Clinical Research
Volume and Patterns of Physical Activity Across the Health and Heart Failure Continuum

https://doi.org/10.1016/j.cjca.2017.07.005Get rights and content

Abstract

Background

The benefits of regular physical activity (PA) are well documented in patients with heart failure (HF), however the amount and intensity of objectively measured PA and sedentary behaviour in HF with preserved (HFPEF) or reduced ejection fraction (HFREF) is not well known.

Methods

In a cross-sectional observational study the energy expenditure of 151 participants (HFPEF: n = 53; HFREF: n = 16; at-risk for HF: n = 48; control participants: n = 34) using SenseWear Mini Armbands (Body Media, Inc, Pittsburgh, PA) were monitored. PA outcomes included time spent in different PA intensities (light and moderate-vigorous PA), sedentary time, steps per day, total daily energy expenditure, PA energy expenditure, and the patterns of PA in bouts of ≥ 10 minutes of moderate-vigorous PA.

Results

The patients with HFPEF had the lowest volume of activity across the 4 groups. After adjusting for covariates, only steps per day remained significantly different across groups (P = 0.0005). A comparison of HFPEF vs HFREF indicated a higher amount of time in bouts of ≥ 10 minutes of moderate-vigorous PA for patients with HFREF (median, 2.4 [interquartile range, 0-13.5] vs 26 [3.7-46.8]; P = 0.0075). In the at-risk group, PA was lower than the recommended levels in the guidelines.

Conclusions

Our findings suggest step count as the most robust outcome in evaluating daily PA in this population. Also, patients with HFPEF showed to be the least active group in the HF continuum. Monitoring volume and pattern of PA for those at risk of HF and patients with HFPEF could help to identify sedentary individuals and to develop tailored behavioural interventions for them.

Résumé

Contexte

Les bienfaits de l’activité physique pratiquée régulièrement ont été bien étudiés chez les patients atteints d’insuffisance cardiaque (IC), mais il en va autrement pour la mesure objective de la quantité et de l’intensité de l’activité physique ainsi que de la sédentarité en présence d’IC avec fraction d’éjection préservée (ICFEP) ou réduite (ICFER).

Méthodologie

Dans le cadre d’une étude d’observation transversale, la dépense énergétique de 151 participants (ICFEP : n = 53; ICFER : n = 16; à risque d’IC : n = 48; participants témoins : n = 34) a été mesurée à l’aide d’un petit brassard SenseWear (Body Media Inc, Pittsburgh, Pennsylvanie). Les paramètres d’évaluation de l’activité physique comportaient le temps consacré à des activités physiques de diverses intensités (légère et modérée à intense), le temps de sédentarité, le nombre de pas par jour, la dépense énergétique quotidienne totale, la dépense énergétique liée à l’activité physique et la fréquence des séances d’activité modérée à intense d’au moins 10 minutes.

Résultats

Les patients atteints d’ICFEP avaient le plus faible volume d'activité parmi les 4 groupes. Une fois les valeurs ajustées pour tenir compte de covariables, seul le nombre de pas par jour est demeuré statistiquement différent entre les groupes (p = 0,0005). Une comparaison entre les groupes ICFEP et ICFER a indiqué un plus grand nombre de séances d’activité modérée à intense d’au moins 10 minutes chez les patients atteints d’ICFER (médian 2,4 [intervalle interquartile, 0-13,5] vs 26 [3,7-46,8]; p = 0,0075). Dans le groupe à risque, l’activité physique était plus faible que ce que les lignes directrices recommandent.

Conclusion

Nos résultats suggèrent que le nombre de pas est le paramètre le plus fiable lorsqu’il est question d’évaluer l’activité physique quotidienne de cette population. De plus, les patients atteints d’ICFEP ont été le groupe le moins actif des patients se trouvant dans le continuum de l’IC. Surveiller la quantité et les habitudes d’activité physique chez les patients à risque d’IC et ceux atteints d’ICFEP pourrait faciliter le repérage des personnes sédentaires afin d’élaborer des interventions comportementales adaptées à leur situation.

Section snippets

Study design

This was a cross-sectional observational study. The sample size was determined on the basis of a power of 0.80, and an α of 0.05 using Cohen d of 0.867 (f = 0.4335) for daily energy expenditure (EE) between patients with HF and healthy control participants.12 A total sample size of 55 was calculated. However, because this was a substudy of the larger Alberta Heart Failure Etiology and Analysis Research Team (HEART) research program,13 (a prospective observational cohort study aimed to define

Results

One hundred fifty-one participants (median age 72 [IQR, 64-78] years, 46% female) were recruited. Data from 6 participants were removed from analysis because of their inability to comply with the minimum required SWA recording time. Participants wore the SWA for a median 4 [IQR, 3-4] days and median 23.8 [IQR, 23.4-23.9] h/d. Age, sex, BMI, and sleeping time were significantly different across groups (Table 1) and therefore considered as covariates to be controlled in the model. Because LVEF is

Discussion

To the best of our knowledge this is the first study to compare PA in healthy, at risk for HF, and patients with HFREF and HFPEF. The major new findings are: (1) steps per day was the most robust activity outcome to evaluate daily PA in this population; (2) patients with HFPEF completed the lowest volume of daily PA defined as time in light and MVPA; (3) the only significant difference between HFPEF and HFREF was the time spent at bouts of MVPA.

Step count is a common method to assess PA in

Conclusions

In the present study step count was the most robust outcome in evaluating daily PA. By monitoring daily PA we determined that patients with HF appear to be habitually sedentary, and those with HFPEF did virtually no continuous MVPA. Although PA guidelines for HF patients typically recommend at least 30 minutes of moderate-intensity PA on most days of the week, our findings suggest that a more realistic initial goal for patient with HF would be to focus on reducing sedentary time and encouraging

Funding Sources

Milad Yavari received a Supporting Training Encompassing All in Diastolic Heart Failure (STEADI HF) award and Alberta Innovates Health Solutions (AIHS) has funded Alberta HEART.

Disclosures

The authors have no conflicts of interest to disclose.

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    See editorial by Stone et al., pages 1462–1464 of this issue.

    See page 1470 for disclosure information.

    Jason R.B. Dyck, PhD is a member of the Alberta Heart Failure Etiology and Analysis Research Team, Alberta Innovates Health Solutions Interdisciplinary Team, Alberta, Canada.

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