Study Validates Two Tools for Measuring Physical Activity in COPD Patients

The study, published in the journal 'Thorax', pooled data on more than 1,300 people from 17 countries in Europe and North America

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Physical activity is essential to improving health and quality of life in people with chronic obstructive pulmonary disease (COPD). A new study by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, has validated two tools used to measure levels of physical activity in patients with this lung disease: PROactive Physical Activity in COPD, in its daily (D-PPAC) and clinical visit (C-PPAC) versions.

Studies have shown that patients with COPD are less physically active than healthy people and that lower levels of physical activity are associated with an increased risk of exacerbations and mortality. Therefore, “measuring physical activity is essential to improving the prognosis of patients with this disease”, commented Judith Garcia-Aymerich, lead author of the study and head of the Non-Communicable Diseases and Environment Programme at ISGlobal.

The study, published in the journal Thorax, aimed to test the validity and responsiveness of D-PPAC and C-PPAC, which measure the experience of physical activity in people with COPD. These two instruments were developed as part of the European Union Innovative Medicines Initiative’s PROactive Project and approved by the European Medicines Agency as recognised tools for studying the effects of new pharmacological treatments.

D-PPAC and C-PPAC consist of a self-administered questionnaire and an activity monitor that collects information on both the amount and difficulty of physical activity. The instruments generate a final score on a scale of 0 to 100, where higher numbers indicate a more positive experience of physical activity.

The study pooled data from more than 1,300 patients (mean age 66 years) from seven randomised controlled trials in 17 countries in Europe and North America, covering a wide a range of COPD severity, ages, physical activity levels and clinical determinants. All of the trials recruited patients with COPD and invited them to complete one or two PPAC questionnaires. Physical activity data were also recorded using activity monitors.

“The study concluded that the D-PPAC and C-PPAC instruments are reliable and valid across gender, age groups, COPD severity, countries and languages, and that they are responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables,” commented Garcia-Aymerich.

The publication of the study marks the culmination of an international project that has spanned more than 10 years and brought together numerous public and private research institutions, patient associations and translational organisations around physical activity and COPD. It is the largest and most diverse population study to date and “will provide important information for the future use of these tools”, concluded Garcia-Aymerich.


Garcia-Aymerich J, Puhan MA, Corriol-Rohou S, de Jong C, Demeyer H, Dobbels F, Erzen D, Frei A, Gimeno-Santos E, Hopkinson NS, Ivanoff N, Karlsson N, Louvaris Z , Polkey MI, Rabinovich RA, Scuri M, Tabberer M, Vogiatzis I , Troosters T, Proactive consortium. Validity and responsiveness of the Daily- and Clinical visit PROactive Physical Activity in COPD (D-PPAC and C-PPAC) instruments. Thorax 2021.