Physical Activity Patterns of Patients With Cardiopulmonary Illnesses


      Nguyen HQ, Steele BG, Dougherty CM, Burr RL. Physical activity patterns of patients with cardiopulmonary illnesses.


      The aims of this paper were (1) to describe objectively confirmed physical activity patterns across 3 chronic cardiopulmonary conditions, and (2) to examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance.


      Cross-sectional study.


      Participants' home environment.


      Patients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD) (n=63), heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60).


      Not applicable.

      Main Outcome Measures

      Seven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer.


      Subjects with COPD had the lowest amount of ambulatory physical activity compared with subjects with heart failure and cardiac dysrhythmias (all 7 activity dimensions, P<.05); total step counts were: 5319 versus 7464 versus 9570, respectively. Six-minute walk distance was correlated (r=.44–.65, P<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with 5 of the physical activity dimensions (r=.22–.40, P<.05). In contrast, correlations between 6-minute walk test distance and physical activity were higher (r=.48–.61, P<.01) albeit in a smaller sample of only patients with heart failure. For all 3 samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or nonsignificant correlations with physical activity.


      All 7 dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of 1 dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a 6-minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures.

      Key Words

      List of Abbreviations:

      ATS (American Thoracic Society), COPD (chronic obstructive pulmonary disease), EF (ejection fraction), FEV1 (forced expiratory volume in 1 second), SAM (StepWatch 3 Activity Monitor), 6MWT (6-minute walk test), V̇o2max (maximal oxygen consumption)
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        • World Health Organization
        Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants.
        World Health Organization, Geneva2011
        • Garcia-Aymerich J.
        • Farrero E.
        • Felez M.A.
        • Izquierdo J.
        • Marrades R.M.
        • Anto J.M.
        Risk factors of readmission to hospital for a COPD exacerbation: a prospective study.
        Thorax. 2003; 58: 100-105
        • Garcia-Aymerich J.
        • Lange P.
        • Benet M.
        • Schnohr P.
        • Anto J.M.
        Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.
        Thorax. 2006; 61: 772-778
        • Garcia-Aymerich J.
        • Lange P.
        • Benet M.
        • Schnohr P.
        • Anto J.M.
        Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study.
        Am J Respir Crit Care Med. 2007; 175: 458-463
        • Waschki B.
        • Kirsten A.
        • Holz O.
        • et al.
        Physical activity is the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease: a prospective cohort study.
        Chest. 2011; 140: 331-342
        • Thompson P.D.
        • Buchner D.
        • Pina I.L.
        • et al.
        Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity).
        Circulation. 2003; 107: 3109-3116
        • US Department of Health and Human Services
        Physical Activity Guidelines Advisory Committee Report.
        US Department of Health and Human Services, Washington (DC)2008
        • Manson J.E.
        • Greenland P.
        • LaCroix A.Z.
        • et al.
        Walking compared with vigorous exercise for the prevention of cardiovascular events in women.
        N Engl J Med. 2002; 347: 716-725
        • Tanasescu M.
        • Leitzmann M.F.
        • Rimm E.B.
        • Hu F.B.
        Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes.
        Circulation. 2003; 107: 2435-2439
        • van den Berg-Emons H.
        • Bussmann J.
        • Balk A.
        • Keijzer-Oster D.
        • Stam H.
        Level of activities associated with mobility during everyday life in patients with chronic congestive heart failure as measured with an “activity monitor”.
        Phys Ther. 2001; 81: 1502-1511
        • Jehn M.
        • Schmidt-Trucksaess A.
        • Schuster T.
        • et al.
        Accelerometer-based quantification of 6-minute walk test performance in patients with chronic heart failure: applicability in telemedicine.
        J Card Fail. 2009; 15: 334-340
        • Jehn M.
        • Schmidt-Trucksass A.
        • Hanssen H.
        • Schuster T.
        • Halle M.
        • Koehler F.
        Association of physical activity and prognostic parameters in elderly patients with heart failure.
        J Aging Phys Act. 2011; 19: 1-15
        • Walker P.P.
        • Burnett A.
        • Flavahan P.W.
        • Calverley P.M.
        Lower limb activity and its determinants in COPD.
        Thorax. 2008; 63: 683-689
        • Tinetti M.E.
        • McAvay G.J.
        • Chang S.S.
        • et al.
        Contribution of multiple chronic conditions to universal health outcomes.
        J Am Geriatr Soc. 2012; 59: 1686-1691
        • Dougherty C.M.
        • Glenny R.W.
        • Kudenchuk P.J.
        • Malinick T.E.
        • Flo G.L.
        Testing an exercise intervention to improve aerobic conditioning and autonomic function after an implantable cardioverter defibrillator (ICD).
        Pacing Clin Electrophysiol. 2010; 33: 973-980
        • Dougherty C.M.
        • Steele B.G.
        • Hunziker J.
        Testing an intervention to improve functional capability in advanced cardiopulmonary illness.
        J Cardiopulm Rehabil Prev. 2011; 31: 35-41
        • Moss A.J.
        • Zareba W.
        • Hall W.J.
        • et al.
        Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.
        N Engl J Med. 2002; 346: 877-883
        • Bardy G.H.
        • Lee K.L.
        • Mark D.B.
        • et al.
        Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
        N Engl J Med. 2005; 352: 225-237
        • ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories
        ATS statement: guidelines for the Six-Minute Walk Test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Balke B.
        • Ware R.
        An experimental study of physical fitness of air force personnel.
        US Armed Forces Med J. 1959; 10: 675-688
        • Cavanaugh J.T.
        • Coleman K.L.
        • Gaines J.M.
        • Laing L.
        • Morey M.C.
        Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults.
        J Am Geriatr Soc. 2007; 55: 120-124
        • Gardner A.W.
        • Montgomery P.S.
        • Scott K.J.
        • Afaq A.
        • Blevins S.M.
        Patterns of ambulatory activity in subjects with and without intermittent claudication.
        J Vasc Surg. 2007; 46: 1208-1214
        • Ware Jr, J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36).
        Med Care. 1992; 30: 473-483
        • Trost S.G.
        • McIver K.L.
        • Pate R.R.
        Conducting accelerometer-based activity assessments in field-based research.
        Med Sci Sports Exerc. 2005; 37: S531-S543
        • Nguyen H.Q.
        • Burr R.L.
        • Gill D.P.
        • Coleman K.
        Validation of the Stepwatch device for measurement of free-living ambulatory activity in patients with COPD.
        J Nurs Meas. 2011; 19: 76-90
        • Tudor-Locke C.
        • Bassett Jr, D.R.
        How many steps/day are enough?.
        Sports Med. 2004; 34: 1-8
        • Tudor-Locke C.E.
        • Myers A.M.
        Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity.
        Res Q Exerc Sport. 2001; 72: 1-12
        • Tudor-Locke C.
        • Johnson W.D.
        • Katzmarzyk P.T.
        Accelerometer-determined steps per day in US adults.
        Med Sci Sports Exerc. 2009; 41: 1384-1391
        • Tudor-Locke C.
        • Hart T.L.
        • Washington T.L.
        Expected values for pedometer-determined physical activity in older populations.
        Int J Behav Nutr Phys Act. 2009; 6: 59
        • Pitta F.
        • Troosters T.
        • Spruit M.A.
        • Probst V.S.
        • Decramer M.
        • Gosselink R.
        Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2005; 171: 972-977
        • Watz H.
        • Waschki B.
        • Boehme C.
        • Claussen M.
        • Meyer T.
        • Magnussen H.
        Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study.
        Am J Respir Crit Care Med. 2008; 177: 743-751
        • Watz H.
        • Waschki B.
        • Meyer T.
        • Magnussen H.
        Physical activity in patients with COPD.
        Eur Respir J. 2009; 33: 262-272
        • Tudor-Locke C.
        • Washington T.L.
        • Hart T.L.
        Expected values for steps/day in special populations.
        Prev Med. 2009; 49: 3-11
        • Hill K.
        • Dolmage T.E.
        • Woon L.
        • Coutts D.
        • Goldstein R.
        • Brooks D.
        Defining the relationship between average daily energy expenditure and field-based walking tests and aerobic reserve in COPD.
        Chest. 2012; 141: 406-412
        • Vaes A.W.
        • Wouters E.F.
        • Franssen F.M.
        • et al.
        Task-related oxygen uptake during domestic activities of daily life in patients with COPD and healthy elderly subjects.
        Chest. 2011; 140: 970-979
        • Steele B.
        • Holt L.
        • Belza B.
        • Ferris S.
        • Lakshminaryan S.
        • Buchner D.M.
        Quantitating physical activity in COPD using a triaxial accelerometer.
        Chest. 2000; 117: 1359-1367
        • Jehn M.
        • Schmidt-Trucksass A.
        • Schuster T.
        • et al.
        Daily walking performance as an independent predictor of advanced heart failure: prediction of exercise capacity in chronic heart failure.
        Am Heart J. 2009; 157: 292-298
        • Sewell L.
        • Singh S.J.
        • Williams J.E.
        • Morgan M.D.
        Seasonal variations affect physical activity and pulmonary rehabilitation outcomes.
        J Cardiopulm Rehabil Prev. 2010; 30: 329-333