Are Heart Failure and Coronary Artery Bypass Surgery Patients Meeting Physical Activity Guidelines?

Yates, Bernice C.; Pozehl, Bunny; Kupzyk, Kevin; Epstein, Crystal Modde; Deka, Pallav

doi:10.1002/rnj.257

Cited by 29 publications

(22 citation statements)

References 22 publications

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“…Moreover, 67% of our participants self-reported a low-sodium diet, which is quite high given the objective measure of approximately 34% in a recent study [46]. In this study, we asked about these lifestyle parameters weekly in both equipment groups and found that self-reported physical activity was also likely overstated, similar to other studies that measure with self-reported questionnaires [48]. For example, Yates et al report that 38% of HF patients self-reported meeting physical activity recommendations, but when measured objectively, 0% met recommendations.…”

Section: Discussionsupporting

confidence: 66%

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study

et al. 2018

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Background Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with ...

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Section: Discussionsupporting

confidence: 66%

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study

et al. 2018

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“… 10 Ter Hoeve et al concluded that centre-based CR was not sufficient to improve and maintain PA levels and suggested home-based CR programmes may be more successful; however, literature is limited in this area. 11 In accord with recent Cochrane systematic reviews of CR, 9 10 the participating patients were relatively young (<60 years), predominantly male, with large differences in the programme location, duration, intensity, modality and length of follow-up.…”

Section: Discussionmentioning

confidence: 84%

Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Dibben

Dalal

Taylor

et al. 2018

Heart

136

129

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ObjectiveTo undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.MethodsDatabases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.ResultsForty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.ConclusionOverall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

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“…72 For example, many HF patients are likely to fail to obtain any activity above the MVPA cut point; consequently, a large number of study participants score 0 min, as was the case in one of the reviewed studies where median minutes of MVPA were zero. 65 Rowlands et al recently suggested several new metrics on the basis of raw acceleration, such as the level of acceleration above which a person's most active 30 min are accumulated (M30), 72 or intensity gradient, which can be used in combination with average acceleration to fully describe PA profile. 83 A similar approach has been employed by one of the reviewed studies that calculated time accumulated in narrow intensity bins (0-20-40-60-80-100 mg) of raw acceleration.…”

Section: Physical Activity Metricsmentioning

confidence: 99%

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

et al. 2020

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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.

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Are Heart Failure and Coronary Artery Bypass Surgery Patients Meeting Physical Activity Guidelines?

Cited by 29 publications

References 22 publications

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study

Cardiac rehabilitation and physical activity: systematic review and meta-analysis

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

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