| Summary: | Christian R Osadnik,1–4,* Matthias Loeckx,1,5,6,* Zafeiris Louvaris,1,7 Heleen Demeyer,1,6 Daniel Langer,1,6 Fernanda M Rodrigues,1,6 Wim Janssens,6,8 Ioannis Vogiatzis,7,9 Thierry Troosters1,6 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; 2Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia; 3Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia; 4Institute for Breathing and Sleep, Melbourne, Victoria, Australia; 5Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; 6Respiratory Division, University Hospitals, KU Leuven, Leuven, Belgium; 7Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece; 8Department of Chronic Disease, Metabolism and Aging, KU Leuven, Leuven, Belgium; 9Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK *These authors contributed equally to this work Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.Materials and methods: Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008–2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day (“PA responders”) after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses.Results: Two hundred thirty-six patients with COPD (median [IQR] FEV1 44 [33–59] % predicted, age 65±8 years, 6MWDi 416 [332–486] m) were included. The proportion of “PA responders” after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; P<0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51–6.36).Conclusion: The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field. Keywords: exercise and pulmonary rehabilitation, COPD, physical activity, clinical respiratory medicine, responder analysis
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