Human Activity Profile Research Articles

Short physical performance battery in aerobic capacity and physical activity evaluation of individuals with peripheral artery disease: An exploratory study

BackgroundPeripheral artery disease (PAD) negatively affects functional ability. Persons with PAD experience gait limitation, and changes in mobility, muscle strength, and balance. Assessing individuals with PAD with tests of lower limb performance during activities other than walking may provide information about aerobic capacity. ObjectiveTo evaluate whether the Short Physical Performance Battery (SPPB) can discriminate aerobic capacity and level of physical activity in individuals with PAD. MethodsThe SPPB, Incremental Shuttle Walking Test (ISWT), and the Human Activity Profile (HAP) were completed by 42 volunteers with PAD. The sample was stratified into tertiles by the distance walked in the ISWT and the Adjusted Activity Score (AAS) of HAP. One-way analysis of variance with a post-hoc least significant difference was used to compare the SPPB values between tertiles of ISWT and AAS of HAP. P-value < 0.05 was considered significant. ResultsThe mean age was 65 ± 7.7 years, the walking distance was 259.29 ± 115.28 m, and AAS of HAP was 68.36 ± 9.04. There was a significant difference in the total SPPB score and scores for gait speed and sit-to-stand for groups stratified by ISWT and AAS of HAP(p = 0.01). The balance domain was different only for groups stratified into tertiles by AAS of HAP(p = 0.04). ConclusionThe results of this study have clinical relevance for the evaluation of individuals with PAD at different aerobic and physical activity levels. The SPPB is a viable alternative in the practice of the specialty of vascular nursing and other areas of health to assess patients whose ability to perform walking tests is often limited.

Aerobic Fitness of Elderly Community and Non-Community Individuals After Chronic Stroke

Introduction: Stroke commonly causes low aerobic fitness and walking speed. Objective: To compare the estimated aerobic fitness of the community and non-community elderly individuals after chronic stroke. Investigate the association between walking speed and aerobic fitness. Methods: Elderly people after stroke classified as community walkers or limited community walkers, according to their walking speed (10-m walk test), in m/s, were assessed with The Human Activity Profile (HAP). The Lifestyle Energy Consumption (LEC) score of the HAP was used to estimate aerobic fitness through the peak oxygen uptake (V̇o2peak). Results: Aerobic fitness of elderly individuals after stroke classified as community walkers was on average 17.3 (6.0) mL kg−1 min−1, while for non-community walkers, it was on average 10.2 (5.6) mL kg−1 min−1. There was a significant difference between groups (−7.05, 95% CI −10.98 to −3.12; P &lt; .001). A statistically significant (P &lt; .001) association with moderate magnitude (r = 0.587) was observed between the LEC and the habitual walking speed. Conclusions: Individuals with lower walking speed have lower aerobic fitness.

#2870 Association between frailty and a history of falls in patients on hemodialysis

Abstract Background and Aims Patients with end-stage renal disease on hemodialysis have a higher prevalence of frailty that is associated with relevant outcomes such as disability, hospitalization, and mortality. Moreover, these patients have musculoskeletal and physical function impairments that contribute to a higher risk of falling. Therefore, the aim of this study was to evaluate the association between frailty and a history of falls in patients on hemodialysis. Method This cross-section multicenter study included patients aged ≥18 years who were undergoing regular hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, and physical limitations including neurological, musculoskeletal and osteoarticular diseases which prevented the correct execution of the physical function tests. Frailty was assessed by Fried phenotype and the criteria were as follows: unintentional weight loss ≥ 4.5 kg in the past year; exhaustion was assessed using the vitality domain of the SF-36 quality of life questionnaire; weakness was measured using a handgrip dynamometer; walking speed was assessed by timing the 4.6 m distance covered at the participant's normal pace; and physical activity level was measured by the Human Activity Profile questionnaire. Patients were stratified into three groups: a score of 0/5 for non-frail, a score of 1-2/5 for pre-frail, and a score of 3-5/5 for frail. The retrospective history of falls was assessed for the last 12 months, and a fall was defined as an “unexpected event in which the individual comes to rest on the ground, floor or lower level”. The association between frailty stratification and a history of falls was analyzed using multivariate multinomial logistic regression model with non-frail group as reference. Then, a model adjusted for potential confounders was constructed. Results This study included 199 patients (59.1 ± 12.5 years, 41.2% female). The prevalences of frailty and pre-frailty were 17.6% and 54.8%, respectively. Patients classified as non-frail showed lower prevalence of a history of falls compared to patients classified as pre-frail and frail (26%, 36% and 54%, respectively, p &amp;lt; 0.001). The absence of a history of falls decreased the chance of patients being classified as frail (OR = 0.23, 95% CI = 0.07-0.78, p = 0.018). After adjusting for age, educational level, time on dialysis, hemoglobin and presence of cardiovascular disease, this association remained significant (OR = 0.16, 95% CI = 0.04-0.57, p = 0.005). Conclusion The prevalence of pre-frailty was approximately three times higher than that of frailty in patients on hemodialysis. A history of falls was associated with frailty in these patients.

The usefulness of patient-reported outcome measures in decision making in Chagas cardiomyopathy: a scoping review.

Chagas cardiomyopathy (ChC) presents many biopsychosocial complexities, highlighting the need to have patient self-report questions. This study demonstrates the scope of the use of patient-reported outcome measures (PROMs) in patients with ChC and highlights the main research gaps. This is a scoping review and the search strategy was performed in the Online Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica database (EMBASE), Accumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central, Latin American Literature and Caribbean in Health Sciences (LILACS) and Diagnostic Test Accuracy (DITA). The search identified 4484 studies and 20 studies met the inclusion criteria. The Short-Form of 36 items (SF-36) had potential prognostic value and the ability to identify systolic dysfunction. The Human Activity Profile was able to screen for functional impairment, and the New York Heart Association showed potential prognostic value. The SF-36 and Minnesota Living with Heart Failure Questionnaire were responsive to interventions. The pharmaceutical care affected adherence to treatment as assessed by the Morisky score and also for SF-36. Despite the increased use of PROMs, there are still a large number of gaps in the literature, and further studies using PROMs are needed.

Functional Status in Peripheral Arterial Disease: Rehabilitated Versus Nonrehabilitated

To analyze patient perception of functional status related to activity and participation of rehabilitated and nonrehabilitated individuals with peripheral arterial disease. Cross-sectional study assessing the activity and participation domain using the Human Activity Profile (HAP) questionnaire and the Participation Scale, respectively. Groups were compared using Chi-squared test and unpaired t-test. A total of 87 individuals (36 rehabilitated) with 65.28±8.29years (66.7% male) were included. HAP classified 58.6% of individuals with weak or inactive physical activity level, and approximately half of the sample did not have participation restriction. HAP scores and Participation Scale (locomotion inside and outside home) were lower in nonrehabilitated than in rehabilitated individuals. Individuals with peripheral arterial disease presented little participation restriction and a great activity limitation, the last one being more evident among nonrehabilitated.

Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study.

Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels. This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their AdjustedActivity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables. Fifty-four individuals with a mean age of 56±17.4years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6±2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2±1.1 points and 0.5±0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r=-0.716; p<0.01). Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.

Assessment of health-related quality of life in patients with Chagas cardiomyopathy using Minnesota living with heart failure questionnaire: A validation study.

Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.

Upper extremity functions and physical activity in chronic maintenance hemodialysis patients: A case-control study.

Continuous hemodialysis (HD) treatment causes many complications in patients. The aim of this study is to evaluate the upper extremity functional capacity, physical activity level, and physical functions of patients receiving continuous HD treatment. Fifty HD patients and fifty healthy subjects were included in the study. Hand grip strength with Dynamometer, range of motion of upper extremity with Digital Goniometer, functional level of the upper extremity with the Turkish version of the Shoulder, Arm, and Hand Problems Questionnaire (The DASH-T), physical activity levels with international physical activity questionnaire short form and physical functions with the human activity profile (HAP) were evaluated. The mean grip strength of the subjects in the control group was 23.3 ± 1.44 kg, while the mean grip strength of the HD patients with fistula was 15.75 ± 3.08 kg (P < .05). In all joint range of motion measurements; the values of HD patients were significantly lower than the control group (P < .05). The DASH symptom scores of the individuals in the HD group (mean 19.19 ± 1.41) were significantly higher than the control group (mean 5.75 ± 1.41) (P < .05). The number of individuals with low-level activity in the HD group (72%) was higher than the control group (34%) (P < .01). The maximum activity score score of the HAP (mean 68.7 ± 1.4) and the adjusted activity score of the HAP (mean 42.54 ± 3.02) were lower in the HD group (P < .0001). HD treatment adversely affects hand grip strength, the range of motion, upper extremity functions, physical activity, and physical function levels of the patients.

#5759 ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVEL QUESTIONNAIRES AND DAILY STEP COUNTS IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims In patients on hemodialysis, sedentary lifestyle is highly prevalent and associated with elevated mortality. The sedentary lifestyle of these patients can be confirmed by assessing the physical activity level (PAL) evaluated by accelerometers and questionnaires. Considering that the PAL questionnaires are quick to perform and inexpensive, the aim of this study was to evaluate the association of three PAL questionnaires with daily step counts measured by an accelerometer in patients on hemodialysis. Method A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, and hospitalization in the past three months. The daily step counts were recorded in the ActiGraph accelerometer (wGT3X-BT) during seven days, and analyzed by excluding the first and last day of recording and calculating the mean among the valid days (≥ 8 hours of wear time). Subsequently, the Human Activity Profile (HAP) questionnaire, the International Physical Activity Questionnaire (IPAQ) and the physical functioning domain of the 36-Item Short Form Survey (PF SF-36) were applied. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between each PAL questionnaire score and daily step counts were tested using Spearman´s correlation coefficients. Then, three multiple linear regression models were constructed with daily step counts as the dependent variable and PAL questionnaire score and potential confounders (age, gender, educational level, time on dialysis, hemoglobin, and body mass index) as independent variables. A p value &amp;lt;0.05 was considered as statistically significant. Results This study included 105 patients (59.2 ± 12.5 years, 60.0% male). Daily step counts correlated significantly with the questionnaires scores (HAP, ρ = 0.552, p &amp;lt; 0.001; IPAQ, ρ = 0.386, p &amp;lt; 0.001; PF SF-36, ρ = 0.337, p &amp;lt; 0.001). After adjusting for potential confounders, the multiple linear regression models showed an association between daily step counts with the HAP questionnaire score (R2 = 0.31; adjusted R2 = 0.26; p &amp;lt; 0.001) and PF SF-36 score (R2 = 0.23; adjusted R2 = 0.18; p = 0.001). Conclusion The PAL questionnaires were associated with daily step counts measured by an accelerometer in patients on hemodialysis. However, our results suggest that the HAP was the best questionnaire to evaluate PAL in these patients.

#4416 MAINTAINING PHYSICAL ACTIVITY IN PATIENTS THROUGH INTRADIALYTIC VIRTUAL REALITY EXERCISE INTERVENTION: THE REVID STUDY

Abstract Background and Aims People suffering from Chronic kidney disease (CKD) have lower levels of physical activity than their healthy counterparts. The lower level of physical activity is associated with impaired physical function in people undertaking hemodialysis. The COVID-19 pandemic has worsened the physical activity level of this cohort. Intradialysis exercise programs have a positive impact on many functional variables, but despite these proven benefits exercise interventions are scarce in clinical practice. Our group is implementing strategies to increase clinical applicability of exercise programs. Virtual reality (VR) intradialysis programs improve function of patients. The main aim of this study was to analyze the impact of an intradialytic non-immersive VR exercise program on physical activity level of people undertaking hemodialysis treatment. Methods A randomized trial (the REVID study) included two groups of patients, exercising at different times during the dialysis session for up to 12 months. The present study includes participants from the REVID study who, once the study finished, continued exercising at their preferred time during the hemodialysis treatment, with the only support of the health professionals at the HD unit. Adherence to the exercise program was measured as a percentage (number of sessions attended divided by the number of sessions offered). The physical activity level was evaluated using the Human Activity Profile (HAP) questionnaire. The HAP scale is self-administered and a list of 94 daily activities; the maximal activity score (MAS) and adjusted activity score (AAS) were calculated in this evaluation. Depending on the outcome of the HAP, patients were classified as having physical activity levels that were “impaired” (&amp;lt;53 points), “moderately active” (53–74 points), or “active” (&amp;gt;74 points). These patients had been exercising The intradialytic exercise consisted of a non-immersive VR game called ‘Treasure Hunt’ in which the participant try to catch targets and avoid obstacles by moving their lower limbs (hip flexion, abduction and adduction, and knee flexion and extension). The difficulty level of the game was graduated according to the characteristics of each player and the patients were allowed to change their legs during the game at their convenience. The impact of the program on physical activity level was analyzed with a non-parametric test for paired simples (p&amp;lt;0.05). Results This study included 11 participants, mean age 71.6 (13.9) years, 9 males, median dialysis vintage 18 months (10 to 50 interquartile range), and Charlson index 6.3 (2.2). The AAS at the baseline of the REVID study was 66 (58-72 interquartile range). The median time that participants exercised in the REVID study was 12 months (6 to 18 months interquartile range). After 3 months of the present study, when they exercised at any time during dialysis, they maintained their physical activity level, from a median AAS of 69 (interquartile range 52-71), to a Median of 70 (interquartile range 41-74). The changes were non-significant. The mean adherence to the exercise sessions was 54.6 (11.7)%. Conclusion This study suggests that an intradialysis virtual reality exercise program maintains the physical activity level of elderly patients undertaking HD. Most of the participants in this long-term intervention were male and moderately active. Future interventions should include an ‘exercise champion’ professional in the units to recruit women and les conditioned participants, and to achive higher adherence rates.

Predictors of balance in individuals with Parkinson’s disease: A cross-sectional study

IntroductionSome previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. ObjectiveTo determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. Material and methodsThis is a cross-sectional study in which the investigated variables included: trunk and knee extensors’ muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. ResultsA total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. ConclusionThe findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.

Translation, Cross-Cultural Adaptation, and Validation of the Physical Activity Scale for Individuals With Physical Disabilities for Brazilian Individuals With Parkinson's Disease.

The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) is not available to Portuguese-Brazil. This study translates, cross-culturally adapts, and validates the PASIPD for Brazilian individuals with Parkinson's disease. The translation process followed guidelines: initial translation, synthesis, back translation, expert committee, and pretest. The validation and reliability processes were conducted with 40 individuals (15 men and 25 women) with Parkinson's disease. Concurrent validity was evaluated between PASIPD to Brazilian Portuguese, International Physical Activity Questionnaire, and Human Activity Profile. PASIPD to Brazilian Portuguese was found to be moderately correlated with International Physical Activity Questionnaire (r = .474, p < .05); however, there was no correlation with Human Activity Profile (r = .271, p < .05). We used the intrarater reliability with intraclass correlation coefficient and test-retest. Intrarater reliability was high (intraclass correlation coefficient = .80). Internal consistency was considered adequate by Cronbach's alpha (α = .70). PASIPD to Brazilian Portuguese is a valid and reliable instrument for evaluating physical activity levels in Brazilian individuals with Parkinson's disease.

Association of physical activity and fine motor performance in individuals with type 2 diabetes mellitus and/or non-alcoholic fatty liver disease

Background Fine motor performance may serve as an early warning sign for reduced cognitive function. Physical activity can help preserve cognitive function; however, the relationship between fine motor performance and physical activity is not well understood. Therefore, this study examined the relationship between fine motor performance and physical activity in individuals at risk for developing cognitive impairment (those with diabetes and/or non-alcoholic fatty liver disease (NAFLD)). Patients and methods Individuals aged 25–69 with and without diabetes and NAFLD were enrolled. For this cross-sectional study, all participants completed the Human Activity Profile and fine motor performance tasks (Grooved Pegboard Test and Trail Making Test). Results There were 93 participants in the study (NAFLD only (n = 29); diabetes + NAFLD (n = 34), controls (n = 30)). Individuals with both diabetes and NAFLD were less physically active and performed slower on the fine motor performance task. A statistically significant correlation was found between physical activity and motor speed among those with NAFLD only (r = 0.436, p<.05), which remained statistically significant after controlling for body mass index (r = 0.385; p<.05). Conclusions This study suggests that those with diabetes + NAFLD have lower levels of physical activity and slower fine motor performance. The relationship between physical activity and fine motor performance was only statistically significant in the group of individuals with NAFLD only. Future research needs to explore the mechanisms that impact fine motor performance and physical activity in individuals at risk for mild cognitive impairment. Individuals with diabetes and/or NAFLD should be identified, advised and encouraged to engage in physical activity. Key Messages Those with NAFLD and T2DM have lower levels of physical activity and slower fine motor performance compared to controls and those with NAFLD only. Future research needs to explore the mechanisms that impact fine motor performance and physical activity in those with T2DM with or without NAFLD. Individuals with impaired fine motor performance should be identified and encouraged to engage in physical activity.

Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life

Purpose To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. Methods Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. Results 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL – SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = −0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). Conclusion In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient. IMPLICATIONS FOR REHABILITATION Although hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient’s lifestyle. In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life. PGI is reliable and correlates with KQDOL – SF and the Social Participation Scale in this population.

Impact of COVID-19 Pandemic on Health-Related Quality of Life and Physical Activity of Patients in Hemodialysis.

Chronic dialysis patients have an increased risk of severe COVID-19 infection-related complications. The aim of this study was to quantify the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and physical activity levels of patients undertaking hemodialysis (HD). This was an observational study that compared data from two periods of time, before the COVID-19 pandemic vs pandemic. We used the Medical Outcomes Survey Short Form (SF-36) to measure the HRQoL and the Human Activity Profile (HAP) questionnaire was used to measure the physical activity. Data were analyzed with a mixed ordinal linear regression. A total of 27 eligible participants were interviewed during COVID-19 pandemic (median age 78 years). The linear regression model showed that the pandemic, after controlling for the covariates age, comorbidity, albumin, and hemoglobin, had a significant impact on the HRQoL. Physical function (-15.7) and social functioning subscales (-28.0) worsened (p = 0.001), and the physical component scale also showed a significant decrease (-3.6; p = 0.05). Time had a significant impact on the Human Activity Profile, with an average activity score diminished with the pandemic (-13.9; p = 0.003). The COVID-19 pandemic had a very negative impact on HRQoL and physical activity level of subjects undertaking hemodialysis. Interventions to improve HRQoL and activity levels of patients undertaking HD are recommended.

Determinants and Clinical Significance of Musculoskeletal Symptoms in Patients With Chronic Graft-Versus-Host Disease.

Musculoskeletal symptoms in chronic graft-versus-host disease (cGVHD) are rare manifestations contributing to disease burden. This study assesses the frequency of muscle cramps, joint and muscle aches, and muscle weakness in a cohort of patients severely affected by cGVHD. Three hundred thirty-four patients participated in the NCI natural history study of cGVHD (NCT00092235) from October 2004 to March 2017. Five-point Lee cGVHD Symptom Scale was dichotomized (less symptom bother—0, 1, 2; severe symptom bother—3, 4) and tested for associations with: Short Form 36 (SF36), 2-minute walk test, grip strength, joint range of motion, and human activity profile, clinical and laboratory data. Seventy-five point four percent of patients reported joint and muscle aches (36.8% severe, Lee Symptom Scale score 3–4), 74.3% muscle cramps (33.5% severe), and 82.34% muscle weakness (45.51% severe), which were associated with reduced functional capacity (SF36 Physical Component Scale, P < 0.0001). Muscle cramps were associated with limited joint movement (P < 0.0001) and skin manifestations (skin thickening, P = 0.0008; itchy skin, P = 0.0003). Muscle cramps did not show association with potential causative agents, such as concomitant calcineurin inhibitors therapy, statins, or use of antidiabetic drugs. Joint and muscle aches showed associations with multiple variables (including strong associations with mood symptoms and fatigue, P < 0.0001). Muscle weakness was not associated with steroid dose, but was significantly associated with depression (P < 0.0001) and anxiety (P = 0.0009). This study documents a high frequency of musculoskeletal symptoms in a cohort of adult patients with cGVHD. The multivariable logistic regression models showed that a joint set of factors were moderately well associated with musculoskeletal symptoms in this study.

MO880: Clinical Characteristics Associated With Human Activity Profile Scores in Hemodialysis Patients With Thyroid Dysfunction: A Substudy of the NIH THYROID-HD Trial

Abstract BACKGROUND AND AIMS Low physical activity is common in hemodialysis (HD) patients and is associated with adverse outcomes in this population (poor health-related quality of life, cardiovascular [CV] disease, death). Prior studies show that hypothyroidism is highly prevalent in HD patients, and is associated with worse self-reported physical function. METHOD In a substudy of the ongoing multi-center NIH THYROID-HD Trial, we examined baseline physical activity scores determined by the Human Activity Profile (HAP), a validated 94-item instrument assessing daily activities across a wide range of energy expenditures, in HD patients with TSH levels in the high-normal (TSH &amp;gt;3–5 mIU/L) and subclinical hypothyroid range (TSH &amp;gt;5–10 mIU/L). The HAP was used to derive the Maximum Activity Score (MAS) and Adjusted Activity Score (AAS), representing greatest and mean estimated energy expenditures, respectively (range 0–94, segmented to low [&amp;lt;52], moderate [54–73] and high [&amp;gt;74] scores). RESULTS Among 100 HD patients who underwent baseline HAP assessment, the mean ± SD MAS and AAS scores were 48 ± 22 and 23 ± 27, respectively; median (IQR) MAS and AAS scores were 49 (31–64) and 9 (0–39), respectively (Figure 1). In the overall cohort, 83% had low, 10% moderate and 7% high AAS scores. MAS and AAS scores were significantly lower in patients who had underlying diabetes versus those without diabetes (Table 1). There was also a trend towards lower (worse) MAS and AAS scores among older versus younger patients (≥65 versus &amp;gt;65 years, respectively) and patients with underlying coronary artery disease (CAD) versus those without CAD. In logistic regression analyses, older age (+∆ 1-year increments) was associated with higher likelihood of low MAS scores, and diabetes trended towards a significant association (defined as &amp;lt; median of observed values) (ref: MAS ≥ median): ORs [95% confidence intervals (95% CIs)]: 1.04 (1.01–1.09); P = 0.005 and 2.57 (0.96–6.86); P = 0.06, respectively. Similarly, older age (+∆ 1-year increments) and diabetes were each associated with higher likelihood of low AAS scores (defined as &amp;lt; 52) (ref: moderate-high AAS scores): ORs (95% CIs): 1.06 (1.02–1.11); P = 0.01 and 4.83 (14.6–16.0); P = 0.01, respectively. CONCLUSION In this substudy of the NIH THYROID-HD Trial, HAP scores in HD patients with high-normal and subclinical hypothyroid range TSH levels were lower than observed in prior historical dialysis cohorts that did not have underlying thyroid dysfunction. Additionally, older age and diabetes were each associated with worse HAP scores. Further research is needed to determine the impact of thyroid hormone replacement on improving physical activity and function in this population, particularly those of elder age and with underlying diabetes.

MO835: Physical Activity Measured by Pedometer And Human Activity Profile in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Physical inactivity is associated with increased mortality in hemodialysis patients and the level is still unclear. Several studies have surveyed physical activity in hemodialysis patients with subjective methods by questionnaires, and some have used objective methods based on accelerometers or pedometers in small population. This study aimed to investigate the level of physical activity of hemodialysis patients with a combination of pedometer and questionnaire and explore the influencing factors limiting the physical activity. METHOD A multi-center cross-sectional survey using pedometer and Human Activity Profile (HAP) was performed in 505 hemodialysis patients. The pedometer (Omron, HJ-321) measured daily steps by continuously wearing for a week. HAP can provide a maximum activity score (MAS) reflecting the most taxing activity the patient is still doing, and an adjusted activity score (AAS) reflecting the level of daily activity. Linear regression was performed to explore factors related to the physical activity. RESULTS A total of 505 patients were included in this study. The average age (means ± SE) was 49.69 ± 13.96 years with 141 (27.92%) patients were elderly (≥60 years old), and 339 (67.13%) were male. Patients walked 4585.84 ± 2887.40 steps/day, 94.65% of patients had physical activity levels below the guideline recommended level (10 000 steps/day), and 60% were in sedentary lifestyle (&amp;lt;5000 steps/day). The AAS score was 63.85 ± 13.99, 112 patients were impaired (&amp;lt;53 points), and 275 were moderately active (≥53 and &amp;lt;74 points). The univariate linear regression showed that the elderly, unemployed, diabetic nephropathy and patients with diabetes or &amp;gt;3 complications had fewer steps and lower MAS and AAS scores (P &amp;lt; 0.05). Besides, the number of steps in patients undergoing hemodialysis 5 times every 2 weeks was significantly lower than that of patients 3 times/week (P = 0.020). And for MAS and AAS, the ability to perform daily activities was significantly impaired in females and patients over 36 months of hemodialysis (P &amp;lt; 0.05). In multivariate linear regression, elderly patients with &amp;gt;3 complications were associated with lower levels of physical activity (P &amp;lt; 0.05). Females [–2.72 (–5.21 to –0.24); P = 0.032] with hypertension [6.14 (1.89–10.40); P = 0.005), congestive heart failure [5.24 (0.94–9.53); P = 0.017] and ischemic heart disease [6.48 (1.01–11.94); P = 0.020] were more likely to have impaired daily physical activity. CONCLUSION This survey demonstrates that hemodialysis patients are engage in physical inactivity. Elderly hemodialysis patients with more complications are prone to physical inactivity. Patients undergoing hemodialysis 5 times every 2 weeks are more likely to be live with sedentary lifestyle, while female patients with hypertension, congestive heart failure and ischemic heart disease are more impaired in daily physical activity. We should pay attention to the physical inactivity of hemodialysis patients.

Determining factors of functioning in hemodialysis patients using the international classification of functioning, disability and health

BackgroundHemodialysis (HD) treatment affects functioning, physical activity level, clinical biomarkers, and body composition. However, the association between these variables with functioning, considering International Classification of Functioning, Disability and Health (ICF) domains remains unclear. Thus, the aim of this study was to investigate the possible association between physical activity, biomarkers, and body composition with functioning in HD patients in reference to the ICF.MethodsEighty HD patients performed different tests grouped according to ICF domain: Body structure and function – handgrip strength (HS), 5-repetition sit-to-stand test, and 60-s sit-to-stand test (5-STS, 60-STS, respectively); Activity – short physical performance battery (SPPB); and Participation – participation scale questionnaire. Physical activity [Human Activity Profile questionnaire (HAP)], body composition (Dual-energy X-ray absorptiometry), Parathormone (PTH), and alkaline phosphatase were analyzed as possible variables associated with ICF domains. Data analyses were performed using simple and multiple regression models adjusted for age, duration of HD, and diuresis volume.ResultsIn the body structure and function domain, appendicular lean mass, PTH level, and age were associated with HS (R2 = 0.558); HAP and PTH were associated with 5-STS (R2 = 0.263); and HAP, PTH, duration of HD, and age were associated with 60-STS (R2 = 0.337). In the activity domain, HAP, PTH, alkaline phosphatase, duration of HD, age, and body fat were associated with SPPB (R2 = 0.689). Finally, only HAP was associated with the participation scale (R2 = 0.067).ConclusionPhysical activity and PTH levels are determinant protagonists of functioning in all ICF domains in hemodialysis patients.

Prospective Phase II Trial of Montelukast to Treat Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation and Investigation into Bronchiolitis Obliterans Syndrome Pathogenesis

Bronchiolitis obliterans syndrome (BOS) is a severe manifestation of chronic graft-versus-host disease (cGVHD) following hematopoietic cell transplantation (HCT). Montelukast interrupts cysteinyl leukotriene (CysLT) activity and may diminish the activation and homing of cells to bronchioles and subsequent fibrosis. We performed a prospective phase II trial to test whether montelukast altered lung decline for patients with BOS after HCT. In this single-arm, open-label, multi-institutional study, the primary endpoints were stability or improvement (<15% decline) in forced expiratory volume in 1 second (FEV1) and a <1-point decline in the slope of FEV1 after 6 months of treatment. Secondary endpoints included symptom and functional responses and immune correlates investigating the role of leukotrienes in BOS progression. The study enrolled 25 patients with moderate to severe lung disease after 3 months of stable cGVHD therapy. Montelukast was well tolerated, and no patient required escalation of BOS-directed therapy. At the primary endpoint, all 23 evaluable patients met the criteria for treatment success using FEV1% predicted, and all but 1 patient had stable or improved FEV1 slope. In those with a >5% improvement in FEV1, clinically meaningful improvements were seen in the Lee scores of breathing, energy, and mood. Improvements in the Human Activity Profile and 6-minute-walk test were observed in those with a <5% decline in FEV1. Overall survival was 87% at 2 years. Immune correlates showed elevated leukotriene receptor levels on blood eosinophils and monocytes versus healthy controls, elevated urine leukotrienes in 45% of the cohort, and CysLT receptors in bronchoalveolar lavage subsets and a predominance of Th2 cells, all pretreatment. These data suggest that montelukast may safely halt the progression of BOS after HCT, and that leukotrienes may play a role in the biology of BOS.