Minimal clinically important differences in daily physical activity outcomes following supervised and home-based exercise in peripheral artery disease

Gardner, Andrew W.; Montgomery, Polly S.; Wang, Ming; Shen, Biyi

doi:10.1177/1358863x211072913

Cited by 15 publications

(6 citation statements)

References 48 publications

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“…In cohort studies with long-term follow-up, the difference of just 1000 steps per day has been associated with a significant decrease in all-cause mortality rate by 15% in both the general population 40 and patients with HF. 41 Furthermore, the minimum clinically important difference for the physically inactive general population 42 as well as patients with chronic conditions such as chronic obstructive pulmonary disease 43 or peripheral artery disease 44 has been estimated to lie between 500 and 1100 steps per day. Thus, it is noteworthy that despite successfully enhancing PA levels, our intervention did not yield a corresponding improvement in functional capacity assessed by the 6MWT.…”

Section: Discussionmentioning

confidence: 99%

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Vetrovsky,

Siranec,

Frybova

et al. 2024

Circulation

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Background: Physical activity is pivotal in managing heart failure with reduced ejection fraction (HFrEF), and walking integrated into daily life is an especially suitable form of such physical activity. This study aimed to determine if a 6-month lifestyle walking intervention combining self-monitoring and regular phone counseling improves functional capacity assessed by the six-minute walk test (6MWT) in stable patients with HFrEF compared to usual care. Methods: The WATCHFUL trial was a 6-month, multicenter, parallel-group, randomized, controlled trial recruiting HFrEF patients from six Czech cardiovascular centers. Eligible participants were ≥18 years old with left ventricular ejection fraction <40% and NYHA class II/III symptoms, on guidelines-recommended medication, excluding those exceeding 450m in the baseline 6MWT. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly phone counseling from research nurses who encouraged them to employ behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The control group patients continued usual care. The primary outcome was the difference between groups in the distance (in meters) walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate-to-vigorous physical activity (MVPA) as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP and hsCRP biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention-to-treat. Results: From 218 screened patients, 202 were randomized (65 years; 22.8% female; 90.6% NYHA II; left ventricular ejection fraction 32.5%; 6MWT 385m; 5071 steps/day; 10.9 minutes of MVPA per day). At six months, no between-group differences were detected for the 6MWT (7.4 m, 95% CI -8.0 to 22.7, p=0.345, N=186). The intervention group increased their average daily step count by 1420 (95% CI: 749; 2091) and daily minutes of MVPA by 8.2 (95% CI: 3.0; 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. Conclusions: While the lifestyle intervention in patients with HFrEF improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the disconnect between increased physical activity and functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Vetrovsky,

Siranec,

Frybova

et al. 2024

Circulation

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“… 43 Finally, the increases from baseline in daily time spent in moderate intensity activity following exercise intervention were clinically important, because they exceeded the anchor‐based large MCID of 11 minu/d. 44 …”

Section: Discussionmentioning

confidence: 99%

Effects of Long‐Term Home Exercise in Participants With Peripheral Artery Disease

Gardner,

Montgomery,

Wang

et al. 2023

JAHA

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Background This randomized controlled trial compared long‐term changes in peak walking time (PWT) and exercise time‐to‐minimum calf muscle oxygen saturation (StO 2 ) in symptomatic participants with peripheral artery disease following a long‐term home exercise program (HEP), a short‐term supervised exercise therapy (SET) program that transitioned to a long‐term HEP (SET/HEP), and a control intervention. Methods and Results For the first 3 months, HEP and SET/HEP groups performed intermittent walking to mild‐to‐moderate claudication pain, whereas the control group performed light resistance training. For the subsequent 15 months, the HEP group continued their exercise program, the SET/HEP group transitioned from SET to the HEP program, and the control group transitioned to only receive walking advice. PWT increased significantly from baseline to month 18 in the HEP group (408 ± 279 meters to 814 ± 393 meters, P <0.001) and in the SET/HEP group (457 ± 288 meters to 818 ± 313 meters, P <0.001). Exercise time‐to‐minimum calf muscle StO 2 increased significantly from baseline to month 18 in the HEP group (238 ± 241 seconds to 497 ± 485 seconds, P <0.05) and in the SET/HEP group (296 ± 289 seconds to 620 ± 450 seconds, P <0.001). These changes in PWT and exercise time‐to‐minimum calf muscle StO 2 were greater than in the control group ( P <0.001 and P <0.01, respectively). Additionally, the change in exercise time‐to‐minimum calf muscle StO 2 was correlated with the change in PWT in both exercise groups combined ( r =0.601, P =0.0015). Conclusions Long‐term HEP and SET/HEP were efficacious in improving PWT and exercise time‐to‐minimum calf muscle StO 2 in symptomatic participants with peripheral artery disease, and these changes were correlated with each other. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00618670.

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“… 24 An effect size of 0.21 was chosen based on previous studies. 24 , 25 This resulted in a minimal sample size of 59 per measurement. 26 Sample size analysis was conducted using Statulator: an online statistical calculator.…”

Section: Methodsmentioning

confidence: 99%

Improving physical activity in hospitalized patients: The preliminary effectiveness of a goal-directed movement intervention

van Grootel,

Bor,

Netjes

et al. 2023

Clin Rehabil

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Objective To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. Design Prospective, pre-post study. Setting A university medical center. Participants Patients admitted to the pulmonology and nephrology/gastro-enterology wards. Intervention The movement intervention consisted of (1) self-monitoring of patients’ physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. Main measures Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. Results A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0–10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. Conclusions The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.

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Minimal clinically important differences in daily physical activity outcomes following supervised and home-based exercise in peripheral artery disease

Cited by 15 publications

References 48 publications

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Effects of Long‐Term Home Exercise in Participants With Peripheral Artery Disease

Improving physical activity in hospitalized patients: The preliminary effectiveness of a goal-directed movement intervention

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