Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program

Heleen Demeyer, Chris Burtin, Hans Van Remoortel, Miek Hornikx, Daniel Langer, Marc Decramer, Rik Gosselink, Wim Janssens, Thierry Troosters, Heleen Demeyer, Chris Burtin, Hans Van Remoortel, Miek Hornikx, Daniel Langer, Marc Decramer, Rik Gosselink, Wim Janssens, Thierry Troosters

Abstract

Background: There is a wide variability in measurement methodology of physical activity. This study investigated the effect of different analysis techniques on the statistical power of physical activity outcomes after pulmonary rehabilitation.

Methods: Physical activity was measured with an activity monitor armband in 57 patients with COPD (mean ± SD age, 66 ± 7 years; FEV1, 46 ± 17% predicted) before and after 3 months of pulmonary rehabilitation. The choice of the outcome (daily number of steps [STEPS], time spent in at least moderate physical activity [TMA], mean metabolic equivalents of task level [METS], and activity time [ACT]), impact of weekends, number of days of assessment, postprocessing techniques, and influence of duration of daylight time (DT) on the sample size to achieve a power of 0.8 were investigated.

Results: The STEPS and ACT (1.6-2.3 metabolic equivalents of task) were the most sensitive outcomes. Excluding weekends decreased the sample size for STEPS (83 vs 56), TMA (160 vs 148), and METS (251 vs 207). Using 4 weekdays (STEPS and TMA) or 5 weekdays (METS) rendered the lowest sample size. Excluding days with < 8 h wearing time reduced the sample size for STEPS (56 vs 51). Differences in DT were an important confounder.

Conclusions: Changes in physical activity following pulmonary rehabilitation are best measured for 4 weekdays, including only days with at least 8 h of wearing time (during waking hours) and considering the difference in DT as a covariate in the analysis.

Trial registry: ClinicalTrials.gov; No.: NCT00948623; URL: www.clinicaltrials.gov.

Figures

Figure 1
Figure 1
– Formula used to calculate daylight time based on the day of the year and latitude (CSIRO [Commonwealth Scientific and Industrial Research Organisation] Biosphere model). Α day length coefficient of 0.8333° (US government definition of day length) and a latitude of 50.78° (Belgium) were used to predict the daylight time. Northern latitudes are positive, southern latitudes are negative, and daylight time is calculated in hours (and converted to minutes).
Figure 2
Figure 2
– Influence of the number of days of measurement and exclusion of weekend days on the calculated sample size and ICC. A, Sample size needed to achieve a power of 0.8 with a significance level of .05 (STEPS, TMA, and METS) in 2 to 5 (random) weekdays and a whole week of measurement. B, ICCs (STEPS, TMA, and METS) in 2 to 5 (random) weekdays and a whole week of measurement. ICC = intraclass correlation coefficient; METS = mean metabolic equivalents of task level; TMA = time spent in at least moderate physical activity; STEPS = daily number of steps.
Figure 3
Figure 3
– Whole-day physical activity pattern. Mean min-by-min physical activity pattern (all data, 7 d) of all patients. A, Mean METs per minute, presented as mean ± SEM (gray). B, Proportion of total number of steps measured presented min by min. METs = metabolic equivalents of task.

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Source: PubMed

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