Physical inactivity and sedentary behavior profiles in individuals with heart failure: comparison with healthy subjects and determinant factors
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Abstract
Objective: Quantify the extent of inactivity and sedentarism in HF in comparison with matched controls; and explore the determinants of variables of inactivity and sedentarism in these individuals.
Method: Individuals with HF and matched controls had their physical activity (PA) in daily life cross-sectionally monitored for one week using an activity monitor. Steps/ day, sedentary time/day (ST/day) and time spent/day in light PA and moderate-to-vigorous PA (MVPA) were recorded. Functional capacity, symptoms, quality of life and anthropometric data were evaluated as potential determinant factors of PA in daily life in HF.
Result: Individuals with HF (n=44) presented lower time/day in MVPA and steps/ day than controls (n=30) (60% and 33% lower, respectively). Further, individuals with HF were even more inactive on weekends than weekdays (MVPA: (6[3-12] vs. 9[4-21]min/day, P=0.005; step count: 4055±2228 vs. 4550±2366 steps/day, P=0.02). Regression models indicated functional capacity as the sole determinant of time spent/day in MVPA (r2=0.23) and one of the determinants of steps/day together with age and body mass index (r2=0.52). Depression symptoms and exertional dyspnea were determinants of ST/day (r2=0.32) and time spent/day in light PA (r2=0.21).
Conclusion: Individuals with HF are 60% less active than healthy individuals, and even more markedly on weekends. Functional capacity was the main determinant of variation in steps/day and time spent/day in MVPA, whereas exertional dyspnea and depression symptoms helped explaining variation in ST/day and time spent/ day in light PA.
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References
Klompstra L, Jaarsma T, Piepoli MF, Ben Gal T, Evangelista L, Stromberg A, et al. Objectively measured physical activity in patients with heart failure: a sub-analysis from the HF-Wii study. Eur J Cardiovasc Nurs. 2022;21(5):499-508. http://doi. org/10.1093/eurjcn/zvab133. PMid:34993536. DOI: https://doi.org/10.1093/eurjcn/zvab133
Pozehl BJ, McGuire R, Duncan K, Hertzog M, Deka P, Norman J, et al. Accelerometer-measured daily activity levels and related factors in patients with heart failure. J Cardiovasc Nurs. 2018;33(4):329-35. http://doi.org/10.1097/ JCN.0000000000000464. PMid:29538050. DOI: https://doi.org/10.1097/JCN.0000000000000464
Evenson KR, Butler EN, Rosamond WD. Prevalence of physical activity and sedentary behavior among adults with cardiovascular disease in the United States. J Cardiopulm Rehabil Prev. 2014;34(6):406-19. http://doi.org/10.1097/ HCR.0000000000000064. PMid:25068393. DOI: https://doi.org/10.1097/HCR.0000000000000064
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. http:// doi.org/10.1093/eurheartj/ehw128. PMid:27206819. DOI: https://doi.org/10.1093/eurheartj/ehw128
Schwendinger F, Wagner J, Infanger D, Schmidt-Trucksass A, Knaier R. Methodological aspects for accelerometer-based assessment of physical activity in heart failure and health. BMC Med Res Methodol. 2021;21(1):251. http://doi.org/10.1186/ s12874-021-01350-6. PMid:34775952. DOI: https://doi.org/10.1186/s12874-021-01350-6
Dibben GO, Gandhi MM, Taylor RS, Dalal HM, Metcalf B, Doherty P, et al. Physical activity assessment by accelerometry in people with heart failure. BMC Sports Sci Med Rehabil. 2020;12(1):47. http://doi.org/10.1186/s13102-020-00196-7. PMid:32817798. DOI: https://doi.org/10.1186/s13102-020-00196-7
Jordan C, Charman SJ, Batterham AM, Flynn D, Houghton D, Errington L, et al. Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis. Heart. 2023;109(18):1357-62. http://doi.org/10.1136/ heartjnl-2022-321943. PMid:36849238. DOI: https://doi.org/10.1136/heartjnl-2022-321943
Yavari M, Haykowsky MJF, Savu A, Kaul P, Dyck JRB, Haennel RG. Volume and patterns of physical activity across the health and heart failure continuum. Can J Cardiol. 2017;33(11):1465-71. http://doi.org/10.1016/j.cjca.2017.07.005. PMid:28985961. DOI: https://doi.org/10.1016/j.cjca.2017.07.005
Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, et al. Usefulness of step counts to predict mortality in Japanese patients with heart failure. Am J Cardiol. 2013;111(12):1767-71. http://doi.org/10.1016/j.amjcard.2013.02.034. PMid:23540653. DOI: https://doi.org/10.1016/j.amjcard.2013.02.034
Omar M, Jensen J, Frederiksen PH, Videbaek L, Poulsen MK, Brond JC, et al. Hemodynamic determinants of activity measured by accelerometer in patients with stable heart failure. JACC Heart Fail. 2021;9(11):824-35. http://doi.org/10.1016/j. jchf.2021.05.013. PMid:34509409. DOI: https://doi.org/10.1016/j.jchf.2021.05.013
Dibben GO, Hillsdon M, Salal HM, Metcalf B, Doherty P, Tang LH, et al. Factors associated with objectively assessed physical activity levels of heart failure patients. J Clin Exp Cardiolog. 2020;11:655.
Waring T, Gross K, Soucier R, ZuWallack R. Measured physical activity and 30-day rehospitalization in heart failure patients. J Cardiopulm Rehabil Prev. 2017;37(2):124-9. http://doi. org/10.1097/HCR.0000000000000204. PMid:27798506. DOI: https://doi.org/10.1097/HCR.0000000000000204
Melin M, Hagerman I, Gonon A, Gustafsson T, Rullman E. Variability in physical activity assessed with accelerometer is an independent predictor of mortality in CHF patients. PLoS One. 2016;11(4):e0153036. http://doi.org/10.1371/journal. pone.0153036. PMid:27054323. DOI: https://doi.org/10.1371/journal.pone.0153036
Maddison R, Jiang Y, Foley L, Scragg R, Direito A, Olds T. The association between the activity profile and cardiovascular risk. J Sci Med Sport. 2016;19(8):605-10. http://doi.org/10.1016/j. jsams.2015.08.001. PMid:26320386. DOI: https://doi.org/10.1016/j.jsams.2015.08.001
Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181-8. http://doi.org/10.1249/ mss.0b013e31815a51b3. PMid:18091006. DOI: https://doi.org/10.1249/mss.0b013e31815a51b3
Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428-46. http://doi.org/10.1183/09031936.00150314. PMid:25359355. DOI: https://doi.org/10.1183/09031936.00150314
Britto RR, Probst VS, Andrade AF, Samora GA, Hernandes NA, Marinho PE, et al. Reference equations for the six-minute walk distance based on a Brazilian multicenter study. Braz J Phys Ther. 2013;17(6):556-63. http://doi.org/10.1590/S1413- 35552012005000122. PMid:24271092. DOI: https://doi.org/10.1590/S1413-35552012005000122
Carvalho VO, Guimarães GV, Carrara D, Bacal F, Bocchi EA. Validação da Versão em Português do Minnesota Living with Heart Failure Questionnaire. Arq Bras Cardiol. 2009;93(1):39- 44. http://doi.org/10.1590/S0066-782X2009000700008. PMid:19838469. DOI: https://doi.org/10.1590/S0066-782X2009000700008
Charlson MEPP, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. http://doi.org/10.1016/0021-9681(87)90171-8. PMid:3558716. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8-27. http://doi.org/10.1097/00005650-199801000- 00004. PMid:9431328. DOI: https://doi.org/10.1097/00005650-199801000-00004
Uszko-Lencer N, Janssen DJA, Gaffron S, Vanfleteren L, Janssen E, Werter C, et al. Clustering based on comorbidities in patients with chronic heart failure: an illustration of clinical diversity. ESC Heart Fail. 2022;9(1):614-26. http://doi.org/10.1002/ ehf2.13704. PMid:34796690. DOI: https://doi.org/10.1002/ehf2.13704
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. http://doi. org/10.1111/j.1600-0447.1983.tb09716.x. PMid:6880820. DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the american college of cardiology/ american heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895-1032. http://doi. org/10.1161/CIR.0000000000001063. PMid:35363499. DOI: https://doi.org/10.1161/CIR.0000000000001073
Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8(1):80. http://doi.org/10.1186/1479-5868-8-80. PMid:21798044. DOI: https://doi.org/10.1186/1479-5868-8-80
Kim Y, Canada JM, Kenyon J, Billingsley HE, Arena R, Lavie CJ, et al. Effects of replacing sedentary time with physical activity on mortality among patients with heart failure: national health and nutrition examination survey follow-up study. Mayo Clin Proc. 2022;97(10):1897-903. http://doi.org/10.1016/j. mayocp.2022.05.009. PMid:35753825. DOI: https://doi.org/10.1016/j.mayocp.2022.05.009
Alahmari AD, Mackay AJ, Patel AR, Kowlessar BS, Singh R, Brill SE, et al. Influence of weather and atmospheric pollution on physical activity in patients with COPD. Respir Res. 2015;16(1):71. http://doi.org/10.1186/s12931-015-0229-z. PMid:26071400. DOI: https://doi.org/10.1186/s12931-015-0229-z
Matthews CE, Ainsworth BE, Thompson RW, Bassett DR Jr. Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc. 2002;34(8):1376- 81. http://doi.org/10.1097/00005768-200208000-00021. PMid:12165695. DOI: https://doi.org/10.1097/00005768-200208000-00021
Diaz KM, Howard VJ, Hutto B, Colabianchi N, Vena JE, Safford MM, et al. Patterns of sedentary behavior and mortality in U.S. middle-aged and older adults: a national cohort study. Ann Intern Med. 2017;167(7):465-75. http://doi.org/10.7326/ M17-0212. PMid:28892811. DOI: https://doi.org/10.7326/M17-0212
Cordova-Rivera L, Gardiner PA, Gibson PG, Winkler EAH, Urroz PD, McDonald VM. Sedentary time in people with obstructive airway diseases. Respir Med. 2021;181:106367. http://doi. org/10.1016/j.rmed.2021.106367. PMid:33831731. DOI: https://doi.org/10.1016/j.rmed.2021.106367
Deka P, Almenar L, Pathak D, Klompstra L, Lopez-Vilella R, Marques-Sule E. Depression mediates physical activity readiness and physical activity in patients with heart failure. ESC Heart Fail. 2021;8(6):5259-65. http://doi.org/10.1002/ehf2.13609. PMid:34523268. DOI: https://doi.org/10.1002/ehf2.13609