Physical inactivity and sedentary behavior profiles over a week in patients with heart failure: comparison with healthy subjects and its determinants

Patients with heart failure (HF) are physically inactive and often exhibit excessive sedentary behavior. Understanding the magnitude of inactivity and time in sedentarism and its determinants could be useful in establish rehabilitation interventions to those patients.

i) To evaluate how much patients with HF are more inactive and sedentary in daily life than their matched controls; ii) to compare the physical activity in daily life (PADL) levels of those patients during weekdays and weekend; and to study its determinants.

In a cross-sectional study, patients with HF and age-, gender- and BMI-matched controls were included. The participants had their PADL objectively evaluated by an activity monitor worn during awake time, for seven consecutive days. Step count, time spent in sedentary behavior (SB), light and moderate-to-vigorous physical activities (MVPA) were recorded; the mean or sum of the days was used for the analyses. Anthropometric data, functional exercise capacity (six-minute walk test, 6MWT), exertional dyspnea (Borg scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS) and health-related quality of life (Minnesota Living with Heart Failure questionnaire, MLHFQ) of the patients with HF were assessed as potential determinants of PADL.

Forty-three patients with HF (23 males; 65±11 yrs; LVEF: 47±15 %; BMI: 30±5 Kg.m-2) and 30 matched controls (11 males; 62±10 yrs; BMI: 29±5 Kg.m-2) were studied. The comparison of PADL profile between patients with HF and controls is presented in the Table 1. Considering the mean and the sum of the days, patients with HF presented time in MVPA, approximately, 60% lower than their controls. Time in SB and in light PA were similar between groups. On average, patients with HF presented 2190 steps/day (or 33%) less than the controls. In comparison to weekdays, patients with HF are even more inactive during weekends, considering both MVPA (9 [4-21] vs. 6 [3-12] min/day; P=0.005) and step count (4550±2366 vs. 4055±2228; P=0.02). Results of multiple stepwise regression models revealed that, in patients with HF, the step count was determined by the 6MWT and dyspnea sensation during the test (r2=0.37); MVPA was determined only by age (r2=0.19); light PA only by depression symptoms (r2=0.10); and SB was determined by the 6MWT, dyspnea sensation during the test and depression symptoms (r2=0.32).

Patients with HF are more physically inactive when compared to healthy individuals; conversely, they are as sedentary as their matched controls. During weekends, patients with HF are even more inactive than during weekdays. Functional capacity and exertional dyspnea determined the number of steps covered during a day and, in addition to depression symptoms, predicted also sedentary behavior in HF.