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Background/Aim: Pivotal objectives of self-management programs are behavior change, coping and better health related quality of life (HRQL). The effects of the “Living well with COPD” (LWWCOPD) self-management program and usual care on coping, HRQL, smoking cessation and exacerbation frequency at 24 months were compared in COPD patients from primary care. Method: Prospective non-randomized controlled study with COPD patients who participated in the “LWWCOPD” program adapted to primary care in Switzerland. COPD patients from the primary care-based COPD Cohort ICE COLD ERIC(http://www.ClinicalTrials.govNCT00706602) served as control. The primary outcome was coping measured by the mastery domain of the Chronic Respiratory Questionnaire (CRQ). We performed multivariate regression analyses where we accounted for the lack of randomization with propensity scores. Results: 71 patients were in the self- management and 385 in the usual care cohort. Patients with the self-management program had significantly higher mastery scores (0.71(95% CI 0.28-1.13)), significantly less moderate to severe exacerbations (incidence rate ratio 0.68(95% CI 0.48-0.97)) and significantly more patients quit smoking (odds ratio 0.26 (95% CI 0.07-0.95). There was an effect on fatigue (0.75(95% CI 0.28-1.22)) whereas the effect just did not reach statistical significance for dyspnea (0.50, 95% CI -0.03-1.03) and emotional function (0.40, 95% CI -0.03-0.82, all CRQ). Conclusion: The LWWCOPD intervention in a primary care setting showed long-term benefits on coping, exacerbations and smoking cessation behavior.

Background: The 1-minute sit-to-stand test (STS) is a simple exercise capacity test, but has not yet been thoroughly validated in COPD. Aims: We aimed to assess the measurement properties and physiological response to the STS. Methods: Patients with COPD who took part in an inpatient pulmonary rehabilitation (PR) programme were included from 2 studies (Switzerland (CH): n=52 and Germany (D): n=205). We assessed the STS, 6MWT and patient reported outcomes pre and post PR. 18 patients conducted additional STSs with cardiopulmonary gas-analysis. We calculated intraclass correlation coefficients (ICCs) between two STSs at baseline (learning effect) and follow-up (reliability) (CH), Pearson correlation coefficients (PCCs) of the STS with previously validated measures (validity), standardised response means (SRM) (responsiveness) and the minimal important difference (MID) with anchor and distributional methods. Results: The mean STS scores at baseline were 16.5±6.6 (CH) and 24.2±7.5 (D). The change scores were 3.6±4.1 (CH) and 4.0±4.3 (D). The ICCs were 0.93 (95%CI: 0.83-0.97) for learning effect and 0.99 (0.97-1.00) for reliability. The PCCs between the STS and 6MWT were 0.59 (CH) and 0.64 (D). The SRMs were 1.16 (0.86-1.45) (CH) and 0.92 (0.78-1.07) (D). The MID was estimated as 3 repetitions. Figure 1 shows the gas exchange response to the STS. Conclusion: The STS is reliable, valid and responsive for measuring exercise capacity in COPD.

Background Comorbidities are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Low physical activity (PA), a critical feature of COPD, is hypothesized to be an important risk factor for comorbidities. Aims To assess the association of PA with prevalence and incidence of 7 categories of comorbidities in COPD. Methods The study included 409 patients from primary care practice in the Netherlands and Switzerland. We assessed PA using the Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire at baseline and followed patients for up to 5 years. During follow-up, patients reported their comorbidities (cardiovascular, neurological, endocrine, musculoskeletal, malignant, and infectious diseases) and completed the Hospital Anxiety and Depression Scale questionnaire for mental health assessment. We implemented logistic regression and survival analysis models for our analysis. Results Increased PA was cross-sectionally associated with lower risk of mental disorders (anxiety or depression) (adjusted odds ratio, 0.70; 95% CI, 0.60 - 0.81; p Conclusions In COPD patients, those with high PA are less likely to have depression or anxiety and are also less likely to develop depression or anxiety over time. PA promotion programs may be considered to lower the burden of mental disorders in COPD patients.

Background: The 1-minute sit-to-stand (1-min STS) test is a simple and easy to conduct measure of exercise capacity in COPD patients. Although the 1-min STS test is increasingly being used, it is uncertain which factors determine the outcome of the test. We aimed to identify characteristics associated with 1-min STS test performance. Methods: COPD patients in a prospective cohort study (ICE COLD ERIC) in the Netherlands and Switzerland were assessed with the 1-min STS test at baseline (n=371). We identified potential determinants and fit linear regression models to identify the associations of these baseline characteristics with baseline sit-to-stand test performance. Results: Mean 1-min STS test score at baseline was 18.68 (SD 8.41). The analysis suggested that physical activity (Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ) score, coefficient per 1 or more repetition: 1.49, 95% CI 0.32 to 2.62; p=0.01), dyspnoea (-2.25, 95% CI -3.40 to -1.10; p

Background: Whereas low levels of physical activity (PA) are consistently associated with higher risk of subsequent exacerbations and mortality in patients with COPD, it is unclear if PA is associated with changes in FEV1, mainly due to the cross-sectional nature of the existing literature. Aims and Objectives: To assess the impact of baseline PA on the change in FEV1 in patients with COPD. Methods: 409 primary care patients from the Netherlands and Switzerland participated in the prospective ICE COLD ERIC cohort study. PA was assessed at baseline and every six months by the Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ). We used multivariable linear regression models to determine the association of PA at baseline (adapted LAPAQ total score 0-23) and subsequent change in FEV1 in liters after 2 and 4 years in patients who were still under follow-up, adjusted for age, sex, smoking, exacerbations, comorbidity and BMI. Results: At baseline, patients had a mean FEV1 of 1.51 (p10: 0.80, p50: 1.45, p90: 2.27) and a mean PA score of 11.5 (p10: 5, p50: 11, p90: 19). After 2 years, FEV1 declined by 0.03 (SD 0.23) (n=339) and after 4 years by 0.13 (SD 0.26) (n=234). The adapted LAPAQ score was neither statistically significantly associated with changes in FEV1 after 2 years (regression coefficient 0.003, 95%CI -0.002 to 0.008) nor after 4 years (0.003, 95%CI -0-004 to 0.009). Conclusions: For patients still under follow-up after 2 and 4 years in our cohort study, FEV1 remained remarkably stable during the study period. PA at baseline was not found to a determinant of changes in FEV1.

Background: The performance of the 1-minute sit to stand (1-min STS) and handgrip strength tests as predictors of clinical outcomes in chronic obstructive pulmonary disease (COPD) has previously been assessed over a short-term follow-up (2 years) but has not been assessed over a longer time period. We examined the predictive performance of the 1-min STS and handgrip tests in regards to mortality, exacerbations and health-related quality of life (HRQoL). Methods: Patients (n=409) with COPD from a prospective cohort study in the Netherlands and Switzerland were followed for 5 years and were assessed with the 1-min STS and handgrip tests at baseline, and at 2 and 4 years. We fit Cox proportional hazards (mortality), negative binomial (exacerbations) and mixed linear (HRQoL) models, whilst adjusting for known predictors for each outcome. Results: The 1-min STS test was significantly associated with mortality (adjusted hazard ratio per 1 more repetition: 0.92, 95% CI 0.88 to 0.97; p=0.002), exacerbations (adjusted incidence rate ratio per 1 more repetition: 1.03, 95% CI 1.01 to 1.04; p Conclusions: The 1-min STS test is a good predictor of clinical outcomes in COPD patients over 5 years, whereas the handgrip test may not be as useful. The 1-min STS test may serve as a simple prognostic approach in the assessment of COPD patients.

Background: Exercise capacity is important for characterising COPD patients and determining prognosis of the disease. Currently, little is known about the potential determinants of a rapid decline in exercise capacity, which may put patients at risk of poor prognosis. We aimed to identify characteristics that predict a rapid decline in exercise capacity. Methods: Patients from a prospective cohort study in the Netherlands and Switzerland were followed for 5 years. Exercise capacity was assessed with the 1-minute sit-to-stand (1-min STS) test at baseline and after 4 years. We included all patients who were able to perform the 1-min STS test at baseline (n=371). Rapid decliners were identified as patients whose number of STS-repetitions decreased ≥25% over these 4 years. We identified potential determinants and fit logistic regression models with the outcome as rapid decliner or not. Results: 57 patients were identified as rapid decliners. Baseline characteristics found to be independently and significantly associated with a rapid decline in exercise capacity were age (OR: 1.07, 95% CI 1.02 to 1.13; p=0.01) and physical activity (Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ) score, OR: 0.42, 95% CI 0.27 to 0.66; p 1 % predicted were not associated with a rapid decline in exercise capacity. Conclusions: We identified two potential determinants of rapid exercise capacity decline as measured by the 1-min STS test in patients with COPD, which could assist in the assessment of patient prognosis and identify patients who may benefit from pulmonary rehabilitation.

Background: Although a large body of literature assessed the determinants of physical activity in patients with COPD, most of the studies were cross-sectional and focused on one or few determinants. We aimed to examine the determinants of physical activity using longitudinal models. Methods: In a prospective cohort study, 409 patients with COPD managed by general practitioners in the Netherlands or Switzerland were recruited and followed for 5 years. Patients completed a validated questionnaire (Longitudinal Aging Study Amsterdam Physical Activity Questionnaire) at baseline and every 6 months about their physical activity. We fitted linear mixed models to study the associations between predictors at baseline and physical activity (an adapted score on a 0-23 scale) across all study follow-up visits. Results: Unadjusted analysis suggested that there was a decrease in physical activity over time (coefficient = -0.22 per visit, 95% CI = -0.28, -0.17, p Conclusion: We identified in a cohort study several statistically significant determinants of physical activity in patients with COPD. It allows to identify patients who remain having low physical activity and who may benefit particularly from pulmonary rehabilitation that addresses the determinants of physical activity.