Subjective Daily Physical Activity Measures in Heart Disease: A Systematic Review

Validity of the Active Australia Survey in an Australian cardiac rehabilitation population

OBJECTIVES

To examine the long-term validity of the Active Australia Survey in a cardiac rehabilitation population using accelerometry as the reference measure.

DESIGN

Cohort validation study.

METHODS

Cardiac rehabilitation participants with coronary heart disease were recruited to a prospective cohort study. Over 7-days, 61 participants wore an ActiGraph ActiSleep accelerometer (1-second epoch, 10-minute bout) and completed the self-administered Active Australia Survey at baseline, 6-weeks, 6 and 12-months. Total daily moderate-to-vigorous physical activity from both methods was compared using Bland-Altman plots and Spearman rank-order correlations.

RESULTS

Participants tended to over-report moderate-to-vigorous physical activity, with more active participants more likely to over-report moderate-to-vigorous physical activity. There was a good level of agreement between the accelerometer 1-second epochs and Active Australia Survey at all time points (mean bias (ratio) 1.04, 1.16, 1.14, and 1.06, respectively), with weak-moderate correlations (ρ = 0.3-0.48). Conversely, there was a poor level of agreement between the accelerometer 10-minute bouts and Active Australia Survey at all time points (mean bias (ratio) 6.78, 9.09, 6.35, and 5.68, respectively), with weak-moderate correlations (ρ = 0.3-0.52). Agreement between the two measures did not improve over time for both 1-second and 10-minute bout accelerometry data.

CONCLUSIONS

The Active Australia Survey may be an acceptable self-report measure of moderate-to-vigorous physical activity in cardiac rehabilitation attendees when capturing any time spent in moderate-to-vigorous physical activity. The Active Australia Survey may be useful to routinely monitor physical activity levels over-time in Australian cardiac rehabilitation programs at both individual and group levels.

TRIAL REGISTRATION

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx.

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

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.

Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease

Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.