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Counting Steps: A New Way to Monitor Patients with Pulmonary Arterial Hypertension

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Abstract

Rationale

Activity levels in patients with pulmonary arterial hypertension (PAH) have correlated with surrogate markers of disease severity. It is not known whether physical activity measures are useful in monitoring patients with PAH.

Objectives

This pilot study aimed to evaluate whether change in physical activity measured by an accelerometer correlates with changes in six-minute walk distance (6MWD), echocardiographic parameters, NT-proBNP, or health-related quality-of-life measures (HRQOL).

Methods

The study design was a prospective, observational study in subjects with prevalent PAH. Subjects wore a wrist-worn accelerometer (Fitbit Charge HR®) between two outpatient visits. Daily step count and activity levels were recorded, and the change over time was correlated with changes in 6MWD, echocardiographic parameters, HRQOL, and NT-proBNP.

Measurements and Main Results

30 subjects were enrolled, of which 20 patients had adequate accelerometer data to be analyzed over the study duration. The mean duration of follow-up was 136.4 ( ± 47.3) days. The change in daily step count correlated with a change in 6MWD (r 0.43, p 0.05). Changes in duration spent in moderately active (r 0.52, p 0.02), lightly active (r 0.48, p 0.05), and sedentary activity levels (r − 0.54, p 0.02) correlated with a change in HRQOL. Changes in activity levels did not correlate with echocardiographic measures or NT-pro BNP.

Conclusions

Changes in daily step count and time spent at fairly active, lightly active, and sedentary activity levels correlate with changes in 6MWD, and HRQOL in subjects with PAH suggesting that accelerometry may be a useful monitoring tool.

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Abbreviations

6MWD:

Six-minute walk distance

6MWT:

Six-minute walk test

BMI:

Body mass index

CTEPH:

Chronic thromboembolic disease

ERA:

Endothelin receptor antagonist

HRQOL:

Health-related quality of life

PA:

Pulmonary artery

PAH:

Pulmonary arterial hypertension

PCWP:

Pulmonary capillary wedge pressure

PDE-5:

Phosphodiesterase type 5

PVR:

Pulmonary vascular resistance

RA:

Right atrium

RHC:

Right heart catheterization

RV:

Right ventricle

SPD:

Steps per day

TAPSE:

Tricuspid annular plane systolic excursion

VAS:

Visual analog scale

WHO FC:

World health organization functional class

WSPH:

World Symposium on pulmonary hypertension

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Funding

This study was funded by United Therapeutics.

Author information

Authors and Affiliations

  1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine At Temple University, Philadelphia, PA, USA

    Sameep Sehgal

  2. Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA

    Ananda Chowdhury

  3. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA

    Fadi Rabih

  4. Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA

    Abhishek Gadre

  5. Department of Cardiovascular Medicine, C5 Research, Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA

    Margaret M. Park

  6. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Margaret M. Park

  7. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Manshi Li & Xiaofeng Wang

  8. Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Kristin B. Highland

  9. 3401 N Broad Street, Suite 710 C, Philadelphia, PA, 19140, USA

    Sameep Sehgal

Authors
  1. Sameep Sehgal
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Consortia

STep-count using an Accelerometer for Monitoring PAH—STAMP Study group

Corresponding author

Correspondence to Sameep Sehgal.

Ethics declarations

Conflict of interest:

Sameep Sehgal—United Therapeutics: Research Funding. Kristin B Highland—Actelion Pharmaceuticals: research funding, speaker's bureau; Bayer Healthcare: Research funding, Speaker's bureau; Boehringer Ingelheim: Consulting, Steering Committee, Research Funding, Speaker's Bureau; Eiger Pharmaceuticals: Research funding; Genetech: Research funding; Gilead Sciences: Speaker's Bureau; Reata Pharmaceuticals: Research funding; United Therapeutics: Research Funding.

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Sehgal, S., Chowdhury, A., Rabih, F. et al. Counting Steps: A New Way to Monitor Patients with Pulmonary Arterial Hypertension. Lung 197, 501–508 (2019). https://doi.org/10.1007/s00408-019-00239-y

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  • DOI: https://doi.org/10.1007/s00408-019-00239-y

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