Validation of the Yale Physical Activity Survey in Chronic Obstructive Pulmonary Disease Patients

The Role of Wearable Sensors to Monitor Physical Activity and Sleep Patterns in Older Adult Inpatients: A Structured Review

Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.

Reliability and Validity of Patient-Reported, Rater-Based, and Hybrid Physical Activity Assessments in COPD: A Systematic Review

Selecting valid and reliable PA assessments in chronic obstructive pulmonary disease (COPD) is crucial to ensure that the information obtained is accurate, valuable, and meaningful. The purpose of this systematic review was to compare the validity and reliability among PA assessments in COPD. An electronic database search of PubMed and CINAHL was completed in December 2019 using MeSH terms on physical activity, COPD, validation, and questionnaires. Transparency in reporting was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist while methodological quality was assessed with the modified Quality Appraisal tool for Reliability studies (QAREL) for reliability studies and the Quality Appraisal of Validity Studies (QAVALS) for validity studies. The search yielded fifteen different measures. The Stanford 7-day recall (PAR) demonstrated the strongest correlations with SenseWear Armband on energy expenditure (r = 0.83; p < 0.001) and moderate correlations for time spent in activity over 3 METs (r = 0.54, p < 0.001). The Multimedia Activity Recall (MARCA) also demonstrated moderate to good correlations with both SenseWear and Actigraph GT3X + accelerometers (r = 0.66-0.74). Assisted and computerized PRO measures (PAR and MARCA) and hybrid measures (C-PPAC and D-PPAC) demonstrate better psychometric properties as compared to other subjective measures and may be considered for quantification of PA in COPD. However, observations drawn from single validation studies limit strength of recommendations and further research is needed to replicate the findings.

Physical Activity Is Associated with Attenuated Disease Progression in Chronic Obstructive Pulmonary Disease

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) progression is variable and affects several disease domains, including decline in lung function, exercise capacity, muscle strength, and health status as well as changes in body composition. We aimed to assess the longitudinal association of physical activity (PA) with these a priori selected components of disease progression.

METHODS

We studied 114 COPD patients from the PAC-COPD cohort (94% male, mean [SD], 70 yr [8 yr] of age, 54 [16] forced expiratory volume in 1 s % predicted) at baseline and 2.6 yr (0.6 yr) later. Baseline PA was assessed by accelerometry. Multivariable general linear models were built to assess the association between PA and changes in lung function, functional exercise capacity, muscle strength, health status, and body composition. All models were adjusted for confounders and the respective baseline value of each measure.

RESULTS

Per each 1000 steps higher baseline PA, forced expiratory volume in 1 s declined 7 mL less (P < 0.01), forced vital capacity 9 mL less (P = 0.03) and carbon monoxide diffusing capacity 0.10 mL·min·mm Hg less (P = 0.04), while the St George's Respiratory Questionnaire symptom domain deteriorated 0.4 points less (P = 0.03), per year follow-up. Physical activity was not associated with changes in functional exercise capacity, muscle strength, other domains of health status or body composition.

CONCLUSIONS

Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.

High levels of incidental physical activity are positively associated with cognition and EEG activity in aging

High levels of physical activity seem to positively influence health and cognition across the lifespan. Several studies have found that aerobic exercise enhances cognition and likely prevents cognitive decline in the elderly. Nevertheless, the association of incidental physical activity (IPA) with health and cognition during aging has not been studied. Thus, the aim of this study was to evaluate the association of IPA level with cognitive functions and resting electroencephalogram (EEG) in healthy old participants. Participants (n = 97) with normal scores on psychometric and neuropsychological tests and normal values in blood analyses were included. A cluster analysis based on the scores of the Yale Physical Activity Scale (YPAS) allowed the formation of two groups: active, with high levels of IPA, and passive, with low levels of IPA. Eyes-closed resting EEG was recorded from the participants; the fast Fourier transform was used offline to calculate absolute power (AP), relative power (RP), and mean frequency (MF) measures. There were no differences in socioeconomic status, cognitive reserve, general cognitive status, or lipid and TSH profiles between the groups. The results of cognitive tests revealed significant differences in the performance variables of the WAIS scores (p = .015), with advantages for the active group. The resting EEG exhibited significantly slower activity involving the frontal, central, and temporal regions in the passive group (p < .05). Specifically, higher delta RP (F7, T3), lower delta MF (F4, C4, T4, T6, Fz, Cz), higher theta AP (C4), higher theta RP (F4, C4, T3, Fz), lower alpha AP (F3, F7, T3), lower alpha RP (F7), and lower total MF (F3, F7, T3, T5, Fz) were found. Altogether, these results suggest that IPA induces a neuroprotective effect, which is reflected both in behavioral and electrophysiological variables during aging.

Factors associated with high healthcare resource utilisation among COPD patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) places a huge economic burden on healthcare systems, especially patients with frequent exacerbations and co-morbidities.

OBJECTIVES

To identify factors associated with high utilisation of healthcare resources in a population of patients with COPD.

METHOD

We conducted an observational, cross-sectional, multicentre study with the aim of identifying the factors associated with high resource utilisation among patients with COPD. Sociodemographic and anthropometric characteristics of the study population, as well as data on health-related quality of life, respiratory symptoms, presence of anxiety and depression, physical activity and lung function were collected. We examined the relationship between these variables and high utilisation of healthcare resources, by performing a multivariate analysis based on a logistic regression model.

RESULTS

115 patients (64 were high users of healthcare resources, and 51 control patients) from 13 hospitals were selected. Patients presenting high resource utilisation had worse FEV₁, worse basal SpO₂, less distance walked in the 6-minute walk test, and increased dyspnoea. They also had a worse BODE index, worse scores in all dimensions of the EURO-QOL 5D and the LCADL scale, and displayed a higher prevalence of depression. Multivariate analysis yielded a statistically significant association between SpO₂, LCADL scores, serum fibrinogen values and total leukocyte count, and high healthcare resource utilisation.

CONCLUSIONS

COPD patients who incur higher healthcare resource utilisation show reduced physical activity, increased respiratory failure and increased systemic inflammation.