorbidity, n (%)
Hypertension	16 (47.1)	19 (54.3)	0.72
Diabetes mellitus	7 (20.6)	10 (28.6)	0.62
Dyslipidemia	7 (20.6)	7 (20.0)	1.00
Pulmonary function
%FEV1, mean (SD)	62.03 (13.3)	62.20 (12.5)	0.96
FEV1, mL, mean (SD)	1526 (476)	1547 (346)	0.83
FVC, mL, mean (SD)	2867 (786)	2930 (497)	0.69
VC, mL, mean (SD)	3031 (771)	3115 (491)	0.59
IC, mL, mean (SD)	2057 (511)	1992 (341)	0.53
CAT score, mean (SD)	12.9 (6.6)	9.9 (6.1)	0.047*
6MWD, mean (SD)	443.0 (90.1)	478.3 (65.9)	0.07
Physical activity
1.0–1.5 METs, min, mean (SD)	292.9 (96.9)	296.4 (92.2)	0.88
≥ 2.0 METs, min, mean (SD)	146.7 (70.9)	147.1 (64.9)	0.98
≥ 3.0 METs, min, mean (SD)	37.0 (24.9)	43.8 (31.3)	0.33

Notes: p-values were estimated using the t-test or χ² test. The characteristics of the patients, there were no significant differences between the two groups in terms of age, gender, BMI, respiratory function, baseline physical activity, except for the total CAT score. * p<0.05.

Abbreviations: Tio/Olo, tiotropium/olodaterol; Tio, tiotropium; BMI, body mass index; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; IC, inspiratory capacity; VC, vital capacity; CAT, COPD assessment test; 6MWD, 6-minute walk distance.

Figure 1 Graphical representation of the factors related to reduction of sedentary time created using a graphical model. Factors with a direct link are connected by lines. The thickness of the line represents the strength of the relationship. The thick lines indicate an absolute value of the correlation coefficient of > 0.4, and the thin line represents a correlation coefficient of 0.2–0.4. The red circle stands for changes in physical activity of 1.0–1.5 METs. The green circle shows treatment with tiotropium/olodaterol, the Orange circles show pulmonary function, the blue circles show clinical characteristics, and the yellow circles represent baseline physical activities.

Abbreviations: IC, inspiratory capacity; FEV1, forced expiratory volume in 1 s; BMI, body mass index; 6MWD, 6-minute walk distance; CAT, COPD assessment test; Tio/Olo, tiotropium/olodaterol; PA 1.0–1.5, baseline physical activity of 1.0–1.5 METs intensity; PA ≥2.0, baseline physical activity of ≥ 2.0 METs intensity; METs, metabolic equivalents.

Figure 2 Changes in sedentary time before and after treatment stratified according to pulmonary function. Patients were stratified into two groups by a median IC of 1970 mL (A), FEV1 of 1510 mL (B), median FVC of 2840 mL (C), and median VC of 3010 mL (D), for stratified analysis of a reduction in sedentary time with Tio or Tio/Olo treatment. The error bars represent standard errors. p values show differences between two groups. In the subgroup of patients with lower baseline IC, Tio/Olo treatment significantly reduced sedentary time compared with Tio treatment.

Abbreviations: METs, metabolic equivalents; Tio, tiotropium; Tio/Olo, tiotropium/olodaterol; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; VC, vital capacity; IC, inspiratory capacity.

Figure 3 Changes in sedentary time before and after treatment stratified by the duration and intensity of physical activity at study entry. Patients were divided into two groups based on a median duration of PA of 1.0–1.5 METs intensity of 282.7 min (A), median duration of PA of ≥ 2.0 METs intensity of 125.1 min (B), and median duration of PA of ≥ 3.0 METs intensity of 31.1 min (C), for stratified analysis of reduction in sedentary time with Tio or Tio/Olo treatment. The error bars represent standard errors. p values show differences between two groups. In the subgroup of patients with a shorter duration of baseline physical activity of ≥2 METs, Tio/Olo treatment significantly reduced sedentary time compared with Tio treatment.

Abbreviations: METs, metabolic equivalents; Tio, tiotropium; Tio/Olo, tiotropium/olodaterol; PA, physical activity; METs, metabolic equivalents.

Figure 4 Decision tree about treatment with Tio or Tio/Olo in treatment-naïve COPD patients. The decision tree was obtained by statistical analysis including patient characteristics (age, BMI, CAT, and 6MWD), pulmonary functions (FEV1, FVC, VC, and IC), and baseline physical activity of 1.0–1.5 METs, PA ≥ 2.0 METs, and PA ≥ 3.0 METs intensity as confounding factors. The decision trees show treatment with Tio (A), and Tio/Olo (B). Tio treatment was most effective for reduction of sedentary time in patients in whom the daily duration of baseline PA of 1.0–1.5 METs was more than 339.4 min. Tio/Olo treatment was most effective in patients in whom the duration of baseline PA of ≥ 2.0 METs was shorter than 111.0 min.

Abbreviations: METs, metabolic equivalents; BMI, body mass index; CAT, COPD assessment test; 6MWD, 6-minute walk distance; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; VC, vital capacity; IC, inspiratory capacity; PA, physical activity; Tio, tiotropium; Tio/Olo, tiotropium/olodaterol.