The Effects of Free-Living Physical Activity on Mortality After Coronary Artery Disease Diagnosis

Comparison of Different Physical Activity Measures in a Cardiac Rehabilitation Program: A Prospective Study

Concordant assessments of physical activity (PA) and related measures in cardiac rehabilitation (CR) is essential for exercise prescription. This study compared exercise measurement from an in-person walk test; wearable activity tracker; and self-report at CR entry, completion (8-weeks) and follow-up (16-weeks). Forty patients beginning CR completed the Six-Minute Walk Test (6MWT), Physical Activity Scale for the Elderly (PASE), and wore Fitbit-Flex for four consecutive days including two weekend days. The sample mean age was 66 years; 67% were male. Increased exercise capacity at CR completion and follow-up was detected by a 6MWT change in mean distance (39 m and 42 m; p = 0.01, respectively). Increased PA participation at CR completion was detected by Fitbit-Flex mean change in step counts (1794; p = 0.01). Relative changes for Fitbit-Flex step counts and a 6MWT were consistent with previous research, demonstrating Fitbit-Flex's potential as an outcome measure. With four days of data, Fitbit-Flex had acceptable ICC values in measuring step counts and MVPA minutes. Fitbit-Flex steps and 6MWT meters are more responsive to changes in PA patterns following exposure to a cardiac rehabilitation program than Fitbit-Flex or PASE-estimated moderate-vigorous PA (MVPA) minutes. Fitbit-Flex step counts provide a useful additional measure for assessing PA outside of the CR setting and accounts for day-to-day variations. Two weekend days and two weekdays are needed for Fitbit-Flex to estimate PA levels more precisely.

Living with a Smoker and Physical Inactivity across Eight Years in High-Risk Medical Patients

Recent research has demonstrated a link between living with a smoker and physical inactivity. However, no research has examined this issue in the context of recovery in medical patients. The present study broadens research on living with a smoker by applying it to physical inactivity in a group of high-risk medical patients with histories of cancer or cardiovascular disease compared to a control group without histories of these conditions. In addition, this study extends the time frame of research on living with a smoker in predicting physical inactivity to eight years. Participants were 76,758 women between 49 and 81 years of age from the Women's Health Initiative Observational Study. Data on living with a smoker were collected at baseline; data on physical activity were collected at baseline and annually from 3 to 8 years. Analyses utilized latent growth modeling. Patient status, compared to control status, was associated with more physical inactivity at baseline. Independent of patient status, living with a smoker predicted a significant increase in the odds of no moderate or strenuous exercise and a significant increase in the odds of no walking at baseline. The effect of living with a smoker on physical inactivity was stronger than that of patient status. Moreover, the living with a smoker effect on physical inactivity remained stable across eight years. These findings highlight an overlooked impediment to compliance with recommendations for lifestyle change among high-risk medical patients.

Location-Based Sedentary Time and Physical Activity in People Living With Coronary Artery Disease

PURPOSE

Sedentary time (ST) and lack of physical activity increase the risk of adverse outcomes for those living with coronary artery disease (CAD). Little is known about how much ST, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) that CAD participants not attending cardiac rehabilitation engage in, the locations where they engage in these behaviors, and how far from home the locations are.

METHODS

Participants completed a survey and wore an accelerometer and global positioning system receiver for 7 d at baseline and 6 mo later.

RESULTS

Accelerometer analyses (n = 318) showed that participants averaged 468.4 ± 102.7 of ST, 316.1 ± 86.5 of LPA, and 32.9 ± 28.9 of MVPA min/d at baseline. ST and LPA remained stable at 6 mo, whereas MVPA significantly declined. The global positioning system (GPS) analyses (n = 315) showed that most of participant ST, LPA, and MVPA time was spent at home followed by other residential, retail/hospitality, and work locations at baseline and 6 mo. When not at home, the average distance to a given location ranged from approximately 9 to 18 km.

CONCLUSIONS

Participants with CAD spent the majority of their time being sedentary. Home was the location used the most to engage in ST, LPA, and MVPA. When not home, ST, LPA, and MVPA were distributed across a variety of locations. The average distance from home to a given location suggests that proximity to home may not be a barrier from an intervention perspective.

Duplicate and salami publication: a prevalence study of journal policies

BACKGROUND

Duplicate and salami publication are unethical, but are common practices with substantial consequences for science and society at large. Scientific journals are the 'gatekeepers' of the publication process. We investigated journal policies on duplicate and salami publication.

METHODS

In 2018, we performed a content analysis of policies of journals in the disciplines of 'epidemiology and public health' and 'general and internal medicine'. Journal policies were searched, extracted, coded and cross-checked. The associations of disciplinary categories and journal impact factors with journal policies were examined using Poisson regression models with a robust error variance.

RESULTS

A total of 209 journals, including 122 in epidemiology and public health and 87 in general and internal medicine, were sampled and their policies investigated. Overall, 18% of journals did not have any policies on either practice, 33% only referred to a generic guideline or checklist without explicit mention about either practice, 36% included policies on duplicate publication and only 13% included policies on both duplicate and salami publication. Having explicit journal policies did not differ by journal disciplinary categories (epidemiology and public health vs general and internal medicine) or impact factors. Further analysis of journals with explicit policies found that although duplicate publication is universally discouraged, policies on salami publication are inconsistent and lack specific definitions of inappropriate divisions of papers.

CONCLUSIONS

Gaps exist in journal policies on duplicate and salami publication, characterized by an overall lack of explicit policies, inconsistency and confusion in definitions of bad practices, and lack of clearly defined consequences for non-compliance. Scientific publication and the academic reward systems must evolve to credit good research practice.

Design and rationale of the MyHeartMate study: a randomised controlled trial of a game-based app to promote behaviour change in patients with cardiovascular disease

INTRODUCTION

Recurrence of cardiac events is common after a first event, leading to hospitalisations and increased health burden. Patients have difficulties achieving the lifestyle changes required for secondary prevention and access to secondary prevention programs is limited. This study aims to evaluate the impact of a game-based mobile app, MyHeartMate, which is designed to motivate engagement in secondary prevention behaviours for cardiovascular risk factors.

METHODS AND ANALYSIS

The MyHeartMate study is a randomised controlled trial with 6-month follow-up and blinded assessment of the primary outcome. Participants (n=394) with coronary heart disease will be recruited from hospitals in metropolitan Sydney and randomly allocated to standard care or the MyHeartMate app intervention. The intervention group will receive the app, which uses game techniques to promote engagement and lifestyle behaviour change for secondary prevention. The primary outcome is difference between the groups in physical activity (metabolic equivalent of task minutes/week) at 6 months. Secondary outcomes include change in low-density lipoprotein cholesterol, systolic blood pressure, medication adherence, body mass index, waist circumference, mood and dietary changes at 6 months. Data on app engagement, and patient perspectives of usability and acceptability, will also be analysed.

ETHICS AND DISSEMINATION

The study has received ethics approval from Northern Sydney Local Health District Human Research Ethics Committee. The study findings will be disseminated via peer-reviewed publications and presentation at international scientific meetings/conferences.

TRIAL REGISTRATION NUMBER

ACTRN12617000869370; Pre-results.

Mid-arm muscle circumference as a substantial factor against mortality among people with elevated gamma gaps

Gamma gap is the difference in total serum proteins and albumin and an elevated gamma gap is related to infections, malignancy, and rheumatic diseases. An elevated gamma gap is also associated with higher mortality due to the correlation with inflammatory status. The study aimed to utilize mid-arm muscle circumference (MAMC) to assist in predicting all-cause mortality, cancer mortality, and cardiovascular mortality in people with elevated gamma gaps. Data were obtained from the third U.S. National Health and Nutrition Examination Survey (1988–1994), which contained 14,011 adults aged 20 to 90 years during up to 14.3 years of follow-up. The Primary analysis examined MAMC in tertiles and revealed the demographic and characteristics of the study population. Receiver operating characteristic curve analysis was used and the most suitable cut-off point of gamma gap was 3.65 g/dl. The secondary analysis employed Cox proportional hazards models stratified by age, gender and body mass index to evaluate the hazard ratios for all-cause mortality, cancer mortality, and cardiovascular mortality associated with the MAMC. As the MAMC tertiles increased in group with gamma gap ≥ 3.65 g/dl, individuals with elder age (60–90 years), normal range of body mass index (19–24.9 kg/m²), and male gender tended to have lower hazard ratios for all-cause mortality, cancer mortality, and cardiovascular mortality. These substantial findings indicate that higher MAMC may be a protective factor of all cause-mortality, cancer mortality, and cardiovascular mortality among older male with normal body mass index and elevated gamma gaps.

Factors Associated With Ambulatory Activity in De Novo Parkinson Disease

BACKGROUND AND PURPOSE

Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease.

METHODS

We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness.

RESULTS

Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%).

DISCUSSION AND CONCLUSIONS

Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).

Effect of physical activity on mortality risk among Americans with retinopathy

Background: Previous work demonstrates that retinopathy is associated with increased mortality risk, with physical activity inversely associated with retinopathy and all-cause mortality. However, no study has evaluated the effects of physical activity on mortality among those with existing retinopathy, which was this study’s purpose.

Methods: Data from the 2005-2006 National Health and Nutrition Examination Survey were utilized, with follow-up through 2011. Retinopathy was objectively-measured using the Canon Non-Mydriatic Retinal Camera CR6-45NM. Physical activity was objectively-measured via up to 7 days of accelerometry assessment.

Results: Six-hundred and seventy one adults (40-85 years) with complete data on the study variables constituted the analytic sample. During the follow-up period, 91 deaths occurred. In the sample, 35 886 person-months occurred with a mortality incidence rate of 2.5 deaths per1000 person-months. Among participants with mild retinopathy, those who met physical activity guidelines at baseline had a 63% reduced risk of all-cause mortality (HR _adjusted = 0.37; 95% CI:0.18-0.75; P = 0.007). Notably, physical activity was not associated with mortality risk among those with moderate/severe retinopathy (HR _adjusted = 0.371.72; 95% CI: 0.62-4.76; P = 0.27).

Conclusion: Physical activity is associated with reduced mortality risk among those with mild retinopathy, but not among those with moderate/severe retinopathy.

The gamma gap and all-cause mortality risk: considerations of physical activity

BACKGROUND

Only one study has examined the association between the 'gamma gap' (total serum protein minus albumin) and all-cause mortality risk. No study has evaluated this relationship while considering patient physical activity behaviour.

OBJECTIVE

To examine the effects of gamma gap on all-cause mortality, with considerations by physical activity behaviour.

METHODS

Data from the 1999-2006 National Health and Nutrition Examination Survey were employed, with follow-up occurring through 2011 via the National Death Index. Gamma gap was evaluated from a comprehensive medical panel, with physical activity assessed via self-report. Various potential confounders were evaluated via self-report, examination and laboratory assessment.

RESULTS

Among the evaluated 14,936 participants, 1,564,112 person-months occurred with an incidence rate of 0.63 deaths per 1000 person-months. The unweighted median follow-up period was 105 months, with 989 deaths occurring during the follow-up period. After adjusting for all covariates with the exception of physical activity, gamma gap was significantly associated with all-cause mortality risk (HR=1.33; 95% CI: 1.07-1.64). The inclusion of physical activity as a covariate did not appreciably alter the relationship between the gamma gap and all-cause mortality (HR = 1.30; 95% CI: 1.05-1.60; p = 0.02). Participants with an elevated gamma gap (≥ 3.1 g/dl; ≥ 31.0 g/l) and who met moderate-to-vigorous physical activity guidelines had a 44% reduced all-cause mortality risk (HR = 0.56; 95% CI: 0.40-0.78; p = 0.001).

CONCLUSION

This study lends further credence to the effect of the gamma gap on all-cause mortality risk independent of other mortality risk factors and physical activity status, as well as provides evidence for a beneficial effect of physical activity on mortality among individuals with an elevated gamma gap. Thus, it may be possible that serial monitoring of total protein and albumin may be beneficial in the clinical setting and we highlight a potential beneficial role of physical activity in patients with elevated gamma gap.