Table 1.
Summary of Studies That Examined Device‐Measured Physical Activity
| Study | Sample Size, N | Device Type; Manufacturera | Study Design | Cardiac Pathological Features | Mean Age, y | Women, % | Follow‐Up, mob | End Points |
|---|---|---|---|---|---|---|---|---|
| Adamson et al, 20049 | 397 | CRT; Medtronic | Secondary analysis of data from RCT | HF | Reported for 3 subgroups: 66±11, 65±12, 66±9 | 42 | Reported for 3 subgroups: 16.6±4.0, 16.9±4.3, 12.6±5.7 | D‐PA added to risk model predicted HF decompensation and hospitalization (S); D‐PA declined in the weeks before hospitalization for acute decompensated HF (S) |
| Braunschweig et al, 200518 | 56 | CRT; Medtronic | Observational cohort study | HF | 66±11 | 17.9 | 4 | D‐PA increased during first month after implantation (S) and continued to increase in NYHA functional class II (S) but remained stable in functional classes III and IV at 4 and 12 wk. NYHA functional class IV was the least active at 12 wk (S) |
| Boehmer et al, 201710 | 900 | CRT‐D; Boston Scientific | International multicenter nonrandomized study | HF | 66.8 10.3 | 28 | 12 | Developed risk prediction model for HF decompensation; final model detected 70% of worsening HF events a median of 34 d before the event |
| Chelu et al, 201619 | 266 | ICD; Medtronic | Retrospective observational cohort study | Persistent AF | 69±10.2 | 12 | 4.3±1.5 y | D‐PA declined at the onset of persistent AF, remained low during AF, and returned to baseline levels in 85% of patients 12 wk after AF termination (S); patients with low AF burden (<6 h/d) returned to their baseline activity faster than patients with a higher AF burden (>6 h/d) |
| Conraads et al, 201411 | 781 | CRT‐D and ICD; Medtronic | Secondary analysis of pooled data from RCTs | HF | 65±10 | 15 | 15±7 | Developed risk prediction algorithm for HF hospitalization and mortality. Mean 30‐d D‐PA predicted HF hospitalization (HR, 0.97) and all‐cause mortality (HR, 0.93) (S); 10 min/d of additional activity associated with 4% reduction in mortality risk (HR, 0.95). Adding D‐PA to CHARM risk model for HF improved risk stratification (S) |
| Cowie et al, 201312 | 2231c | CRT‐D; Medtronic | Secondary analysis of pooled data from RCTs | HF | 68±11 | 31 | 10.6±5.8 | Developed risk prediction model for HF hospitalization. In the validation data set, D‐PA was associated with a 2.5‐fold increase in 30‐d risk for HF hospitalization (S); D‐PA combined with other diagnostic data predicted HF hospitalization |
| de la Uz et al, 201716 | 1905 | ICD and pacemaker; Medtronic | Observational study | Pediatric device patients | Median age, 14 y; interquartile range, 12–16 y | 38.7 | 28 d | Mean activity was 5.4 (SD, 2.0) h/d. Increased activity was associated with being a man, having a pacemaker, epicardial device location, rate response turned off, having experienced a shock, and younger age (S) |
| Gilliam et al, 200720 | 1421 | CRT‐D; Boston Scientific | Observational registry study | HF | 69.3±11 | 21.8 | 12 | D‐PA increased over time (S); mean D‐PA was lower in patients >70 y old compared with those <70 y old (S) |
| Jamé et al, 20178 | 1008 | CRT‐D; Boston Scientific | Secondary analysis of data from RCT | HF | NR | 25 | ≥26 wk | Decline in D‐PA of >40% was short‐term predictor of mortality, HF events, and ventricular tachyarrhythmias in adj and unadj models (S) |
| Kadhiresan et al, 200221 | 30 | CRT; Boston Scientific | Validation study using data from RCT | HF | 60±6 | 50 | 3 | D‐PA was positively correlated with the 6MWT (S), demonstrating 84% sensitivity and 73% specificity to detect changes in distance walked from baseline to 12‐wk follow‐up |
| Kawabata et al, 200722 | 178 | CRT and CRT‐D; Boston Scientific | Observational cohort study | HF | 65±8 | 20 | 21.9±11.6 | Younger age (<65 y) was associated with increased D‐PA (S), whereas the associations between D‐PA and ischemia, permeant AF, and diabetes mellitus were NS; baseline D‐PA was higher in patients with device replacement compared with de novo implantations (S) |
| Kramer et al, 201523 | 98 437 | CRT‐D and ICD; Boston Scientific | Observational registry study | All patients with CIEDs | 67.7±13.1 | 28.9 | Median of 2.2 y | Baseline and time‐varying D‐PA predicted survival; 4‐y survival was highest in most‐active quintile (S); 30 min/d less activity in a given month associated with a 48% increase in mortality risk (S) |
| Kramer et al, 201724 | 26, 509 | CRT‐D; Boston Scientific | Observational registry study | HF | 70.2±11.0 | 29.3 | Median of 2.3 y | Activity increased from baseline to 6 mo (S) for most patients (activity did not improve or declined in 15.5% of patients); activity change from baseline to 6 mo predicted 3‐y survival (S); in adj models, higher 6‐mo activity change was associated with a lower mortality risk (HR, 0.65 per 30‐min increase in activity) (S); patients in the highest vs lowest quintiles of 6‐mo D‐PA change were younger and were less likely to have a prior ICD (S) |
| Kramer et al, 201725 | 219 | ICD, pacemaker, and implantable loop recorder; Boston Scientific | Observational registry study | All patients with CIEDs | 68±13 | 30 | ≥7 d | D‐PA associated with mobility and frailty in adj and unadj models (S) |
| Melczer et al, 201626 | 17 | CRT and CRT‐D; Biotronik | Validation study | HF | 57.4±9.5 | 17.6 | 7 d | Daily D‐PA data (PA % values) correlated weakly (r=0.37) with MET values derived from ActiGraph GT3X+ (r=0.37) |
| Pressler et al, 201327 | 73 | ICD and CRT; Medtronic | Validation study | HF | 60±20 | 21 | 7 d | Study showed strong intraindividual correlation between D‐PA and AiperMotion 440d (r>0.7); total daily activity measured by both devices differed (S) |
| Sears et al, 201528 | 174 | ICD and CRT; Medtronic | Secondary analysis of data from RCT | All patients with CIEDs | 62±13 | 17 | 1 | Median D‐PA was low (22.5 h/wk); D‐PA declined after ICD shock (S) but not ATP therapy; association between D‐PA and the number of ATP therapies was NS, whereas D‐PA significantly declined after ICD shock, and that as the number of shocks increased, D‐PA decreased (S); 5≥ shocks was associated with the largest decline in D‐PA (S) |
| Sears et al, 201729 | 2790 | ICD and CRT; Medtronic | Secondary analysis of data from RCT | All patients with CIEDs | 65±12 | 21 | 24 | D‐PA declined after ICD shock (−23.7 min/d when corrected for device type, time since implantation, and the effect of hospitalization) (S), and gradually recovered to a normal level after ≈90 d. D‐PA was inversely associated with the number of prior shocks, such that more shocks led to a greater decline in D‐PA. Type of shock therapy (appropriate vs inappropriate) was not associated with D‐PA |
| Sharma et al, 201530 | 775 | CRT‐D; Medtronic | Secondary analysis of pooled data from RCTs | HF | 69±11 | 32 | 13±5 | Developed model to predict 30‐d risk for HF hospitalization; D‐PA was associated with a 5.1% HF hospitalization event rate in unadj models |
| Shoemaker et al, 201731 | 16 | ICD and CRT‐D; Medtronic | Validation study | HF | 64.9±11.3 | 43.7 | 3 | Moderate‐to‐strong correlations between D‐PA and Actigraph GT3X were reported for hours of activity/day, steps/day, and changes in activity over time (S); D‐PA underestimated activity by 0.80 h and CIs were large; most patients with ICDs engaged in <15 min/wk of moderate‐intensity activity (measured by the Actigraph GT3X) |
| Shoemaker et al, 201232, e | 102 | CRT‐D and ICD; Medtronic | Retrospective medical record review | HF | 64.6±13.3 | 29.4 | 7.5 | D‐PA moderately correlated with 1‐ and 5‐y mortality (S) |
| Shoemaker et al, 201633, e | 16 | ICD and CRT; Medtronic | Secondary analysis of data from RCT | HF | 66±14 | 43.8 | Association between seasonal weather change and daily D‐PA (NS) | |
| Shoemaker et al, 201334, e | 102 | ICD; Medtronic | Secondary analysis of data from a retrospective observational study | HF | 64.6±13.3 | 29.4 | 6 | Described 4 patterns of daily D‐PA, ranging from low (<30 min/d) to high (>360 min/d); activity patterns remained stable over time; D‐PA associated with age, NYHA functional class, female sex, and LVEF (S) |
| Small et al, 200935 | 326 | CRT‐D; Medtronic | Multicenter retrospective cohort study | HF | 70±11 | 25.0 | 333±97 d | Association between low D‐PA (<30 min) and hospital admissions for acute decompensated HF was NS |
| Singh et al, 200913 | 1206 | CRT‐D; Boston Scientific | Secondary analysis of pooled data sets | HF | 66.8±11.8; 67.6±11.2 | 21.7 | Median of 18 mo | D‐PA combined with device diagnostissc data predicted mortality (S) |
| Tyagi et al, 201517 | 96 | Pacemaker; Medtronic | Retrospective medical record review | Preserved left ventricular function | NR | NR | 4.1±2.2 y | All‐cause mortality increased as active minutes per day decreased (S); in adj analyses, low activity (<1 h/d) was associated with a 7.4‐fold increase in mortality during follow‐up compared with those engaging in activity >3 h/d (S) |
| Vegh et al, 20147 | 164 | CRT; Medtronic and St Jude | Validation study | HF | 67.3±12.9 | 23.0 | Median of 18 mo | D‐PA was moderately correlated with the 6MWT (S); D‐PA predicted HF hospitalizations, mortality, and ventricular reverse remodeling (S); one additional hour of activity at 1 mo was associated with a 1.38‐fold improvement in echocardiographic response (S) |
| Whellan et al, 201014 | 694 | CRT‐D; Medtronic | Prospective observational cohort study | HF | 68.4±10.7 | 32.7 | 11.7±2.0 | D‐PA combined with HF device diagnostic data predicted risk of HF hospitalization within the next 30 d in unadj (HR, 5.5) and adj (HR, 4.8) models (S) |
| Zhao et al, 201736 | 845 | CRT‐D and ICD; Biotronik | Retrospective observational registry study | All patients with CIED | 60.4±14.4 | 26.3 | 31.1 ± 12.9 | D‐PA ≤113 min/d predicted all‐cause mortality in unadj (HR, 4.1) and adj (HR, 3.6) models and cardiac death in unadj (HR, 4.1) and adj (HR, 3.7) models (S); D‐PA correlated well with HRV (r=0.6) (S) |
6MWT indicates 6‐minute walk test; adj, adjusted statistical models; AF, atrial fibrillation; CHARM, Candesartan in Heart Failure–Assessment of Mortality and Morbidity; CI, confidence interval; CIED, cardiovascular implantable electronic device; CRT, cardiac resynchronization therapy; CRT‐D, CRT defibrillator; D‐PA, device‐measured physical activity; HF, heart failure; HR, hazard ratio; HRV, heart rate variability; ICD, implantable cardioverter‐defibrillator; LVEF, left ventricular ejection fraction; MET, metabolic equivalent value; NR, not reported; NS, statistically nonsignificant; NYHA, New York Heart Association; RCT, randomized clinical trial; S, statistically significant (P≤0.05); and unadj, unadjusted statistical models.
a
Device manufacturers: St Jude Medical device (St Jude Medical Inc, Sylmar, CA), Medtronic (Medtronic Inc, Minneapolis, MN), Boston Scientific CRM (formally Guidant Corporation), and Biotronik (Biotronik, Berlin, Germany).
b
Data presented as mean±SD months unless otherwise indicated.
c
Study sample included patients from a development data set (N=921) and a validation data set (N=1310).
d
AiperMotion 300 PfH (Aipermon GmbH & Co KG, Munich, Germany).
e
Study measured D‐PA by conducting a “visual estimation” of mean daily activity obtained from graphs of “Patient Activity” in Medtronic Cardiac Compass device reports.