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Gore S, Khanna H, Kumar A. Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis. Phys Ther 2023; 103:pzad119. [PMID: 37658777 PMCID: PMC10630615 DOI: 10.1093/ptj/pzad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure. METHODS PubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development, and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance). RESULTS Eleven randomized controlled trials including 1523 participants ranging from 45 to 80 years old and an intervention duration ranging from 2 to 26 weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups. CONCLUSION Results of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in noncardiac rehabilitation settings, or no exercise. IMPACT Heart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.
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Affiliation(s)
- Shweta Gore
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Hargun Khanna
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Amit Kumar
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
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2
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Zhou Y, Sun X, Yang G, Ding N, Pan X, Zhong A, Guo T, Peng Z, Chai X. Sex-specific differences in the association between steps per day and all-cause mortality among a cohort of adult patients from the United States with congestive heart failure. Heart Lung 2023; 62:175-179. [PMID: 37541137 DOI: 10.1016/j.hrtlng.2023.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND There is a lack of understanding of how daily step counts differentially affect the risk of all-cause mortality in adult with congestive heart failure (CHF) by sex in the United States (US). OBJECTIVES To explore the relationship between daily step counts and all-cause mortality in patients with CHF by sex. METHODS This is a cohort analysis from the National Health and Nutrition Examination Survey from 2005 to 2006. Multiple Cox hazard regression was performed to explore the association of step counts and all-cause mortality in patients with CHF by sex. RESULTS In this study, 363 unweighted samples were enrolled from NHANES 2005-2006, representing about 8.4 million of the US population. Further, 46.28% were women, and the average age was 46 years. Patients with CHF in the more than 5581 steps/day group (HR, 0.31 [95% CI, 0.16-0.58]) had a significantly reduced risk of all-cause mortality compared with the patients in the less 5581 steps/day group after accounting for all covariates. In men, after accounting for all the covariates, there was a significant difference in more than 5581 steps/day group (HR, 0.33 [95% CI, 0.14-0.76]) on all-cause mortality in men with CHF compared with men in the less than 5581 steps/day group. CONCLUSIONS Step count is associated with all-cause mortality in patients with CHF. Taking 5581 daily steps was associated with a decreased risk of all-cause mortality in patients with CHF.
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Affiliation(s)
- Yang Zhou
- Department of Intensive Care Unit, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xin Sun
- College of nursing, Changsha Medical University, Changsha, Hunan province, 410000, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Ning Ding
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xiaogao Pan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Aifang Zhong
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Tuo Guo
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Zhenyu Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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3
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Williams GJ, Al-Baraikan A, Rademakers FE, Ciravegna F, van de Vosse FN, Lawrie A, Rothman A, Ashley EA, Wilkins MR, Lawford PV, Omholt SW, Wisløff U, Hose DR, Chico TJA, Gunn JP, Morris PD. Wearable technology and the cardiovascular system: the future of patient assessment. Lancet Digit Health 2023; 5:e467-e476. [PMID: 37391266 DOI: 10.1016/s2589-7500(23)00087-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/26/2023] [Accepted: 04/19/2023] [Indexed: 07/02/2023]
Abstract
The past decade has seen a dramatic rise in consumer technologies able to monitor a variety of cardiovascular parameters. Such devices initially recorded markers of exercise, but now include physiological and health-care focused measurements. The public are keen to adopt these devices in the belief that they are useful to identify and monitor cardiovascular disease. Clinicians are therefore often presented with health app data accompanied by a diverse range of concerns and queries. Herein, we assess whether these devices are accurate, their outputs validated, and whether they are suitable for professionals to make management decisions. We review underpinning methods and technologies and explore the evidence supporting the use of these devices as diagnostic and monitoring tools in hypertension, arrhythmia, heart failure, coronary artery disease, pulmonary hypertension, and valvular heart disease. Used correctly, they might improve health care and support research.
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Affiliation(s)
- Gareth J Williams
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al-Baraikan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Frank E Rademakers
- Faculty of Medicine, Department of Cardiology, KU Leuven, Leuven, Belgium
| | - Fabio Ciravegna
- Dipartimento di Informatica, Universitàdi Torino, Turin, Italy
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Allan Lawrie
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, CA, US
| | - Martin R Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Patricia V Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Stig W Omholt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement & Nutrition Sciences, University of Queensland, QLD, Australia
| | - D Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Timothy J A Chico
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; BHF Data Centre, Health Data Research UK, London, UK
| | - Julian P Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; Academic Directorate of Cardiothoracic Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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4
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Wu YC, Chen CN. Physical Therapy for Adults with Heart Failure. Phys Ther Res 2023; 26:1-9. [PMID: 37181483 PMCID: PMC10169313 DOI: 10.1298/ptr.r0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
Heart failure (HF) is a complex clinical syndrome caused by structural and/or functional abnormalities that results in significant disease burdens not only to the patients and their families but also to the society. Common symptoms/signs of HF include dyspnea, fatigue, and exercise intolerance, which significantly reduce the quality of life of individuals. Since the coronavirus disease 2019 (COVID-19) pandemic in 2019, it has been found that individuals with cardiovascular disease are more vulnerable to COVID-19-related cardiac sequelae including HF. In this article, we review the updated diagnosis, classifications, and interventional guidelines of HF. We also discuss the link between COVID-19 and HF. The latest evidence about physical therapy for patients with HF in both the stable chronic phase and acute cardiac decompensation phase is reviewed. Physical therapy for HF patients with circulatory support devices is also described.
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Affiliation(s)
- Yi-Chen Wu
- Department of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taiwan
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Popham S, Burq M, Rainaldi EE, Shin S, Dunn J, Kapur R. An Algorithm to Classify Real-World Ambulatory Status From a Wearable Device Using Multimodal and Demographically Diverse Data: Validation Study. JMIR BIOMEDICAL ENGINEERING 2023; 8:e43726. [PMID: 38875664 PMCID: PMC11041455 DOI: 10.2196/43726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Measuring the amount of physical activity and its patterns using wearable sensor technology in real-world settings can provide critical insights into health status. OBJECTIVE This study's aim was to develop and evaluate the analytical validity and transdemographic generalizability of an algorithm that classifies binary ambulatory status (yes or no) on the accelerometer signal from wrist-worn biometric monitoring technology. METHODS Biometric monitoring technology algorithm validation traditionally relies on large numbers of self-reported labels or on periods of high-resolution monitoring with reference devices. We used both methods on data collected from 2 distinct studies for algorithm training and testing, one with precise ground-truth labels from a reference device (n=75) and the second with participant-reported ground-truth labels from a more diverse, larger sample (n=1691); in total, we collected data from 16.7 million 10-second epochs. We trained a neural network on a combined data set and measured performance in multiple held-out testing data sets, overall and in demographically stratified subgroups. RESULTS The algorithm was accurate at classifying ambulatory status in 10-second epochs (area under the curve 0.938; 95% CI 0.921-0.958) and on daily aggregate metrics (daily mean absolute percentage error 18%; 95% CI 15%-20%) without significant performance differences across subgroups. CONCLUSIONS Our algorithm can accurately classify ambulatory status with a wrist-worn device in real-world settings with generalizability across demographic subgroups. The validated algorithm can effectively quantify users' walking activity and help researchers gain insights on users' health status.
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Affiliation(s)
- Sara Popham
- Verily Life Sciences, South San Francisco, CA, United States
| | - Maximilien Burq
- Verily Life Sciences, South San Francisco, CA, United States
| | - Erin E Rainaldi
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sooyoon Shin
- Verily Life Sciences, South San Francisco, CA, United States
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
- Duke Clinical Research Institute, Durham, NC, United States
| | - Ritu Kapur
- Verily Life Sciences, South San Francisco, CA, United States
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Nelson MB, Shiroma EJ, Kitzman DW, Duncan PW, Reeves GR, Whellan DJ, Mentz RJ, Chen H, Pastva AM. Physical activity and relationship to physical function, quality of life, and cognitive function in older patients with acute decompensated heart failure. Am Heart J 2023; 256:85-94. [PMID: 36372251 PMCID: PMC9840656 DOI: 10.1016/j.ahj.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Volitional physical activity level is predictive of a variety of health outcomes, but has not been examined in patients recently hospitalized for acute decompensated HF (ADHF). METHODS Ten to 14 days after index hospitalization for ADHF, 93 participants wore a wrist-mounted triaxial accelerometer (ActiGraph GT3X+) to objectively quantify sedentary behavior, light physical activity, and moderate-to-vigorous physical activity. Levels were compared to 2 groups of age-matched NHANES participants: healthy and chronic, stable HF. The relationship between physical activity levels and physical function [Short Physical Performance Battery (SPPB)], HF-specific quality-of-life (QOL) [Kansas City Cardiomyopathy Questionnaire (KCCQ)], and cognition [Montreal Cognitive Assessment (MOCA)] were examined. RESULTS ADHF participants accumulated a median 1,008 (IQR 896, 1,109) minutes of sedentary time, 88 (57, 139) minutes of light physical activity, and 10 (6, 25) minutes of moderate-to-vigorous physical activity per day. Sedentary time, light physical activity, or moderate-to-vigorous activity did not differ by sex or EF subtype. ADHF participants spent only 9% of awake time nonsedentary, compared to 34% and 27% for healthy adults and adults with chronic, stable HF, respectively. Among ADHF participants, SPPB, KCCQ, and MOCA scores did not differ among quartiles of total physical activity. CONCLUSIONS Older patients recently hospitalized for ADHF have very low levels of physical activity and high levels of sedentary time, both of which may be potential targets for interventions in this high-risk population. Physical activity level was not significantly associated with objectively measured physical function, QOL, or cognition, suggesting that this measure provides independent information regarding the patient experience of living with HF. TRIAL REGISTRATION NCT02196038, https://clinicaltrials.gov/ct2/show/NCT02196038.
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Affiliation(s)
- Michael Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD
| | - Dalane W Kitzman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Sections on Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Robert J Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy M Pastva
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC.
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Suzuki N, Otsuki S, Izumi D, Akagawa R, Sakaguchi Y, Hakamata T, Ikami Y, Hasegawa Y, Yagihara N, Iijima K, Chinushi M, Inomata T. Clinical impact of nocturnal ventricular tachyarrythmias in electrical storm. Pacing Clin Electrophysiol 2022; 45:1330-1337. [DOI: 10.1111/pace.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Naomasa Suzuki
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Sou Otsuki
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Daisuke Izumi
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Rie Akagawa
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yuta Sakaguchi
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Takahiro Hakamata
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yasuhiro Ikami
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yuki Hasegawa
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Nobue Yagihara
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Kenichi Iijima
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | | | - Takayuki Inomata
- Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
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Izawa KP, Kasahara Y, Watanabe S, Oka K, Brubaker PH, Kida K, Akashi YJ. Association of objectively measured daily physical activity and health utility to disease severity in chronic heart failure patients: A cross-sectional study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 10:100051. [PMID: 38560645 PMCID: PMC10978131 DOI: 10.1016/j.ahjo.2021.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 04/04/2024]
Abstract
Background and aims Physical activity (PA) levels are related to mortality and morbidity in patients with chronic heart failure (CHF). Health utility (HU), a very important cost-effectiveness analysis for health care and health status, is measured by several preference-based utility measures. This study aimed to evaluate the relation between PA and HU and the effect of disease severity on PA and HU in patients with CHF. Methods We enrolled 226 consecutive outpatients with CHF (mean age, 57.5 years; males, 79.6%) in this retrospective cross-sectional study. Patients were divided into three groups by NYHA class for classification of disease severity. Patient characteristics, average step count in steps/day, PA energy expenditure (PAEE) in kcal/day for 7 days as assessed by accelerometer, and HU assessed by Short Form-6D were compared between the groups. Results Average step count (r = 0.37, P < 0.01) and average PAEE (r = 0.36, P < 0.01) correlated positively with HU in all patients. Patients were classified into three groups by NYHA class: class I (n = 92), class II (n = 97), and class III (n = 37). Average step counts (7618.58, 6452.51, and 4225.63 steps/day, P < 0.001), average PAEE (244.65, 176.88, and 103.72 kcal/day, P < 0.001), and HU (0.68, 0.63, and 0.57, P < 0.001) respectively decreased with the increase in NYHA class (P < 0.001). Conclusion This study showed a significant relationship of daily PA and HU to disease severity in patients with CHF. Although causation cannot be determined from this study, these results suggest that PA and HU may provide important information related to the severity of disease in patients with CHF.
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Affiliation(s)
- Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yusuke Kasahara
- Department of Rehabilitation Medicine, St. Marianna University Yokohama-city Seibu Hospital, Yokohama, Japan
| | - Satoshi Watanabe
- Department of Rehabilitation Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Peter H. Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Atwater BD, Li Z, Pritchard J, Greiner MA, Nabutovsky Y, Hammill BG. Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation. Circ Cardiovasc Qual Outcomes 2021; 14:e007580. [PMID: 34284598 DOI: 10.1161/circoutcomes.120.007580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR. METHODS This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants. RESULTS The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of -1.0 (SD, 59.7) min/d (P<0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69-0.85], P=0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82-1.21], P=0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups. CONCLUSIONS Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.
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Affiliation(s)
- Brett D Atwater
- Inova Heart and Vascular Institute, Fairfax, VA (B.D.A.).,Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (B.D.A.)
| | - Zhen Li
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | - Jessica Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | | | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
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Shoemaker MJ, Kampfschulte A, Rustmann S, Dickinson MG. Dynamic factor analysis of seasonal variation in daily physical activity in individuals with heart failure and implanted cardiac devices. Heart Lung 2021; 50:754-762. [PMID: 34225086 DOI: 10.1016/j.hrtlng.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/03/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of the present study was to determine the presence and magnitude of seasonal variation in daily physical activity (PA) in those with heart failure (HF). METHODS Retrospective study and dynamic factor analysis (DFA) of Patient Activity data from Medtronic implanted cardioverter defibrillator and cardiac resynchronization devices (ICD/CRTs). RESULTS In a data set of 435 patients, distinct states/trends were identified by DFA including a classic, sinusoidal pattern of seasonal variation and a pattern of decline over the course of 12 months, which were associated with specific clinical characteristics. Overall, model fitting was good. CONCLUSIONS Those with low comorbidities, better NYHA Class, higher BMI, no hospitalization, and male sex demonstrated greater seasonal variation of at least 40 min per day between winter (lowest PA) and spring/summer (highest PA). Those with female sex and hospitalization demonstrated overall downward trajectories of approximately 40 and 80 min, respectively, over the course of the year.
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Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, United States; Spectrum Health, Department of Rehabilitation, Grand Rapids, MI, United States.
| | | | - Sarah Rustmann
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, United States
| | - Michael G Dickinson
- Spectrum Health, Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, United States
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11
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Subjective Daily Physical Activity Measures in Heart Disease: A Systematic Review. J Phys Act Health 2021; 18:450-460. [PMID: 33668019 DOI: 10.1123/jpah.2020-0661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 01/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The measurement of daily physical activity (DPA) is important for the prognosis and quantifying clinical outcomes in individuals with heart disease. The measurement of DPA is more feasible using subjective measures when compared with objective measures. The purpose of this systematic review of the literature was to identify the subjective measures of DPA that have established reliability and validity in individuals with heart disease to assist clinician and researcher instrument selection. METHODS A systematic search of PubMed, CINAHL, MEDLINE, and ProQuest databases was performed. Methodological rigor was assessed using 3 different quality appraisal tools. Qualitative synthesis of included studies was performed. RESULTS Twenty-two unique studies covering 19 subjective DPA measures were ultimately included. Methodological rigor was generally fair, and validity coefficients were moderate at best. CONCLUSIONS Only 4 subjective measures that have established test-retest reliability and that provide an estimate of energy expenditure, metabolic equivalents, or minutes of DPA were compared against accelerometry or a DPA diary in patients with heart disease: SWISS Physical Activity Questionnaire, Total Activity Measure 1 and 2, and Mobile Physical Activity Logger. Depending on the clinician or researcher needs, instrument selection would depend on the recall period and the DPA construct being measured.
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Gardner RS, Thakur P, Hammill EF, Nair DG, Eldadah Z, Stančák B, Ferrick K, Sriratanasathavorn C, Duray GZ, Wariar R, Zhang Y, An Q, Averina V, Boehmer JP. Multiparameter diagnostic sensor measurements during clinically stable periods and worsening heart failure in ambulatory patients. ESC Heart Fail 2021; 8:1571-1581. [PMID: 33619893 PMCID: PMC8006698 DOI: 10.1002/ehf2.13261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 11/14/2022] Open
Abstract
Aims This study aims to characterize the range of implantable device‐based sensor values including heart sounds, markers of ventilation, thoracic impedance, activity, and heart rate for patients with heart failure (HF) when patients were deemed to be in clinically stable periods against the time course of acute decompensation and recovery from HF events. Methods and results The MultiSENSE trial followed 900 patients implanted with a COGNIS CRT‐D for up to 1 year. Chronic, ambulatory diagnostic sensor data were collected and evaluated during clinically stable periods (CSP: unchanged NYHA classification, no adverse events, and weight change ≤2.27 kg), and in the timeframe leading up to and following HF events (HF admissions or unscheduled visits with intravenous HF treatment). Physiologic sensor data from 1667 CSPs occurring in 676 patients were compared with those data leading up to and following 192 HF events in 106 patients. Overall, the mean age was 66.6 years, and the population were predominantly male (73%). Patients were primarily in NYHA II (67%), with a mean LVEF of 29.6% and median NT‐proBNP of 754.5 pg/mL. Sensor values during CSP were poorer in patients who had HF events during the study period than those without HF events, including first heart sound (S1: 2.18 ± 0.84 mG vs. 2.62 ± 0.95 mG, P = 0.002), third heart sound (S3: 1.13 ± 0.36 mG vs. 0.91 ± 0.30 mG, P < 0.001), thoracic impedance (45.66 ± 8.78 Ohm vs. 50.33 ± 8.43 Ohm, P < 0.001), respiratory rate (19.09 ± 3.10 br/min vs. 17.66 ± 2.39 br/min, P = 0.002), night time heart rate (73.39 ± 8.36 b.p.m. vs. 69.56 ± 8.09 b.p.m., P = 0.001), patient activity (1.69 ± 1.84 h vs. 2.56 ± 2.20 h, P = 0.006), and HeartLogic index (11.07 ± 12.14 vs. 5.31 ± 5.13, P = 0.001). Sensor parameters measured worsening status leading up to HF events with recovery of values following treatment. Conclusions Device‐based physiologic sensors not only revealed progressive worsening leading up to HF events but also differentiated patients at increased risk of HF events when presumed to be clinically stable.
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Affiliation(s)
| | | | | | - Devi G Nair
- Cardiology Associates of North-East Arkansas, Jonesboro, AR, USA
| | | | - Branislav Stančák
- East-Slovak Institute of Cardiovascular Diseases, Kosice, Slovak Republic
| | | | | | | | | | - Yi Zhang
- Boston Scientific, Arden Hills, MN, USA
| | - Qi An
- Boston Scientific, Arden Hills, MN, USA
| | | | - John P Boehmer
- Penn State Milton S Hershey Medical Center, Hershey, PA, USA
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Schubert C, Archer G, Zelis JM, Nordmeyer S, Runte K, Hennemuth A, Berger F, Falk V, Tonino PAL, Hose R, ter Horst H, Kuehne T, Kelm M. Wearable devices can predict the outcome of standardized 6-minute walk tests in heart disease. NPJ Digit Med 2020; 3:92. [PMID: 32665977 PMCID: PMC7347580 DOI: 10.1038/s41746-020-0299-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022] Open
Abstract
Wrist-worn devices with heart rate monitoring have become increasingly popular. Although current guidelines advise to consider clinical symptoms and exercise tolerance during decision-making in heart disease, it remains unknown to which extent wearables can help to determine such functional capacity measures. In clinical settings, the 6-minute walk test has become a standardized diagnostic and prognostic marker. We aimed to explore, whether 6-minute walk distances can be predicted by wrist-worn devices in patients with different stages of mitral and aortic valve disease. A total of n = 107 sensor datasets with 1,019,748 min of recordings were analysed. Based on heart rate recordings and literature information, activity levels were determined and compared to results from a 6-minute walk test. The percentage of time spent in moderate activity was a predictor for the achievement of gender, age and body mass index-specific 6-minute walk distances (p < 0.001; R 2 = 0.48). The uncertainty of these predictions is demonstrated.
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Affiliation(s)
- Charlotte Schubert
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin (Deutsches Herzzentrum Berlin, DHZB), 13353 Berlin, Germany
| | - Gareth Archer
- Cardiothoracic Centre, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S5 7AT UK
| | - Jo M. Zelis
- Department of Cardiology, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
| | - Sarah Nordmeyer
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Kilian Runte
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, German Heart Center Berlin (Deutsches Herzzentrum Berlin, DHZB), 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Volkmar Falk
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (Deutsches Herzzentrum Berlin, DHZB), 13353 Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, 8092 Zurich, Switzerland
| | - Pim A. L. Tonino
- Department of Cardiology, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
| | - Rod Hose
- Cardiothoracic Centre, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S5 7AT UK
| | - Herman ter Horst
- Department of Chronic Disease Management, Philips Electronics Nederland B.V., 5656 AE Eindhoven, The Netherlands
| | - Titus Kuehne
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin (Deutsches Herzzentrum Berlin, DHZB), 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Marcus Kelm
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin (Deutsches Herzzentrum Berlin, DHZB), 13353 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
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Blomqvist A, Bäck M, Klompstra L, Strömberg A, Jaarsma T. Utility of single-item questions to assess physical inactivity in patients with chronic heart failure. ESC Heart Fail 2020; 7:1467-1476. [PMID: 32372549 PMCID: PMC7373918 DOI: 10.1002/ehf2.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Aim The purpose of this study was to explore the utility of two single‐item self‐report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross‐sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self‐reported physical activity or low self‐reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: ρ = 0.24, P = 0.016 for SR1 and ρ = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self‐reported physical activity group (P < 0.001). Conclusions There might be utility in the single SR question for high‐specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.
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Affiliation(s)
- Andreas Blomqvist
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
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O'Donnell J, Smith-Byrne K, Velardo C, Conrad N, Salimi-Khorshidi G, Doherty A, Dwyer T, Tarassenko L, Rahimi K. Self-reported and objectively measured physical activity in people with and without chronic heart failure: UK Biobank analysis. Open Heart 2020; 7:e001099. [PMID: 32153787 PMCID: PMC7046950 DOI: 10.1136/openhrt-2019-001099] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/18/2019] [Accepted: 11/27/2019] [Indexed: 01/06/2023] Open
Abstract
Objective The impact of heart failure (HF) on perceived and objectively measured levels of physical activity (PA) can inform risk stratification and treatment recommendation. We aimed to compare self-reported and objectively measured PA levels in a large sample of participants with and without HF. Methods A validated PA questionnaire was used to estimate self-reported weekly PA among 1600 participants with HF and 387 580 participants without HF. Accelerometer data were studied in 596 participants with HF and 96 105 participants without HF for a period of 7 days. Using multivariable linear regression models, we compared the PA levels between participants with HF and without HF, focusing on both the average daily PA levels and the intensity of PAs throughout the day. Results PA levels were significantly lower in participants with HF using both self-report (excess metabolic equivalent of task hours per week of 26.5 (95% CI 24.7 to 28.4) vs 34.7 (95% CI 34.5 to 34.9), respectively (p<0.001)) and accelerometer measures (mean accelerations of 23.7 milligravity (95% CI 23.1 to 24.4) vs 28.1 milligravity (95% CI 28.0 to 28.1), respectively (p<0.001)). Findings were consistent across different PA intensities. Hour-by-hour comparisons showed that accelerometer-derived PA levels of patients with HF were reduced throughout the day. Conclusion Perceived and objectively recorded PA levels of patients with chronic HF are significantly lower than those of individuals without HF. This difference is continuous throughout the different hours of the day, with individuals with HF being on average 16% less active than individuals without HF. In patients with HF, increases in everyday activity may be a potential alternative to structured exercise programmes.
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Affiliation(s)
- Johanna O'Donnell
- George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Karl Smith-Byrne
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carmelo Velardo
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Nathalie Conrad
- George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Aiden Doherty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Terence Dwyer
- George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Kazem Rahimi
- George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
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16
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Kelly JP, Ballew NG, Lin L, Hammill BG, Stivland TM, Jones PW, Curtis LH, Hernandez AF, Greiner MA, Atwater BD. Association of Implantable Device Measured Physical Activity With Hospitalization for Heart Failure. JACC-HEART FAILURE 2020; 8:280-288. [PMID: 32035894 DOI: 10.1016/j.jchf.2019.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the association of physical activity (PA) level and longitudinal PA trajectory with a composite heart failure hospitalization and mortality endpoint over a 5-year follow-up period following implantation. BACKGROUND Low device measured PA early after implantation of an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is associated with poor outcomes. METHODS We linked daily PA data from the Boston Scientific ALTITUDE dataset of patients with ICD or CRT-D implantation to Medicare claims data. We used a joint model to investigate the association of the composite endpoint with 1) the time-varying point estimate of PA and 2) the time-varying trajectory/slope of PA during follow-up. RESULTS Among 20,927 patients with median activity level 85 min/day, 14.1% and 49.6% experienced the composite endpoint at 1 and 5 years. Adjusted joint model results showed that there was a 1.13 (95% confidence interval: 1.12 to 1.13)-fold increase in the hazard of the composite endpoint for 75 min of daily PA relative to 85 min of PA; and a within-patient 10-min decrease in average daily PA over an 8-week period from 85 to 75 min was associated with a hazard ratio of 4.02 (95% confidence interval: 3.82 to 4.22) for the composite endpoint. CONCLUSIONS Patients with large decreases in PA have significantly higher risk of experiencing heart failure hospitalization or death. PA data from implantable devices may identify patients before clinical decompensation.
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Affiliation(s)
- Jacob P Kelly
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina; Alaska Heart & Vascular Institute, Anchorage, Alaska.
| | - Nicholas G Ballew
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Li Lin
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Bradley G Hammill
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Paul W Jones
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Lesley H Curtis
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Adrian F Hernandez
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Brett D Atwater
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
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Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther 2020; 100:14-43. [PMID: 31972027 DOI: 10.1093/ptj/pzz127] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.
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Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, 301 Michigan NE, Suite 200, Grand Rapids, MI 49503 (USA). Dr Shoemaker is a board-certified clinical specialist in geriatric physical therapy
| | - Konrad J Dias
- Physical Therapy Program, Maryville University of St Louis, St Louis, Missouri. Dr Dias is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Kristin M Lefebvre
- Department of Physical Therapy, Concordia University St Paul, St Paul, Minnesota. Dr Lefebvre is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - John D Heick
- Department of Physical Therapy, Northern Arizona University, Flagstaff, Arizona. Dr Heick is a board-certified clinical specialist in orthopaedic physical therapy, neurologic physical therapy, and sports physical therapy
| | - Sean M Collins
- Physical Therapy Program, Plymouth State University, Plymouth, New Hampshire
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Herkert C, Kraal JJ, van Loon EMA, van Hooff M, Kemps HMC. Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study. JMIR Mhealth Uhealth 2019; 7:e15045. [PMID: 31855191 PMCID: PMC6940867 DOI: 10.2196/15045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. OBJECTIVE The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. METHODS EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). RESULTS A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8%, SD 7.6%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. CONCLUSIONS Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms.
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Affiliation(s)
- Cyrille Herkert
- Máxima Medical Center, Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Eindhoven, Netherlands
| | - Jos Johannes Kraal
- Máxima Medical Center, Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Eindhoven, Netherlands
| | - Eline Maria Agnes van Loon
- Máxima Medical Center, Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Eindhoven, Netherlands
| | - Martijn van Hooff
- Máxima Medical Center, Department of Sports Medicine, Eindhoven, Netherlands
| | - Hareld Marijn Clemens Kemps
- Máxima Medical Center, Flow, Center for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Eindhoven, Netherlands
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Burnham JP, Lu C, Yaeger LH, Bailey TC, Kollef MH. Using wearable technology to predict health outcomes: a literature review. J Am Med Inform Assoc 2019; 25:1221-1227. [PMID: 29982520 PMCID: PMC7263786 DOI: 10.1093/jamia/ocy082] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/31/2018] [Indexed: 12/05/2022] Open
Abstract
Objective To review and analyze the literature to determine whether wearable technologies can predict health outcomes. Materials and methods We queried Ovid Medline 1946 -, Embase 1947 -, Scopus 1823 -, the Cochrane Library, clinicaltrials.gov 1997 – April 17, 2018, and IEEE Xplore Digital Library and Engineering Village through April 18, 2018, for studies utilizing wearable technology in clinical outcome prediction. Studies were deemed relevant to the research question if they involved human subjects, used wearable technology that tracked a health-related parameter, and incorporated data from wearable technology into a predictive model of mortality, readmission, and/or emergency department (ED) visits. Results Eight unique studies were directly related to the research question, and all were of at least moderate quality. Six studies developed models for readmission and two for mortality. In each of the eight studies, data obtained from wearable technology were predictive of or significantly associated with the tracked outcome. Discussion Only eight unique studies incorporated wearable technology data into predictive models. The eight studies were of moderate quality or higher and thereby provide proof of concept for the use of wearable technology in developing models that predict clinical outcomes. Conclusion Wearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology.
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Affiliation(s)
- Jason P Burnham
- Department of Internal Medicine, Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chenyang Lu
- Department of Computer Science & Engineering, Washington University in St. Louis, Missouri, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, Missouri, USA
| | - Thomas C Bailey
- Department of Internal Medicine, Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marin H Kollef
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Impact of Cardiac Resynchronization Therapy on Daily Physical Activity in Heart Failure Patients. J Cardiopulm Rehabil Prev 2019; 38:E1-E4. [PMID: 30142127 DOI: 10.1097/hcr.0000000000000345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac resynchronization therapy (CRT) has emerged as a beneficial therapy for heart failure (HF) patients. It has been shown to enhance cardiac pump function and increase exercise capacity in patients with HF who display wide QRS complex on their electrocardiogram. To date, few studies have assessed daily physical activity (PA) in CRT patients. The objective of this pilot study was to assess the impact of CRT on the physical function and daily PA of HF patients who met the standard indications for CRT implantation. METHODS The daily PA of 18 CRT patients was measured using a SenseWear Armband for ∼3 d. Daily PA measurements included steps/d and time spent sedentary (≤1.5 metabolic equivalent tasks), in light PA (1.6-2.9 metabolic equivalent tasks), and in moderate-vigorous PA (≥3 metabolic equivalent tasks). To assess exercise capacity, a 6-min walk test was performed pre- and post-CRT. RESULTS There was no significant change in the 6-min walk test distance from pre- to post-CRT (383 ± 99 m at baseline vs 402 ± 104 m post-CRT). There was a decrease in total steps/d from 3405 ± 2334 pre-CRT to 2553 ± 1692 post-CRT (P = .017). Furthermore, no significant changes were observed pre- to post-CRT with regard to the additional PA assessments. CONCLUSIONS Our patients exhibited a sedentary lifestyle pre- and post-CRT. These findings underscore the need for a cardiac rehabilitation program that encourages post-CRT patients to decrease sedentary time.
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Abstract
BACKGROUND Few studies report objective accelerometer-measured daily physical activity levels in patients with heart failure (HF). OBJECTIVE We examined baseline accelerometer-measured physical activity from the Heart Failure Exercise and Resistance Training Camp trial, a federally funded (R01-HL112979) 18-month intervention study to promote adherence to exercise in patients with HF. Factors associated with physical activity levels were also explored. METHODS Patients with diagnosed HF (stage C chronic HF confirmed by echocardiography and clinical evaluation) were recruited from 2 urban medical centers. Physical activity energy expenditure and the number of minutes of moderate or vigorous physical activity (MVPA) were obtained from 7 full days of measurement with the accelerometer (Actigraph Model GT3X, Pensacola, Florida) for 182 subjects who met minimum valid wear time parameters. Additional measures of health-related factors were included to explore the association with physical activity levels. RESULTS Subjects had 10.2 ± 10.5 minutes of MVPA per day. Total physical activity energy expenditure was 304 ± 173 kcal on average per day. There were 23 individuals (12.6%) who met the recommended goal of 150 minutes of MVPA per week. Men, whites, New York Heart Association class II, and subjects with better physical function had significantly higher levels of activity. CONCLUSIONS Consistent with previous research, patients with HF are not meeting recommended guidelines for 150 minutes of MVPA per week.
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Vetrovsky T, Siranec M, Marencakova J, Tufano JJ, Capek V, Bunc V, Belohlavek J. Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure. PLoS One 2019; 14:e0222569. [PMID: 31518367 PMCID: PMC6743766 DOI: 10.1371/journal.pone.0222569] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Although numerous activity trackers have been validated in healthy populations, validation is lacking in chronic heart failure patients who normally walk at a slower pace, making it difficult for researchers and clinicians to implement activity monitors during physical activity interventions. METHODS Six consumer-level activity monitors were validated in a 3-day field study in patients with chronic heart failure and healthy individuals under free living conditions. Furthermore, the same devices were evaluated in a lab-based study during treadmill walking at speeds of 2.4, 3.0, 3.6, and 4.2 km·h-1. Concordance correlation coefficients (CCC) were used to evaluate the agreement between the activity monitors and the criterion, and mean absolute percentage errors (MAPE) were calculated to assess differences between each device and the criterion (MAPE <10% was considered as a threshold for validity). RESULTS In the field study of healthy individuals, all but one of the activity monitors showed a substantial correlation (CCC ≥0.95) with the criterion device and MAPE <10%. In patients with heart failure, the correlation of only two activity monitors (Garmin vívofit 3 and Withings Go) was classified as at least moderate (CCC ≥0.90) and none of the devices had MAPE <10%. In the lab-based study at speeds 4.2 and 3.6 km·h-1, all activity monitors showed substantial to almost perfect correlations (CCC ≥0.95) with the criterion and MAPE in the range 1%-3%. However, at slower speeds of 3.0 and 2.4 km·h-1, the accuracy of all devices substantially deteriorated: their correlation with the criterion decreased below 90% and their MAPE increased to 4-8% and 10-45%, respectively. CONCLUSIONS Even though none of the tested activity monitors fall within arbitrary thresholds for validity, most of them perform reasonably well enough to be useful tools that clinicians can use to simply motivate chronic heart failure patients to walk more.
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michal Siranec
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jitka Marencakova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - James J. Tufano
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Vaclav Capek
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Mediano MFF, Leifer ES, Cooper LS, Keteyian SJ, Kraus WE, Mentz RJ, Fleg JL. Influence of Baseline Physical Activity Level on Exercise Training Response and Clinical Outcomes in Heart Failure: The HF-ACTION Trial. JACC. HEART FAILURE 2018; 6:1011-1019. [PMID: 30497641 PMCID: PMC6317714 DOI: 10.1016/j.jchf.2018.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to evaluate the influence of baseline physical activity (PA) on responses to aerobic exercise training and clinical events in outpatients with chronic systolic heart failure (HF) from the multicenter HF-ACTION (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure) trial. BACKGROUND The influence of baseline PA on exercise capacity, responses to exercise training and clinical outcomes in patients with chronic HF is unclear. METHODS Of 2,130 participants who provided consent for this analysis, 1,494 patients (64%) had complete baseline PA data, using a modified version of the International Physical Activity Questionnaire-Short Form questionnaire and were included in the analysis; 742 received usual care and 752 were allocated to the exercise training group. Changes in exercise capacity, all-cause mortality and hospitalization, cardiovascular (CV) mortality and hospitalization, and CV mortality and HF hospitalization were evaluated as a function of baseline PA tertile. RESULTS At baseline, the highest PA tertile showed greater peak oxygen uptake, cardiopulmonary exercise test duration, and 6-min walk test distance than the other 2 PA tertiles, as well as lower New York Heart Association functional class, lower Beck depression score, and lower atrial fibrillation prevalence than the lowest PA tertile. Compared to the lowest PA tertile, the middle tertile had 18% lower risk of CV death/CV hospitalizations, and the upper tertile showed 23% lower risk of CV death/HF hospitalizations. Exercise capacity and clinical outcome responses to training were similar and largely nonsignificant across baseline PA tertiles with significant benefit of training on exercise test duration for all tertiles. CONCLUSIONS In patients with chronic systolic HF, aerobic exercise training significantly improves exercise test duration to a similar extent across baseline PA tertiles. Although higher baseline PA was associated with lower risk of clinical events, no significant differences in event rates within each PA tertile were seen between subgroups randomized to exercise training versus usual care. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure [HF-ACTION]; NCT00047437).
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Affiliation(s)
- Mauro F F Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | - Eric S Leifer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Sargeant JA, Yates T, McCann GP, Lawson CA, Davies MJ, Gulsin GS, Henson J. Physical activity and structured exercise in patients with type 2 diabetes mellitus and heart failure. PRACTICAL DIABETES 2018. [DOI: 10.1002/pdi.2180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Jack A Sargeant
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Thomas Yates
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences; University of Leicester and the NIHR Leicester Biomedical Research Centre; Glenfield Hospital, Leicester UK
| | - Claire A Lawson
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Melanie J Davies
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences; University of Leicester and the NIHR Leicester Biomedical Research Centre; Glenfield Hospital, Leicester UK
| | - Joseph Henson
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
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25
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Objective Improvement in Daily Physical Activity in Heart Failure Remains Elusive: A Systematic Review. Cardiopulm Phys Ther J 2018. [DOI: 10.1097/cpt.0000000000000071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Palmisano P, Guerra F, Ammendola E, Ziacchi M, Luigi Pisanò EC, Dell'Era G, Aspromonte V, Zaccaria M, Di Ubaldo F, Capucci A, Nigro G, Occhetta E, Maglia G, Ricci RP, Boriani G, Accogli M. Physical Activity Measured by Implanted Devices Predicts Atrial Arrhythmias and Patient Outcome: Results of IMPLANTED (Italian Multicentre Observational Registry on Patients With Implantable Devices Remotely Monitored). J Am Heart Assoc 2018; 7:JAHA.117.008146. [PMID: 29478022 PMCID: PMC5866336 DOI: 10.1161/jaha.117.008146] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To determine whether daily physical activity (PA), as measured by implanted devices (through accelerometer sensor), was related to the risk of developing atrial arrhythmias during long‐term follow‐up in a population of heart failure (HF) patients with an implantable cardioverter defibrillator (ICD). Methods and Results The study population was divided into 2 equally sized groups (PA cutoff point: 3.5 h/d) according to their mean daily PA recorded by the device during the 30‐ to 60‐day period post‐ICD implantation. Propensity score matching was used to compare 2 equally sized cohorts with similar characteristics between lower and higher activity patients. The primary end point was time free from the first atrial high‐rate episode (AHRE) of duration ≥6 minutes. Secondary end points were: first AHRE ≥6 hours, first AHRE ≥48 hours, and a combined end point of death or HF hospitalization. Data from 770 patients (65±15 years; 66% men; left ventricular ejection fraction 35±12%) remotely monitored for a median of 25 months were analyzed. A PA ≥3.5 h/d was associated with a 38% relative reduction in the risk of AHRE ≥6 minutes (72‐month cumulative survival: 75.0% versus 68.1%; log rank P=0.025), and with a reduction in the risk of AHRE ≥6 hours, AHRE ≥48 hours, and the combined end point of death or HF hospitalization (all P<0.05). Conclusions In HF patients with ICD, a low level of daily PA was associated with a higher risk of atrial arrhythmias, regardless of the patients' baseline characteristics. In addition, a lower daily PA predicted death or HF hospitalization.
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Affiliation(s)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University University Hospital "Umberto I-Lancisi-Salesi,", Ancona, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Monaldi Hospital Second University of Naples, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University of Bologna S.Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Gabriele Dell'Era
- Division of Cardiology, University of Eastern Piedmont Maggiore della Carità Hospital, Novara, Italy
| | | | - Maria Zaccaria
- Cardiology Unit "Card. G. Panico" Hospital, Tricase, Italy
| | - Francesco Di Ubaldo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University University Hospital "Umberto I-Lancisi-Salesi,", Ancona, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University University Hospital "Umberto I-Lancisi-Salesi,", Ancona, Italy
| | - Gerardo Nigro
- Department of Cardiology, Monaldi Hospital Second University of Naples, Italy
| | - Eraldo Occhetta
- Division of Cardiology, University of Eastern Piedmont Maggiore della Carità Hospital, Novara, Italy
| | - Giampiero Maglia
- Cardiology-Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Renato Pietro Ricci
- Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia Policlinico di Modena, Italy
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Abstract
Background: Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients. Aim: The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients. Methods: The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies. Conclusions: Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.
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Affiliation(s)
- Paula R Pullen
- Department of Kinesiology, University of North Georgia, Oakwood, GA, USA
| | | | - Walter R Thompson
- College of Education and Human Development at Georgia State University, Atlanta, GA, USA
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28
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Abstract
PURPOSE OF REVIEW The purpose of this study was to explore the potential of wearable activity trackers to promote self-care management for physical activity in heart failure (HF). RECENT FINDINGS Exercise participation decreases hospital admissions and improves quality of life in HF, and activity tracking devices provide more precise means to assess free-living physical activity and thus enable tailored exercise instruction. Use of activity trackers by cardiac patients for self-monitoring and motivational purposes is associated with increased levels of physical activity and is predictive of disease severity. However, more research is required to establish the feasibility and validity of these devices in HF patients. It is also critical that the devices can be easily used to collect, process and utilise relevant data. Activity trackers have the potential to promote HF self-care because they provide monitoring of physical activity behaviours and the potential to generate habit formation and goal reinforcement, all of which foster physical activity.
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Yavari M, Haykowsky MJ, Savu A, Kaul P, Dyck JR, Haennel RG. Volume and Patterns of Physical Activity Across the Health and Heart Failure Continuum. Can J Cardiol 2017; 33:1465-1471. [DOI: 10.1016/j.cjca.2017.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
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Vetrovsky T, Siranec M, Parenica J, Griva M, Stastny J, Precek J, Pelouch R, Bunc V, Linhart A, Belohlavek J. Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials. J Transl Med 2017; 15:153. [PMID: 28673328 PMCID: PMC5496141 DOI: 10.1186/s12967-017-1257-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/24/2017] [Indexed: 12/28/2022] Open
Abstract
Background Regular physical activity is recommended for patients with chronic heart failure to improve their functional capacity, and walking is a popular, effective, and safe form of physical activity. Pedometers have shown potential to increase the amount of walking across a range of chronic diseases, but it is unknown whether a pedometer-based intervention improves functional capacity and neurohumoral modulation in heart failure patients. Methods Two multicenter randomized controlled trials will be conducted in parallel: one in patients with chronic heart failure with reduced ejection fraction (HFrEF), the other in patients with chronic heart failure with preserved ejection fraction (HFpEF). Each trial will consist of a 6-month intervention with an assessment at baseline, at 3 months, at the end of the intervention, and 6 months after completing the intervention. Each trial will aim to include a total of 200 physically inactive participants with chronic heart failure who will be randomly assigned to intervention or control arms. The 6-month intervention will consist of an individualized pedometer-based walking program with weekly step goals, behavioral face-to-face sessions with a physician, and regular telephone calls with a research nurse. The intervention will be based on effective behavioral principles (goal setting, self-monitoring, personalized feedback). The primary outcome is the change in 6-min walk distance at the end of the 6-month intervention. Secondary outcomes include changes in serum biomarkers levels, pulmonary congestion assessed by ultrasound, average daily step count measured by accelerometry, anthropometric measures, symptoms of depression, health-related quality of life, self-efficacy, and MAGGIC risk score. Discussion To our knowledge, these are the first studies to evaluate a pedometer-based walking intervention in patients with chronic heart failure with either reduced or preserved ejection fraction. The studies will contribute to a better understanding of physical activity promotion in heart failure patients to inform future physical activity recommendations and heart failure guidelines. Trial registration The trials are registered in ClinicalTrials.gov, identifiers: NCT03041610, registered 29 January 2017 (HFrEF), NCT03041376, registered 1 February 2017 (HFpEF)
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic
| | - Michal Siranec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic
| | - Jiri Parenica
- Cardiology Department of University Hospital Brno, Jihlavska 340/20, 625 00, Brno, Czech Republic
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Havlickovo nabrezi 600, 762 75, Zlin, Czech Republic
| | - Jiri Stastny
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Havlickovo nabrezi 600, 762 75, Zlin, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, I. P. Pavlova 185/6, 779 00, Olomouc, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Charles University in Prague - Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic.
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31
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Jamé S, Kutyifa V, Polonsky B, McNitt S, Al-Ahmad A, Moss AJ, Zareba W, Wang PJ. Predictive value of device-derived activity level for short-term outcomes in MADIT-CRT. Heart Rhythm 2017; 14:1081-1086. [DOI: 10.1016/j.hrthm.2017.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 10/19/2022]
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WILKOFF BRUCEL, RICHARDS MARK, SHARMA ARJUN, WOLD NICHOLAS, JONES PAUL, PERSCHBACHER DAVID, OLSHANSKY BRIAN. A Device Histogram-Based Simple Predictor of Mortality Risk in ICD and CRT-D Patients: The Heart Rate Score. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:333-343. [DOI: 10.1111/pace.13036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/09/2016] [Accepted: 01/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - MARK RICHARDS
- Northwest Ohio Cardiology Consultants; ProMedica Cardiology; Toledo Ohio
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Concurrent Validity of Daily Activity Data From Medtronic ICD/CRT Devices and the Actigraph GT3X Triaxial Accelerometer: A Pilot Study. Cardiopulm Phys Ther J 2017. [DOI: 10.1097/cpt.0000000000000042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hanada S, Kudo T, Kanzaki T, Sakata K, Iwakiri H. Association Between Liver Function and Peak Oxygen Uptake in Heart Failure Patients: A Retrospective Observational Study. Prog Rehabil Med 2017; 2:20170014. [DOI: 10.2490/prm.20170014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Satoru Hanada
- Department of Rehabilitation, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
| | - Takeaki Kudo
- Department of Cardiovascular Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
| | - Tomohiro Kanzaki
- Department of Rehabilitation, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
| | - Koji Sakata
- Department of Cardiovascular Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
| | - Hironao Iwakiri
- Department of Cardiovascular Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Miyazaki, Japan
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Shoemaker MJ, Oberholtzer NL, Jongekrijg LE, Bowen TE, Cartwright K, Hanson K, Serba D, Dickinson MG, Kowalk A. Exercise- and Psychosocial-Based Interventions to Improve Daily Activity in Heart Failure: A Pilot Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822316683660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In individuals with heart failure (HF), low daily activity is associated with a poorer prognosis. The purpose of this pilot study was to investigate the effects of two home-based interventions on the primary HF-related outcome of daily activity and secondary outcomes of exercise tolerance, HF-related health status, and lower extremity functional strength in 16 patients with HF and implanted Medtronic implantable cardioverter defibrillator and cardiac resynchronization devices using a single-blind, randomized controlled pilot trial. Interventions were either daily activity feedback and encouragement or health coaching and home-based exercise. There were no significant differences in primary or secondary outcomes either between or within groups. Three subjects in each treatment group improved in two or more secondary outcomes, and only one improved in daily activity. Although the present pilot study incorporated both exercise and psychosocial components in the intervention, there was no effect on daily activity, perhaps because readiness for behavioral change was not accounted for either in group stratification/allocation or inclusion criteria.
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Affiliation(s)
| | | | | | | | | | - Kim Hanson
- Grand Valley State University, Grand Rapids, MI, USA
| | - Deb Serba
- Grand Valley State University, Grand Rapids, MI, USA
| | - Michael G. Dickinson
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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Izawa KP, Watanabe S, Oka K, Kasahara Y, Morio Y, Hiraki K, Hirano Y, Omori Y, Suzuki N, Kida K, Suzuki K, Akashi YJ. Sarcopenia and physical activity in older male cardiac patients. Int J Cardiol 2016; 222:457-461. [DOI: 10.1016/j.ijcard.2016.07.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/27/2016] [Indexed: 12/25/2022]
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Churilla JR, Richardson MR, Pinkstaff SO, Fletcher BJ, Fletcher GF. Associations between heart failure and physical function in US adults. QJM 2016; 109:669-674. [PMID: 27026699 DOI: 10.1093/qjmed/hcw042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a paucity of nationally representative data in the area of heart failure (HF) and physical function (PF). AIM Examine the relationship(s) between HF and PF in a nationally representative sample of United States (US) adults. DESIGN Cross-section analysis of US adults. METHODS Sample (n = 6623) included adult (≥40 years of age) participants from the 1999-2006 National Health and Nutrition Examination Survey. Participants reporting HF answered questions related to their abilities to accomplish specific upper extremity and lower extremity tasks, and household chores. RESULTS Prevalence estimates of reporting much difficulty or the inability to stand from an armless chair was 9.9% and 4.3% (P = 0.002) in those with and without HF, respectively. Similar estimates were revealed for much difficulty or inability to lift or carry 10 pounds (16.8% and 8.6%, P = 0.0004) and much difficulty or inability to do household chores (13.3% and 6.1%, P = 0.0008). Following adjustments participants reporting HF had significantly greater odds of reporting much difficulty or the inability to stand from an armless chair [odds ratio (OR) 1.93; 95% confidence intervals (CI) 1.25, 2.96], much difficulty or the inability to lift or carry 10 lbs (OR 1.90; 95% CI 1.36, 2.65) and much difficulty or inability to do household chores (OR 2.06; 95% CI 1.41, 3.02) compared with participants not reporting HF. CONCLUSIONS Findings suggest US adults reporting HF are more likely to report poorer PF.
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Affiliation(s)
- J R Churilla
- From the Department of Clinical and Applied Movement Sciences-Exercise Science, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
| | - M R Richardson
- From the Department of Clinical and Applied Movement Sciences-Exercise Science, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
| | - S O Pinkstaff
- Department of Clinical and Applied Movement Sciences-Physical Therapy, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
| | - B J Fletcher
- School of Nursing, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
- Mayo Clinic - Cardiology Division, Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - G F Fletcher
- Mayo Clinic - Cardiology Division, Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Abstract
BACKGROUND Previous studies indicate that seasonal variation affects daily physical activity (PA), but none have investigated this relationship in individuals with heart failure (HF) who also have implanted cardioverter defibrillators and cardiac resynchronization therapy (ICD/CRT) devices. The purpose of the present study was to determine if seasonal variation in temperature affects daily PA in patients with HF and ICD/CRTs. PATIENTS AND METHODS Secondary analysis of data from 16 subjects with HF and Medtronic® ICD/CRT devices enrolled in a randomized trial investigating interventions to improve daily PA. Due to the rolling study enrollment, daily PA data for all subjects were not available for the entire time frame and were divided into two groups. Determination of seasonal variation of daily PA was determined using visual analysis of daily PA plotted with average temperature, autocorrelation, visual analysis of seasonal subseries plots and boxplot analysis, as well as Wilcoxon signed-rank tests. RESULTS Subjects 1-8 demonstrated the greatest differences in daily PA during periods of seasonal transition whereas subjects 9-16 demonstrated the greatest variation in daily PA with greatest seasonal temperature difference. Wilcoxon signed-rank testing of the lowest and highest months for daily PA revealed median differences of 0.30 (p = 0.050) and 0.36 hours (p = 0.036) for subjects 1-8 and 9-16, with effect sizes of 0.69 and 0.74, respectively. CONCLUSIONS Seasonal variation in mean temperature appears to affect daily PA in individuals with HF and ICD/CRT devices by a magnitude of 0.30-0.36 hours, which may need to be accounted for in future research investigating interventions to improve daily PA.
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Etemadi M, Inan OT, Heller JA, Hersek S, Klein L, Roy S. A Wearable Patch to Enable Long-Term Monitoring of Environmental, Activity and Hemodynamics Variables. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2016; 10:280-8. [PMID: 25974943 PMCID: PMC4643430 DOI: 10.1109/tbcas.2015.2405480] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We present a low power multi-modal patch designed for measuring activity, altitude (based on high-resolution barometric pressure), a single-lead electrocardiogram, and a tri-axial seismocardiogram (SCG). Enabled by a novel embedded systems design methodology, this patch offers a powerful means of monitoring the physiology for both patients with chronic cardiovascular diseases, and the general population interested in personal health and fitness measures. Specifically, to the best of our knowledge, this patch represents the first demonstration of combined activity, environmental context, and hemodynamics monitoring, all on the same hardware, capable of operating for longer than 48 hours at a time with continuous recording. The three-channels of SCG and one-lead ECG are all sampled at 500 Hz with high signal-to-noise ratio, the pressure sensor is sampled at 10 Hz, and all signals are stored to a microSD card with an average current consumption of less than 2 mA from a 3.7 V coin cell (LIR2450) battery. In addition to electronic characterization, proof-of-concept exercise recovery studies were performed with this patch, suggesting the ability to discriminate between hemodynamic and electrophysiology response to light, moderate, and heavy exercise.
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Affiliation(s)
- Mozziyar Etemadi
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158 USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - J. Alex Heller
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158 USA
| | - Sinan Hersek
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Liviu Klein
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94131 USA
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158 USA
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Louvaris Z, Vogiatzis I. Physiological basis of cardiopulmonary rehabilitation in patients with lung or heart disease. Breathe (Sheff) 2015; 11:120-7. [PMID: 26306112 PMCID: PMC4487369 DOI: 10.1183/20734735.021114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Educational Aims Summary Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD) and those with congestive heart failure (CHF). Both of these symptoms negatively impact on patients’ daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Vogiatzis
- Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece ; 1st Dept of Respiratory Medicine, Pulmonary Rehabilitation Unit, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece ; 1st Dept of Critical Care Medicine, Pulmonary Rehabilitation Center, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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Izawa KP, Watanabe S, Hirano Y, Matsushima S, Suzuki T, Oka K, Kida K, Suzuki K, Osada N, Omiya K, Brubaker PH, Shimizu H, Akashi YJ. Gender-related differences in maximum gait speed and daily physical activity in elderly hospitalized cardiac inpatients: a preliminary study. Medicine (Baltimore) 2015; 94:e623. [PMID: 25789953 PMCID: PMC4602490 DOI: 10.1097/md.0000000000000623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients.A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75, 28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups.Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P < 0.001) and average daily PAEE (r = 0.47, P < 0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 ± 1889.92 vs 4037.33 ± 1866.81 steps, P < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 0.001), respectively.Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients.
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Affiliation(s)
- Kazuhiro P Izawa
- From the Graduate School of Health Sciences, Kobe University, Kobe (KPI); Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki (SW, SM, TS); Department of Physical Therapy, Tokushima Bunri University, Tokushima (YH); Faculty of Sport Sciences, Waseda University, Tokorozawa (K. Oka); Division of Cardiology, St. Marianna University Toyoko Hospital, Kawasaki (NO); Division of Cardiology, St. Marianna University Yokohama-city Seibu Hospital, Yokohama, Japan (K. Omiya); Department of Health and Exercise Science, Wake Forest University, Winston-Salem, USA (PHB); Department of Orthopedic Surgery (HS); and Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan (KK, KS, YJA)
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Sharma V, Rathman LD, Small RS, Whellan DJ, Koehler J, Warman E, Abraham WT. Stratifying patients at the risk of heart failure hospitalization using existing device diagnostic thresholds. Heart Lung 2014; 44:129-36. [PMID: 25543319 PMCID: PMC4390994 DOI: 10.1016/j.hrtlng.2014.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/23/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
Background Heart failure hospitalizations (HFHs) cost the US health care system ~$20 billion annually. Identifying patients at risk of HFH to enable timely intervention and prevent expensive hospitalization remains a challenge. Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization devices with defibrillation capability (CRT-Ds) collect a host of diagnostic parameters that change with HF status and collectively have the potential to signal an increasing risk of HFH. These device-collected diagnostic parameters include activity, day and night heart rate, atrial tachycardia/atrial fibrillation (AT/AF) burden, mean rate during AT/AF, percent CRT pacing, number of shocks, and intrathoracic impedance. There are thresholds for these parameters that when crossed trigger a notification, referred to as device observation, which gets noted on the device report. We investigated if these existing device observations can stratify patients at varying risk of HFH. Methods We analyzed data from 775 patients (age: 69 ± 11 year, 68% male) with CRT-D devices followed for 13 ± 5 months with adjudicated HFHs. HFH rate was computed for increasing number of device observations. Data were analyzed by both excluding and including intrathoracic impedance. HFH risk was assessed at the time of a device interrogation session, and all the data between previous and current follow-up sessions were used to determine the HFH risk for the next 30 days. Results 2276 follow-up sessions in 775 patients were evaluated with 42 HFHs in 37 patients. Percentage of evaluations that were followed by an HFH within the next 30 days increased with increasing number of device observations. Patients with 3 or more device observations were at 42× HFH risk compared to patients with no device observation. Even after excluding intrathoracic impedance, the remaining device parameters effectively stratified patients at HFH risk. Conclusion Available device observations could provide an effective method to stratify patients at varying risk of heart failure hospitalization.
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Affiliation(s)
| | | | - Roy S Small
- Lancaster General Hospital, Lancaster, PA, USA
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Izawa KP, Watanabe S, Oka K, Osada N, Omiya K, Brubaker PH, Shimizu H. Differences in daily in-hospital physical activity and geriatric nutritional risk index in older cardiac inpatients: preliminary results. Aging Clin Exp Res 2014; 26:599-605. [PMID: 24791961 DOI: 10.1007/s40520-014-0233-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known about the differences in the geriatric nutritional risk index (GNRI) status in older patients and their relationship to accelerometer-derived measures of physical activity (PA) levels. We determined both differences in daily measured PA based on the GNRI and related cut-off values for PA in elderly cardiac inpatients. METHODS We divided 235 consecutive elderly cardiac inpatients (mean age 73.6 years, men 70.6%) into four groups by age and GNRI: older-high group, 65-74 years with high GNRI (≥92 points) (n = 111); older-low group, low GNRI (<92 points) (n = 30); very old-high group, ≥75 years with high GNRI (n = 55); and very old-low group with low GNRI (n = 39). Average step count and physical activity energy expenditure (PAEE in kcal) per day for 2 days of these inpatients were assessed by accelerometer and compared between the four groups to determine cut-off values of PA. RESULTS Step counts and PAEE were significantly lower in the low-GNRI versus high-GNRI groups in the older (2,742.1 vs. 4,198.1 steps, 55.4 vs. 101.3 kcal, P < 0.001), and very old (2,469.6 vs. 3,423.7 steps, 54.5 vs. 79.1 kcal, P < 0.001) cardiac inpatients. Respective cut-off values for step counts and PAEE were 3,017.6 steps/day and 69.4 kcal (P < 0.01) in the older and 2,579.4 steps/day and 58.8 kcal in the very old cardiac inpatients (P < 0.01). CONCLUSION Poor nutritional status, as indicated by a low GNRI, may be a useful predictor of step counts and PAEE. The cut-off values determined in this study might be target values to be attained by older cardiac inpatients.
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Conraads VM, Spruit MA, Braunschweig F, Cowie MR, Tavazzi L, Borggrefe M, Hill MRS, Jacobs S, Gerritse B, van Veldhuisen DJ. Physical activity measured with implanted devices predicts patient outcome in chronic heart failure. Circ Heart Fail 2014; 7:279-87. [PMID: 24519908 DOI: 10.1161/circheartfailure.113.000883] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF). METHODS AND RESULTS Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resynchronization therapy enrolled in the Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure (SENSE-HF)(1) study and the Diagnostic Outcome Trial in Heart Failure (DOT-HF) were pooled. The devices continuously measured and stored total daily active time (single-axis accelerometer). Early PA (average daily activity over the earliest 30-day study period) was studied as a predictor of time to death or HF-related hospital admission (primary end point). Data from 781 patients were analyzed (65±10 years; 85% men; left ventricular ejection fraction, 26±7%). Older age, shorter height, ischemic cause, peripheral artery disease, atrial fibrillation, diabetes mellitus, rales, peripheral edema, higher New York Heart Association class, lower diastolic blood pressure, and no angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were associated with reduced early PA. The primary end point occurred in 135 patients (15±7 months of follow-up). In multivariable analysis including baseline variables, early PA predicted death or HF hospitalization, with a 4% reduction in risk for each 10 minutes per day additional activity (hazard ratio [HR], 0.96; confidence interval [CI], 0.94-0.98; P=0.0002 compared with a model with the same baseline variables but without PA). PA also predicted death (HR, 0.93; CI, 0.90-0.96; P<0.0001) and HF hospitalization (HR, 0.97; CI, 0.95-0.99; P=0.011). CONCLUSIONS Early PA, averaged over a 30-day window early after defibrillator implantation or cardiac resynchronization therapy in patients with chronic HF, predicted death or HF hospitalization, as well as mortality and HF hospitalization separately, accounting for baseline HF severity. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00400985, NCT00480077.
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Duppen N, Takken T, Hopman M, ten Harkel A, Dulfer K, Utens E, Helbing W. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J Cardiol 2013; 168:1779-87. [DOI: 10.1016/j.ijcard.2013.05.086] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/04/2013] [Indexed: 12/25/2022]
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Taylor A. The effects of exercise training on patients with chronic heart failure. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.1999.4.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Jehn M, Prescher S, Koehler K, von Haehling S, Winkler S, Deckwart O, Honold M, Sechtem U, Baumann G, Halle M, Anker SD, Koehler F. Tele-accelerometry as a novel technique for assessing functional status in patients with heart failure: feasibility, reliability and patient safety. Int J Cardiol 2013; 168:4723-8. [PMID: 23962782 DOI: 10.1016/j.ijcard.2013.07.171] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/19/2013] [Accepted: 07/20/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The six-minute walk test (6MWT) is an established measure of functional exercise capacity associated with clinical prognosis in Chronic Heart Failure (CHF). The aim of this study is to evaluate the employment of tele-accelerometry for the remote assessment of 6MWT in CHF. METHODS 155 patients were subjected to tele-accelerometry in form of monthly 6MWTs in their home surroundings. Accelerometer output included steps/6 min and walking speed. Data was directly transferred via mobile network to the Telemedicine Centre subsequent to test completion. 6MWT distance was measured by hand wheel and steps were counted with a digital hand-counter at baseline (Test 1) and at 12 months follow-up (Test 2). RESULTS Accelerometer accuracy was within the 99th percentile. There was a significant correlation between step count, walking speed and measured 6MWT distance (Test 1: steps: r=0.80, P<0.001; Test 2: steps: r=0.90, P<0.001 and Walking Speed Test 1: r=0.80, P<0.001; Walking Speed Test 2: r=0.86, P<0.001). The reproducibility of tele-accelerometry was within 95% margin for all performance parameters, which showed stronger associations to quality of life questionnaire (Short Form - 36) Physical Component Score (PCS) than New York Heart Association (NYHA) functional class. CONCLUSION Tele-accelerometry is feasible in patients with CHF and output parameters are indicative of exercise capacity. The benefit of this approach lies in its simplicity under every day circumstances by enabling routine performance testing to assess patients' functional status.
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Affiliation(s)
- Melissa Jehn
- Division of Pneumological Oncology and Transplantology; Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
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Usefulness of step counts to predict mortality in Japanese patients with heart failure. Am J Cardiol 2013; 111:1767-71. [PMID: 23540653 DOI: 10.1016/j.amjcard.2013.02.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to determine both an association between mortality and physical activity (PA) objectively measured by accelerometer and cutoff values for PA in Japanese outpatients with heart failure (HF). This prospective observational study comprised 170 HF outpatients (mean age, 65.2 years; 77% men). Peak oxygen uptake (VO2) and the relation between ventilation and carbon dioxide production (VE/VCO2 slope) as indices of exercise capacity were measured during cardiopulmonary exercise testing with a cycle ergometer. PA was assessed by accelerometer-measured average step count (steps) per day for 1 week. Study endpoint was cardiovascular-related death. Over an average follow-up of 1,377.1 (median, 1,335) days, 31 cardiovascular-related deaths occurred. Patients were then divided into survivor (n = 139) and nonsurvivor (n = 31) groups. Brain natriuretic peptide level was significantly different between groups. Peak VO2 and steps were also significantly lower and VE/VCO2 slope higher in the nonsurvivors versus survivors. Univariate Cox proportional hazards analysis showed brain natriuretic peptide, peak VO2, VE/VCO2 slope, and steps to be significant prognostic indicators of survival. Multivariate analysis showed PA of ≤4,889.4 steps/day to be a strong and independent predictor of prognosis (hazard ratio: 2.28, 95% confidence interval: 1.31-6.30; p = 0.008). Kaplan-Meier curves after log-rank test showed significant prognostic difference between PA of ≤4,889.4 and >4,889.4 steps/day in the 2 groups (log-rank: 12.19; p = 0.0005). In conclusion, step count as objectively measured by accelerometer may be a prognostic indicator of mortality in Japanese outpatients with HF.
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Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Osada N, Omiya K, Shimizu H. Association between mental health and physical activity in patients with chronic heart failure. Disabil Rehabil 2013; 36:250-4. [PMID: 23614372 DOI: 10.3109/09638288.2013.785604] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. METHODS We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n = 148) and poor-MH (<68 points) group (n = 95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. RESULTS PA correlated positively with MH in all patients (steps: r = 0.46, p < 0.001; EE: r = 0.43, p < 0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1 ± 280.7 versus 7174.1 ± 221.5 steps, p < 0.001; 133.9 ± 10.8 versus 215.9 ± 8.4 kcal, p < 0.001). Cut-off values of 5590.8 steps and 141.1 kcal were determined as PA target values associated with improved MH. CONCLUSIONS Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.
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Affiliation(s)
- Kazuhiro P Izawa
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital , Kanagawa , Japan
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