Self-reported and objectively measured physical activity in people with and without chronic heart failure: UK Biobank analysis

Abstract

Objective: The impact of heart failure (HF) on perceived and objectively measured levels of physical activity (PA) can inform risk stratification and treatment recommendation. We aimed to compare self-reported and objectively measured PA levels in a large sample of participants with and without HF.

Methods: A validated PA questionnaire was used to estimate self-reported weekly PA among 1600 participants with HF and 387 580 participants without HF. Accelerometer data were studied in 596 participants with HF and 96 105 participants without HF for a period of 7 days. Using multivariable linear regression models, we compared the PA levels between participants with HF and without HF, focusing on both the average daily PA levels and the intensity of PAs throughout the day.

Results: PA levels were significantly lower in participants with HF using both self-report (excess metabolic equivalent of task hours per week of 26.5 (95% CI 24.7 to 28.4) vs 34.7 (95% CI 34.5 to 34.9), respectively (p<0.001)) and accelerometer measures (mean accelerations of 23.7 milligravity (95% CI 23.1 to 24.4) vs 28.1 milligravity (95% CI 28.0 to 28.1), respectively (p<0.001)). Findings were consistent across different PA intensities. Hour-by-hour comparisons showed that accelerometer-derived PA levels of patients with HF were reduced throughout the day.

Conclusion: Perceived and objectively recorded PA levels of patients with chronic HF are significantly lower than those of individuals without HF. This difference is continuous throughout the different hours of the day, with individuals with HF being on average 16% less active than individuals without HF. In patients with HF, increases in everyday activity may be a potential alternative to structured exercise programmes.

Keywords: epidemiology; heart failure; heart failure treatment; public health.

Figure 1

Summary of self-reported and accelerometer-derived PA behaviours in participants with or without HF. (A) Box plots of percentage time spent within different categories of mean age-adjusted/sex-adjusted self-reported PA among participants with (blue) or without (grey) diagnosed HF. All differences are significant (p<0.01). (B) Box plots of percentage time spent within different mean age-adjusted/sex-adjusted acceleration ranges for participants with (blue) and without (grey) diagnosed HF. All differences are significant (p<0.01). (C) Mean (solid line) and CIs (shaded area) of mean acceleration during different hours of the dayfor participants with (blue) and without (grey) diagnosed HF. HF, heart failure; PA, physical activity.

Figure 2

Flowchart of the participants included in the baseline and accelerometer analyses. Some participants included in the accelerometer analysis did not provide self-reported activity data at baseline; others developed HF in the period between baseline assessment and accelerometer recording. Participants falling into both the baseline and accelerometer analysis groups (overlapping analysis) were included in a separate sensitivity analysis. HF, heart failure.

Figure 3

Comparison of self-reported (p<0.001) and accelerometer-derived (p<0.001) physical activityPA in participants with or without heart failureHF. Shaded areas depict unadjusted physical activityPA distributions and dashed lines show age-adjusted/sex-adjusted mean physical activityPA. HF, heart failure; MET, metabolic equivalent of task; PA, physical activity.