Device-measured physical activity, sedentary time, and sleep in patients with arrhythmogenic cardiomyopathy: descriptive values and stability over 30 measurement days

Abstract

INTRODUCTION: Observational studies have consistently shown that exercise triggers and accelerate disease progression in patients with arrhythmogenic cardiomyopathy (AC), and sports participation is generally restricted. Therefore, individuals with AC may be susceptible to engage in low physical activity levels. This study aimed to objectively describe the patterns of physical activity (PA), sedentary time (SED), and sleep in patients with AC and to examine the reproducibility of accelerometer-derived measures over four consecutive weeks. METHODS: A total of 71 (49.6 [SD=17.5] years) patients with AC wore a wrist-worn Axivity AX3 accelerometer for 30 consecutive days, and the raw signal was processed using the R-package GGIR. The participants were classified as meeting the 2020 World Health Organization guidelines using previously proposed thresholds for wrist accelerometers. The reproducibility of each metric was determined based on Intraclass Correlation Coefficients (ICCs; 95% CI) that were calculated using linear-mixed models adjusted for age, BMI, and season. RESULTS: In total, 59.2% of participants did not meet the physical activity guidelines. AC patients spent 71.1% of awake time in SED and only 2.5% of awake time in moderate-to-vigorous physical activity (MVPA). No significant differences were found in physical activity related variables between sex and age groups. However, patients ≥50 years (n= 33) spent longer periods of sedentary time in comparison to those <50 years (mean difference 38.9 min/d, 95% CI 5.8 to 72.2, p = <0.05), and participants with obesity (BMI ≥30 kg/m2, n= 10) accumulated longer periods of SED (mean difference 66.6 min/d, 95% CI 5.2 to 128.1, p = <0.05), and less MVPA (mean difference 22.8 min/d, 95% CI 0.7 to 44.9, p = <0.05) than those without obesity. The ICCs ranged from 0.67 for MVPA (95% CI=0.61, 0.72) to 0.92 for light-intensity physical activity (95% CI=0.89, 0.93) using a 7-day assessment period, however, stability improved for assessment periods of 14 days. CONCLUSION: Nearly 60% of the patients with AC did not meet the WHO 2020 physical activity guidelines. Accelerometer-based classifications of activity are moderately stable over time, indicating that a 7-day assessment period and to a greater extent a 14-day period provides a reproducible measure of physical activity, sedentary time and sleep.

Lifestyle physical activity intensity and rapid-rate non-sustained ventricular tachycardia in arrhythmogenic cardiomyopathy

“…In this study, we observed that lifestyle physical activity was not associated with the occurrence of RR-NSVTs in AC patients, including both desmosomal and non-desmosomal forms. 10 Specifically, we observed that: (i) AC patients with RR-NSVTs did not show higher lifestyle physical activity levels than AC patients without RR-NSVTs during our 30-day recording; (ii) AC patients with RR-NSVTs showed similar physical activity patterns in the days when the RR-NSVTs occurred compared to the days without RR-NSVT; and (iii) the RR-NSVTs did not systematically occurred after or during physical activity. It is noteworthy that AC patients did barely engage in activities of vigorous intensity, with an average of 3 min/day in this study sample and with 80% of the patients not reaching 1 min/day.…”

“…The association of the lifestyle physical activity with the risk of ventricular tachycardia has not been investigated to date. In this study, we observed that lifestyle physical activity was not associated with the occurrence of RR-NSVTs in AC patients, including both desmosomal and non-desmosomal forms [10]. Specifically, we observed that: (i) AC patients with RR-NSVTs did not show higher lifestyle physical activity levels than AC patients without RR-NSVTs during our 30-day recording; (ii) AC patients with RR-NSVTs showed similar physical activity patterns in the days when the RR-NSVTs occurred compared to the days without RR-NSVT; and (iii) the RR-NSVTs did not systematically occurred after or during physical activity.…”

“…22,23 Activities of vigorous intensity were rarely performed by the AC patients included in this study (i.e., 80% of participants performed less than 1 min/day in vigorous intensity activities, and 5.7 min/day was the maximum value recorded). 10 Thus, we merged the time in activities of moderate and vigorous intensity into one category (i.e., moderate-tovigorous physical activity) for person-and day-level analyses. Additionally, we also combined all activities of any intensity (i.e., including light, moderate, and vigorous intensity) for analyses.…”

“…Lifestyle physical activities may reach light (i.e., 1.5-2.9 times the resting energy expenditure or metabolic equivalents [METs]), moderate (i.e., ≥3 METs) or even vigorous (i.e., ≥6 METs) intensities [9]. AC patients are exposed to these lifestyle activities in their daily life (e.g., when commuting, working, or in their leisure time) [10], and there are not evidence-based guidelines about whether lifestyle activities of any intensity should be discouraged. Activities of light-to-moderate intensity are recommended in this population based on previous observational studies [6][7][8]11].…”

Lifestyle physical activity and rapid-rate non-sustained ventricular tachycardia in arrhythmogenic cardiomyopathy

“…Lifestyle physical activities may reach light (ie, 1.5-2.9 times the resting energy expenditure or metabolic equivalents (METs)), moderate (ie, ≥3 METs) or even vigorous (ie, ≥6 METs) intensities. 8 Patients with AC are exposed to these lifestyle activities in their daily life (eg, when commuting, working or in their leisure time), 9 and there are not evidence-based…”