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How physically active are adults with heart failure? A systematic review and meta-analysis.

Lookup NU author(s): Dr Sarah Charman, Madi Cooper, Dr David Houghton, Linda Errington, Dr Leah Avery


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Background: In heart failure (HF) patients, physical activity improves symptoms and quality of life. However, there is little robust evidence on habitual physical activity levels in this population to inform the development of interventions.Purpose(s): To conduct a systematic review and meta-analysis to quantify habitual physical activity levels of HF patients.Method(s): We searched nine databases (MEDLINE, Embase, PsycINFO, CINAHL, CDSR, Central, Web of Science, Scopus, and Cochrane Library). Two reviewers screened studies independently for eligibility: primary research reporting habitual physical activity levels of adults (>=18 years old), with a confirmed diagnosis of HF under the New York Heart Association classifications or left ventricular ejection fraction. Data on study and population characteristics, method of physical activity measurement, and physical activity metrics were extracted. A 12-item checklist was developed to assess the quality of reporting of device-based studies. We conducted a random effects meta-analysis (restricted maximum likelihood with Knapp-Hartung standard error adjustment), with effect size heterogeneity quantified using the tau statistic.Result(s): Sixty-two studies were eligible for inclusion (N=5729 HF patients). Although a variety of physical activity metrics were reported, herein we delimit the findings to a meta-analysis of 22 studies (N=1534 HF patients) reporting mean steps per day measured with a device. The pooled mean steps per day was 5062 (95% Confidence Interval (CI): 4243 to 5880; P<0.0001). Between-study variability (tau) was +/-1784 steps per day. The 95% prediction interval for the mean steps per day in a future study conducted in similar settings was 1251 to 8872. The probability that the mean steps per day in a future study would exceed the threshold of 7000 associated with meeting minimum recommended amounts of moderate-vigorous physical activity was 0.15 (unlikely). Meta regression by study-level covariates of age (years; range 46-79), sex (proportion male) and device type (pedometer vs. other) revealed that only age accounted for a substantial proportion (40%) of the between-study variability in mean steps per day. A 10-year increment in mean age of patients was associated with 1332 fewer steps per day (95% CI: 538 to 2126; P<0.0002). Reporting of device-based studies was generally poor.Conclusion(s): The pooled mean steps per day fromthismeta-analysis is reflective of a low-active population. However, there was substantial between-study variability with the 95% prediction interval ranging from virtually inactive to moderately active. The probability that the mean steps per day in a future study would be commensurate with the minimum recommended physical activity level was low, suggesting that this population is generally low-active. Our results inform future interventions to motivate HF patients to make incrementally small increases to physical activity to improve symptoms and quality of life.

Publication metadata

Author(s): Jordan C, Charman SJ, Batterham AM, Flynn D, Ashley K, Cooper M, Houghton D, Errington L, Avery L

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Heart Failure 2021 and the World Congress on Acute Heart Failure

Year of Conference: 2021

Pages: 166-166

Online publication date: 05/09/2021

Acceptance date: 29/06/2021

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/ejhf.2297

Series Title: European Journal of Heart Failure