Physical activity assessment by accelerometry in people with heart failure

Abstract

Background: International guidelines for physical activity recommend at least 150 min per week of moderate-tovigorous physical activity (MVPA) for adults, including those with cardiac disease. There is yet to be consensus on the most appropriate way to categorise raw accelerometer data into behaviourally relevant metrics such as intensity, especially in chronic disease populations. Therefore the aim of this study was to estimate acceleration values corresponding to inactivity and MVPA during daily living activities of patients with heart failure (HF), via calibration with oxygen consumption (VO 2) and to compare these values to previously published, commonly applied PA intensity thresholds which are based on healthy adults. Methods: Twenty-two adults with HF (mean age 71 ± 14 years) undertook a range of daily living activities (including laying down, sitting, standing and walking) whilst measuring PA via wrist-and hip-worn accelerometers and VO 2 via indirect calorimetry. Raw accelerometer output was used to compute PA in units of milligravity (mg). Energy expenditure across each of the activities was converted into measured METs (VO 2 /resting metabolic rate) and standard METs (VO 2 /3.5 ml/kg/min). PA energy costs were also compared with predicted METs in the compendium of physical activities. Location specific activity intensity thresholds were established via multilevel mixed effects linear regression and receiver operator characteristic curve analysis. A leave-one-out method was used to cross-validate the thresholds. Results: Accelerometer values corresponding with intensity thresholds for inactivity (< 1.5METs) and MVPA (≥3.0METs) were > 50% lower than previously published intensity thresholds for both wrists and waist accelerometers (inactivity: 16.7 to 18.6 mg versus 45.8 mg; MVPA: 43.1 to 49.0 mg versus 93.2 to 100 mg). Measured METs were higher than both standard METs (34-35%) and predicted METs (45-105%) across all standing and walking activities. Conclusion: HF specific accelerometer intensity thresholds for inactivity and MVPA are lower than previously published thresholds based on healthy adults, due to lower resting metabolic rate and greater energy expenditure during daily living activities for HF patients. Trial registration: Clinical trials.gov NCT03659877, retrospectively registered on September 6th 2018.

Accelerometer-assessed physical behavior and the association with clinical outcomes in implantable cardioverter-defibrillator recipients: A systematic review

“…In addition to the initial use of device-embedded accelerometers for rate-responsiveness pacing, ICD manufactures have used their proprietary algorithms to collect daily summaries of PA. Out of 30 studies evaluating device-embedded accelerometry, 13 reported on the threshold for discrimination between activity and inactivity based on an acceleration exceeding a preset fixed threshold (equivalent to approximately 3.2 km/h or a step rate of 70–80 steps per minute). Aside from the underreporting of the applied thresholds and problematic generalizability of these data, a recent study by Dibben and colleagues 68 demonstrated that HF-specific accelerometer intensity thresholds for (in)activity were substantially lower (< 50%) than commonly used. Raw accelerometer data obtained using wearable accelerometers, however, are universal and can be converted into specific metrics such as the performance during the most active period of the day, measures of variability, rest-activity patterns, sleep behavior, time spent in different intensities of activity, and sedentary time.…”

The Validity of the Energy Expenditure Criteria Based on Open Source Code through two Inertial Sensors

“…This would produce a more precise system of energy expenditure calculation for a greater number of activities. This would be essential to compare the energy expenditure obtained by equations with the VO2 via indirect calorimetry [ 19 , 47 ]. The applications of the proposed method can be related to any EE estimation for physical activities, such as physical activity promotion for walking/running, clinical applications, like sedentary behaviour change for health care, and technical use for losing weight.…”

Assessment of Physical Activity Using Waist-Worn Accelerometers in Hospitalized Heart Failure Patients and Its Relationship with Kansas City Cardiomyopathy Questionnaire

“…In addition, there are few studies validating accelerometers in the HF patient population [ 7 ]. Therefore, the estimated physical activity derived from healthy adults, such as Mets, may deviate significantly from those obtained in patients with HF [ 30 ]. Meanwhile, for patients who were sufficiently stabilized on RHC, %sedentary time strongly correlated with VO 2 assessed by CPX in the subgroup analysis of our study.…”