Assessment of Physical Activity Using Waist-Worn Accelerometers in Hospitalized Heart Failure Patients and Its Relationship with Kansas City Cardiomyopathy Questionnaire.

Yasuyuki Shiraishi,Masataka Kawana,Takehiro Kimura,Shun Kohsaka,Nozomi Niimi,Makoto Takei,Ayumi Goda,Keiichi Fukuda,Takashi Kohno

doi:10.3390/jcm10184103

Abstract

The health benefits of physical activity have been widely recognized, yet there is limited information on associations between accelerometer-related parameters and established patient-reported health status. This study investigated the association between the waist-worn accelerometer measurements, cardiopulmonary exercise testing (CPX), and results of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in heart failure (HF) patients hospitalized for acute decompensation. A total of 31 patients were enrolled and wore a validated three-axis accelerometer for 2 weeks and completed the short version of the KCCQ after removing the device. Daily step counts, exercise time (metabolic equivalents × hours), and %sedentary time (sedentary time/device-equipped time) were measured. Among the measured parameters, the best correlation was observed between %sedentary time and the KCCQ overall and clinical summary scores (r = −0.65 and −0.65, each p < 0.001). All of the individual domains of the KCCQ (physical limitation, symptom frequency, and quality of life), with the exception of the social limitation domain, showed moderate correlations with %sedentary time. Finally, oxygen consumption assessed by CPX demonstrated only weak associations with the accelerometer-measured parameters. An accelerometer could complement the KCCQ results in accurately assessing the physical activity in HF patients immediately after hospitalization, albeit its correlation with CPX was at most moderate.

Highlights

The health benefits of physical activity have been widely recognized to minimize disease incidence and progression, such as heart failure (HF), and further to optimize patients’ health status [1,2,3]
There is still limited information on clinical factors associated with physical activity/quality of life (QoL) and for which accelerometer-measured parameters are useful indicators associated with exercise capacity and QoL scores in HF patients [7]
We aimed to (1) investigate clinical factors associated with physical activity measured by waist-worn accelerometers and QoL and (2) examine the overall association between the level of physical activity assessed by the self-reported questionnaire, the accelerometer, and cardiopulmonary exercise testing (CPX) in a group of HF patients recently discharged after acute decompensation regardless of left ventricular ejection fraction

Summary

Introduction

The health benefits of physical activity have been widely recognized to minimize disease incidence and progression, such as heart failure (HF), and further to optimize patients’ health status [1,2,3]. Self-reported questionnaires are frequently used to assess physical activity and quality of life (QoL), with minimal time investment, costs, and participant burden, which favors their use in both epidemiological studies and large-scale clinical trials. Secondary analysis of three randomized controlled trials targeting patients with HF with preserved ejection fraction reported that lower QoL scores were associated with impaired physical activity levels assessed by an accelerometer (e.g., average daily accelerometry units or accelerometry hours active per day) [5]. II III Clinical frailty scale, n (%) 2 (fit) 3 (managing well) 4 (very mild frailty) 5 (mild frailty) Triggers of acute decompensation Nonadherence to diet, n (%) Nonadherence to medication, n (%) Overwork, n (%) Arrhythmia, n (%) Coronary ischemia, n (%) Infection, n (%) Others or none, n (%) Comorbidities ≥1 HF hospitalization in the past year, n (%) Coronary artery disease, n (%) Atrial fibrillation, n (%) Hypertension, n (%) Diabetes mellitus, n (%) Stroke, n (%) COPD, n (%) Laboratory tests Hemoglobin, g/dL Creatinine, mg/L Blood urea nitrogen, mg/L Sodium, mEq/L Potassium, mEq/L Total bilirubin, mg/L Albumin, mg/L BNP at hospitalization, pg/mL BNP at discharge, pg/mL BNP improvement, % HF treatment Loop diuretics, n (%) ACEI or ARB, n (%) ARNI, n (%) Beta blocker, n (%) MRA, n (%) SGLT2i, n (%) ICD, n (%) CRT, n (%) CPX parameters * Peak VO2, mL/kg/min AT VO2, mL/kg/min VE vs. VCO2 slope Accelerometer-measured parameters Daily step count, n/day Exercise time %sedentary time, %

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