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Simple physical performance measures in patients with COPD

Current international recommendations for COPD advise multi-component assessments of disease severity not solely the Forced Expiratory Volume in one second (FEV1) (1). It is well established that the extra-pulmonary manifestations of COPD, such as lower limb skeletal muscle impairment, contribute to symptoms, exercise limitation, and reduced health-related quality of life.

In gerontology, simple physical performance measures such as the four metre gait speed or the five repetition sit to stand tests, are measured as part of a comprehensive geriatric assessment (2). A meta-analysis of cohort studies confirmed a strong association between the four metre gait and survival in older adults (3).

In this podcast, Dr William Man, Consultant Respiratory Physician, Royal Brompton and Harefield NHS Foundation Trust, London UK is interviewed by Dr Rachael Evans. Dr Man is internationally recognised for his research in COPD and Pulmonary Rehabilitation. Dr Man discusses simple lower limb physical performance measures in patients with COPD, including the psychometric properties, their role in phenotyping patients regarding sarcopenia and frailty, and their potential clinical utility, drawing on evidence in COPD from his research group and others, but also the gerontology literature.

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  1. Global Strategy for Diagnosis, Management, and Prevention of COPD - 2016, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. Available from: www.goldcopd.org
  2. Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342:1032.
  3. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011; 305:50.
  4. Kon SS, Jones SE, Schofield SJ, et al Gait speed and readmission following hospitalisation for acute exacerbations of COPD: a prospective study.Thorax. 2015 Dec;70(12):1131-7. 
  5. Kon SS, Canavan JL, Nolan CM, et al. The 4-metre gait speed in COPD: responsiveness and minimal clinically important difference. Eur Respir J. 2014 May;43(5):1298-305
  6. Jones SE, Kon SS, Canavan JL, et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax. 2013 Nov;68(11):1015-20.
  7. Kon SS, Patel MS, Canavan JL, et al. Reliability and validity of 4-metre gait speed in COPD. Eur Respir J. 2013 Aug;42(2):333-40. 
  8. Karpman C, Lebrasseur NK, Depew ZS, et al. Measuring gait speed in the out-patient clinic: methodology and feasibility. Respir Care. 2014 Apr;59(4):531-7.
  9. Singer JP, Diamond JM, Gries CJ, et al. Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation. Am J Respir Crit Care Med 2015;192(11):1325-34.