The Effect of Exercise on Systemic Inflammation in Veterans With COPD and OSA
The Effect of Exercise on Systemic Inflammation in Veterans With COPD and OSA
The overlap syndrome (OS), i.e. the association of both Chronic Obstructive Pulmonary Disease
 (COPD) and Obstructive Sleep Apnea (OSA) in a single Veteran, is prevalent and associated
 with increased cardiovascular disease (CVD) morbidity. Home-based exercise interventions that
 translate to a lifestyle with increased physical activity (PA) are an ideal strategy as 150
 minutes of leisure time PA a week is associated with a significant reduction in risk of CVD
 related events and death. This novel research study will help develop a home exercise
 intervention that is largely accepted by OS Veterans, as a first step toward implementing PA
 into the routine medical care of the large Veteran population with COPD and OSA. This data
 will be used for larger studies on CVD risk and its modification with exercise in OS, a
 research area that is urgently needed given its high impact on Veterans' morbidity, mortality
 and health-care associated costs.
The term "overlap syndrome" (OS) is used to describe the association of both chronic
 obstructive pulmonary disease (COPD) and obstructive sleep apnea disease (OSA) in a single
 Veteran. Given the high prevalence of both COPD and OSA, it is expected that a third of
 Veterans with OSA could be affected by OS. Importantly, Veterans with OS have a higher
 cardiovascular morbidity and mortality than either OSA or COPD-only Veterans, likely due to
 worse nocturnal hypoxia and subsequent inflammation and endothelial dysfunction. Therefore,
 therapy for Veterans with OS that decreases cardiovascular disease (CVD) by targeting
 inflammation is a high priority. Home-based exercise interventions that translate to a
 lifestyle with increased physical activity (PA) are an ideal strategy as 150 minutes of
 leisure time PA a week is associated with reduction in risk of CVD-related events and death.
 Further, PA decreases biomarkers of systemic inflammation. However, no data is available on
 the effect of exercise on biomarkers of systemic inflammation in Veterans with OS. It is
 difficult to increase the leisure time PA in adults with COPD and OSA as this population is
 more sedentary due to a combination of increased obesity, daytime sleepiness and dyspnea.
 Therefore, home-based exercise would be ideal for these Veterans. The objective of this
 proposal is to conduct a single arm 12-week home-based exercise pilot intervention to
 determine the effect on biomarkers of systemic inflammation in 50 Veterans with OS on CPAP.
 The investigator hypothesizes that 1) Baseline PA intensity and duration will correlate
 inversely with the biomarkers of systemic inflammation independently of nocturnal hypoxia;
 and 2) Exercise training using a home-based computer exercise program will decrease
 biomarkers of systemic inflammation and increase exercise capacity in Veterans.
Inclusion Criteria:

 -  Veterans from the Salem VAMC pulmonary clinics will be screened for a diagnosis of OSA
 and treatment with CPAP therapy. In addition, an inclusion criterion also will be a
 recent PFT diagnostic of COPD (FEV1/FVC <0.7 and FEV1< 80%). Only Veterans with OS who
 are compliant with CPAP therapy will be enrolled in the study.

 Exclusion Criteria:

 -  orthopedic problems, fall-risk, balance problems;

 -  any regular participation in structured exercise sessions;

 -  other concomitant sleep disorder;

 -  unstable cardiovascular or pulmonary disease;

 -  acute infectious illness in the prior month;

 -  hospitalization in prior month;

 -  prescription of systemic glucocorticoids or immune-suppressive agents in the prior
 month and

 -  weight above 330 pounds, the limit allowed by the Wii pressure sensor floor mat.