Actigraphy to Evaluate Changes in Physical Activity After Autologous Breast Reconstruction

Abstract

Purpose Early ambulation and return to preoperative (baseline) ambulatory level is protective against postoperative venous thromboembolism. The duration of decreased physical activity after surgery is unknown for most procedures, as surgeons typically estimate physical recovery based on subjective patient reporting. This study aims to quantify the time it takes to return to baseline ambulatory status after breast reconstruction using actigraphy devices. Methods Actigraphy devices were used to evaluate preoperative and postoperative physical activity levels in patients undergoing autologous breast reconstruction at a single academic institution. Steps and resting heart rate (HR) were used as metrics of physical activity and physiological state. “Baseline” physical activity was defined by the average daily step count during the 14 days before surgery. “Return to baseline” occurred when the 7-day daily step average was greater than or equal to 95% of their baseline steps. Study participation was considered complete once a patient returned to baseline or surpassed 8 postoperative weeks. Results From May 2019 to April 2020, 17 patients were enrolled in the study before deep inferior epigastric perforator breast reconstruction. The mean age was 48.2 years and mean BMI was 27.6. This cohort averaged 7908 ± 3271 preoperative steps. Two patients returned to baseline activity by postoperative day 28. In total, 8 patients returned by postoperative week 8. Preoperative resting HR average was 73.5 ± 9.43 beats per minute. The average resting HR was elevated by 2.59%, 4.28%, and 2.31% at weeks 1, 2, and 3, respectively. The 7-day daily average resting HR had normalized by week 4. Conclusions Return to baseline physical activity after surgery may take longer than previously perceived, particularly after physiologically demanding surgeries, such as free flap breast reconstruction. These findings indicate that surgeons may underestimate the impact of surgery on physical decline and, consequently, may undertreat with venous thromboembolism prophylaxis.

Association of patient activity bio-profiles with health-related quality of life in patients with newly diagnosed multiple myeloma: a prospective observational cohort study

“… 11 , 12 , 13 In a study involving adult hematopoietic stem cell transplant recipients, average daily steps were associated with increases in pain, fatigue, and gastrointestinal symptoms. 11 Similar studies have demonstrated altered activity patterns in cancer patients recovering postoperatively from surgery, 14 , 15 , 16 sickle cell patients experiencing painful vaso-occlusive crises, 17 and terminal cancer patients receiving pain medications. 18 Additionally, past research indicates that increased physical activity may be associated with long term benefits in cancer survivors, including improved quality of life and decreased cancer recurrence.…”

Assessing Adipocyte Viability and Surgeons’ Work Efficiency by Comparing Different Liposuction Methods

“…ActiGraph technology is a tool that can help assess ergonomics; however, in most cases, patients undergoing different surgical procedures are below its scope. 31,32 In addition, no other specific algorithms or prior research related to actigraphy and liposuction were found.…”

Double-Blinded Randomized Control Trial Comparing Liposomal Bupivacaine and Plain Bupivacaine in Transversus Abdominis Plane For Deep Inferior Epigastric Artery Perforator (DIEP) Flap Breast Reconstruction

“…1,4 Although these are positive outcomes, there remains significant postoperative abdominal donor-site morbidity, 5,6 including a decline in physical activity during the early postoperative period. 7 Efforts to reduce postoperative pain and opioid-dependence have led to the creation and widespread application of enhanced recovery after surgery (ERAS) pathways, which have helped decrease opioid use and reduce hospital stay and costs. 8 As part of the ERAS pathway, transversus abdominis plane (TAP) blocks are proven to reduce perioperative pain after abdominally based autologous breast reconstruction, and use of liposomal bupivacaine has been associated with reduced narcotic use after surgery.…”

“…1,4 Although these are positive outcomes, there remains significant postoperative abdominal donor-site morbidity, 5,6 including a decline in physical activity during the early postoperative period. 7…”