Changes in physical activity around the time of major adverse cardiac events in patients with implantable cardioverter-defibrillators

BACKGROUND

With modern implantable cardioverter-defibrillators (ICDs), biometric measures including physical activity have become readily available to physicians. However, despite the increased availability, applications of these data to the clinical setting remain poorly studied. We sought to investigate whether changes in physical activity occur preceding and following cardiac events in patients with ICDs.

METHODS

We reviewed the electronic medical records of patients with ICDs implanted for any indication in 2018 and 2019 in the University of Pennsylvania health system. Patients with ICDs that reported physical activity were included in the study only if they experienced major adverse cardiac event(s) (MACE) that were preceded by at least 6 months without MACE after device implantation.

RESULTS

Seventy-four of the 827 charts reviewed met inclusion criteria. Baseline activity levels from 6 to 2 months prior to MACE were 2.18-2.21 h/day. In the month prior to MACE, average activity decreased significantly to 2.09 h/day, and subsequently decreased again during the calendar month in which MACE occurred to 1.96 h/day. The lowest average monthly activity levels occurred in the month after MACE, with incremental but non-significant recovery occurring over the subsequent 2 months.

CONCLUSIONS

In a cohort of ICD recipients, a significant decrease in physical activity was observed in the month preceding MACE. To our knowledge, this is the first study that observes time-dependent changes in activity in relation to MACE in a generalizable cohort of ICD recipients. ICD activity monitoring in patients at high risk for MACE may enhance patient care.

From Meaningful Outcomes to Meaningful Change Thresholds: A Path to Progress for Establishing Digital Endpoints

This paper examines the use of digital endpoints (DEs) derived from digital health technologies (DHTs), focusing primarily on the specific considerations regarding the determination of meaningful change thresholds (MCT). Using DHTs in drug development is becoming more commonplace. There is general acceptance of the value of DHTs supporting patient-centric trial design, capturing data outside the traditional clinical trial setting, and generating DEs with the potential to be more sensitive to change than conventional assessments. However, the transition from exploratory endpoints to primary and secondary endpoints capable of supporting labeling claims requires these endpoints to be substantive with reproducible population-specific values. Meaningful change represents the amount of change in an endpoint measure perceived as important to patients and should be determined for each digital endpoint and given population under consideration. This paper examines existing approaches to determine meaningful change thresholds and explores examples of these methodologies and their use as part of DE development: emphasizing the importance of determining what aspects of health are important to patients and ensuring the DE captures these concepts of interest and aligns with the overarching endpoint strategy. Examples are drawn from published DE qualification documentation and responses to qualification submissions under review by the various regulatory authorities. It is the hope that these insights will inform and strengthen the development and validation of DEs as drug development tools, particularly for those new to the approaches to determine MCTs.

Physical Therapy for Adults with Heart Failure

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.

Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices

BACKGROUND

Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns.

METHODS

Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods.

RESULTS

Activity significantly decreased during the pandemic period compared to one year prior by an average of 0.53 ± 1.18h/day (P < 0.001) for PPM patients and 0.51 ± 1.2h/day (P < 0.001) for ICD patients. Stratification of subjects by active time (< 2 versus ≥ 2h/day) showed patients with < 2h, particularly those with ICDs, had modestly greater activity reductions with the pandemic onset. Logistical regression analyses suggest a trend toward a greater reduction in active time at the onset of the pandemic and an increased risk of hospital or emergency department (ED) admission for PPM patients, but not ICD patients.

CONCLUSION

The onset of the pandemic in the United States was associated with a significant drop in PPM and ICD patient active hours that was modestly more pronounced in less active patients and cannot be explained by one year of aging or seasonal variation. If sustained, these populations may experience excess cardiovascular morbidity.

Pulmonary hypertension in interstitial lung disease: Clinical trial design and endpoints: A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative-Group 3 Pulmonary Hypertension

Pulmonary hypertension (PH) associated with interstitial lung disease (ILD) is an attractive target for clinical trials of PH medications. There are many factors that need to be considered to prime such studies for success. The patient phenotype most likely to respond to the intervention requires weighing the extent of the parenchymal lung disease against the severity of the hemodynamic impairment. The inclusion criteria should not be too restrictive, thus enabling recruitment. The trial should be of sufficient duration to meet the chosen endpoint which should reflect how the patient feels, functions, or survives. This paper summarizes prior studies in PH-ILD and provides a framework of the type of studies to be considered. Inclusion criteria, clinical trial endpoints, and pharmacovigilance in the context of PH-ILD trials are also addressed. Through lessons learnt from prior studies, suggestions and guidance for future clinical trials in PH-ILD are also provided.

A Phase-2 Exploratory Randomized Controlled Trial of INOpulse in Patients with Fibrotic Interstitial Lung Disease Requiring Oxygen

RATIONALE

Patients with fibrotic interstitial lung disease often progress to the point of requiring supplemental oxygen. This is invariably accompanied by an impaired quality of life and limitations on activities of daily living.

OBJECTIVE

This study aimed to assess the improvement in physical activity in patients with interstitial lung disease requiring supplemental oxygen treated with pulsed inhaled nitric oxide (iNO) via INOpulse. Additionally, it sought to explore the safety and clinical benefits of INOpulse on multiple patient reported outcomes.

METHODS

Ambulatory fibrotic lung disease patients on supplemental oxygen were randomized in a 2:1 ratio to iNO at 45 µg/kg ideal body weight (IBW)/hr (iNO45) or placebo for four months (3 months post-baseline) of blinded treatment. The study assessed multiple exploratory efficacy endpoints including moderate-to vigorous physical activity (MVPA) as measured by actigraphy and patient reported outcomes using the UCSD Shortness of Breath Questionnaire (UCSD SOBQ) and the St. George's Respiratory Questionnaire (SGRQ).

RESULTS

44 patients (30 iNO45, 14 placebo) were enrolled. A placebo-corrected clinical benefit of 12.3-minutes per day increase in MVPA was observed in the iNO45 group. Clinically meaningful beneficial trends were observed for the UCSD SOBQ (6.05 points) and the SGRQ Total (3.75) scores, as well as the SGRQ activity (5.84), and SGRQ Impact (6.30) domains.

CONCLUSIONS

INOpulse was well tolerated and associated with maintenance of physical activity and improved symptomatology in patients with interstitial lung disease who require supplemental oxygen. Further validation of this beneficial effect warrants further study in a phase 3 trial that is currently underway. Clinical Trial Registration with ClinicalTrials.gov: NCT03267108 Primary Source of Funding: Bellerophon Therapeutics.

Dynamic factor analysis of seasonal variation in daily physical activity in individuals with heart failure and implanted cardiac devices

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.

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

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.

A Randomized, Double-Blind, Placebo-Controlled Study of Pulsed, Inhaled Nitric Oxide in Subjects at Risk of Pulmonary Hypertension Associated With Pulmonary Fibrosis

BACKGROUND

The interstitial lung diseases include a variety of disorders, many of which are characterized by fibrotic changes (fILD). Of the fILDs, Idiopathic pulmonary fibrosis is the most common. Pulmonary hypertension (PH) frequently complicates fILD and is associated with impaired functional capability, lower physical activity, and significantly reduced life expectancy. There is no proven treatment for patients with fILD-PH. We report results from the first cohort of a phase 2b/3 trial with pulsed inhaled nitric oxide (iNO) in patients with fILD-PH.

METHODS

Subjects in cohort 1 were randomized to iNO 30 μg/kg ideal body weight/h (iNO30) or placebo for 8 weeks of blinded treatment; subjects then transitioned to open-label extension (OLE) on iNO30 followed by dose escalation to iNO45 then iNO75. Activity monitoring was used to assess changes in daily activity. Safety and efficacy were evaluated.

RESULTS

Twenty-three patients were randomized to iNO30 and 18 to placebo. During blinded treatment, iNO30 subjects showed an average improvement in moderate/vigorous physical activity (MVPA) and remained stable in overall activity. Placebo subjects showed an average drop of 26% in MVPA and a 12% drop in overall activity. The iNO group had an improvement in oxygen saturation. During OLE, subjects maintained their activity levels including placebo subjects who transitioned from a decline to a maintenance in all activity parameters. Inhaled nitric oxide at all doses (30, 45, and 75) was safe and well tolerated.

CONCLUSIONS

Treatment with iNO30 demonstrated clinically and statistically significant benefit in MVPA and clinically significant benefit in overall activity. In the OLE, higher doses of iNO were also safe and well tolerated while showing maintenance in activity parameters.

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure

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.

Quantification of Seasonal Variation in Daily Physical Activity in Individuals with Heart Failure and Implantable Cardioverter Defibrillator/Cardiac Resynchronisation Therapy Devices

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Measuring Physical Activity With Implanted Cardiac Devices: A Systematic Review

Background

Physical activity is predictive of cardiovascular outcomes in patients with cardiovascular implantable electronic devices, yet it is not regularly assessed in routine care. Current‐generation cardiovascular implantable electronic devices, however, continuously monitor patient activity through a built‐in accelerometer, which provides new opportunities to remotely assess patient activity, detect changes in clinical status, and incorporate these data in risk stratification models. This review critically examines the literature on device‐measured physical activity (D‐PA), with a focus on identifying methodological issues that may affect interpretation of study results.

Methods and Results

We conducted a systematic review of D‐PA studies published from January 1 1995 to December 30 2017, identifying 29 studies meeting inclusion criteria, 5 of which were validation reports. Few technical details about D‐PA sensors are reported, and procedures for analyzing and interpreting D‐PA data are heterogeneous. Trends in D‐PA over time and associations with clinical outcomes were reported by 22 studies, and in 7 studies, D‐PA was combined with other device parameters in risk stratification models, demonstrating modest‐to‐good sensitivity in predicting acute heart failure decompensation, hospitalization, and mortality.

Conclusions

Current evidence suggests that D‐PA may be useful for assessing physical activity and predicting clinical outcomes in patients with cardiovascular implantable electronic devices when combined with other device parameters. Future work must address challenges related to D‐PA data measurement, interpretation, and generalizability to support expanded clinical applications of this technology.

Accelerometer-Measured Daily Activity in Heart Failure With Preserved Ejection Fraction: Clinical Correlates and Association With Standard Heart Failure Severity Indices

BACKGROUND

Daily physical activity assessed by accelerometers represents a novel method to assess the impact of interventions on heart failure (HF) patients' functional status. We hypothesized that daily activity varies by patient characteristics and correlates with established measures of HF severity in HF with preserved ejection fraction.

METHODS AND RESULTS

In this ancillary study of the NEAT-HFpEF trial (Nitrate's Effects on Activity Tolerance in HF With Preserved Ejection Fraction), average daily accelerometer units (ADAU) and hours active per day were assessed during a 14-day period before starting isosorbide mononitrate or placebo (n=110). Baseline ADAU was negatively associated with age, female sex, height, and body mass index, and these variables accounted for 28% of the variability in ADAU (P<0.007 for all). Adjusting for these factors, patients with lower ADAU were more likely to have had an HF hospitalization, orthopnea, diabetes mellitus and anemia, be treated with β-blockers, have higher ejection fraction, relative wall thickness and left atrial volume, and worse New York Heart Association class, HF-specific quality of life scores, 6-minute walk distance, and NT-proBNP (N-terminal pro-B-type natriuretic peptide; P<0.05 for all). Associations between hours active per day and clinical characteristics were similar. Relative to baseline, there were no significant associations between changes in ADAU or hours active per day and changes in standard functional assessments (New York Heart Association, quality of life, 6-minute walk distance, and NT-proBNP) with isosorbide mononitrate.

CONCLUSIONS

Daily activity is a measure of HF-related and global functional status in HF with preserved ejection fraction. As compared with intermittently assessed standard HF assessments, change in daily activity may provide unique information about the impact of HF interventions on functional status.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02053493.

Accelerometry-Assessed Latent Class Patterns of Physical Activity and Sedentary Behavior With Mortality

INTRODUCTION

Latent class analysis provides a method for understanding patterns of physical activity and sedentary behavior. This study explored the association of accelerometer-assessed patterns of physical activity/sedentary behavior with all-cause mortality.

METHODS

The sample included 4,510 U.S. National Health and Nutrition Examination Survey participants aged ≥40 years enrolled in 2003-2006 with mortality follow-up through 2011. Participants used a hip-worn accelerometer for 1 week that provided minute-by-minute information on physical activity/sedentary behavior. Accelerometry patterns were derived using latent class analysis. Cox proportional hazards models provided adjusted hazard ratios with 95% CIs. Analyses were conducted from 2014 to 2016.

RESULTS

During an average of 6.6 years of follow-up, 513 deaths occurred. For average counts/minute, the more-active classes had a lower risk of mortality compared with the lowest (Class 1). Findings were generally similar for percentage of the day in minutes and bouts of moderate to vigorous physical activity, defined two ways. For percentage of the day in sedentary behavior, generally no associations were identified. However, the class with the highest percentage of the day in sedentary bouts (Class 1) had a higher risk of mortality (adjusted hazard ratio, 2.10; 95% CI=1.11, 3.97) versus the class with fewer sedentary bouts (Class 7).

CONCLUSIONS

In this national observational study, time spent in physical activity reduced the risk of all-cause mortality and time spent in sedentary bouts increased the risk of all-cause mortality, regardless of how both were accumulated. The latent class analysis contributed to understanding the impact of patterning of physical activity and sedentary behavior on mortality.

Exercise- and Psychosocial-Based Interventions to Improve Daily Activity in Heart Failure: A Pilot Study

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.

Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

The US physical activity (PA) recommendations were based primarily on studies in which self-reported data were used. Studies that include accelerometer-assessed PA and sedentary behavior can contribute to these recommendations. In the present study, we explored the associations of PA and sedentary behavior with all-cause and cardiovascular disease (CVD) mortality in a nationally representative sample. Among the 2003-2006 National Health and Nutrition Examination Survey cohort, 3,809 adults 40 years of age or older wore an accelerometer for 1 week and self-reported their PA levels. Mortality data were verified through 2011, with an average of 6.7 years of follow-up. We used Cox proportional hazards models to obtain adjusted hazard ratios and 95% confidence intervals. After excluding the first 2 years, there were 337 deaths (32% or 107 of which were attributable to CVD). Having higher accelerometer-assessed average counts per minute was associated with lower all-cause mortality risk: When compared with the first quartile, the adjusted hazard ratio was 0.37 (95% confidence interval: 0.23, 0.59) for the fourth quartile, 0.39 (95% confidence interval: 0.27, 0.57) for the third quartile, and 0.60 (95% confidence interval: 0.45, 0.80) second quartile. Results were similar for CVD mortality. Lower all-cause and CVD mortality risks were also generally observed for persons with higher accelerometer-assessed moderate and moderate-to-vigorous PA levels and for self-reported moderate-to-vigorous leisure, household and total activities, as well as for meeting PA recommendations. Accelerometer-assessed sedentary behavior was generally not associated with all-cause or CVD mortality in fully adjusted models. These findings support the national PA recommendations to reduce mortality.

Seasonal variation of daily physical activity in individuals with heart failure

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.

Device-measured physical activity versus six-minute walk test as a predictor of reverse remodeling and outcome after cardiac resynchronization therapy for heart failure

Implanted devices can provide objective assessment of physical activity over prolonged periods. The purpose of this study was to investigate the prognostic value of device-measured physical activity data compared with a six-minute walk test (6MWT) in predicting clinical response to cardiac resynchronization therapy (CRT). This was a single-center study in which patients who underwent CRT for standard indications were evaluated. Daily physical activity and 6MWT were evaluated postimplant at 1, 3, and 6 months. The primary end point was a composite of heart failure hospitalization, transplant, left ventricular (LV) assist device, and all-cause death at 3 years. Echocardiographic response, defined as a ≥10% improvement in LV ejection fraction (LVEF), at 6 months was the secondary end point. About 164 patients were included: average age was 67.3 ± 12.9 years, 77% were men, baseline LVEF was 25% ± 7%. Kaplan-Meier curves showed superior freedom from the composite end point in the highest tertile of both 6MWT and physical activity compared with the lowest tertile (41 vs 23 cases, respectively, p <0.001) for 6MWT and for activity (22 vs 7 cases, respectively, p = 0.001). In an adjusted multivariate model, independent predictors of improved clinical outcome included 1-month physical activity (hazard ratio 0.546, 95% confidence interval [CI] 0.361 to 0.824, p = 0.004) and 6MWT (hazard ratio 0.581, 95% CI 0.425 to 0.795, p = 0.001). An additional hour of higher activity at 1 month translated to a 1.38 times (95% CI 1.075 to 1.753, p = 0.011) higher likelihood of improved echocardiographic response. In conclusion, device-based measures of physical activity may be useful in predicting echocardiographic reverse remodeling and long-term clinical outcome in patients receiving CRT.

Physical activity measured with implanted devices predicts patient outcome in chronic heart failure

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.

Effect of 'activity monitor-based' counseling on physical activity and health-related outcomes in patients with chronic diseases: A systematic review and meta-analysis

AIM

This review evaluated the effects of activity monitor-based counseling on physical activity (PA) and generic and disease-specific health-related outcomes in adults with diabetes mellitus type II (DMII), chronic obstructive pulmonary disease (COPD), or chronic heart failure (CHF).

METHODS

Four electronic databases were searched for randomized controlled trials using activity monitor-based counseling versus control intervention or usual care in adults with DMII, COPD, or CHF. Pooled effect sizes were calculated using a random effects model.

RESULTS

Twenty-four articles were included: 21 DMII studies and 3 COPD studies. No CHF studies were identified. Pooled analysis showed that activity monitor-based counseling resulted in a significantly greater improvement in PA compared to control intervention or usual care in DMII. Furthermore, these interventions had a beneficial effect on hemoglobin A1c (HbA1c), systolic blood pressure, and body mass index (BMI) (P < 0.05), whereas no differences were found on diastolic blood pressure, and health-related quality of life. Meta-analysis of COPD studies was not possible due to lack of available data.

CONCLUSION

Activity monitor-based counseling had a beneficial effect on PA, HbA1c, systolic blood pressure, and BMI in patients with DMII. Data in patients with COPD and CHF are limited or non-existing, respectively.