Abstract
BackgroundLow levels of physical activity are implicated in low life expectancies of people receiving maintenance haemodialysis. Accelerometers are increasingly being used to quantify activity behaviours of this population but guidance to quality-assure such data is lacking. The objective of this study was to provide data processing and reduction recommendations to ensure accelerometer-derived outcomes are sufficiently reliable for interpretative analysis.MethodsSeventy people receiving maintenance haemodialysis (age 55.9 ± 15.7 years, 34% women, 23% diabetic) from a single outpatient renal unit volunteered for the study. Participants wore Actigraph GT3x and ActivPAL monitors during waking hours over seven days. Reliability of accelerometer output (normalised to wear-time) was assessed via intraclass correlation coefficient (ICC). The Spearman-Brown prophecy formula was subsequently applied to the ICCs to derive the minimum required accelerometer wear-time for each behavioural outcome.ResultsMonitor wear compliance was greater on dialysis compared to non-dialysis days (90% v 77%). Participants were significantly more active on non-dialysis days compared to dialysis days but there were no significant differences in estimated behaviours between days within the same condition. Average measure ICCs for all accelerometer outcomes were high (range 0.76–0.96). Computations indicated that habitual physical activity and sedentary behaviour could be estimated with a minimum reliability level of 0.80 from one dialysis day and two non-dialysis days, and at least eight hours monitor wear per day. Applying this rubric allowed 90% of participant data to be retained for further analysis.ConclusionsRegardless of accelerometer, one dialysis and two non-dialysis days data with a minimum of eight hours wear each day should enable habitual activity of people receiving maintenance haemodialysis to be characterised with acceptable reliability. These recommendations reconcile the tension between wear-time criteria stringency and retention of an adequately representative sample.
Highlights
Low levels of physical activity are implicated in low life expectancies of people receiving maintenance haemodialysis
In the last two decades, a great number of studies have consistently documented that low levels of physical activity (PA) are highly prevalent among people receiving maintenance haemodialysis (MHD) for established renal failure (ERF) [1,2,3,4,5]
Actigraph and ActivPAL wear compliance for the seven-day monitoring period was 73 and 63% respectively, with higher compliance observed for all three dialysis days (90 and 79% respectively) compared to the four non-dialysis days (77 and 67% respectively)
Summary
Low levels of physical activity are implicated in low life expectancies of people receiving maintenance haemodialysis. In the last two decades, a great number of studies have consistently documented that low levels of physical activity (PA) are highly prevalent among people receiving maintenance haemodialysis (MHD) for established renal failure (ERF) [1,2,3,4,5]. Even higher proportions of low PA seem to emerge from studies which employed more objective measurements, such as accelerometry, as about two thirds of people receiving MHD were categorised as either low active or sedentary [6, 7]. Low PA has been linked to lower quality of life as well as to the development of adverse clinical outcomes such as hospitalisations, major cardiovascular events and mortality in people receiving MHD [2, 3, 12]. The World Health Organisation target of a 10% relative reduction in the prevalence of insufficient physical activity by 2025 to reduce premature mortality indicates PA may shortly be monitored alongside physiological health indices [13]
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