The association of pre‐operative home accelerometry with cardiopulmonary exercise variables

Cui, Helen; Kirby, Gerald S.; Surmacz, K.; Hargrove, Caroline; Griffiths, John; Turney, Benjamin

doi:10.1111/anae.14181

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…However, wear-time compliance has been a problem with hip-worn devices which limits the validity of the data analysis 27. Cui et al 28 fixed an accelerometer to participants’ chests using an adhesive plaster; however, one quarter of participants did not wear the device for 72 hours which may limit the validity of data. We opted for a wrist-worn device to circumvent this issue, and asked participants to wear the device continuously (day and night) for a 7-day period to simplify proceedings.…”

Section: Discussionmentioning

confidence: 99%

Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study

et al. 2019

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ObjectivesTo use wrist-worn accelerometers (Axivity AX3) to establish normative physical activity (PA) and acceptability data for the high-risk elderly preoperative population, to assess whether PA could be modified by a prehabilitation intervention as part of routine care, to assess any correlation between accelerometer-measured PA and self-reported PA and to assess the acceptability of wearing wrist-worn accelerometers in this population.Study designProspective, observational, pilot study.SettingSingle National Health Service Hospital.ParticipantsFrail patients≥65 years awaiting major surgery referred to a multidisciplinary preoperative clinic at which they received a routine intervention aimed at improving their PA. 35 patients were recruited. Average age 79.9 years (SD=5.6).Primary outcomesNormative PA data measured as a mean daily Euclidean norm minus one (ENMO) in milli-gravitational units (mg).Secondary outcomesMeasure PA levels (mg) following a routine preoperative intervention. Determine correlation between patient-reported PA (measured using the Physical Activity Scale for the Elderly) and accelerometer-measured PA (mg). Assess acceptability of wearing a wrist-worn accelerometer measured using Visual Analogue Scale (VAS) questionnaire and device wear time (hours).ResultsMedian baseline daily PA was 14.3 mg (IQR 9.75–22.04) with an improvement in PA detected following the intervention (median ENMO post intervention 20.91 mg (IQR 14.83–27.53), p=0.022). There was no significant correlation between accelerometer-measured and self-reported PA (baseline ρ=0.162 (p=0.4), post intervention ρ=−0.144 (p=0.5)). We found high acceptability ratings (median score of 10/10 on VAS, IQR 8–10) and wear-time compliance (163.2 hours (IQR 150–167.5) preintervention and 166.1 hours (IQR 162.5–167) post intervention).ConclusionsAccelerometery is acceptable to this population and increases in PA levels measured following an unoptimised routine clinical intervention which indicates that health behavioural change interventions may be successful during the preoperative period. Accelerometers may therefore be a useful tool to design and validate interventions for improving PA in this setting.Trial registration number NCT03737903.

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Section: Discussionmentioning

confidence: 99%

Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study

et al. 2019

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“…7 The DASI questionnaire (Supplementary Table 1) was developed in a sample of English-speaking adults undergoing exercise testing in the USA, 6 and has a score ranging from 0 to 58.2, with higher scores indicating greater levels of fitness. The questionnaire is a valid measure of preoperative cardiopulmonary fitness, 5,8,9 but there is a disagreement as to how best to convert DASI scores to estimated metabolic equivalents. 10,11 It is also unclear what specific thresholds in DASI scores define an elevated perioperative risk, and whether the DASI questionnaire provides additional prognostic information when used in combination with preoperative biomarkers, such as brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT pro-BNP).…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Wijeysundera

Beattie

Abbott

et al. 2020

British Journal of Anaesthesia

110

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Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. Methods: The analysis included 1546 participants (!40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. Results: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96e0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92e0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00e1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01e1.05). Conclusions: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

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“…In previous studies of preoperative accelerometer use, overall accelerometer activity was moderately correlated with cardiopulmonary exercise testing-derived peak oxygen consumption and ventilatory threshold. 34 In addition to accelerometers, short exercise tests may be utilized to identify patients at high risk of complications. Six-minute walk test distance is strongly correlated with the ventilatory threshold and distance can be used to risk stratify patients before major noncardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Physical Function Questions to Predict Moderate-Vigorous Physical Activity as Measured by Hip Accelerometry

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Functional capacity assessment is a core component of current perioperative cardiovascular evaluation and management guidelines for noncardiac surgery. The authors investigated the ability of standardized physical function questions to predict whether participants engaged in moderate physical activity as measured by hip accelerometers. Methods Participant responses to physical functioning questions and whether they engaged in moderate physical activity were extracted from the National Health and Nutrition Examination Survey (2003 to 2004 and 2005 to 2006). Physical activity intensity was measured using hip accelerometers. Adult participants with at least one Revised Cardiac Risk Index condition were included in the analysis. Standardized physical function questions were evaluated using a classification and regression tree analysis. Training and test datasets were randomly generated to create and test the analysis. Results Five hundred and twenty-two participants were asked the physical functioning questions and 378 of 522 (72.4%) had a bout of moderate-vigorous activity. Classification and regression tree analysis identified a “no difficulty” response to walking up 10 stairs and the ability to walk two to three blocks as the most sensitive questions to predict the presence of a 2-min bout of moderate activity. Participants with positive responses to both questions had a positive likelihood ratio of 3.7 and a posttest probability greater than 90% of a 2-min bout of moderate-vigorous activity. The sensitivity and specificity of positive responses to physical functioning questions in the pruned tree were 0.97 (95% CI, 0.94 to 0.98) and 0.16 (95% CI, 0.10 to 0.23) for training data, and 0.88 (95% CI, 0.75 to 0.96) and 0.10 (95% CI, 0.00 to 0.45) for the test data. Participants with at least one 2-min bout of moderate activity had a greater percentage of overall daily active time (35.4 ± 0.5 vs. 26.7 ± 1.2; P = 0.001) than those without. Conclusions Standardized physical function questions are highly sensitive but poorly specific to identify patients who achieve moderate physical activity. Additional strategies to evaluate functional capacity should be considered.

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The association of pre‐operative home accelerometry with cardiopulmonary exercise variables

Cited by 8 publications

References 26 publications

Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study

Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study

Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Accuracy of Physical Function Questions to Predict Moderate-Vigorous Physical Activity as Measured by Hip Accelerometry

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