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Exercise helps COPD patients avoid hospital readmission

Thursday April 17, 2014
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Patients with chronic obstructive pulmonary disease who participated in moderate to vigorous physical activity had a lower risk of hospital readmission within 30 days compared with those who were inactive, according to a study.

As published April 8 on the website of the Annals of the American Thoracic Society, researchers examined the electronic health records of 6,042 Kaiser Permanente patients in Southern California who were age 40 or older and were hospitalized with COPD between Jan. 1, 2011, and Dec. 31, 2012.

As part of Kaiser Permanente’s clinical practice to inquire about exercise as a vital sign, the patients’ self-reported physical activity was documented in their EHR during routine clinical visits, along with other vital signs such as blood pressure. Patient data was categorized in three physical activity groups: inactive, insufficiently active and active.

The researchers found that patients with COPD who exercised 150 minutes a week or more had a 34% lower risk of readmission within 30 days compared with those who were inactive. Patients who reported less than 150 minutes of moderate or vigorous physical activity still had a 33% lower risk of 30-day readmission compared with those who did not exercise at all.

“The results of this study are groundbreaking because measures of physical activity were derived from routine clinical care, instead of lengthy physical activity surveys or activity devices in smaller research samples,” the study’s lead author, Huong Nguyen, RN, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation, said in a news release.

“Previous research has only analyzed the relationship between physical inactivity and increased mortality rate and hospitalizations, but not 30-day readmissions in patients with COPD.”

The patient base in this study was 68% white, 15% black, 12% Hispanic and 4% Asian/Pacific Islander. The gender split in the study was similar to the overall COPD patient population, according to the researchers.

“Many healthcare systems are currently focused on providing interventions at or soon after hospital discharge to reduce readmissions,” Nguyen said. “This study is novel in that we were able to capture information about patients’ usual physical activity well before the initial hospitalization and provides evidence that supports the promotion of physical activity across the COPD care continuum.

“Our findings suggest that regular physical activity could buffer the stresses of hospitalization. Future studies will focus on determining whether we can reduce hospitalizations by improving physical activity in patients with COPD.”

According to a 2013 joint statement by the American Thoracic Society and the European Respiratory Society, exercise training, as part of pulmonary rehabilitation, has demonstrated improvement in quality of life in COPD patients. The two groups developed a set of physical activity training guidelines, which state that exercising three to five times a week will help improve COPD symptoms, physical functioning and quality of life.

In 2009, Kaiser Permanente became one of the first healthcare organizations to systemically log patients’ physical activity in their electronic health records. As part of clinical practice, patients are asked about their level of physical activity during routine outpatient visits, with their responses documented in their EHR.

Study abstract: www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201401-017OC#.U0wnNFeRceU

American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation: www.thoracic.org/statements/resources/copd/PRStatementrccm-2E201309-1634st.pdf


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