LCADL Dyspnea Scale and Physical Activity in COPD Patients

Research Article

Austin J Musculoskelet Disord. 2014;1(1): 1006.

LCADL Dyspnea Scale and Physical Activity in COPD Patients

Carpes MF1, Castro AAM1, Simon KM2, Porto EF3, Fleig Mayer A4

1Physical Therapy Department at the Federal University of Pampa – UNIPAMPA – Rio Grande do Sul, Brazil

2Physical Therapy

3Physical Therapy Department at the Adventist University – UNASP – São Paulo, Brazil

4Physical Therapy Department at the University of the State of Santa Catarina – UDESC – Santa Catarina, Brazil

*Corresponding author: Marta Fioravanti Carpes, Federal University of Pampa, BR 472 - Km 592, PO Box 118, Uruguaiana, Rio Grande do Sul, Brazil

Received: August 03, 2014; Accepted: August 22, 2014; Published: August 25, 2014


Introduction: Chronic obstructive pulmonary disease (COPD) patients commonly present dyspnea as a limiting factor to activities of daily living (ADL) accomplishment. However, it might be possible that this limitation may be decreased with regular aerobic physical activity. The London Chest Activity Daily Living (LCADL) scale assesses COPD patient’s dyspnea during ADL accomplishment.

Objectives: Analyze if there is an association between the LCADL dyspnea scale and aerobic physical activity in COPD patients.

Methods: The overall LCADL score was calculated summing the five domain scores, Body Mass Index (BDI) and airflow limitation (FEV1). Patients were grouped according to their current physical activity profile and were classified as Physically Active (PA) and Physically Inactive (PI).

Results: Out of 38 patients, 15 (39.47%) were considered physically active (PA) and 23 (60.53%) physically inactive (PI). PA patients presented mean values for the BMI of 24.5 ± 4.2, for FEV1 of 40.7 ± 11.7, for LCADL total score of 21.0 ± 13.6 and LACDL predicted value (%) of 35.5 ± 16.7. PI patients presented mean values for BMI of 23.5 ± 4.4, for FEV1 of 33.7 ± 11.4, for LCADL total score of 32.8 ± 15.1 and LACDL predicted value (%) of 53.14 ± 19.5. LCADL score was worse in the PI than in the PA patients (p=0.015).

Conclusion: Physical inactivity contributes to higher scores in the LCADL scale which is associated to higher scores of dyspnea perception during activities of daily living accomplishment.

Keywords: COPD; Physical activity; Dyspnea; Activities of daily living


Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable respiratory impairment characterized by non-reversible airflow obstruction. Airflow obstruction is progressive and it is associated with an abnormal inflammatory response in the lungs due to toxic gases and particles, especially caused by tobacco use [1].

Chronic pulmonary obstruction leads to pulmonary mechanics changes [2] that contribute to dynamic hyperinflation and dyspnea in COPD patients [3-10]. Specially, this mechanism can be seen during high-intensity exercise tests or even during simple activities of daily living [8-24]. Therefore, patients with increasing dyspnea [18] present lower levels of physical activity performed [24].

The London Chest Activity Daily Living (LCADL) scale is frequently used to analyze dyspnea limitation during exercises and Activities of Daily Living (ADL) accomplishment in COPD patients [25]. Comprehensive exercise training has already been proven to diminish referred dyspnea during common ADL COPD patients accomplishes [5]. Therefore, regular physical activity promotes pulmonary and systemic benefits for COPD patients [18,26,27], such as the increase of muscular vessels, oxidative enzymes and mitochondrias [3-19,28,29]. Those changes contribute to increased body composition, peripheral muscle strength, exercise capacity and decreased dyspnea in COPD patients [11].

Nevertheless, it is not fully understood if the aerobic physical activity may influence on COPD patients perceived dyspnea. Therefore, we aimed to analyze the perceived dyspnea within physically active and inactive COPD patients.

Materials and Methods

This was a retrospective study with 166 patients comprised from the Clínica Médica Espaço Vital database. The study was analyzed and approved by the Ethics Committee of the Vale do Itajaí University (n° 393/09). Physical activity practices, age, smoking history, Body Mass Index (BMI), forced expiratory volume in the first second (FEV1) and LCADL score were the measured variables.

The inclusion criteria were COPD diagnosis (FEV1/FVC<0.7 and FEV1<80% predicted), smoking history over 20 packs/year and clinical stability within the past month prior to the initial assessment.

Exclusion criteria were inability to perform any study’s assessments, disease exacerbation during the protocol, having any associated disease that might have limited physical practice, being part of any supervised muscular training program and not have signed a written consent.

The final sample consisted of 38 COPD patients that were eligible according to our study inclusion/exclusion criteria.


At first patients were taught they were being submitted to the protocol and were asked to sign an informed consent. Afterwards the Body Mass Index (BMI), physical activity, spirometry and dyspnea were measured.

Body mass index (BMI)

Height and weight were measured on a weighting scale (Filizola®, São Paulo, Brazil). BMI was calculated using the formula: weight/ height [2,30].

Physical activity

Patients were asked if they practiced any physical activity. Patients were considered Physically Active (PA) when they practiced moderate or intense level of physical activity throughout a 30 minutes period every day or for three days per week, respectively. Moderate or intense level of PA was defined according to the amount of load bared by patients during exercise; this amount corresponded to over 60% of the maximum load achieved in a Cardiopulmonary Exercise Test (CPET) previously performed by a trained physical therapist or athletic trainer [10]. Patients who were part of a pulmonary rehabilitation program or any other regular physical activity program were excluded since this is a health care supervised type of exercise.


Spirometry was carried out according to the American Thoracic Society (ATS) guidelines. Bronchodilator challenge was made after fifteen minutes after patients inhaled 400 mcg of albuterol [31,32].

Activities of daily living (ADL) and dyspnea

Dyspnea and ADL limitation was measured by means of the LCADL. This scale in composed of 15 questions within four domains: personal care, domestic activities, physical activity and leisure. Every item of the domains is to score from zero to five. The highest the value the higher is the inability to accomplish any ADL due to excessive dyspnea. LCADL total score may range from 0 to 75 points [5,25].

Statistical analysis

The Kolmogorov-Smirnov test was used to identify sample normality and its distribution was found to be parametric. Therefore data for age, pack/years, BMI, FEV1 and LCADL are described as mean ± standard deviation and percentage value of the LCADL. Differences of these variables between groups PA and PI were obtained by using the non-paired Student`s t test. In order to test the proportional variation between physical activity and LCADL scores the Qui-squared test was used. A p≤0.05 was considered as statistical significant.


Out of 38 recruited patients, 24 (63%) were male and 14 (37%) were female. Overall baseline characteristics of patients are displayed on Table 1.