Objectively measured preoperative physical activity and sedentary behaviour among Finnish patients scheduled for elective cardiac procedures: baseline results from randomized controlled trial

Sini Vasankari, Juha Hartikainen, Ville Vasankari, Vesa Anttila, Kari Tokola, Henri Vähä-Ypyä, Pauliina Husu, Harri Sievänen, Tommi Vasankari, Jari Halonen, Sini Vasankari, Juha Hartikainen, Ville Vasankari, Vesa Anttila, Kari Tokola, Henri Vähä-Ypyä, Pauliina Husu, Harri Sievänen, Tommi Vasankari, Jari Halonen

Abstract

Background: We investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults.

Methods: Cardiac patients (n = 139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5-2.9 METs) and moderate-to-vigorous (MVPA, ≥ 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017.

Results: Cardiac patients had fewer daily steps than the FinFit population (p = 0.01), and less SB accumulating from < 20 min bouts (p = 0.002) but more from 20 to 60 min bouts (p = 0.002). Particularly, CABG group had less daily MVPA (p = 0.002) and MVPA accumulating from > 10 min bouts (p < 0.001) than the FinFit population.

Conclusions: We found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively. Trial registration clinicaltrials.gov (NCT03470246). Registered 19 March 2018, https://ichgcp.net/clinical-trials-registry/NCT03470246.

Keywords: Accelerometry; Aortic valve stenosis; Coronary artery disease; Mitral valve insufficiency; Physical activity; Sedentary behavior.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study participation flow diagram. CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVS: mitral valve surgery; PCI-CA: percutaneous coronary intervention or coronary angiography
Fig. 2
Fig. 2
Average time spent sleeping, and during wake time in physical activity and sedentary behaviour in different patient groups and FinFit2017 population sample. CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVS: mitral valve surgery; PCI-CA: percutaneous coronary intervention or coronary angiography; FinFit2017: population-based sample of 60-69-year-old Finnish adults.
Fig. 3
Fig. 3
Mean number of daily steps. The values denote mean and 95% confidence interval. CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVS: mitral valve surgery; PCI-CA: percutaneous coronary intervention or coronary angiography; FinFit2017: population-based sample of 60-69-year-old Finnish adults. *Indicates statistically significant difference (p < 0.05) between patient groups and FinFit2017 group (Independent samples t-test assuming that variances are not equal)
Fig. 4
Fig. 4
Total physical activity (A), moderate-to-vigorous physical activity (B) and sedentary behaviour (C) accumulating from different bout lengths (mean hours or minutes per day). CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVS: mitral valve surgery; PCI-CA: percutaneous coronary intervention or coronary angiography; FinFit2017: population-based sample of 60-69-year-old Finnish adults. *Indicates statistically significant difference (p < 0.05) between the patient groups and the FinFit2017 group (Independent samples t-test assuming that variances are not equal).

References

    1. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88. doi: 10.1016/S0140-6736(18)32203-7.
    1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858. doi: 10.1016/S0140-6736(18)32279-7.
    1. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1–25. doi: 10.1016/j.jacc.2017.04.052.
    1. Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990–2017. Circulation. 2020;141:1670–80. doi: 10.1161/CIRCULATIONAHA.119.043391.
    1. Ferket BS, Oxman JM, Iribarne A, Gelijns AC, Moskowitz AJ. Cost-effectiveness analysis in cardiac surgery: a review of its concepts and methodologies. J Thorac Cardiovasc Surg. 2018;155(4):1671–81. doi: 10.1016/j.jtcvs.2017.11.018.
    1. Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, et al. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128:2259–79. doi: 10.1161/01.cir.0000435708.67487.da.
    1. Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130,000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390:2643–54. doi: 10.1016/S0140-6736(17)31634-3.
    1. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12. doi: 10.1016/j.jacc.2015.10.044.
    1. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur J Prev Cardiol. 2016;23(11):NP1-NP96.
    1. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–29. doi: 10.1016/S0140-6736(12)61031-9.
    1. van Laar C, TImman ST, Noyez L. Decreased physical activity is a predictor for a complicated recovery post cardiac surgery. Health Qual Life Outcomes. 2017;15(1):5. doi: 10.1186/s12955-016-0576-6.
    1. Ekblom-Bak E, Hellénius ML, Ekblom Ö, Engström LM, Ekblom B. Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults. Eur J Cardiovasc Prev Rehabil. 2010;17(2):175–80. doi: 10.1097/HJR.0b013e32833254f2.
    1. Imboden MT, Harber MP, Whaley MH, Finch WH, Bishop DL, Kaminsky LA. Cardiorespiratory Fitness and Mortality in Healthy Men and Women. J Am Coll Cardiol. 2018;72(19):2283–92. doi: 10.1016/j.jacc.2018.08.2166.
    1. Smith JL, Verrill TA, Boura JA, Sakwa MP, Shannon FL, Franklin BA. Effect of cardiorespiratory fitness on short-term morbidity and mortality after coronary artery bypass grafting. Am J Cardiol. 2013;112(8):1104–9. doi: 10.1016/j.amjcard.2013.05.057.
    1. Chomistek AK, Manson JE, Stefanick ML, Lu B, Sands-Lincoln M, Going SB, et al. Relationship of sedentary behaviour and physical activity to incident cardiovascular disease: results from the Women’s Health Initiative. J Am Coll Cardiol. 2013;61(23):2346–54. doi: 10.1016/j.jacc.2013.03.031.
    1. Vasankari V, Husu P, Vähä-Ypyä H, Suni J, Tokola K, Halonen J, et al. Association of objectively measured sedentary behaviour and physical activity with cardiovascular disease risk. Eur J Prev Cardiol. 2017;24(12):1311–18. doi: 10.1177/2047487317711048.
    1. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14:75. doi: 10.1186/s12966-017-0525-8.
    1. Prince SA, Blanchard CM, Grace SL, Reid RD. Objectively-measured sedentary time and its association with markers of cardiometabolic health and fitness among cardiac rehabilitation graduates. Eur J Prev Cardiol. 2016;23(8):818–25. doi: 10.1177/2047487315617101.
    1. Noyez L, Biemans I, Verkroost M, van Swieten H. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery? Neth Heart J. 2013;21:439–45. doi: 10.1007/s12471-013-0444-5.
    1. Alharbi M, Bauman A, Neubeck L, Gallagher R. Measuring overall physical activity for cardiac rehabilitation participants: a review of the literature. Heart Lung Circ. 2017;26(10):1008–25. doi: 10.1016/j.hlc.2017.01.005.
    1. Vähä-Ypyä H, Vasankari T, Husu P, Suni J, Sievänen H. A universal, accurate intensity-based classification of different physical activities using raw data of accelerometer. Clin Physiol Funct Imaging. 2015;35:64–70. doi: 10.1111/cpf.12127.
    1. Vähä-Ypyä H, Vasankari T, Husu P, Mänttäri A, Vuorimaa T, Suni J, et al. Validation of cut-points for evaluating the intensity of physical activity with accelerometry-based mean amplitude deviation (MAD) PLoS One. 2015;10(8):e0134813. doi: 10.1371/journal.pone.0134813.
    1. Vähä-Ypyä H, Husu P, Suni J, Vasankari T, Sievänen H. Reliable recognition of lying, sitting, and standing with a hip-worn accelerometer. Scand J Med Sci Sports. 2018;28:1092–1102. doi: 10.1111/sms.13017.
    1. Vasankari V, Halonen J, Husu P, Vähä-Ypyä H, Tokola K, Suni J, et al. Personalised eHealth intervention to increase physical activity and reduce sedentary behaviour in rehabilitation after cardiac operations: study protocol for the PACO randomised controlled trial (NCT03470246) BMJ Open Sport Exerc Med. 2019;5:e000539. doi: 10.1136/bmjsem-2019-000539.
    1. Husu P, Tokola K, Vähä-Ypyä H, Sievänen H, Suni J, Heinonen O, et al. Physical activity, sedentary behavior and time in bed among Finnish adults measured 24/7 by tri-axial accelerometry. J Meas Phys Behav. 2021;4(2):163–173. doi: 10.1123/jmpb.2020-0056.
    1. Vasankari V, Husu P, Vähä-Ypyä H, Suni JH, Tokola K, Borodulin K, et al. Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers. BMJ Open Sport Exerc Med. 2018;4:e000363. doi: 10.1136/bmjsem-2018-000363.
    1. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–28. doi: 10.1001/jama.2018.14854.
    1. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Gardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54:1451–62. doi: 10.1136/bjsports-2020-102955.
    1. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. (Accessed 7 April 2021)
    1. Frederix I, Van Driessche N, Hansen D, Berger J, Bonne K, Alders T, et al. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients. Eur J Prev Cardiol. 2015;22(2):150–8. doi: 10.1177/2047487313514018.
    1. Hukkanen H, Husu P, Sievänen H, Tokola K, Vähä-Ypyä H, Valkeinen H, et al. Aerobic physical activity assessed with accelerometer, diary, questionnaire, and interview in a Finnish population sample. Scand J Med Sci Sports. 2018;28:2196–2206. doi: 10.1111/sms.13244.
    1. Kehler DS, Stammers AN, Tangri N, Hiebert B, Fransoo R, Schultz ASH, et al. Systematic review of preoperative physical activity and its impact on postcardiac surgical outcomes. BMJ Open. 2017;7:e015712. doi: 10.1136/bmjopen-2016-015712.
    1. Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation; A randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J. 2009;158(5):734–41. doi: 10.1016/j.ahj.2009.08.021.
    1. Oldridge N, Taylor RS. Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: A systematic review of economic evaluations of randomized clinical trials. Eur J Prev Cardiol. 2020;27(10):1045–55. doi: 10.1177/2047487319881839.
    1. Snowdon D, Haines TP, Skinner EH. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. J Physiother. 2014;60(2):66–77. doi: 10.1016/j.jphys.2014.04.002.
    1. Grimes L, Outtrim JG, Griffin SJ, Ercole A. Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study. BMJ Open. 2019;9:e032346. doi: 10.1136/bmjopen-2019-032346.
    1. Vasankari V, Halonen J, Vasankari T, Anttila V, Airaksinen J, Sievänen H, et al. Physical activity and sedentary behaviour in secondary prevention of coronary artery disease: A review. Am J Prev Cardiol. 2021;5:100146. doi: 10.1016/j.ajpc.2021.100146.

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