Research

Holy Grail: Could exercise help prevent virus-related COPD exacerbations?



Can you describe the aim of your research in 10 words? 

To help prevent and treat respiratory infections or lung diseases.

What have you learned about mechanisms and interventions for respiratory infections and lung disease so far? 

Chronic obstructive pulmonary disease (COPD) exacerbations are often caused by viral infections, such as the common cold and influenza. People with COPD are susceptible to exacerbations due to imbalanced responses to viral infections, where deficient anti-viral immunity precedes excessive activation of the immune system and causes lung inflammation and symptoms. Whilst current treatments like steroid inhalers can help reduce symptoms in people with COPD, these drugs are immunosuppressive and can increase risk of secondary infection. Complementary treatments are needed that reduce reliance on steroids. Our research has shown that exercise programs can reduce the number of people experiencing a COPD exacerbation. The mechanisms underlying this protection are not clear.

You recently won a grant to assess whether exercise has anti-viral and anti-inflammatory effects in COPD. Can you tell me a bit about that project?

This project will recruit 30 people living with COPD who have frequent exacerbations. Half of these people will receive an exercise program while the other half will be placed on a waiting list for eight weeks. Using bronchoscopy, we will collect lung immune cells at the start of the project and after eight weeks, we will measure whether exercise can boost anti-viral responses of lung cells. Additionally, mice with COPD will either undergo treadmill running or rest alongside steroid or no-steroid treatment before infection with viruses that cause exacerbations. Lung tissue from the mice will be used to test whether exercise reduces inflammation during an exacerbation and increases anti-viral immunity with or without steroid treatment. I will lead this project under the mentorship of Professor Anne Holland (Monash University) and Associate Professor Nathan Bartlett (University of Newcastle) who are world-leading researchers in non-drug treatments and viral immunology, respectively, in COPD.

You mentioned the mechanisms behind exercise’s potential anti-viral and anti-inflammatory effects in COPD aren’t yet clear. Are there any proposed mechanisms? If so, what are they?

I hope to have a more definitive answer on this at the end of the project. There is accumulating evidence to suggest that exercise alone has independent effects on exacerbations versus other interventions it may be delivered alongside (e.g. education) in COPD. I think this is at least partly due to exercise modulating the immune system. My view is informed by two key areas. Firstly, prior research has shown regular exercise in previously-sedentary populations can result in reduced severity of self-reported respiratory infections and improved immune responses to viral vaccines (e.g. influenza). Secondly, previous research has shown that people living with COPD are more physically inactive than age-matched healthy counterparts and that this physical inactivity may be linked to systemic inflammation. Our project will test the effects of exercise on aspects of the immune system that have been shown to be linked with increased susceptibility to exacerbations.

How could this work affect patient care and how long until it does? 

Unlike a brand-new drug or treatment, our work shouldn’t take long to affect patient care. If successful, I would anticipate impact within 5 years. This is because exercise programs are already being used in the care of people living with COPD. The key difference would be how the exercise programs are delivered. Currently, people with COPD are usually referred by their clinicians for exercise treatment to help with breathlessness or exercise intolerance. Confirming exercise’s anti-viral and anti-inflammatory effects in COPD would support exercise treatment in those susceptible to frequent exacerbations. Unfortunately, we know that too-few people living with COPD are currently able to access exercise treatments. Our body of work showing that exercise can reduce exacerbations alongside conclusive proof of mechanisms will provide a strong call for increased provision of exercise programs. Why do I think that? Because exacerbations are a leading cause of preventable hospitalisations in chronic disease and represent major costs of COPD treatment in health services.

What drew you to this line of research? 

Avoiding exacerbations and hospitalisations are outcomes that matter the most to people living with COPD. Our research has shown that exercise programs can help people with COPD avoid exacerbations and hospitalisations. My PhD was all about understanding the link between changes in the immune system with exercise and risk of respiratory infection, albeit in a different population (endurance athletes).  Since my PhD I have been motivated to understand why people with COPD are susceptible to respiratory infections that are a major cause of exacerbations. This research allows me to bring these areas together to better understand how exercise delivers outcomes that are of priority to people with COPD.

It’s great you’ve got this grant supporting your research. How did the grant come about and what does it mean for you and your work?

The fellowship from the Lung Foundation is supported by Boehringer Ingelheim. Monash University have matched this funding. I applied in January 2022 and was officially awarded the fellowship at the Lung Foundation Australia’s Hope Research Fund lunch in June 2022. This news left me with two overriding emotions. One of relief as an early-career researcher in a competitive funding environment and one of excitement as I truly believe that the proposed work will lead to important steps in understanding exacerbations of COPD and place exercise treatments where they need be, at the centre of disease management. This funding allows early-career researchers like me to focus time and resources on this project. I cannot proceed with this research without this support, it is essential. As this is my first grant since moving to Australia, it is also an important step towards establishing my own research program here.

You sound so passionate about research and helping people with COPD. What’s your holy grail — the one thing you’d like to achieve in your research career? 

The holy grail for me is to confirm how exercise can prevent respiratory infections or exacerbations of COPD. I’d suggest that prevention of exacerbations is also the holy grail for many researchers in the wider field of respiratory medicine. Personally, I think there are still important strides to be made with the treatments that are already available to us, whether that’s about improving access to them or personalising the way we deliver them.

What is your biggest research hurdle? 

I’m probably not alone here in viewing funding as the biggest research hurdle. You can have the best ideas for research projects but ultimately, they often require resources or staff to support you to deliver them. As someone who is still early in their career this is a big, and will be an ongoing, hurdle.

Last question: What new hobby have you picked up during COVID, what’s the best thing about it and how did it help lift your spirits?

Hmm, I didn’t start a new hobby but I did establish a routine to help maintain a hobby. Before the pandemic I would attend a local sports centre for my own exercise training. Too often though, I would miss out on sessions because I’d prioritise other things over travelling there. With sports centres closed during the pandemic, we decided to kit-out our garage with strength and conditioning equipment. It meant I could regularly exercise at home during lockdowns and  continue with this routine as work and family-life returned to (almost pre-COVID level) normal. It has provided me with the flexibility to exercise at home at a time that suits me. Of course, my key research interests are in the immunological effects of exercise but I’m very much aware of the more well-known physical and psychological benefits of exercise. These benefits were needed to lift sprits during lockdowns!

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