Lachant Daniel, Light Allison, Lachant Michael, Annis Jeffrey, Hemnes Anna, Brittain Evan, White R James
Department of Medicine, Division of Pulmonary and Critical Care Medicine University of Rochester Medical Center Rochester New York USA.
Department of Medicine, Division of Cardiology Vanderbilt University Nashville Tennessee USA.
Pulm Circ. 2023 Sep 10;13(3):e12285. doi: 10.1002/pul2.12285. eCollection 2023 Jul.
Pulmonary arterial hypertension (PAH) patients have low activity. Activity intensity or duration could be a measure of clinical status or improvement. We aimed to determine whether standard or novel actigraphy measures could detect increases in activity after adding therapy. This was a prospective, single-center observational study evaluating activity after adding therapy in Group 1 PAH; we also report a validation cohort. For our study, two different accelerometers were used, a wrist (ActiGraph) and chest (MC10) device. Patients were analyzed in two groups, Treatment Intensification (TI, adding therapy) or Stable. Both groups had baseline monitoring periods of 7 days; the TI group had follow-up at 3 months, while Stables had follow-up within 4 weeks to assess stability. Activity time and steps were reported from both devices' proprietary algorithms. In ActiGraph only, steps in 1-min intervals throughout the day were ranked (not necessarily contiguous). Average values for each week were calculated and compared using nonparametric testing. Thirty patients had paired data (11 Stable and 19 TI). There was no between-group difference at baseline; we did not observe therapy-associated changes on average daily steps or activity time/intensity. The top 5 min of steps (capacity) increased after adding therapy; there was no difference in the stable group. This key finding was validated in a previously reported randomized trial studying a behavioral intervention to increase exercise. Total daily activity metrics are influenced by both disease and non-disease factors, making therapy-associated change difficult to detect. Peak minute steps were a treatment-responsive marker in both a pharmacologic and training intervention.
肺动脉高压（PAH）患者活动量较低。活动强度或持续时间可能是临床状态或改善情况的一项衡量指标。我们旨在确定标准或新型活动记录仪测量方法能否检测出添加治疗后活动量的增加。这是一项前瞻性单中心观察性研究，评估在第1组PAH患者中添加治疗后的活动情况；我们还报告了一个验证队列。在我们的研究中，使用了两种不同的加速度计，一种是腕部（ActiGraph）设备，另一种是胸部（MC10）设备。患者被分为两组，强化治疗组（TI，添加治疗）或稳定组。两组均有7天的基线监测期；TI组在3个月时进行随访，而稳定组在4周内进行随访以评估稳定性。两种设备的专有算法均报告了活动时间和步数。仅在ActiGraph中，全天每分钟的步数进行了排序（不一定是连续的）。计算每周的平均值，并使用非参数检验进行比较。30名患者有配对数据（11名稳定组和19名TI组）。基线时两组之间没有差异；我们未观察到治疗相关的平均每日步数或活动时间/强度变化。添加治疗后，步数最多的5分钟（能力）增加；稳定组没有差异。这一关键发现已在先前报道的一项研究行为干预以增加运动的随机试验中得到验证。每日总活动指标受疾病和非疾病因素的影响，使得治疗相关的变化难以检测。在药物治疗和训练干预中，每分钟的峰值步数都是治疗反应性标志物。
