Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials

Vetrovsky, Tomas; Širanec, Michal; Pařenica, Jiří; Gřiva, Martin; Šťastný, Jiří; Přeček, Jan; Pelouch, Radek; Bunc, Václav; Linhart, Aleš; Bělohlávek, Jan

doi:10.1186/s12967-017-1257-x

Cited by 19 publications

(25 citation statements)

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“…The present findings add to a growing body of evidence suggesting that lower levels of PA may independently associate with poor transplant clinical outcomes, independent of other psychosocial characteristics. Our findings extend previous work in pulmonary and cardiac samples demonstrating that lower levels of actigraphy‐assessed PA are predictive of poorer clinical outcomes. Our work also extends previous findings among lung transplant recipients by demonstrating that greater post‐transplant depressive symptoms also are associated with worse clinical outcomes, independent of PA.…”

Section: Discussionsupporting

confidence: 86%

“…Recent case series data suggest that cardiothoracic transplant recipients exhibit lower levels of PA within 1 year of transplantation compared with age‐ and gender‐matched controls and that PA may be improved through intervention . In addition, lower levels of PA have been associated with poorer clinical outcomes in both pulmonary and cardiac patients. Although few studies have examined PA and related factors following transplant, we recently demonstrated that lower functional capacity (eg, six‐minute walk distance [6MWD]) was independently associated with worse clinical outcomes after lung transplantation .…”

Section: Introductionmentioning

confidence: 99%

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Depressive symptoms, physical activity, and clinical events: The ADAPT prospective pilot study

Smith

Frankel

Bacon

et al. 2019

Clinical Transplantation

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Background: Physical inactivity and depressive symptoms following cardiothoracic transplantation are recognized as potentially modifiable psychosocial factors to improve clinical outcomes. However, few studies have prospectively assessed these in ambulatory, outpatient transplant recipients. Methods:We conducted a prospective, single-center study examining actigraphy-assessed physical activity (PA) levels over a 1-week period in heart or lung transplant recipients recruited at 6 months (range 4-9) post-transplant. Depressive symptoms (Centers for Epidemiologic Study of Depression [CESD]), quality of life (QoL), and clinical events (transplant-related hospitalization and death) were collected. Clustered Cox proportional hazards models were used to examine the associations between PA, psychological measures, and clinical events. Results: Among 105 potentially eligible participants, 66 (63%) met inclusion criteria and were enrolled between July, 2016 and May, 2017, including 42 lung and 24 heart transplant recipients. The mean age of the population was 53 years, 41% were women and 18% were black. Participants tended to be sedentary, with the majority of activity spent within the "sedentary" level (61%) and an average daily step count of 7188 (SD = 2595). In addition, participants tended to exhibit subclinical depressive symptoms, (mean CESD = 9.4 [SD = 8]) with only a subset exhibiting levels suggestive of clinical depression (22%). Over a median follow-up of 1.4 years (1.14, 1.62), 21 participants (32%) experienced at least one transplant-related hospitalization, including two deaths. In adjusted survival models, greater intensity of PA (HR = 0.45 [0.24, 0.84] per 0.2 METs, P = .012) was associated with a lower risk of clinical events, whereas greater depressive symptoms (HR = 2.11 [1.58, 2.82] per 9 CESD points, P < .001) at 6 months were associated a higher likelihood of subsequent transplantrelated hospitalization and/or death. Conclusions: Physical inactivity and depressive symptoms at 6 months post-transplant were predictive of subsequent adverse clinical events among ambulatory cardiothoracic transplant recipients. Future studies should examine whether improving these potentially modifiable post-transplant risk factors improves clinical outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Depressive symptoms, physical activity, and clinical events: The ADAPT prospective pilot study

Smith

Frankel

Bacon

et al. 2019

Clinical Transplantation

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“…These patients were participants of an ongoing multicentre randomized controlled trial of a 6-month intervention in the form of an unsupervised, individual, outside walking programme that combined weekly step goals, selfmonitoring, and regular phone-based counselling, followed by a 6-month follow-up period. 6 As part of the intervention, the patients were requested to wear a wrist-worn accelerometer, and they were recommended to continue wearing it during the follow-up period and beyond. All patients, those still participating in the intervention and those in the follow-up phase and beyond, were included in this study, provided their accelerometer data were available.…”

Section: Methodsmentioning

confidence: 99%

The detrimental effect of COVID‐19 nationwide quarantine on accelerometer‐assessed physical activity of heart failure patients

et al. 2020

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Aims A reduction of habitual physical activity due to prolonged COVID-19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. Methods and results We analysed the daily number of steps in 26 heart failure patients during a 6-week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist-worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. Conclusions The introduction of the nationwide quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3-week study period. Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential despite the unfavourable circumstances of quarantine.

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“…(1) Limit the use of steps only to the studies that focus on walking, for example, when the aim of the intervention is to increase daily number of steps, or when participants are instructed to self-monitor their steps. 57 In addition, researchers and clinicians must be cognizant of the inaccuracy of most devices at slow gait speeds. 58 (2) Use time spent in PA intensity levels with caution, especially in patients with reduced cardiorespiratory fitness.…”

Section: Practical Recommendationsmentioning

confidence: 99%

Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

et al. 2020

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Aims Accelerometers are becoming increasingly commonplace for assessing physical activity; however, their use in patients with cardiovascular diseases is relatively substandard. We aimed to systematically review the methods used for collecting and processing accelerometer data in cardiology, using the example of heart failure, and to provide practical recommendations on how to improve objective physical activity assessment in patients with cardiovascular diseases by using accelerometers. Methods and results Four electronic databases were searched up to September 2019 for observational, interventional, and validation studies using accelerometers to assess physical activity in patients with heart failure. Study and population characteristics, details of accelerometry data collection and processing, and description of physical activity metrics were extracted from the eligible studies and synthesized. To assess the quality and completeness of accelerometer reporting, the studies were scored using 12 items on data collection and processing, such as the placement of accelerometer, days of data collected, and criteria for non-wear of the accelerometer. In 60 eligible studies with 3500 patients (of those, 536 were heart failure with preserved ejection fraction patients), a wide variety of accelerometer brands (n = 27) and models (n = 46) were used, with Actigraph being the most frequent (n = 12), followed by Fitbit (n = 5). The accelerometer was usually worn on the hip (n = 32), and the most prevalent wear period was 7 days (n = 22). The median wear time required for a valid day was 600 min, and between two and five valid days was required for a patient to be included in the analysis. The most common measures of physical activity were steps (n = 20), activity counts (n = 15), and time spent in moderate-to-vigorous physical activity (n = 14). Only three studies validated accelerometers in a heart failure population, showing that their accuracy deteriorates at slower speeds. Studies failed to report between one and six (median 4) of the 12 scored items, with non-wear time criteria and valid day definition being the most underreported items. Conclusions The use of accelerometers in cardiology lacks consistency and reporting on data collection, and processing methods need to be improved. Furthermore, calculating metrics based on raw acceleration and machine learning techniques is lacking, opening the opportunity for future exploration. Therefore, we encourage researchers and clinicians to improve the quality and transparency of data collection and processing by following our proposed practical recommendations for using accelerometers in patients with cardiovascular diseases, which are outlined in the article.

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Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials

Cited by 19 publications

References 55 publications

Depressive symptoms, physical activity, and clinical events: The ADAPT prospective pilot study

Depressive symptoms, physical activity, and clinical events: The ADAPT prospective pilot study

The detrimental effect of COVID‐19 nationwide quarantine on accelerometer‐assessed physical activity of heart failure patients

Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

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