Objectively Measured Physical Activity in Patients with Coronary Artery Disease: A Cross-Validation Study

Abstract

Physical activity (PA) and sedentary behavior (SB) levels in healthy adults are predominately based on self-reporting measures, which generally overestimate PA but underestimate SB. Patients with coronary artery disease (CAD) eligible for cardiac rehabilitation (CR) follow an individualized program; thus, objective assessment of physical performance and regular daily activity is required. This study aimed to compare self-reported and objectively measured PA and SB in patients with CAD prior to out-patient CR. We included 91 patients with CAD and assessed their PA with an accelerometer for 8 days prior to CR, along with the short form of the international physical activity questionnaire. We found that most patients were sedentary (61%, ~8 h/day), and on average performed 63 min/day of moderate-to-vigorous-intensity physical activity (MVPA). Males performed less daily light-intensity physical activity (−5%, p = 0.011) and performed more MVPA (+2%, p = 0.002) compared to females. Maximal aerobic capacity was significantly associated with MVPA (Spearman rho = 0.483, p < 0.001) and MVPA >10 min bouts (Spearman rho = 0.391, p < 0.001). Self-reported measures overestimated MVPA (total MVPA, +108 min/day, p < 0.001; MVPA >10 min bouts, +152 min, p < 0.001) and underestimated SB (−174 min/day, p < 0.001) compared to objective measures. There was no significant correlation between methods in MVPA (Spearman rho = 0.147, p = 0.165)), MVPA >10 min bouts (Spearman rho = −0.059, p = 576), and SB (Spearman rho = 0.139, p = 0.187). Quantitative analysis demonstrated the huge proportional bias for MVPA, MVPA >10 min bouts, and SB. Our findings demonstrate that self-reported physical activity provides inaccurate estimates of MVPA and SB in patients with CAD entering the ambulatory CR. This strongly supports the more objective assessments of daily PA, preferably using an accelerometer.

Agreement between self‐reported and objectively assessed physical activity among out‐of‐hospital cardiac arrest survivors

“…Answers were compared with the objectively assessed moderate and vigorous physical activity analysed by cut-off points of a highly accurate diagnostic instrument, the accelerometer, as a reference standard (Innerd, 2020). Our results are similar to a systematic review about physical activity questionnaires and accelerometery that showed weak to moderate correlations (Skender et al, 2016).…”

“…The level of physical activity and adherence to physical activity guidelines among out-of-hospital cardiac arrest (OHCA) survivors is unknown (Ambrosetti et al, 2020;Bull et al, 2020;Visseren et al, 2021). While objective measures are often considered as reference standard for assessment of physical activity (Innerd, 2020), selfreports are often the only feasible method in many settings. In the large international Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, two questions for self-reported physical activity were included as a part of the cardiovascular risk assessment, based on the recommendations for primary and secondary prevention (Lilja et al, 2020).…”

“…Assessments of physical activity in clinical practise and research can include both self‐reports by questionnaires and objective assessments with accelerometers (Skender et al, 2016). Previous studies recommend objective assessments of physical activity, preferably accelerometery, to get accurate information of physical activity among populations with cardiac disease (Kambic et al, 2021; Orrell et al, 2007). An accelerometer assesses the acceleration of body movements in different directions to interpret the amount and intensity of the physical activity (Migueles et al, 2017).…”

Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care for Adults With Peripheral Artery Disease

“…First, the patients’ physical activity was subjectively assessed using the short form of the International Physical Activity Questionnaire, which was recently shown to overestimate physical activity and underestimate sedentary behavior compared with accelerometry in patients with coronary artery disease . The same discrepancies between objectively and subjectively assessed physical activity have also been shown in patients with PAD .…”

Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs

“…On the other hand, both physical activity and the decrease of sedentary behaviors could reduce several comorbidities. Therefore, the use of technologies and devices focused on increasing physical activity could improve wellbeing [ 28 , 29 ]. In our study, half of the participants (44.6% of men and 50% of women) were not interested in receiving continuing advice about cardiac rehabilitation in their mobile phone or Smartphone, primarily because of concerns about their data privacy after registering in the virtual applications or games.…”