1. An Exploration of the Relationship Between Physical Activity, Mortality and Time to First Admission in Subjects Admitted into Hospital with an Acute Exacerbation of Chronic Respiratory Disease (CRD).
Harvey-Dunstan TC1,2, Greening NJ,1,2,3, Hussain SF4, Chaplin EJ1, Chimera R4 , Morgan MD1,2,3, Steiner MC1,2,5, Singh SJ1,2,5
1Centre for Exercise & Rehabilitation Science, Glenfield Hospital, Leicester, UK; 2University of Leicester, UK;
3Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK; 4Kettering General Hospital, UK; 5National Centre for Exercise Medicine, Loughborough University, UK.
hen-Wolloff L1, Tal-Singer R3,olkey MI4,
Morgan MD1,2, Steiner MC1,5, Singh SJ1,5
1Centre for Exercise & Rehabilitation Science, Glenfield Hospital, Leicester, UK; 2University of Leicester, UK;
3GSK R&D, King of Prussia, PA USA;, 4Royal Brompton & Harefield NHS Foundation Trust, London, UK; 5Loughborough University, UK.
Background
Physical inactivity is a predictor of mortality in stable Chronic Obstructive Pulmonary Disease (COPD) (1) and there is a link between physical inactivity at the point of admission with acute exacerbations and mortality.
Our aim was to describe the association between physical activity, mortality at twelve months and number of days to first admission, in a cohort of patients admitted into hospital with an acute exacerbation of CRD (AECRD).
Results
Adequate physical activity data (five consecutive days of 12 hours or greater) was collected from 88 patients (Table 1 - Baseline Demographics).
Mean steps/day were 490[531] with a mean TEE/day of 1735[397].
When adjusted for co-variates there was no significant association between mean steps or TEE to time to first admission (95% CI; to [OR 1.00] p=0.76, and, 95% CI 0.99 to 1.00 [OR 1.00] p=0.16) respectively.
There was a significant association between steps and TEE to time to death at twelve months (95% CI; 0.99 to 1.00 [OR 1.00] p< and 95% CI 0.99 to 1.00 [OR 1.00] p<0.01) respectively.
Table 1: Baseline Demographics
 n=88
Mean /
*Median
SD /
*IQR
Age (years) 74 9
Gender (% male)
51 (%)
FEV1 %Predicted 52 23
BMI 27 7
Charlson Index* 2
2-4
MRC Baseline* 4
4-4
Inpatient steps/day
490
531
Inpatient TEE/day
1735
397
ISWT at hospital discharge (m) 70 71
ESWT at hospital discharge (sec)
109 79
Previous hospital admission (% Yes)
56%
Previous hospital days in twelve months 11
Methods
Patients admitted with an acute exacerbation of CRD were recruited as part of Multicentre RCT (2).
Physical activity was measured using the SenseWear Pro armband (figure 1) from the point of recruitment (within 48 hours of admission) and for the duration of the in-patient stay.
Steps per day along with Total Energy Expenditure (TEE) were retrieved at discharge from hospital and reported as a mean over five days (days two to six of admission), see Figure 2 for example output. Days to first admission and mortality at twelve months were collected prospectively.
Analysis was completed using appropriate parametric and non- parametric testing and Cox Regression.
Figure 1: SenseWear PRO3 Armband
Figure 2: Example of 24 hours monitoring for one patient during an inpatient stay for an AECRD
Conclusion
Statistically there was an association between steps and TEE during an inpatient admission to time to death at twelve months but this association was not observed for time to first admission. Given the eqivical Odds Ratios observed, caution is required when translated into the clinical context.
References:
(1) Garcia-Aymerich J doi: /thx
(2) Greening NJ doi: /bmj.g4315