S27 MRC grade 2: is there a difference in activity and exercise capacity between COPD and healthy controls?

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Abstract

Introduction

COPD patients are often assessed by MRC scale and comparisons made to a healthy population. MRC grade of a healthy population is not usually reported and assumed to be 1, however this may not be accurate. The characteristics of COPD individuals with MRC grade 2 aren't well defined and furthermore it has not been established if physical activity is impaired, compared to a similar healthy population.

Aim

To establish if there is a difference in activity and exercise capacity between COPD individuals and healthy controls, who all have assessed themselves as MRC grade 2.

Methods

We recruited 75 patients with COPD (prior to a rehabilitation intervention) and 22 healthy controls (target age 40–90 years), with a self-selected MRC of 2. They wore a SenseWear activity monitor (AM) for 12-waking hours for 2 weekdays. The AM records total energy expenditure (EE), step count and time spent above different MET levels. Demographic data were recorded, spirometry performed and participants completed 2 Incremental Shuttle Walk Tests (ISWT). Individuals with COPD completed an endurance shuttle walk test (set at 85% VO2 peak, measured from ISWT) which is used to prescribe a walking programme, while wearing AM to determine their prescribed METS level.

Results

Abstract S27 table 1 shows baseline characteristics and between group differences for COPD individuals (42 males) and healthy controls (10 males). Adjusting for baseline age, step count and ISWT remained significant, (ANCOVA, p<0.05). 9 (40.91%) healthy controls achieved the recommended 10 000 steps/day compared to only 6 (8.0%) COPD individuals. Although COPD individuals achieved more than 30 min of recommended moderate activity daily, they only achieved 24.07 (36.11) min of activity at an intensity above their individually prescribed METS level.

Conclusions

Exercise capacity and physical activity were significantly reduced in those with COPD compared to those with no respiratory disease, despite both groups categorising themselves as equally functionally limited on the MRC scale. This highlights the importance of interventions to increase physical performance for COPD individuals, especially for those who would not normally be referred to activity/exercise promotion schemes. Early intervention may help prevent the downward disability spiral commonly seen within respiratory disease and reduce functional decline.

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