Utility of single-item questions to assess physical inactivity in patients with chronic heart failure

Andreas Blomqvist, Maria Bäck, Leonie Klompstra, Anna Strömberg, Tiny Jaarsma, Andreas Blomqvist, Maria Bäck, Leonie Klompstra, Anna Strömberg, Tiny Jaarsma

Abstract

Aim: The purpose of this study was to explore the utility of two single-item self-report (SR) questions to assess physical inactivity in patients with heart failure (HF).

Methods and results: This is a cross-sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self-reported physical activity or low self-reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: ρ = 0.24, P = 0.016 for SR1 and ρ = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self-reported physical activity group (P < 0.001).

Conclusions: There might be utility in the single SR question for high-specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.

Keywords: Accelerometer; Heart failure; Physical inactivity; Self-report.

Conflict of interest statement

None to report.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Figures

Figure 1
Figure 1
(A) Scatter plot of SR1 vs. activity counts (n = 104). (B) Scatter plot of SR2 vs. activity counts (n = 106).
Figure 2
Figure 2
Physical activity measured by the ActiGraph, plotted as a function of level of physical activity as defined by the SR1.
Figure 3
Figure 3
Physical activity measured by the ActiGraph, plotted as a function of level of physical activity as defined by the SR2.

References

    1. Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, Gaggin H, Freeman AM, Allen K, Madan S, Massera D, Litwin SE, American College of Cardiology's N, Lifestyle Committee of the Prevention of Cardiovascular Disease C. Lifestyle modifications for preventing and treating heart failure. J Am Coll Cardiol 2018;72():2391–2405.
    1. Thivel D, Tremblay A, Genin PM, Panahi S, Riviere D, Duclos M. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Front Public Health 2018; 6: 288.
    1. Organization WH . Global Recommendations on Physical Activity for Health. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: 2010.
    1. Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. Gerontologist 2016; 56: S268–S280.
    1. Downing J, Balady GJ. The role of exercise training in heart failure. J Am Coll Cardiol 2011; 58: 561–569.
    1. Cacciatore F, Amarelli C, Ferrara N, Della Valle E, Curcio F, Liguori I, Bosco Q, Maiello C, Napoli C, Bonaduce D, Abete P. Protective effect of physical activity on mortality in older adults with advanced chronic heart failure: a prospective observational study. Eur J Prev Cardiol 2019; 26: 481–488.
    1. Doukky R, Mangla A, Ibrahim Z, Poulin MF, Avery E, Collado FM, Kaplan J, Richardson D, Powell LH. Impact of physical inactivity on mortality in patients with heart failure. Am J Cardiol 2016; 117: 1135–1143.
    1. Oerkild B, Frederiksen M, Hansen JF, Prescott E. Self‐reported physical inactivity predicts survival after hospitalization for heart disease. Eur J Cardiovasc Prev Rehabil 2011; 18: 475–480.
    1. Waring T, Gross K, Soucier R, ZuWallack R. Measured physical activity and 30‐day rehospitalization in heart failure patients. J Cardiopulm Rehabil Prev 2017; 37: 124–129.
    1. Conraads VM, Spruit MA, Braunschweig F, Cowie MR, Tavazzi L, Borggrefe M, Hill MR, Jacobs S, Gerritse B, van Veldhuisen DJ. Physical activity measured with implanted devices predicts patient outcome in chronic heart failure. Circ Heart Fail 2014; 7: 279–287.
    1. Fulcher KK, Alosco ML, Miller L, Spitznagel MB, Cohen R, Raz N, Sweet L, Colbert LH, Josephson R, Hughes J. Greater physical activity is associated with better cognitive function in heart failure. J Health Psychology 2014; 33: 1337.
    1. von Haehling S. Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature. ESC Heart Fail 2018; 5: 1074–1082.
    1. Andreae C, Årestedt K, Evangelista L, Strömberg A. The relationship between physical activity and appetite in patients with heart failure: a prospective observational study. Eur J Cardiovasc Nurs 2019; 18: 410–417.
    1. Chin APMJ, van Poppel MN, van Mechelen W. Effects of resistance and functional‐skills training on habitual activity and constipation among older adults living in long‐term care facilities: a randomized controlled trial. BMC Geriatr 2006; 6: 9.
    1. Schertz A, Herbeck Belnap B, Chavanon ML, Edelmann F, Wachter R, Herrmann‐Lingen C. Motivational interviewing can support physical activity in elderly patients with diastolic heart failure: results from a pilot study. ESC Heart Failure 2019.
    1. Skender S, Ose J, Chang‐Claude J, Paskow M, Bruhmann B, Siegel EM, Steindorf K, Ulrich CM. Accelerometry and physical activity questionnaires—a systematic review. BMC Public Health 2016; 16: 515.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self‐report measures for assessing physical activity in adults: a systematic review. The International Journal of Behavioral Nutrition and Physical Activity 2008; 5: 56.
    1. Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, Richardson CR, Smith DT, Swartz AM. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. J Circulation 2013; 128: 2259–2279.
    1. Brage S, Westgate K, Franks PW, Stegle O, Wright A, Ekelund U, Wareham NJ. Estimation of free‐living energy expenditure by heart rate and movement sensing: a doubly‐labelled water study. PLoS One 2015; 10: e0137206.
    1. Migueles JH, Cadenas‐Sanchez C, Ekelund U, Delisle Nystrom C, Mora‐Gonzalez J, Lof M, Labayen I, Ruiz JR, Ortega FB. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med 2017; 47: 1821–1845.
    1. Matthews CE, Hagströmer M, Pober DM, Bowles HR. Best practices for using physical activity monitors in population‐based research. J Medicine science in sports exercise 2012; 44: S68.
    1. Colley RC, Butler G, Garriguet D, Prince SA, Roberts KC. Comparison of self‐reported and accelerometer‐measured physical activity in Canadian adults. Health Rep 2018; 29: 3–15.
    1. Jaarsma T, Klompstra L, Ben Gal T, Boyne J, Vellone E, Back M, Dickstein K, Fridlund B, Hoes A, Piepoli MF, Chiala O, Martensson J, Stromberg A. Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF‐Wii study; a multicentre randomized controlled trial. Eur J Heart Fail 2015; 4a: 743–748.
    1. Jaarsma T, Klompstra L, Ben Gal T, Ben Avraham B, Boyne J, Bäck M, Chialà O, Dickstein K, Evangelista L, Hagenow A, Hoes AW. Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicenter randomised controlled trial. Eur J Heart Fail 2020.
    1. Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. Journal of science medicine in sport 2011; 14: 411–416.
    1. Corder K, Brage S, Ekelund U. Accelerometers and pedometers: methodology and clinical application. Curr Opin Clin Nutr Metab Care 2007; 10: 597–603.
    1. Choi L, Ward SC, Schnelle JF, Buchowski MS. Assessment of wear/nonwear time classification algorithms for triaxial accelerometer. Med Sci Sports Exerc 2012; 44: 2009–2016.
    1. Jaarsma T, Arestedt KF, Martensson J, Dracup K, Stromberg A. The European Heart Failure Self‐care Behaviour scale revised into a nine‐item scale (EHFScB‐9): a reliable and valid international instrument. Eur J Heart Fail 2009; 11: 99–105.
    1. Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double‐blind, placebo‐controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 1992; 124: 1017–1025.
    1. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699.
    1. Youden WJ. Index for rating diagnostic tests. Cancer 1950; 3: 32–35.
    1. Uchmanowicz I, Loboz‐Rudnicka M, Jaarsma T, Loboz‐Grudzien K. Cross‐cultural adaptation and reliability testing of Polish adaptation of the European Heart Failure Self‐care Behavior Scale (EHFScBS). Patient Prefer Adherence 2014; 8: 1521–1526.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J HF 2016; 18: 891–975.
    1. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutrition 2007; 9.
    1. Schäfer‐Keller P, Steiger J, Bock A, Denhaerynck K, De Geest S. Diagnostic accuracy of measurement methods to assess non‐adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transpl 2008; 8: 616–626.
    1. Tudor‐Locke CE, Myers AM. Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity. Res Q Exerc Sport 2001; 72: 1–12.
    1. Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Brubaker PH, Osada N, Omiya K, Shimizu H. Usefulness of step counts to predict mortality in Japanese patients with heart failure. Am J Cardiol 2013; 111: 1767–1771.
    1. Walsh JT, Charlesworth A, Andrews R, Hawkins M, Cowley AJ. Relation of daily activity levels in patients with chronic heart failure to long‐term prognosis. Am J Cardiol 1997; 79: 1364–1369.
    1. Alosco ML, Spitznagel MB, Cohen R, Raz N, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Decreased physical activity predicts cognitive dysfunction and reduced cerebral blood flow in heart failure. J Neurol Sci 2014; 339: 169–175.
    1. Tudor‐Locke C, Craig CL, Thyfault JP, Spence JC. A step‐defined sedentary lifestyle index: <5000 steps/day. Applied Physiology, Nutrition, and Metabolism = Physiologie appliquee, nutrition et metabolisme 2013; 38: 100–114.
    1. Demeyer H, Burtin C, Hornikx M, Camillo CA, Van Remoortel H, Langer D, Janssens W, Troosters T. The minimal important difference in physical activity in patients with COPD. PLoS One. 2016; 11: e0154587.
    1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health‐related research. Public health reports (Washington, DC: 1974) 1985; 100: 126–131.
    1. Masse LC, de Niet JE. Sources of validity evidence needed with self‐report measures of physical activity. J Phys Act Health 2012; 9: S44–S55.
    1. Loprinzi PD. Physical activity, weight status, and mortality among congestive heart failure patients. Int J Cardiol 2016; 214: 92–94.

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