Evaluation of a New Motion Sensor in Patients With Chronic Obstructive Pulmonary Disease

doi:10.1016/j.apmr.2012.05.027

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 12, December 2012, Pages 2319-2325

https://doi.org/10.1016/j.apmr.2012.05.027 Get rights and content

Abstract

Sant'Anna T, Escobar VC, Fontana AD, Camillo CA, Hernandes NA, Pitta F. Evaluation of a new motion sensor in patients with chronic obstructive pulmonary disease.

Objective

To assess the criterion validity and reproducibility of a new pedometer in patients with chronic obstructive pulmonary disease (COPD).

Design

Cross-sectional study.

Setting

Outpatient physiotherapy clinic from a university hospital.

Participants

Patients with COPD (N=30; 17 men; forced expiratory volume in the first second, 44±17% predicted) were videotaped while performing 2 protocols: one including 2 slow and 2 fast 5-minute walks, and another including a circuit of activities of daily living (ADLs). Concomitantly, patients wore 2 motion sensors: the new pedometer and a multisensor accelerometer.

Interventions

None.

Main Outcome Measures

Step counting (SC), energy expenditure (EE), walking distance (WD), activity time (AT), and walking intensity (WI) registered by the pedometer were compared with video and the multisensor as criterion methods.

Results

Correlations between the pedometer and the criterion method were high for SC during slow and fast walking (r=.79 and r=.95) and for EE during fast walking (r=.83). Correlation was more modest for EE during slow walking (r=.65) and for WD and WI during both speeds (.47<r<.68). The agreement between methods was also good, according to Bland-Altman plots. The device was reproducible for registering SC, WD, and EE during slow walking and for all variables during fast walking (intraclass correlation coefficient >.79 for all). During the ADLs circuit, the pedometer underestimated AT by an average of 55% but provided an acceptable EE estimation in a group basis (average difference of 6% with the multisensor).

Conclusions

In patients with COPD, the new pedometer analyzed in the present study is reproducible for most outcomes and highly valid for SC during slow and fast walking and EE during fast walking. The device's validity is more limited for EE during slow walking, and WD and WI at both speeds. Furthermore, during the performance of ADLs, it significantly underestimates activity time but provides an acceptable estimation of EE in a group basis.

Section snippets

Study Design and Participants

Thirty patients with COPD (17 men) with no exacerbation episodes for at least 3 months were recruited to take part in this cross-sectional study. All participants had taken part recently or were currently enrolled in programs of respiratory physiotherapy at the University Hospital of the State University of Londrina, Brazil. The patient's latest assessment of lung function (<6mo) performed by hospital staff was used to confirm COPD diagnosis and classify degree of obstruction according to

Results

All of the 30 recruited patients successfully completed the protocols. Because there was no difference between first and second walk in both speeds concerning almost all variables of interest (P>.170), we standardized to use only the first walk of each speed in the analysis. Regarding the number of steps, walking distance, and walking intensity, there was a statistical difference between the first and second slow walking (P<.002), although not of a clinically important difference (1.5%, 2%, and

Discussion

The present study showed that, in patients with COPD, although the PW had a somewhat limited validity to estimate walking distance, walking intensity, and energy expenditure during the slow walk, it was highly valid to register the number of steps. Additionally, it was reproducible not only for step counting, but also in the estimation of walking distance and energy expenditure in the slow walk. During the fast walk, the PW was reproducible concerning all variables and highly valid to estimate

Conclusions

In patients with COPD, the PW is reproducible for most outcomes and highly valid for step counting during slow and fast walking and energy expenditure estimation during fast walking. The device's validity is more limited for energy expenditure estimation during slow walking and walking distance and intensity at both speeds. Furthermore, during the performance of a circuit of ADLs, the device significantly underestimates activity time but provides an acceptable estimation of energy expenditure

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Citation Excerpt :
The most frequently used outcomes, outcome measures and instruments to assess single free-living PA-related intensity were dyspnoea with the modified Borg scale; cardiac function via HR, measured with HR monitors; and pulmonary gas exchange, especially VO2, measured with portable gas analysers. In total, 32 studies referred to absolute intensity [20, 22-28, 30, 31, 33, 34, 36-38, 40-47, 49, 51, 52, 56, 57, 60-63] and 32 to relative intensity [20, 22-26, 29-36, 39, 40, 42, 46-48, 50-55, 57, 58, 60-62]. From the latest studies, 2 estimated maximum intensity using equations [47, 54].
Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD).
This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures.
PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100.
We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV_1%pred) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0–10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO₂), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO_2peak vs metabolic equivalent of task [MET];%HR_peak vs Fatigue Borg; MET vs walking speed) to 100% (%HR_reserve vs dyspnoea Borg; fatigue and exertion Borg vs walking speed).%VO_{2peak/reserve} elicited the highest intensity. Hence, Borg scores,%HR_reserve and MET may underestimate PA-related intensity.
Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial
2018, Physiotherapy (United Kingdom)
To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD).
Randomised controlled trial.
University-based outpatient clinic.
Thirty-six patients with predominantly moderate-to-severe COPD completed the study.
Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions.
Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression.
After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome.
High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-to-severe COPD, rendering it an equally beneficial therapeutic option for this population.
NCT01691131.
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Citation Excerpt :
Concordance correlation coefficients were <0.05, indicating poor agreement and inspection of the Bland and Altman plots indicated worse agreement at faster walking speeds. Computing the product of step length and step count is a common method of calculating distance travelled and is used by other activity monitors.15 The distance measure of the Fitbit One activity monitors uses a default step length based on height and gender, and this may explain the inaccurate distance outputs.
In order to quantify the effects of physical activity such as walking on chronic disease, accurate measurement of physical activity is needed. The objective of this study was to determine the validity and reliability of a new activity monitor, the Fitbit One, in a population of healthy adults.
Cross-sectional study.
Thirty healthy adults ambulated at 5 different speeds (0.90, 1.12, 1.33, 1.54, 1.78 m/s) on a treadmill while wearing three Fitbit One activity monitors (two on the hips and one in the pocket). The order of each speed condition was randomized. Fitbit One step count output was compared to observer counts and distance output was compared to the calibrated treadmill output. Two-way repeated measures ANOVA, concordance correlation coefficients, and Bland and Altman plots were used to assess validity and intra-class correlation coefficients (ICC) were used to assess reliability.
No significant differences were noted between Fitbit One step count outputs and observer counts, and concordance was substantial (0.97–1.00). Inter-device reliability of the step count was high for all walking speeds (ICC ≥ 0.95). Percent relative error was less than 1.3%. The distance output of the Fitbit One activity monitors was significantly different from the criterion values for each monitor at all speeds (P < 0.001) and exhibited poor concordance (0.0–0.05). Inter-device reliability was excellent for all treadmill speeds (ICC ≥ 0.90). Percent relative error was high (up to 39.6%).
The Fitbit One activity monitors are valid and reliable devices for measuring step counts in healthy young adults. The distance output of the monitors is inaccurate and should be noted with caution.
Incremental shuttle walking test: A reproducible and valid test to evaluate exercise tolerance in adults with noncystic fibrosis bronchiectasis
2014, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Future studies correlating the distance walked with Vo2peak measured on the ISWT should substantiate this test as an objective measure of the cardiopulmonary capacity in non-CF bronchiectasis patients. In a recent validation study of the Power Walker accelerometer, patients wore it attached to the waist, in the hemiclavicular line30; because this validation study was published after our study had already begun, we followed the recommendations of the manufacturer. Therefore, we cannot affirm that the accelerometer presents the same performance when it is worn in a pocket.
To analyze the reliability, validity, and determinants of the incremental shuttle walk test (ISWT) in adults with noncystic fibrosis bronchiectasis.
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Outpatient clinic.
Subjects (N=75; 26 men) underwent, on different days, cardiopulmonary exercise testing (CPET) and 2 ISWTs, 30 minutes apart. The number of steps in daily life was recorded. Concurrent validity was tested by the relation between distance walked with peak load and oxygen consumption ( $\dot{V}$ o₂).
None.
Distance walked (m) was compared between the first and second ISWTs; greatest distance walked was correlated with peak load and Vo₂peak obtained from CPET, steps per day, and dyspnea evaluated by the Medical Research Council (MRC) scale; and desaturation was compared between CPET and the ISWT.
Distance walked was equivalent between the first ISWT (441±152m) and the second ISWT (445±153m) with an excellent intraclass correlation coefficient (.995; 95% confidence interval, .99–.997). There were significant correlations between distance walked and peak load (r=.82), $\dot{V}$ o₂ (r=.72), steps per day (r=.61), and the MRC scale (r=−.69). Age, body mass index, sex, forced vital capacity (% predicted), dyspnea, and steps per day explained 70% of the variation in distance walked (m) and 60% of the variance when expressed as percent predicted. Higher desaturation was observed during the ISWT (−4%±4%) than cycling (−2±3%) (P<.001).
The ISWT is reliable, represents functional capacity, and induces greater desaturation than cycling. Age, body composition, pulmonary function, dyspnea, and physical activity in daily life are determinants of the distance walked on the ISWT.
Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review
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Validity and Reliability of a Piezoelectric Pedometer for Measuring Physical Activity in Children
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: Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)/Brazil (grant no. 302061/2010-0); Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES)/Brazil (grant nos. 05768419942 and 00847546993); and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)/Brazil (grant no. 2010/03223-2).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Reprints are not available from the author.

: In-press corrected proof published online on Jul 31, 2012, at www.archives-pmr.org.

View full text

Original articleEvaluation of a New Motion Sensor in Patients With Chronic Obstructive Pulmonary Disease

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Study Design and Participants

Results

Discussion

Conclusions

Chest

Respir Med

Arch Phys Med Rehabil

Prev Med

Gait Posture

Characteristics of physical activities in daily life in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Profile of the level of physical activity in the daily lives of patients with COPD in Brazil

J Bras Pneumol

Potential consequences for stable chronic obstructive pulmonary disease patients who do not get the recommended minimum daily amount of physical activity

J Bras Pneumol

Does the BODE index reflect the level of physical activity in daily life in patients with COPD?

Rev Bras Fisioter

Quantifying physical activity in daily life with questionnaires and motion sensors in COPD

Eur Respir J

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

Am J Respir Crit Care Med

Activity monitoring and energy expenditure in COPD patients: a validation study

COPD

Measurement properties of the SenseWear armband in adults with chronic obstructive pulmonary disease

Thorax

Original article
Evaluation of a New Motion Sensor in Patients With Chronic Obstructive Pulmonary Disease