Study Examines Link Between Pain and Exercise in COPD

Asturias, Spain, young woman training in gym on a treadmill, legs section
A study found a high prevalence of pain in a cohort of veterans with COPD interested in physical activity and that physical activity could decrease pain in COPD.

A significant association between pain and decreased exercise capacity was identified in people with chronic obstructive pulmonary disease (COPD) who were interested in exercising, according to findings published in BMC Pulmonary Medicine. The findings also demonstrated a high prevalence of pain among these patients.

Although optimal medical management is available for people with COPD, physical and psychological symptom burden remains a challenge, and pain remains a common but underappreciated symptom in this patient population.

In this study, investigators conducted a retrospective secondary analysis combining cohorts from 3 previous studies of patients in the Veterans Affairs Boston Healthcare System. The study aimed to assess the prevalence of pain in people with COPD who are ready to partake in physical activity; determine the cross-sectional and longitudinal links between pain, exercise capacity, and physical activity; analyze the effects of a web-based pedometer-mediated physical activity intervention on pain; and determine the effect of pain on the response to physical activity intervention.

A total of 375 veterans (98% men; mean age, 70 years) interested in engaging in physical activity from the 3 study cohorts were included in the analysis. At baseline, participants had a percent predicted forced expiratory volume in 1 second (FEV1) of 59±21 and a BMI of 29±6 kg/m2. The average 6-minute walk test (6MWT) distance was 376±96 m, and daily step counts were 3167±2364 steps per day. No significant differences in age, percent predicted FEV1, and body mass index were noted among the 3 cohorts.

 Among participants, 83% reported at least mild pain and/or at least some interference with activity due to pain at enrollment. Scoring for pain ranged from 0 to 100, with 100 denoting no pain and 0 denoting very severe pain that caused extreme interference with activity. The average body pain score was 60±26 points.

Greater bodily pain was found to be associated with lower 6MWT distance (P=.0013) and longitudinally, exacerbated bodily pain was linked to a decline in 6MWT distance (P=.0312). However, no association was found between baseline bodily pain and baseline daily step counts. There was also no association between changes in physical activity and either baseline bodily pain or change in bodily pain.

Bodily pain scores improved with the physical activity intervention compared with usual care (P =.0054); however, pain scores did not influence the effect of the physical activity intervention on daily step counts.

“Identifying and treating pain should be routine parts of exercise counseling in COPD,” the investigators concluded, adding that their technology-based physical activity intervention might represent a nonpharmacological treatment for pain.


Raphaely RA, Mongiardo MA, Goldstein RL, Robinson SA, Wan ES, Moy ML. Pain in veterans with COPD: relationship with physical activity and exercise capacity. BMC Pulm Med. 2021;21(1):238. doi:10.1186/s12890-021-01601-8