Prevalence and stability of physical frailty traits in patients with COPD refraining from PR participation - A 12-month prospective cohort study

<bold>Introduction:</bold> Physical frailty is common in COPD. Yet, the trajectory of physical frailty remains sparsely explored and specifically so in patients who refrain from PR. <bold>Aim:</bold> To investigate the prevalence and 12-month stability of physical frailty in patients with severe COPD who decline PR, and secondly to investigate the association of frailty with all-cause mortality. <bold>Methods:</bold> Patients underwent repeated assessment that included Short Physical Performance Battery (SPPB), physical activity (PAL) and capacity, respiratory symptoms, EuroQol 5D, pain, fatigue, and comorbidities. <bold>Results:</bold> 102 patients with COPD (61 females, mean±SD age 70±9 yr., FEV1 34±11 %, 6MWD 360±150 meters, PAL 1990 [IQR 800; 3675] step/day, CAT 19±7) were analyzed. Physical frailty (SPPB ≤ 7 points) was found in 41% and median SPPB score was 8 (IQR 5-10) at baseline. A 69% remained frail at 12-month follow-up, while 9% reversed to prefrail (8-9 points) and 22% died. A 48% who were prefrail (8-9 point) and 15% of the non-frail deteriorated to be physical frail at 12-month follow-up. In adjusted multinominal regression models, baseline frailty (OR 24.16 [95% CI 6.44; 90.70]), 30-seconds sit-to-stand (OR 0.68 [95% CI 0.57; 0.82]) and handgrip strength (OR 0.89 [95% CI 0.83; 0.96]) were independently associated with physical frailty at 12-month follow-up. Age adjusted odds ratio for mortality was increased but not statistically associated with physical frailty (OR 3.16 [95% CI: 0.84; 10.84]). <bold>Conclusion:</bold> Physical frailty is persistent after 12-month in COPD patients not participating in a PR program. Frailty was not statistically associated with 12-month all-cause mortality.