Leisure-Time Physical Activity and Mortality in Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study
Leisure-time physical activity was associated with lower all-cause, cardiovascular, and cancer mortality in adults with chronic obstructive pulmonary disease.
*Retrospective cohort study; Level 2b (OCEBM).
Citation
Wang CC, Chen YY, Yen YF, et al. Leisure-Time Physical Activity and Mortality in Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study. Archives of Physical Medicine and Rehabilitation. 2026;107:1716-1722.
Background
Chronic obstructive pulmonary disease is a major cause of death and disability. Physical activity is known to improve health, but its relationship with specific causes of death in this population is less clear.
Patients
6,584 Taiwanese adults older than 18 years with chronic obstructive pulmonary disease identified from national survey and insurance data. Excluded: 185 people with missing physical activity data.
Intervention
Any leisure-time physical activity, categorized as 0 to less than 800, or at least 800 metabolic equivalent minutes per week.
Control
No leisure-time physical activity.
Outcome
All-cause mortality and cause-specific mortality from cardiovascular disease, respiratory disease, infection, and cancer.
Follow-up Period
Mean 11.1 years; data followed through December 31, 2021.
Results
| Physical activity level | All-cause mortality | Cardiovascular mortality | Cancer mortality |
|---|---|---|---|
| 0 to <800 metabolic equivalent minutes/week | Adjusted hazard ratio 0.84 (95% CI, 0.73-0.96) | Adjusted hazard ratio 0.53 (95% CI, 0.39-0.73) | NS |
| ≥800 metabolic equivalent minutes/week | Adjusted hazard ratio 0.62 (95% CI, 0.54-0.72) | Adjusted hazard ratio 0.47 (95% CI, 0.33-0.65) | Adjusted hazard ratio 0.63 (95% CI, 0.48-0.84) |
CI = confidence interval; NS = not statistically significant. Metabolic equivalent minutes estimate activity intensity multiplied by time.
Results were adjusted for demographics, smoking, alcohol use, diet, and major comorbidities. A dose-response pattern was observed.
Limitations
Observational design cannot prove causation. Physical activity was self-reported only at baseline. Disease severity, lung function, disease duration, medication use, and exacerbation history were unavailable, leaving risk of residual confounding and reverse causation.
Funding
No funding reported; no disclosures.
Clinical Application
Encourage feasible leisure-time activity in chronic obstructive pulmonary disease; this supports existing advice but does not define an exact prescription.
Discussion
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In this retrospective cohort study, higher leisure-time physical activity in COPD was associated with lower all-cause mortality (≥800 MET-min/wk adjusted HR 0.62 vs none); given the nonrandomized design, how valid and applicable is this association for changing exercise counseling? In this retrospective cohort study, patients with COPD reporting ≥800 MET-min/wk of leisure-time physical activity had an adjusted HR of 0.62 for all-cause mortality compared with inactive patients. What is the best interpretation?