Physical Activity Patterns In Patients Research Articles

Mapping physical activity patterns in hospitalised patients with moderate to severe acquired brain injury - MAP-ABI: Protocol for an observational study

IntroductionThe physical activity level in patients hospitalised for rehabilitation across multiple diagnoses is low. Moderate to severe acquired brain injury further reduces activity levels as impaired physical and cognitive functioning affect mobility independence. Therefore, supervised out-of-bed mobilisation and physical activity training are essential rehabilitation strategies. Few studies have measured the physical activity patterns in the early phases of rehabilitation after moderate to severe brain injury. ObjectivesTo map and quantify physical activity patterns in patients admitted to brain injury rehabilitation. Further, to investigate which factors are associated with activity and if the early physical activity level is associated with functional outcome at discharge. MethodsThis observational study includes patients admitted to rehabilitation after moderate to severe acquired brain injury. Mobility and physical activity patterns are measured continuously during rehabilitation at two separate seven-day periods using a wearable activity tracker. Activity will be categorised into four levels and presented descriptively. Linear and logistic regression models will analyse associations between descriptive variables and activity levels. DiscussionThis protocol describes an observational study investigating patients' mobility and physical activity patterns with moderate to severe acquired brain injury during in-hospital rehabilitation. The ability to increase the amount of mobilisation and physical activity in subgroups may have profound consequences on the rehabilitation outcome. Furthermore, data from this study may be used to inform a large variety of trials investigating physical rehabilitation interventions. (NCT05571462).

Physical activity patterns of patients immediately after lumbar surgery

Purpose: To describe the physical activity patterns of patients in the first week after lumbar surgery, and to investigate factors that potentially limit walking time early after surgery. Materials and methods: Adults undergoing lumbar decompression, discectomy and/or fusion surgery (N = 216, mean age 62 years, SD 13.9) were invited to participate. Walking time and step count were recorded for the first seven post-operative days, using an ActivPAL accelerometer. Participants recorded daily pain scores, supervision requirements while walking, and any complications that prevented walking. Results: On the first post-operative day, participants spent an average of 17 min (SD 20) walking, by Day 6, participants spent an average of 53 min (SD 38) walking. Participants who reported minor post-operative complications had a significantly lower step count than those without complications (p < 0.01). A lower step count was associated with a longer time to achieve independent mobility (r= −0.60, 95% CI −0.68 to −0.50), and a longer hospital admission (r= −0.70, 95% CI −0.76 to −0.63). Conclusions: This study found that patients walk for less than an hour a day over the week after lumbar surgery. Further research is required to investigate whether intervention designed to increase walking time improves post-operative activity and longer-term patient outcome. IMPLICATIONS FOR REHABILITATION While resuming walking after lumbar surgery is a common focus of early rehabilitation, little is known about how much walking patients do, or how walking impacts recovery. The findings from this study describe activity patterns early after lumbar surgery, which may be used to inform patients about normal post-operative recovery. A lower post-operative step count was associated with several patient factors, including a fusion procedure and more severe post-operative pain, which may be used to guide peri-operative care and rehabilitation protocols.

Physical Activity Levels in Peripheral Artery Disease Patients.

BackgroundIncreases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients.ObjectiveTo describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease.MethodsThis cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05.ResultsPatients spent in average of 640 ± 121 min/day, 269 ± 94 min/day, 36 ± 27 min/day and 15 ± 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05).ConclusionThe patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations.

Diurnal Physical Activity Patterns in Patients With Chronic Obstructive Pulmonary Disease.

People with chronic obstructive pulmonary disease (COPD) have reduced physical activity (PA) levels compared with healthy controls. The pattern of their PA level during the day is much less documented. A better understanding of these diurnal PA patterns could help optimize interventions targeting PA levels in this population. The aim of this study was to examine, in patients with COPD, diurnal PA patterns using accelerometer data and different approaches to data handling (arbitrary, mealtime, equal tertiles). Fourteen COPD patients (aged 71 ± 9 yr; forced expiratory volume in 1 sec [FEV1]: 58% ± 13% predicted) completed the study. Daily PA was assessed via accelerometry for 7 d, 24 hr/d. Diurnal PA patterns were evaluated using an arbitrary (08:00-12:00, 12:01-16:00, 16:01-20:00), mealtime (wake time-lunchtime, lunchtime-suppertime, suppertime-bedtime), and equal tertiles (tertiles 1, 2, and 3) approaches. Results were interpreted on the basis of descriptive statistics and effect sizes (Cohen f) for time-of-day changes in PA. Regardless of the handling approach used, mean PA levels decreased in the evening and the effect size for time-of-day changes in PA level was large (f = 0.97; 1.82; and 1.66 for the arbitrary, mealtimes, and tertiles approaches, respectively). The observation of a decrease in the evening was highly homogeneous across our sample, particularly with the mealtime and equal tertiles handling approach. Results from this study support prior findings that PA levels decrease substantially in the evening in patients with COPD, thereby providing a better understanding of within-day PA behavior and offering valuable insight into interventions targeting PA.

Reduced Physical Activity Patterns In Patients With Thalassemia Compared To Healthy Controls

Background: Patients with Thal (Thalassemia) are presumed to be inactive for many of the same reasons as healthy adults, though there are limited published data to support this claim. The primary aim of this study was to compare physical activity patterns in subjects with Thal to healthy controls as well as to explore the effects of transfusion therapy on physical activity in transfusion dependent patients with Thal. Methods: 37 Thal (23 Thal major, 14 Thal intermedia, 21 Female, 27.3±10.1 years) and 30 healthy controls (17 Female, 28.0 ± 13.7 years) wore an ActiGraph accelerometer for one to two weeks. Results: Thal subjects recorded a significantly fewer total number of steps per day and lower total energy expenditure compared to healthy controls (p=0.001). None of the adult Thal subjects met the recommended 10,000 steps/day as opposed to 27% of healthy adult controls (p=0.004). Thal spent significantly less time in moderate (p=0.03) to vigorous (p=0.005) activities and more time in sedentary activity (p=0.006). Conclusion: It is now clear that Thal spend significantly less time in physically demanding activities than age-matched healthy controls, a result that has long been assumed though not previously documented. Further research is needed to define an appropriate physical activity regimen best suited for patients with Thal while examining its effect on mental and physical health. J O U R N A L O F H E M A T O L O G Y A N D O N C O L O G Y R E S E A R C H ISSN NO: 2372-6601 Research DOI : 10.14302/issn.2372-6601.jhor-15-776 Corresponding author Ellen B. Fung, PhD RD CCD, Department of Hematology, UCSF Benioff Children's Hospital, Oakland, 747 52 Street, Oakland, CA 94609, Phone: 510-428-3885 x 4939, Fax: 510-450-5877 , efung@mail.cho.org

Physical Activity And Sleep Patterns Following Physical And Cognitive Challenge In Patients With Chronic Fatigue Syndrome.

Chronic fatigue syndrome (CFS) is a disorder characterised by profound fatigue which is not relieved by rest and can be exacerbated by physical or cognitive activity. Patients generally report poor sleep and being less physically active than pre-illness; little is known how this is affected by exertion. PURPOSE: To characterise sleep and physical activity patterns in patients with CFS during the post-exertional exacerbation of fatigue following physical and cognitive challenge. METHODS: Two studies were conducted: a physically-demanding challenge (moderate-intensity aerobic exercise; EXER), and a cognitively-demanding challenge (simulated driving; COG). Each study included a well-characterised sample of patients with CFS (EXER: N=10; COG: N=11) and healthy matched control participants (EXER: N=12; COG: N=11). In each study, self-reported ratings of fatigue and symptoms were obtained at baseline and at time-points in the first 24 hours post-challenge. A triaxial accelerometer was worn for a 24 hour baseline period and the first 24 hours following each challenge. RESULTS: Patients with CFS reported substantial fatigue, functional impairment and poor sleep at baseline in each study (all p<0.02). Patients displayed comparable performance to control participants during each challenge, but reported higher perceived exertion (p<0.02). Each challenge induced an immediate exacerbation of fatigue in patients (p<0.02), which was maintained 24 hours following. Patients displayed longer night-time sleep (overall mean CFS: 8.9±1.1 hrs/night, controls: 7.5±1.2 hrs/night, p<0.001) and more time spent lying down during waking hours (overall mean CFS: 29±15%, controls: 14±10%, p<0.001). Patients’ sleep duration and activity patterns were not affected by either challenge, excepting a trend towards less movement (p=0.06) and more lying down (p=0.07) following the exercise challenge. Patient’s fatigue at baseline correlated with a more severe reduction in movement during waking hours following the challenges (r=-.58, p=0.006). CONCLUSION: Patients with CFS displayed low levels of daytime physical activity and excessive night-time sleep at baseline. Despite the exacerbation of fatigue by both exercise and cognitive challenge, patients’ physical activity patterns were not significantly affected. Individual differences in post-exertional change in physical function were linked to baseline levels of fatigue.

OP0258-HPR Self-Reported Disease Characteristics do not Explain Why Younger Women with SPA Are Less Physically Active than Older Women with the Disease

BackgroundExercise is a commonly used treatment for patients with spondyloarthritis (SpA) but younger women reach WHOs recommended level of physical activity (PA) to a less extent than peers in the...

Influence of Pedometers on Habitual Physical Activity Patterns in Patients with Vascular Disease

Influence of Pedometers on Habitual Physical Activity Patterns in Patients with Vascular Disease

Influence of pedometers on habitual physical activity patterns in patients with vascular disease

Background: Pedometers are used to measure physical activity and motivate individuals to be more active. Little is known regarding the impact of the conditions when issuing a pedometer. We explored the influence of pedometers on daily physical activity in patients with cardiovascular disease, with and without additional information, direction, or encouragement. Methods: Subjects included males (n=45) and females (n=5) (mean age 70.9 ± 7.4 years) with abdominal aortic aneurysm (AAA) disease from the AAA STOP trial. The No Contact (NC) group (n=25) was mailed a packet containing a pedometer, 12 monthly log sheets, and 12 postage-paid return envelopes, but no letter or instructions. Interviews were conducted after 12 months. The Exercise Treatment (ET) group (n=25) received their pedometers at their first study visit; the pedometers were set up for each individual and goals were discussed. Additionally, they received weekly follow-up and reminders to use their pedometers and increase their daily physical activity. Results: Twelve of the 25 (48%) NC subjects returned ≥6 monthly logs. Energy expenditure significantly differed between the NC and ET groups at both the 12-month (1331.8 ± 244.1 kcals/week vs. 2357.3 ± 369.6 kcals/week, respectively, p=0.02) and 24-month follow-up (1053.6 ± 227.3 kcals/week vs. 2371.9 ± 434.6 kcals/week respectively, p=0.01). Only 8% (2/25) in the NC group changed their exercise routine due to the pedometer, while 16% (4/25) increased their exercise volume due to wearing the pedometer. Conclusions: Receiving a pedometer did not aid in increasing daily physical activity in adults with vascular disease. Education, goal setting, and encouragement are needed to supplement the use of a pedometer to increase energy expenditure.

Association Between Physical Activity Measurements and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Heart Failure

BackgroundA hallmark characteristic of heart failure (HF) is reduced physical activity (PA) patterns. The relationship between key cardiopulmonary exercise testing (CPX) variables and PA patterns has not been investigated. Therefore, we evaluated PA patterns in patients with ischemic HF and its relationship to peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, and the oxygen uptake efficiency slope (OUES). Methods and ResultsSixteen patients with HF wore an accelerometer for six days to measure total steps/day as well as percentage of time at light, moderate, and vigorous PA. Symptom-limited CPX was performed on a treadmill using a ramping protocol. Total steps correlated with VO2 (r = 0.64 P < .05), the VE/VCO2 slope (r = −0.72; P < .05), and the OUES (0.63; P < .05). The percentage of time at light-intensity PA correlated with the VE/VCO2 slope (r = 0.58; P < .05) and the OUES (r = −0.51; P < .05). The percentage of time at vigorous-intensity PA correlated with peak VO2 (r = 0.55; P < .05) and the VE/VCO2 slope (r = −0.52; P < .05). ConclusionsPA assessed by accelerometer is significantly associated with key CPX variables in patients with HF.

Differences in physical activity patterns in patients with spondylarthritis

To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes. In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis. A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity. Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle.

Physical Activity Patterns of Patients With Cardiopulmonary Illnesses

Nguyen HQ, Steele BG, Dougherty CM, Burr RL. Physical activity patterns of patients with cardiopulmonary illnesses. ObjectivesThe aims of this paper were (1) to describe objectively confirmed physical activity patterns across 3 chronic cardiopulmonary conditions, and (2) to examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. DesignCross-sectional study. SettingParticipants' home environment. ParticipantsPatients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD) (n=63), heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). InterventionsNot applicable. Main Outcome MeasuresSeven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer. ResultsSubjects with COPD had the lowest amount of ambulatory physical activity compared with subjects with heart failure and cardiac dysrhythmias (all 7 activity dimensions, P<.05); total step counts were: 5319 versus 7464 versus 9570, respectively. Six-minute walk distance was correlated (r=.44–.65, P<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with 5 of the physical activity dimensions (r=.22–.40, P<.05). In contrast, correlations between 6-minute walk test distance and physical activity were higher (r=.48–.61, P<.01) albeit in a smaller sample of only patients with heart failure. For all 3 samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or nonsignificant correlations with physical activity. ConclusionsAll 7 dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of 1 dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a 6-minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures.

Physical Activity Patterns in Patients in Different Stages of Chronic Obstructive Pulmonary Disease

It has previously been suggested that exercise capacity is decreased in COPD and that it is associated with degree of disease. The reduced exercise capacity may plausibly be due to low levels of physical activity in this patient group. The aim of the present study was to assess exercise capacity and physical activity in different stages of COPD and to examine the associations between exercise capacity, pulmonary function and degree of physical activity. A total of 44 COPD patients and 17 healthy subjects participated in the study. Exercise capacity was assessed using the 6-minute walking test and physical activity was assessed using an accelerometer worn all waking hours during 7 days. Mean exercise capacity was significantly lower in COPD patients compared with healthy subjects. Mean physical activity level and time spent at least moderately active were significantly lower in patients with moderate and severe COPD compared with healthy subjects while no differences in time spent sedentary were observed between the study groups. Pulmonary function, mean physical activity level and time spent at least moderately physically active were significantly associated with exercise capacity in the patients. We conclude that patients with moderate and severe COPD are less physically active compared with healthy subjects. Furthermore, mean physical activity level and physical activity of at least moderate intensity are positively associated with exercise capacity in COPD, while time spent sedentary is not, which stresses an important role of physical activity on exercise capacity in these patients.

Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: A case control study

ObjectivesDeviations in daily physical activity patterns may play an important role in the development and maintenance of fatigue in the chronic fatigue syndrome (CFS). The aim of this study is to gain insight into the objective daily physical activity pattern of patients with CFS in comparison with healthy controls. The secondary objective is studying the awareness in performing physical activities. MethodsThe objective daily physical activity pattern was measured with a tri-axial accelerometer in 35 patients with CFS and in 35 age- and gender-matched healthy controls. The objective daily physical activity level and distribution of physical activities at low, medium and high intensity levels during the day were measured. Moreover, variability in performing physical activities within and between subjects was computed. Subjective ratings of self-reported daily physical activity levels were assessed at a visual analog scale. ResultsCFS patients were significantly less physically active in the afternoon and evening, and spent fewer activities at high intensity levels and more at low intensity levels. Moreover, CFS patients showed more variability in their own physical activity pattern during the afternoon. The heterogeneity in the physical activity pattern between subjects within the CFS and control group did not differ. Finally, CFS patients were more aware about their daily physical activity level than healthy controls. ConclusionCFS patients showed deviations in the objectively measured daily physical activity pattern. Future research should elucidate the relation between impaired balances in daily physical activity patterns and fatigue severity in CFS.

Little therapy, little physical activity: Rehabilitation within the first 14 days of organized stroke unit care

To examine rehabilitation interventions and resulting physical activity patterns of patients managed in acute stroke units to help inform development of a randomized controlled trial of very early rehabilitation. An open observational study of patient activity and therapist report of patient interventions. A survey of stroke unit resources. Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity, location and person(s) present were ascertained at each observation. Therapists completed treatment records. Senior staff completed stroke unit surveys. Patients after stroke (n=58) were with therapists 5.2% of the observed day. Few patients (17.1%) received daily therapy by more than one therapist. When patients received therapy, average session times were 24 minutes of physiotherapy, 23 minutes of occupational therapy and 33 minutes of speech pathology. The more time that family members were present, the longer the treatment time. Four to 11 min of upper-limb therapy was provided. Muscle weakness and left hemiparesis were associated with less upper-limb activity. These acute stroke care units were resourced according to recommended staff-patient ratios. Patients received little therapy and had low levels of physical activity.