Volume 140, Issue 2, Pages 331-342 (August 2011) Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD  Benjamin Waschki, MD, Anne Kirsten, MD, Olaf Holz, PhD, Kai-Christian Müller, PhD, Thorsten Meyer, PhD, Henrik Watz, MD, Helgo Magnussen, MD  CHEST  Volume 140, Issue 2, Pages 331-342 (August 2011) DOI: 10.1378/chest.10-2521 Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 1 Kaplan-Meier survival curves according to World Health Organization categories of physical activity level (PAL). A higher 4-year risk of mortality was observed for sedentary patients (PAL, 1.40-1.69 [dashed line]; log-rank P = .002) and very inactive patients (PAL < 1.40 [solid line]; log-rank P < .001) than for active patients (PAL ≥ 1.70 [dotted line]). Number of deaths and corresponding total number of patients per category were 20 and 65, respectively, for very inactive patients; 6 and 67, respectively, for sedentary patients; and 0 and 37, respectively for active patients. df = degrees of freedom. CHEST 2011 140, 331-342DOI: (10.1378/chest.10-2521) Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 2 Comparison of the relative risk of death associated with physical activity and established predictors of mortality. After adjustment for age and sex, the relative risk was calculated for each one-half SD increase (+) or decrease (–) in continuous predictors and for each 1-point increase in categorized scores. The ADO index already includes the effect of age and was adjusted for sex only. MMRC dyspnea grade was multiplied by 2. All predictors were distributed within a range of 9 to 11 integral numbers or score points. The relative risk of mortality was calculated from hazard ratios (HRs) shown in Table 2 as follows: for HRs < 1.00, [(1/HR) – 1] × 100%; for HRs > 1.00, (HR – 1) × 100%. Values were missing for fat-free mass index (n = 5). ADO = age, dyspnea, and airflow obstruction; BODE = BMI, airway obstruction, dyspnea, and exercise capacity; IC/TLC = inspiratory to total lung capacity ratio; MMRC = modified Medical Research Council; SGRQ = St. George Respiratory Questionnaire. CHEST 2011 140, 331-342DOI: (10.1378/chest.10-2521) Copyright © 2011 The American College of Chest Physicians Terms and Conditions

Figure 3 Receiver operating characteristic curves for the BODE index, the ADO index, and the composite of PAL, adiponectin level, and ABI as predictors of mortality in patients with COPD. The corresponding areas under the curves for the composite of PAL, adiponectin level, and ABI; the BODE index; and the ADO index were 0.85, 0.76, and 0.75, respectively. ABI = ankle-brachial index. See Figure 1 and 2 legends for expansion of other abbreviations. CHEST 2011 140, 331-342DOI: (10.1378/chest.10-2521) Copyright © 2011 The American College of Chest Physicians Terms and Conditions