Exercise Capacity and Balance in Patients with Anemic and Non-Anemic Chronic Obstructive Pulmonary Disease (COPD)

Sarayoot Mongkol; Tichaporn Sookkua; Sukanya Kreeinthong

Authors

Sarayoot Mongkol Faculty of Physical Therapy, Saint Louis College
Tichaporn Sookkua Faculty of Physical Therapy, Saint Louis College
Sukanya Kreeinthong Faculty of Physical Therapy, Saint Louis College

Keywords:

Chronic obstructive pulmonary disease (COPD), anemia, six-minute walk test (6MWT), Timed Up and Go (TUG)

Abstract

Chronic obstructive pulmonary disease (COPD) is a major public health problem associated with functional decline and reduced quality of life. Anemia is a common comorbidity in COPD and may further worsen physical performance, potentially increasing healthcare utilization and fall risk. The aim was to compare exercise capacity and balance performance among healthy individuals, non-anemic COPD patients, and anemic COPD patients. A cross-sectional study was conducted in 120 participants allocated into three groups: healthy controls (n = 40), non-anemic COPD patients (n = 40), and anemic COPD patients (n = 40). Exercise capacity was evaluated using the six-minute walk test (6MWT), and balance performance was assessed using the Timed Up and Go (TUG) test. Pulmonary function was measured by spirometry. Data were analyzed using one-way ANOVA with Bonferroni post hoc comparisons. The anemic COPD group demonstrated significantly shorter six-minute walk distance and longer TUG completion time compared with both non-anemic COPD patients and healthy controls (p < .05). Pulmonary function parameters were significantly lower in both COPD groups compared with controls, but did not differ between anemic and non-anemic COPD patients. Anemia is associated with additional functional limitations in COPD patients independent of airflow obstruction. Routine screening and integrated management of anemia may improve functional outcomes and support more effective rehabilitation planning in COPD care.

References

Alisamir, M., Ebrahimi, M., & Rahim, F. (2022). Anemia in chronic obstructive pulmonary disease: A systematic review. Respiratory Investigation, 60(4), 510-521. https://doi.org/10.1016/j.resinv.2022.03.006

Garcia-Pachon, E., & Padilla-Navas, I. (2024). The impact of anemia on long-term mortality in hospitalized patients with exacerbation of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 19, 2229-2237. https://doi.org/10.2147/COPD.S469627

Graham, B. L., Steenbruggen, I., Miller, M. R., Barjaktarevic, I. Z., Cooper, B. G., Hall, G. L., Hallstrand, T. S., Kaminsky, D. A., McCarthy, K., McCormack, M. C., Oropez, C. E., Rosenfeld, M., Stanojevic, S., Swanney, M. P., & Thompson, B. R. (2019). Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. American Journal of Respiratory and Critical Care Medicine, 200(8), e70-e88. https://doi.org/10.1164/rccm.201908-1590ST

Han, L., Li, P., He, Q., Yang, C., Jiang, M., Wang, Y., Cao, Y., Han, H., Liu, X., & Wu, W. (2023). Revisiting skeletal muscle dysfunction and exercise in chronic obstructive pulmonary disease: emerging significance of myokines. Aging and Disease, 15(6), 2453. https://doi.org/10.14336/AD.2023.1125

Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M., Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E., ... Singh, S. J. (2014). An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. European Respiratory Journal, 44(6), 1428-1446. https://doi.org/10.1183/09031936.00150314

Langefeld, K. (2024). Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2024/02/GOLD-2024_v1.2-11Jan24_WMV.pdf

Loughran, K. J., Atkinson, G., Beauchamp, M. K., Dixon, J., Martin, D., Rahim, S., & Harrison, S. L. (2020). Balance impairment in individuals with COPD: a systematic review with meta-analysis. Thorax, 75(7), 539-546. https://doi.org/10.1136/thoraxjnl-2019-213608

Mesquita, R., Wilke, S., Smid, D. E., Janssen, D. J., Franssen, F. M., Probst, V. S., Wouters, E. F. M., Muris, J. W. M., Pitta, F., & Spruit, M. A. (2016). Measurement properties of the Timed Up & Go test in patients with COPD. Chronic Respiratory Disease, 13(4), 344-352. https://doi.org/10.1177/1479972316647178

Ucgun, H., Kaya, M., Ogun, H., & Denizoglu Kulli, H. (2024). Exploring balance impairment and determinants in chronic obstructive pulmonary disease: a comparative study with healthy subjects. Diagnostics, 14(14), 1489. https://doi.org/10.3390/diagnostics14141489

World Health Organization. (2024). Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. https://www.who.int/publications/i/item/9789240088542

Xiang, Y., & Luo, X. (2024). Extrapulmonary comorbidities associated with chronic obstructive pulmonary disease: A review. International Journal of Chronic Obstructive Pulmonary Disease, 19, 567-578. https://doi.org/10.2147/COPD.S447739