Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

Abstract

Aims Accelerometers are becoming increasingly commonplace for assessing physical activity; however, their use in patients with cardiovascular diseases is relatively substandard. We aimed to systematically review the methods used for collecting and processing accelerometer data in cardiology, using the example of heart failure, and to provide practical recommendations on how to improve objective physical activity assessment in patients with cardiovascular diseases by using accelerometers. Methods and results Four electronic databases were searched up to September 2019 for observational, interventional, and validation studies using accelerometers to assess physical activity in patients with heart failure. Study and population characteristics, details of accelerometry data collection and processing, and description of physical activity metrics were extracted from the eligible studies and synthesized. To assess the quality and completeness of accelerometer reporting, the studies were scored using 12 items on data collection and processing, such as the placement of accelerometer, days of data collected, and criteria for non-wear of the accelerometer. In 60 eligible studies with 3500 patients (of those, 536 were heart failure with preserved ejection fraction patients), a wide variety of accelerometer brands (n = 27) and models (n = 46) were used, with Actigraph being the most frequent (n = 12), followed by Fitbit (n = 5). The accelerometer was usually worn on the hip (n = 32), and the most prevalent wear period was 7 days (n = 22). The median wear time required for a valid day was 600 min, and between two and five valid days was required for a patient to be included in the analysis. The most common measures of physical activity were steps (n = 20), activity counts (n = 15), and time spent in moderate-to-vigorous physical activity (n = 14). Only three studies validated accelerometers in a heart failure population, showing that their accuracy deteriorates at slower speeds. Studies failed to report between one and six (median 4) of the 12 scored items, with non-wear time criteria and valid day definition being the most underreported items. Conclusions The use of accelerometers in cardiology lacks consistency and reporting on data collection, and processing methods need to be improved. Furthermore, calculating metrics based on raw acceleration and machine learning techniques is lacking, opening the opportunity for future exploration. Therefore, we encourage researchers and clinicians to improve the quality and transparency of data collection and processing by following our proposed practical recommendations for using accelerometers in patients with cardiovascular diseases, which are outlined in the article.

The detrimental effect of COVID‐19 nationwide quarantine on accelerometer‐assessed physical activity of heart failure patients

“…Indeed, the mean daily step count of the patients before the onset of the quarantine was higher than the step count usually observed in other studies focusing on HF populations. 8,16 However, when we entered the daily step count, the time elapsed since enrolment into the trial, and whether the patient was in the intervention or follow-up phase of the trial as covariates into the model, neither of them had a significant effect on the percentage change, suggesting that our results can possibly be generalized to the HF populations outside a trial setting.…”

“…Non-wear time was identified as bouts of ≥60 consecutive minutes with zero steps, and only days with at least 10 h of wear time were deemed valid and included in the analysis. 8 Only patients with at least four valid days, including one weekend day, in both 3-week periods before and during the quarantine were included in the analysis.…”

Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

“…One aspect that is increasingly relevant to all research is the ability to compare data across studies. This was also included in a literature review 23 looking at the methods used for collecting physical activity data in patients with HF. Researchers and clinicians are encouraged to improve the quality and transparency of data collection and processing.…”

“…The challenges outlined above are exacerbated in patients with HF because of their very low physical activity levels, frailty and abnormalities of cognition, such that not all monitors are suitable in all patients. A recently published review 23 assessed the methods used for collecting and processing accelerometer data in cardiology, but more work is needed to address the challenges of comprehensive and consistent collecting, reporting, and analysing of physical activity in patients with HF.…”

Increased Cardiopulmonary Fitness Is Associated with a Greater Reduction in Depression among People Who Underwent Bariatric Surgery

“…Non-wear time was detected using the Choi et al algorithm [ 41 ], and only valid days, i.e., those with the minimum wear time of 480 min per day, were included in the analysis. At least three valid days at both T0 and T3 assessments were required for the analysis [ 42 ].…”