The Effect of Exercise on Systemic Inflammation in Veterans With COPD and OSA

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.