Increase in physical activity reduces chronic obstructive pulmonary disease mortality: an emulated target trial using nationwide cohort data

SESSION TITLE: Obstructive Lung Disease Posters 8 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Little is known about the impact of increased physical activity (PA) on mortality and exacerbation rates in patients who have not performed regular exercise before a chronic obstructive pulmonary disease (COPD) diagnosis. METHODS: This study emulated a target trial using data from the Korean Health Insurance System. We included COPD patients aged ≥40 years who were not performing regular PA before COPD diagnosis and who had at least one health screening visit before and after their COPD diagnosis between January 1, 2010 and December 31, 2018. The main exposure was regular PA, which was defined as vigorous PA on ≥3 days per week or moderate PA on ≥5 days per week. Primary and secondary endpoint was the all-cause mortality rate and initial severe exacerbation after COPD diagnosis, respectively. RESULTS: A total of 110,097 person-trials were included (27,564 PA increase and 82,533 control groups). No differences were observed between covariates after matching. The adjusted HR of all-cause mortality for PA increase group compared to the control group was 0.84 (95% CI: 0.79, 0.89). In subgroup analysis, patients >65 years, women, never smokers, or the higher CCI group showed a stronger effect of PA increase on reduced mortality than younger men, ever smokers, or the lower CCI group (p for interaction <0.05). The fully adjusted HR for the risk of severe exacerbation comparing the PA increase group to the control was 0.90 (95% CI: 0.87, 0.94). CONCLUSIONS: An increase in PA levels showed a potential to reduce mortality and exacerbation in patients with COPD, although personalized interventions and further clinical trials are necessary. CLINICAL IMPLICATIONS: This study emphasizes the importance of physical activity modification for patients with COPD and encourages healthcare providers to promote physical activity in real-world practice. The positive association between physical activity and COPD might lead to the integration of physical activity promotion into public health programs for patients with COPD. DISCLOSURES: No relevant relationships by Juhee Cho No disclosure on file for Danbee Kang No relevant relationships by Taeyun Kim No disclosure on file for Hyunsoo Kim No relevant relationships by Sunga Kong No relevant relationships by Hye Yun Park No disclosure on file for Sun Hye Shin