Physical activity is extremely low and should be encouraged in patients with severe aortic stenosis waiting for transcatheter aortic valve implantation

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Amsterdam UMC - location AMC Background Physical activity is crucial to preserve muscle mass and muscle function, which is hard to regain at older age. Therefore, even short periods of physical inactivity can be harmful for older adults. Due to symptoms of aortic stenosis patients planned for an elective Transcatheter Aortic Valve Implantation (TAVI) treatment could be at risk of physical inactivity. Specifically, because many of these patients are already older and frail, this could be harmful for physical functioning and even mortality at the long-term. Purpose To determine physical activity in patients planned for TAVI, using a wearable. Methods Consecutive patients undergoing TAVI from January 2020 to September 2021 were included. All patients were asked to wear a Stepwatch activity monitor to objectively measure physical activity in the period before the TAVI. The Stepwatch is a valid tool to determine physical activity in frail and older adults, because it is able to detect slow or irregular movement. Patients were asked to wear the Stepwatch for seven consecutive days during every awake hour. By three complete days of at least 10 hours of wear time the data were included in the analysis. Two parameters were collected: the number of steps per day and activity time at moderate intensity. For number of steps per day patients were classified as extremely inactive (<2500), inactive (<7500) or active (>7500). For time at moderate intensity, it was determined how many patients did meet the activity guidelines (>150 min of moderate activity per week). Results In total 89 patients were included; mean age was 81 ± 5 years and 54% was male. Average number of steps per day were 6249 ± 2999. In total 19% (n=17) of the patients were extreme inactive, 67% (n=59) were inactive, and 15% (n=13) were active. Patients were moderate active for a median of 8 [IQR: 0 – 43] minutes per week. In total 6% (n=5) of the patients met the recommended guidelines of at least 150 minutes of moderate physical activity per week. Conclusion Older and frail patients with severe aortic stenosis planned for TAVI are mainly inactive. Most patients only moved at low intensity and a very small number of patients (6%) met the activity guidelines. The extremely low physical activity in patients waiting for TAVI, make them at high risk for muscle breakdown and adverse health outcomes at the longer term. (P)rehabilitation interventions should be developed to encourage patients with severe aortic stenosis to become more active during waiting time before TAVI.