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@ARTICLE{Palmen:305510,
      author       = {B. Palmen and Z. Ebadi and M. van Herck and Y. M. J.
                      Goërtz and Q. Deng and M. Thong$^*$ and C. Burtin and J. B.
                      Peters and R. T. M. Sprooten and E. W. M. A. Bischoff and E.
                      F. M. Wouters and M. A. G. Sprangers and J. H. Vercoulen and
                      S. Houben-Wilke and A. W. Vaes and D. J. A. Janssen and M.
                      A. Spruit},
      title        = {{B}idirectional {A}ssociations {B}etween {P}hysical
                      {A}ctivity, {S}edentary {B}ehavior, and {D}aily {S}ymptoms
                      in {P}atients {W}ith {C}hronic {O}bstructive {P}ulmonary
                      {D}isease: {L}ongitudinal {O}bservational {S}tudy.},
      journal      = {JMIR mhealth and uhealth},
      volume       = {13},
      issn         = {2291-5222},
      address      = {Toronto},
      publisher    = {JMIR Publications},
      reportid     = {DKFZ-2025-02194},
      pages        = {e65653 - e65653},
      year         = {2025},
      abstract     = {Questionnaire-based symptom assessment may introduce recall
                      bias and lacks bidirectional exploration. This is
                      particularly relevant, given the unclear direction of the
                      associations between physical activity (PA), sedentary time
                      (ST), and symptoms in patients with chronic obstructive
                      pulmonary disease (COPD). Understanding these associations
                      could inform symptom management strategies and improve
                      patient quality of life.This study aimed to investigate the
                      direction of the association between PA, ST, and symptoms in
                      patients with COPD using accelerometry and ecological
                      momentary assessment (EMA).A subsample from the FAntasTIGUE
                      study answered 8 randomly timed EMA questionnaires daily for
                      5 days. Ten symptoms were rated on a 7-point Likert scale:
                      'I feel relaxed, short of breath, energetic, cheerful,
                      insecure, irritated, satisfied, anxious, tired, and mentally
                      fit.' Concurrently, step count and ST were measured using
                      the ActiGraph GT9X Link placed on the right hip. Step count
                      and ST 15 and 30 minutes pre- and post-EMA were used in
                      multilevel models, controlled for pre-EMA steps and ST, and
                      the previous EMA score. Significant confounders were used as
                      covariates, and patient ID was used as random
                      intercept.Thirty-four patients (19/34, $56\%$ men, mean age
                      66, SD 7 years; forced expiratory volume in 1 second
                      $52±20\%$ predicted; 1035 EMA responses) were included.
                      Feeling more relaxed was associated with a higher step count
                      15 minutes post-EMA (β=5.1; $95\%$ CI 0.9 to 10.1; P=.046).
                      Conversely, higher step count 15 and 30 minutes pre-EMA was
                      associated with feeling less relaxed (β=-5.2×10-4; $95\%$
                      CI -9.7×10-4 to -7.0×10-5; P=.02; and β=-3.2×10-4;
                      $95\%$ CI -5.6×10-4 to -7.9×10-5; P=.009), more short of
                      breath (β=8.5×10-4; $95\%$ CI 4.7×10-4 to 1.2×10-3;
                      P<.001; and β=4.6×10-4; $95\%$ CI 2.6×10-4 to 6.6×10-4;
                      P<.001), and tired (β=5.1×10-4; $95\%$ CI 7.2×10-5 to
                      9.4×10-4; P=.02; and β=2.9×10-4; $95\%$ CI 5.3×10-5 to
                      5.2×10-4; P=.02). Higher ST 15 and 30 minutes pre-EMA was
                      associated with feeling more anxious (β=1.7×10-4; $95\%$
                      CI 1.7×10-5 to 3.2×10-4; P=.03; and β=8.5×10-5; $95\%$
                      CI 2.5×10-6 to 1.7×10-4; P=.04).A bidirectional
                      association of feeling relaxed with PA was found in patients
                      with COPD. Higher step count was related to feeling more
                      short of breath and tired, whereas higher ST was associated
                      with heightened anxiety.},
      keywords     = {Humans / Pulmonary Disease, Chronic Obstructive: psychology
                      / Pulmonary Disease, Chronic Obstructive: complications /
                      Male / Female / Sedentary Behavior / Aged / Longitudinal
                      Studies / Exercise: psychology / Exercise: physiology /
                      Middle Aged / Surveys and Questionnaires / Accelerometry:
                      methods / Accelerometry: instrumentation / Ecological
                      Momentary Assessment: statistics $\&$ numerical data /
                      Quality of Life: psychology / COPD (Other) / accelerometry
                      (Other) / chronic obstructive pulmonary disease (Other) /
                      ecological momentary assessment (Other) / physical activity
                      (Other) / sedentary behavior (Other) / symptom assessment
                      (Other)},
      cin          = {C071},
      ddc          = {610},
      cid          = {I:(DE-He78)C071-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41124569},
      pmc          = {pmc:PMC12543037},
      doi          = {10.2196/65653},
      url          = {https://inrepo02.dkfz.de/record/305510},
}