Changes in physical activity during hospital admission for chronic respiratory disease

Abstract

Background and objective: Establishing the amount of inpatient physical activity (PA) undertaken by individuals hospitalized for chronic respiratory disease is needed to inform interventions. This observational study investigated whether PA changes when a person is an inpatient, how long is required to obtain representative PA measures and whether PA varies within a day and between patients of differing lengths of stay. Methods: A total of 389 participants were recruited as early as possible into their hospitalization. Patients wore a PA monitor from recruitment until discharge.Step count was extracted for a range of wear time criteria. Single-day intraclass correlation coefficients (ICC) were calculated, with an ICC ≥ 0.80 deemed acceptable. Results: PA data were available for 259 participants. No changes in daily step count were observed during the inpatient stay (586 (95% CI: 427-744) vs 652 (95% CI: 493-812) steps/day for day 2 and 7, respectively). ICC across all wear time criteria were > 0.80. The most stringent wear time criterion, retaining 80% of the sample, was ≥11 h on ≥1 day. More steps were taken during the morning and afternoon than overnight and evening. After controlling for the Medical Research Council (MRC) grade or oxygen use, there was no difference in step count between patients admitted for 2-3 days (short stay) and those admitted for 7-14 days (long stay). Conclusion: Patients move little during their hospitalization, and inpatient PA did not increase during their stay. A wear time criterion of 11 waking hours on any single day was representative of the entire admission whilst retaining an acceptable proportion of the initial sample size. Patients may need encouragement to move more during their hospital stay.Objectively measured inpatient physical activity (PA) was examined for 259 individuals hospitalized due to an acute exacerbation of chronic respiratory disease. PA did not recover as an inpatient, with patients averaging 616 AE 649 steps/day. A single day of PA monitoring provided data representative of the entire inpatient stay.

Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice

“…There is no published consensus on how many days and hours of data are required to capture representative data in an HD population, but our findings align with work in other populations living with long-term conditions. A single day of at least 11 h data was representative of PA in a cohort of inpatients living with Chronic Obstructive Pulmonary Disease, as activity restriction enforced by hospitalisation (comparable to an HD day) reduced variability in step count [38]. In the same population, in free-living conditions (akin to non-HD days in the current study), 4 days of at least 8 h of wear time have been recommended [22].…”

Contemporary Concise Review 2019: Chronic obstructive pulmonary disease

“…Orme et al . showed that patients, who were hospitalized for an acute COPD exacerbation, walked, on average, only ~600 steps/day, which did not improve over the course of their hospitalization despite improvements in their clinical condition. Together, these data highlight the pressing need to develop and implement interventions to encourage mobility and enhance physical activity of COPD patients especially during exacerbations.…”

Physical exercise during acute exacerbations of chronic obstructive pulmonary disease: Australian physiotherapy practice

“…Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are clinically impactful events characterised in their pulmonary component by heightened respiratory symptoms (dyspnoea, cough and sputum production) 1 and in their extrapulmonary components by musculoskeletal dysfunction, 2 muscle weakness 3 and decreased physical activity levels. [4][5][6] Pulmonary rehabilitation (PR) comprising multidisciplinary evaluation, physical exercise training and education/psychological support 7 is one of the most effective therapies to improve important health outcomes in this patient group when applied during the period of disease stability 8 and shortly following AECOPD. 9 International guidelines recommend PR to commence within 2-4 weeks of discharge, [10][11][12] however rates of referral, uptake and completion of PR following AECOPD are suboptimal.…”