Author
Summary: Prof. Gratiana Steinkamp, as published in Alpha1 Journal 1/2023.
The term physical activity describes what one actually does each day. Medical professionals understand capacity to mean what one is capable of doing or what one could physically accomplish. This doesn't mean that one actually does it. It is clear, however, that a lot of activity leads to better capacity. Medical rehabilitation aims to improve capacity in the long term. Maintaining good capacity is a lifelong task for everyone, and especially for those with chronic illnesses.
The influence of exercise on health and illness
How quickly a lack of physical activity affects your capacity becomes apparent when you've had to spend a few days in bed due to illness. When you get up for the first time afterward, your legs feel wobbly. You've lost muscle mass from lying down. In cases of severe illness, up to 1 kg of muscle can be lost per day. Considering that women have an average of about 30 kg and men around 35 kg of muscle mass, 1 kg is a considerable amount. The COVID-19 pandemic has shown that it can take a while to regain your previous level of performance.
While humans have continued to evolve in terms of thought and inventions, the amount of physical activity has decreased drastically: while Stone Age people covered distances of around 30 km per day, this figure had dropped to only about 15 km per day by the 19th century. Nowadays, most of our time is spent sitting, and many people walk only 1 km a day.
The World Health Organization (WHO) recommends two and a half hours of physical activity per week as a physical activity goal. In its October 2022 report, the WHO details how prevalent physical inactivity has become. Approximately 80 percent of adolescents and 60 percent of those over 70 are not physically active enough; the situation is slightly better for other adults, at 60 percent. Germany fares worse than its neighbors. In poorer countries, lack of exercise is a much less common problem than in wealthier ones. Furthermore, the average daily step count decreased by a third due to the COVID-19 pandemic. This, too, has contributed to the pandemic's negative impact on health.
A British study with 80,000 participants demonstrates the significant role physical activity plays in long-term health. Their daily step count was continuously recorded over seven days using a reliable fitness tracker (accelerometer). Seven years later, researchers analyzed how many individuals had died since the start of the study and the documented causes of death. A clear correlation emerged between mortality and the number of daily steps: the more steps taken, the lower the subsequent mortality rate. This held true for daily steps up to 10,000; beyond that, overall mortality remained roughly the same. High activity levels reduced mortality from both cardiovascular disease and cancer. A protective effect of regular exercise was also demonstrated for Alzheimer's disease.
Measuring movement
The first pedometer was developed in Japan in 1964. Even then, 10,000 steps per day were recommended. Nowadays, there are other ways to measure movement. Most cell phones have built-in pedometers. However, they can only fully record activity if the phone is constantly carried on the body. Fitness trackers or watches are therefore more informative. Using the number of steps taken, doctors determine the activity level; those who take fewer than 5,000 steps per day are considered "inactive.".
You can motivate yourself to be more active by setting clear goals. For example, being able to dress yourself again, resuming a former hobby, or having your clothes fit better. Having a dog is a great motivator to leave the house and go for a walk several times a day. Many seniors also look after their grandchildren and are more physically active doing so than when alone. Joining a pulmonary rehabilitation program and exercising with others also brings more activity into everyday life. Everyone should do what they enjoy and what is good for them. A training plan must be tailored to the individual's needs and adapted accordingly.
rehabilitation
A rehabilitation program encompasses several different facets. Endurance and strength training is just one aspect. Experts from various professional groups work with their patients in the areas of physiotherapy, relaxation, education, mental health, nutrition, and occupational therapy. The rehabilitation clinic also conducts comprehensive diagnostics to document the patient's current condition. Doctors and therapists also optimize medication and/or oxygen therapy.
The indications for pulmonary rehabilitation were defined in guidelines 10 years ago. These include chronic conditions such as shortness of breath or reduced exercise tolerance, but also a reduced quality of life or psychosocial problems that can arise as a result of the lung disease.
In some scientifically monitored rehabilitation programs, muscle tissue samples have been examined. These studies show that not only is the mass of muscle cells reduced, but this can also affect the function of the muscle fibers. Specifically in AATD (Alpha Type I Dysfunction), it seems difficult to increase the number of type I muscle fibers, responsible for endurance, through training. Rehabilitation has a greater effect on type IIA muscle fibers, which generate muscle strength. Researchers have found differences in the response of COPD and Alpha1 patients in studies, suggesting that the training program may need to be more precisely tailored. An individually customized training program can demonstrate convincing and lasting results, as illustrated by the case study of one patient. It is important to remain physically active after rehabilitation to prevent the progress made. Minimizing sitting and lying down in everyday life and increasing movement is beneficial for health.
„"The KAIA COPD app was developed specifically for COPD patients and runs on smartphones or tablets."“
Digital health applications (DiGA): The KAIA COPD app, developed specifically for COPD patients, runs on smartphones and tablets. It has been recognized as a DiGA by the Federal Institute for Drugs and Medical Devices and can be prescribed by a general practitioner. With the prescription, you contact your health insurance provider and receive a QR code. This code activates the app, which you download from the internet. The activation is valid for three months and must be renewed in the following quarter.
The KAIA COPD app has three pillars: physical training, breathing techniques, and information. While exercising, users can record themselves with their phone's camera. The programmed artificial intelligence recognizes whether the exercise is being performed correctly and provides feedback with recommendations if necessary. This works almost as well as being present with a sports therapist. Using diagnostic tests such as the stand-up test or the toe-reach test, the app assesses the user's fitness level at the beginning of the workout.
In a study, the KAIA COPD app was tested on patients discharged from pulmonary rehabilitation. Those who used the app for six months were able to maintain their step count at home, the same level they had reached at the end of their rehabilitation. In contrast, a control group experienced a significant drop in step count after six months, from 5,000 to 3,100 steps per day. Patients who used the app at least four times a week were even able to increase their step count by an additional 1,000 steps per day. The app-user group also demonstrated stable health-related quality of life, while the other patients experienced a decline. Thus, the KAIA COPD app has been proven to help maintain the positive effects of rehabilitation over six months. This digital COPD therapy via smartphone app provides a useful health companion for everyday life.
Telemedicine
In the USA, a telemedicine rehabilitation concept for COPD patients has been developed. There, the smartphone facilitates contact between the patient and the doctor or physiotherapist. The patient's exercises, including equipment training, are directly observed and commented on by the therapist.
The benefits of this program were tested on 80 COPD patients who had been hospitalized due to an exacerbation. After discharge, three telemedicine appointments per week were intended to prevent further exacerbations. In the first 30 days after discharge, 18 patients in the control group required readmission, while only 6 patients in the telemedicine training group required readmission. Here, too, the health of people with lung disease was stabilized through the use of modern digital technologies. A similar program, PneumoFactory, was developed in Germany.
Ultimately, every rehabilitation program should be individually tailored to the patient. Doctors and therapists suggest measures, and the patient decides what suits them best. Even as COPD medications become increasingly effective, non-pharmacological methods continue to make a significant contribution. Apps and telemedicine are new components that patients can incorporate into their individual programs.
