Newsletter Article

Physical Activity in COPD Patients

April 2016

According to the latest estimates by the World Health Organization, Chronic obstructive pulmonary disease (COPD) affects over 64 million people.[1] They predict that COPD will be the world’s third leading cause of death by 2030. Patients who have been hospitalized due to an acute exacerbation of COPD have a rehospitalization rate of 25% and a death rate of 21% within a year.[2]

In a study on patients hospitalized due to COPD, physical activity was assessed after discharge and during outpatient visits.[3] Patients were classified based on moderate to vigorous physical activity (MVPA) levels and were considered to be either inactive, insufficiently active, or sufficiently active. One year after their hospitalization, patients who were insufficiently active had a 28% lower risk of death compared to patients that were inactive. Patients that were sufficiently active had a 47% lower risk of death compared to patients that were inactive. The insufficiently active group had MVPA of 1-149 minutes per week. This shows that even a small amount of exercise can help improve the chance of survival for COPD patients.

Some COPD patients experience chronic lung inflammation, which can cause further difficulty in breathing. This inflammation causes a measurable change in C-reactive protein levels in the blood. A recent study on COPD patients measured inflammation over time using C-reactive protein levels in the blood.[4] Researchers found that increases in physical activity were not associated with a reduction in all-cause mortality for the entire group, but for those with chronic inflammation, for every 60 min increase in physical activity there was a 31% reduced risk in mortality.

A growing body of research suggests that increases in physical activity can help prevent rehospitalization or death in patients with COPD. Although even small amounts of activity can be beneficial, greater increases in both time and intensity appear to be most effective.


Artichokes are really flower buds that are harvested and eaten before they begin to open. If left undisturbed, an artichoke will bloom into a large pink or purple flower with many thin spiky petals. Artichokes first appeared in the historic record when the Greek philosopher Theophratus (371-287 B.C.) mentions them being grown in Italy and Sicily.[5]

Artichokes possess several properties that may help reduce cholesterol.[6] First, they are a good source of dietary fiber, which binds to LDL and lowers overall cholesterol numbers. Second, artichokes contain the bitter compounds cynarin and sesquiterpene-lactones. These can inhibit cholesterol synthesis and also increase cholesterol excretion in the bile. Artichokes are also a very good source of Vitamin K, which plays roles in neuronal and bone health.

Artichokes are typically prepared by boiling upside down in water. Once cooked, the leaves can be removed and the soft lower part can eaten by scraping across the teeth. Underneath the leaves and near the stem is the heart of the artichoke. This tastes very similar to the leaves, but it is much larger piece that can be eaten plain, marinated, or prepared in a dish.

Simply Delicious Artichokes

4 artichokes
1/4 cup plus 1 teaspoon salt
1 lemon, halved, plus 2 tablespoons lemon juice
12 tablespoons (1 1/2 sticks) unsalted butter

In a large pot, bring 3 quarts of water and 1/4 cup of the salt to a boil. Place the artichokes on a cutting board and trim the stem ends off until the bottom is flat so the artichokes can sit upright. Cut the top third from each artichoke and discard. With kitchen scissors, cut and discard the pointed tip from each of the remaining outer leaves. Rub the cut areas with the lemon halves. Squeeze any remaining juice from the lemon halves and add the juice and lemon halves to the boiling water.

Using a slotted spoon, carefully add the artichokes to the boiling water. Top with a heavy pot lid, reduce heat, and cook at a slow boil until the artichokes are tender, about 20-30 minutes. With oven mitts or potholders, carefully remove the lid and transfer the artichokes to a colander set in a sink. Turn each artichoke upside down, which allows the water to drain, and until cool enough to handle.

To make the lemon-butter sauce, melt the butter over medium heat in a small saucepan. Add the remaining 2 tablespoons of lemon juice and the remaining teaspoon of salt, and stir to combine. Remove the lemon-butter sauce from the heat and transfer to small dipping bowls to serve with the artichokes.Serve the artichokes either warm or cold.

Recipe from


Athletes train for years to perfect their skills in their chosen sport. In nearly all sports, the primary physical requirements are strength and power. Periodization is specific method of strength training designed to optimize athletic performance and reduce the risk of injury.

A periodization model is divided into three types of training: hypertrophy, strength, and power resistance sessions. The traditional periodization model uses only one type of training for every session over a long period of time.[7] These phases are performed by first using high-volume and low-intensity training (hypertrophy), followed by training using less volume at a higher intensity (strength and power), and ending with low-volume and high-intensity training (peaking). This traditional model that uses an increase in intensity and weight is known as linear periodization. This type of training was originally done by performing each phase for months at a time. Studies have shown that varying these phases more often than months at time are better at increasing muscle size, strength, and power.[8]

Daily undulating periodization uses a different training phase during each session. The typical order is a day of hypertrophy, followed by a day of strength, and followed by a day of power. A study varied this model by adjusted the order to hypertrophy, power, and strength (HPS).[9] While much of the research on periodization has used untrained subjects, this study used college-aged powerlifters, which makes it more relatable to an athletic population. The HPS group had significantly greater increases in 1RM bench press. The effect sizes showed meaningful differences for 1RM squat and 1RM bench press for the HPS group as well.

Varying the volume and intensity can result in greater improvements than a normal resistance training program and manipulating the order of these days can create even better results.

Health Matters is written by Lindsey Guthrie, MS, RD, LD/N and Tyler Guthrie, MS, CSCS.


  1. World Health Organization. Chronic obstructive pulmonary disease (COPD).
  2. American Journal of Managed Care. Physical Activity Tied to Lower Risk of Mortality After COPD Hospitalization.
  3. Moy ML, Gould MK, Liu IA, Lee JS, Nguyen HQ. Physical activity assessed in routine care predicts mortality after a COPD hospitalization. ERJ Open Research. 2016; 2(1): 000062.
  4. Loprinzi PD, Walker JF. Increased daily movement associates with reduced mortality among COPD patients having systemic inflammation. International Journal of Clinical Practice. 2016; 70: 286.
  5. What’s Cooking America . History of Artichokes.
  6. Nutrition and You. Artichoke Nutrition Facts.
  7. Issurin VB. New Horizons for the Methodology and Physiology of Training Periodization. Sports Medicine. 2010; 40(3): 189.
  8. Simao R, Spineti J, de Salles BF, et al. Comparison Between Nonlinear and Linear Periodized Resistance Training: Hypertrophic and Strength Effects. Journal of Strength and Conditioning Research. 2012; 26(5): 1389.
  9. Zourdos MC, Jo E, Khamoui AV, et al. Modified daily undulating periodization model produces greater performance than a traditional configuration in powerlifters. Journal of Strength and Conditioning Research. 2016; 30(3): 784.