Cutoff Points for Step Count to Predict 1-year All-Cause Mortality in Patients with Idiopathic Pulmonary Fibrosis

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Kazuya Shingai ◽  
Toshiaki Matsuda ◽  
Yasuhiro Kondoh ◽  
Tomoki Kimura ◽  
Kensuke Kataoka ◽  
...  

<b><i>Background:</i></b> Although physical activity is associated with mortality in patients with idiopathic pulmonary fibrosis (IPF), reference values to interpret levels of physical activity are lacking. <b><i>Objectives:</i></b> This study aimed to investigate the prognostic significance of physical activity assessed by step count and its cutoff points for all-cause mortality. <b><i>Methods:</i></b> We measured physical activity (steps per day) using an accelerometer in patients with IPF at the time of diagnosis. Relationships among physical activity and mortality, as well as cutoff points of daily step count to predict all-cause mortality were examined. <b><i>Results:</i></b> Eighty-seven patients (73 males) were enrolled. Forty-four patients (50.1%) died during the follow-up (median 54 months). In analysis adjusting for Gender-Age-Physiology stage and 6-min walk distance, daily step count was an independent predictor of all-cause mortality (hazard ratio (HR) = 0.820, 95% confidence interval (CI) = 0.694–0.968, <i>p</i> = 0.019). The optimal cutoff point (receiving operating characteristic analysis) for 1-year mortality was 3,473 steps per day (sensitivity = 0.818 and specificity = 0.724). Mortality was significantly lower in patients with a daily step count exceeding 3,473 steps than in those whose count was 3,473 or less (HR = 0.395, 95% CI = 0.218–0.715, <i>p</i> = 0.002). <b><i>Conclusions:</i></b> Step count, an easily interpretable measurement, was a significant predictor of all-cause mortality in patients with IPF. At the time of diagnosis, a count that exceeded the cutoff point of 3,473 steps/day more than halved mortality. These findings highlight the importance of assessing physical activity in this patient population.

Author(s):  
Emma Pearson ◽  
Harry Prapavessis ◽  
Christopher Higgins ◽  
Robert Petrella ◽  
Lauren White ◽  
...  

Abstract Background Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.


2020 ◽  
Author(s):  
Emma Pearson ◽  
Harry Prapavessis ◽  
Christopher Higgins ◽  
Robert Petrella ◽  
Lauren White ◽  
...  

Abstract Background Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (± 500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results The main analysis included 61,170 users (mean age = 32yrs; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion Despite an explosion of physical activity app interest (100,000 + published apps), low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.


2020 ◽  
Author(s):  
Emma Pearson ◽  
Harry Prapavessis ◽  
Christopher Higgins ◽  
Robert Petrella ◽  
Lauren White ◽  
...  

Abstract Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements.Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week).Results: The main analysis included 61,170 users (mean age=32yrs; % female=64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p<0.0001; ηp2=0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2=0.699) with each new STC corresponding to approximately 200 more steps per day.Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.


2021 ◽  
Author(s):  
Jyotika Devi Prasad ◽  
Anne E Holland ◽  
Ian N Glaspole ◽  
Glen P Westall

Abstract BackgroundPhysical inactivity is associated with poor outcomes in patients with many chronic lung diseases, however little is known about physical activity in patients with idiopathic pulmonary fibrosis (IPF). Our aim was to describe daily physical activity (DPA) in patients with a confirmed diagnosis of IPF and analyse its associations with traditional markers of disease severity and quality of life.MethodsFifty-nine patients with IPF had DPA parameters and sedentary time assessed with the Sensewear armband for seven consecutive days. Participants completed the Hospital Anxiety and Depression scale (HADS), St Georges Respiratory Questionnaire (SGRQ) and Leicester Cough Questionnaire (LCQ). Data on current markers of disease severity; forced vital capacity (FVC), carbon monoxide diffusion capacity (DLCO) and 6-minute walk test (6MWT) as well as prognostic markers; composite physiologic index (CPI) and gender age and physiology (GAP) was collected.ResultsPatients had a median daily step count of 3957 (300–7614), mean daily moderate to vigorous (MV) physical activity duration of 8.6 minutes (-13.1 to 30.3) and mean total daily sedentary time of 1234.6 minutes (± 122.8). Patients with early stages of IPF according to GAP stage had significantly higher daily step count than those with more severe disease (p < 0.003). Age, BMI and DLCO accounted for 54% variability in physical activity duration. The 6-minute walk distance and DLCO accounted for 44% variability in daily step count. Patient reported outcomes had weak association with daily step count and MV physical activity duration.ConclusionIn IPF, increasing disease severity is associated with reduced DPA. DPA may be a meaningful outcome for future trials of therapies designed to enhance patient functioning and wellbeing.Trial Registration: please note that a request has been made for retrospective registration with the Australian New Zealand Clinical Trial Registry with the request number being 381161. Due to holiday period closure, this is yet to be processed. I will supply this as soon as accepted.


2020 ◽  
Author(s):  
Emma Pearson ◽  
Harry Prapavessis ◽  
Christopher Higgins ◽  
Robert Petrella ◽  
Lauren White ◽  
...  

Abstract Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results: The main analysis included 61,170 users (mean age=32yrs; % female=64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p<0.0001; ηp2=0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2=0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.


2014 ◽  
Vol 33 (10) ◽  
pp. 1051-1057 ◽  
Author(s):  
Marieke De Craemer ◽  
Ellen De Decker ◽  
Ilse De Bourdeaudhuij ◽  
Maïté Verloigne ◽  
Yannis Manios ◽  
...  

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Seth S Martin ◽  
David I Feldman ◽  
Roger S Blumenthal ◽  
Steven R Jones ◽  
Wendy S Post ◽  
...  

Introduction: The recent advent of smartphone-linked wearable pedometers offers a novel opportunity to promote physical activity using mobile health (mHealth) technology. Hypothesis: We hypothesized that digital activity tracking and smart (automated, real-time, personalized) texting would increase physical activity. Methods: mActive (NCT01917812) was a 5-week, blinded, sequentially-randomized, parallel group trial that enrolled patients at an academic preventive cardiovascular center in Baltimore, MD, USA from January 17 th to May 20 th , 2014. Eligible patients were 18-69 year old smartphone users who reported low leisure-time physical activity by a standardized survey. After establishing baseline activity during a 1-week blinded run-in, we randomized 2:1 to unblinded or blinded tracking in phase I (2 weeks), then randomized unblinded participants 1:1 to receive or not receive smart texts in phase II (2 weeks). Smart texts provided automated, personalized, real-time coaching 3 times/day towards a daily goal of 10,000 steps. The primary outcome was change in daily step count. Results: Forty-eight patients (22 women, 26 men) enrolled with a mean (SD) age of 58 (8) years, body mass index of 31 (6), and baseline daily step count of 9670 (4350). The phase I change in activity was non-significantly higher in unblinded participants versus blinded controls by 1024 steps/day (95% CI -580-2628, p=0.21). In phase II, smart text receiving participants increased their daily steps over those not receiving texts by 2534 (1318-3750, p<0.001) and over blinded controls by 3376 (1951-4801, p<0.001). The unblinded-texts group had the highest proportion attaining the 10,000 steps/day goal (p=0.02) (Figure). Conclusions: In present-day adult smartphone users receiving preventive cardiovascular care in the United States, a technologically-integrated mHealth strategy combining digital tracking with automated, personalized, real-time text message coaching resulted in a large short-term increase in physical activity.


10.2196/18142 ◽  
2020 ◽  
Vol 8 (9) ◽  
pp. e18142
Author(s):  
Ramin Mohammadi ◽  
Mursal Atif ◽  
Amanda Jayne Centi ◽  
Stephen Agboola ◽  
Kamal Jethwani ◽  
...  

Background It is well established that lack of physical activity is detrimental to the overall health of an individual. Modern-day activity trackers enable individuals to monitor their daily activities to meet and maintain targets. This is expected to promote activity encouraging behavior, but the benefits of activity trackers attenuate over time due to waning adherence. One of the key approaches to improving adherence to goals is to motivate individuals to improve on their historic performance metrics. Objective The aim of this work was to build a machine learning model to predict an achievable weekly activity target by considering (1) patterns in the user’s activity tracker data in the previous week and (2) behavior and environment characteristics. By setting realistic goals, ones that are neither too easy nor too difficult to achieve, activity tracker users can be encouraged to continue to meet these goals, and at the same time, to find utility in their activity tracker. Methods We built a neural network model that prescribes a weekly activity target for an individual that can be realistically achieved. The inputs to the model were user-specific personal, social, and environmental factors, daily step count from the previous 7 days, and an entropy measure that characterized the pattern of daily step count. Data for training and evaluating the machine learning model were collected over a duration of 9 weeks. Results Of 30 individuals who were enrolled, data from 20 participants were used. The model predicted target daily count with a mean absolute error of 1545 (95% CI 1383-1706) steps for an 8-week period. Conclusions Artificial intelligence applied to physical activity data combined with behavioral data can be used to set personalized goals in accordance with the individual’s level of activity and thereby improve adherence to a fitness tracker; this could be used to increase engagement with activity trackers. A follow-up prospective study is ongoing to determine the performance of the engagement algorithm.


2004 ◽  
Vol 16 (4) ◽  
pp. 355-367 ◽  
Author(s):  
Greet Cardon ◽  
Ilse De Bourdeaudhuij

In this study pedometer counts were recorded for 6 consecutive days for 92 children (mean age = 9.6 years; range 6.5–12.7) and were compared with the number of minutes per day in which the participants engaged in moderate-to-vigorous physical activity (MVPA). Diaries filled out with the assistance of one of the children’s parents were used to determine minutes of MVPA. The average daily step count was significantly higher in boys than in girls, although the average daily MVPA engagement in minutes did not vary significantly between genders. Based on the regression equations, 60 min of MVPA was equivalent to 15,340 step counts in boys, 11,317 step counts in girls, and 13,130 step counts when results for both genders were combined. A moderate correlation (r = .39, p < .001) was found between pedometer step counts and reported minutes of MVPA. According to the present study findings, however, predictions and promotion of daily MVPA engagement in children based on pedometer counts per day should be made with caution.


2018 ◽  
Vol 140 ◽  
pp. 63-70 ◽  
Author(s):  
Emily S. Wan ◽  
Ana Kantorowski ◽  
Diana Homsy ◽  
Reema Kadri ◽  
Caroline R. Richardson ◽  
...  

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