Original studyReduced customary activity in chronic heart failure: assessment with a new shoe-mounted pedometer
Abstract
Although many methods exist to assess the degree of incapacity of patients with chronic heart failure during normal daily activities, all have their limitations. In this study we describe a new shoe-mounted pedometer and compare it with body worn pedometers in normal volunteers and in patients with chronic heart failure. Ten young normal healthy volunteers participated in a comparison of the new shoe-mounted device with body born pedometers and counting of direct footfall. Seventeen patients with chronic heart failure and 10 aged-matched healthy elderly subjects participated in a comparison of both pedometers over 7 days. In the young volunteers the shoe-mounted pedometers were more accurate than the body-borne devices. With both pedometers the patients with chronic heart failure had a reduced level of activity compared with the normal volunteers over the 1 week period (P = 0.01). In both the patients and volunteers the shoe-mounted device recorded a higher score than the body borne pedometrs (P < 0.01). The electronic shoe mounted pedometers are a more accurate way of assessing customary activity. In patients with chronic heart failure customary activity is substantially reduced compared with fit healthy elderly subjects.
References (4)
- AJ Cowley et al.
Exercise tolerance in patients with heart failure:-how should it be measured?
Eur Heart J
(1991) - DP Lipkin et al.
Six minute walk test for assessing exercise capacity in patients with chronic heart failure
Br Med J
(1986)
Cited by (30)
Assessment of physical activity in cardiovascular diseases
2005, Annales de Readaptation et de Medecine PhysiqueObjectifs. – Répertorier les indices de mesure de l'activité physique les plus appropriés au domaine des maladies cardiovasculaires. Pour tenir compte des contraintes pratiques et financières permettant une application clinique courante, seuls l'actimétrie et les questionnaires d'activité ont été étudiés.
Méthode. – Afin de rechercher les outils de mesure de l'activité physique présentant un niveau suffisant de validité, de reproductibilité et de sensibilité, une analyse systématique de la littérature a été effectuée à partir de la base de données Medline en utilisant comme mots clés : accelerometry, ambulatory accelerometry, ambulatory monitoring, cardiovascular diseases, daily activity, heart disease, pedometer, physical activity, questionnaire.
Résultats. – Quinze questionnaires d'activité de niveau suffisant de validité et de reproductibilité ont été retenus. Pour l'analyse mécanique de l'activité, le moniteur d'activité apparaît supérieur bien que plus complexe aux accéléromètres ou podomètres utilisés seuls.
Conclusion. – L'utilisation de questionnaires validés est actuellement le moyen le plus adapté à la mesure de l'activité physique au cours des maladies cardiovasculaires. À l'avenir le développement des moniteurs d'activité devrait représenter un complément, voire une alternative.
Purpose. – To identify the more useful among many methods available for the measurement of physical activity in patients with cardiovascular disease. For practical and financial reasons only questionnaires and mechanical monitoring, which are appropriate for use in large studies, were assessed.
Methods. – To select tools valuable for clinical and epidemiological measurement of physical activity, with sufficient validity, reproducibility and sensitivity, we reviewed the literature in Medline with use of keywords: accelerometry, ambulatory accelerometry, ambulatory monitoring, cardiovascular diseases, daily activity, heart disease, pedometer, physical activity, questionnaire.
Results. – Considering appropriate level of reproducibility and validity, 15 questionnaires are available. For measuring postures and motions during daily life, activity monitor seems to be more valid than pedometers or single accelerometers.
Conclusion. – At present the preferred method is a questionnaire, provided it is valid, repeatable, easy to use and inexpensive. In the future mechanical monitoring (especially activity monitor) will be probably a good alternative.
Pedometer-determined ambulatory activity in individuals with type 2 diabetes
2002, Diabetes Research and Clinical PracticeThis cross-sectional study presents the first normative data on pedometer-determined ambulatory activity, defined as steps/day, in 160 (98 males, 62 females; age=52.4±5.3 years; BMI=32.3±5.7) free-living individuals with type 2 diabetes. Participants took 6662±3077 steps per day, less than that reported in nondiabetic samples and more than that reported for samples living with more restrictive chronic conditions including claudication, joint replacement, chronic obstructive lung disease, and chronic heart failure. Steps/day and BMI were inversely and significantly correlated (r=−0.27, P<0.01). Further, there was a significant difference between BMI categories (from normal weight to obesity class III) with regard to steps/day (F=2.96, P<0.05). The difference was most apparent between the highest obesity classes (II and III) and normal weight categories. This data is useful for sample comparison purposes. In addition the standard deviation or variance estimates can be used to calculate samples sizes for intervention efforts. Objective quantification of ambulatory activity via simple and inexpensive pedometers permits researchers and practitioners to easily screen for level of activity along a continuum. This study opens the door for future research and clinical applications including identifying threshold values related to important health outcomes and evaluating incremental change due to various interventions in this population.
A reduced level of daily activities is thought to be an important determinant of aerobic exercise intolerance in patients with chronic heart failure chronic heart failure; however, few data exist about the relationship between habitual physical activity level and peak aerobic capacity in patients at different clinical stages of left ventricular dysfunction.
The purposes of this study were as follow: (1) to validate a simple interviewer-administered scoring system for evaluation of habitual physical activity level of patients with chronic heart failure and asymptomatic left ventricular dysfunction (ALVD); (2) to determine the relationship between habitual physical activity level and peak aerobic capacity in chronic heart failure and ALVD patients; and (3) to compare habitual activity levels among different New York Heart Association (NYHA) classes in these populations.
Cardiology division at a tertiary-care hospital.
We studied 167 consecutive patients with chronic heart failure (NYHA class I to III), 40 patients with ALVD, and 52 healthy subjects (HS).
Habitual physical activity level was evaluated by means of an interview-based activity scoring system considering leisure time and occupational activities and also recent deconditioning events (eg, hospital admissions); a final activity score (AS) ranging from 0.8 to 5 was obtained. All patients and HS performed a symptom-limited cardiopulmonary exercise test up to a respiratory exchange ratio of ≥ 1.1. AS was an independent predictor of peak oxygen consumption ( o2) in all groups, with a significantly higher o2 vs AS relationship slope in the ALVD and HS groups than in the chronic heart failure group. Moreover, AS was found to be significantly lower in chronic heart failure than in ALVD patients and HS (1.6 ± 0.6 vs 2.2 ± 0.7 vs 3.5 ± 1.1, respectively; p < 0.0001), as was peak o2 (14.7 ± 3.7 mL/kg/min vs 20 ± 4 mL/kg/min vs 33.1 ± 10 mL/kg/min, respectively; p < 0.0001), but the latter differences were canceled after adjusting for AS values. Significant AS and peak o2 reductions were observed in chronic heart failure patients with NYHA class progression from I to III.
Habitual physical activity level is progressively decreased with worsening of heart failure symptoms and is related to peak aerobic capacity in both chronic heart failure and ALVD patients. However, this relationship appears to be weak in patients with chronic heart failure, whereas daily activity is a strong independent predictor of peak aerobic capacity both in ALVD patients and HS. This may be related to the intervention of factors other than skeletal muscle deconditioning in the exercise pathophysiology of chronic heart failure patients.
Relation of daily activity levels in patients with chronic heart failure to long-term prognosis
1997, American Journal of CardiologySymptom-limited, laboratory-based exercise tests are often used to define prognosis in patients with chronic heart failure, but they do not relate to measures of normal daily activity. Invasive measures of central hemodynamics similarly relate poorly to outcome. Pedometer scores of weekly walking are markedly reduced in patients with heart failure, but whether this less artificial measure of exercise capacity is important in predicting prognosis is not known. Eighty-four patients with chronic heart failure were followed for a mean of 710 days during which 44 died and 3 underwent cardiac transplantation. Symptom-limited treadmill exercise capacity using 2 different protocols did not predict survival, whereas reduced weekly pedometer scores were strong predictors of death (p < 0.001). Other variables that predicted death included resting cardiac output, arterial blood pressure, diuretic requirements, New York Heart Association class, increased bilirubin, and hyponatremia (all p < 0.01). Reduced levels of daily activity are strong predictors of death in chronic heart failure and appear more powerful than laboratory-based exercise tests. This type of assessment is valuable in identifying patients at high risk and provides an objective measure of incapacity during normal daily life. The exercise capacity of patients unable to exercise in the laboratory could also be assessed using this technique. This may prove invaluable in clinical and mortality trials.
Using technology-based techniques to assess postural control and gait in older adults
1996, Clinics in Geriatric MedicineIncreasingly sophisticated instrumentation and techniques to assess gait and postural control in older adults are now available. These technology-based methods may be most useful in understanding the mechanisms underlying age-related and disease-related changes in gait and postural control. Further work is needed to ensure that these methods: (1) are used ina hypothesis-driven manner; (2) are made more simple, portable, and user friendly; and (3) are used in an appropriate and cost-effective manner.
Predictors of exercise capacity and everyday activity in older heart failure patients
2006, European Journal of Heart Failure