Validation of two activity monitors in patients with COPD

obesity in COPD. Unfortunately van den Bemt et al were not able to distinguish in their study between the prevalence of fat abundance in absolute or relative terms (ie, obesity vs sarcopenic obesity). In our review, we specifically focused on the impact of excessive fat mass (in both absolute and relative terms) on the pathogenesis of systemic features of COPD such as systemic inflammation and cardiovascular disease rather than that of a high BMI per se, since pulmonary disease severity appears to be associated not only with a decline in BMI but also with a shift in body composition. Insight into the pathogenesis of a disturbed energy balance in COPD patients with fat abundance is needed to determine if a generic-or a disease-(and maybe even disease state-) specific intervention approach is needed. Fat mass is merely determined by an imbalance between dietary intake and energy expenditure. No data are yet available regarding dietary intake in obese and non-obese patients with COPD adjusting for GOLD stage. Several studies, however, have consistently demonstrated a very low physical activity level (the most variable component of energy expenditure) in patients with COPD. 3 The studies so far therefore clearly point towards promoting exercise in early-stage COPD patients with obesity in order to improve energy balance, decrease dyspnoea and possibly also prevent adverse effects of fat abundance on cardiometabolic risk as outlined in our review.