Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study

Andreas Horner; Horst Olschewski; Sylvia Hartl; Arschang Valipour; Georg-Christian Funk; Michael Studnicka; Monika Merkle; Bernhard Kaiser; Eva Maria Wallner; Stephan Brecht; Bernd Lamprecht

doi:10.2147/COPD.S435278

Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study

Int J Chron Obstruct Pulmon Dis. 2023 Nov 29:18:2755-2767. doi: 10.2147/COPD.S435278. eCollection 2023.

Authors

Affiliations

¹ Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria.
² Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
³ Department of Respiratory and Critical Care Medicine, Klinik Penzing and Sigmund Freud University, Medical School, Vienna, Austria.
⁴ Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria.
⁵ Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria.
⁶ Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
⁷ Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria.
⁸ A. Menarini Pharma GmbH, Vienna, Austria.

Abstract

Background: Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease.

Methods: We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain.

Results: After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV₁%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8-10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C - total score and all subscores).

Conclusions: In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.

Keywords: PHQ-9; St. George’s Respiratory Questionnaire; chronic obstructive pulmonary disease; depression; pain; physical activity; quality of life.

MeSH terms

Aged
Cross-Sectional Studies
Depression / diagnosis
Depression / epidemiology
Female
Humans
Male
Middle Aged
Pain
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / therapy
Quality of Life*
Surveys and Questionnaires

Grants and funding

Funding of this study was provided by A. Menarini Pharma GmbH. The funding source had no role in data analysis, interpretation of the data, or decision to submit results.