Higher daily step counts, as measured by actigraphy, were linked to heart failure symptoms and health status, although reductions in step counts were not, in a new study.

Daily step counts between 1000 and 5000 were significantly associated with symptoms and physical limitations, as reflected in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom (TS) and physical limitation (PL) scores.

Participants whose step counts increased by 2000 steps per day demonstrated a 5.2-point increase in their KCCQ-TS scores and a 5.33-point increase in their KCCQ-PL scores, with higher scores reflecting improvement.

However, declines in step counts were not associated with significant declines in KCCQ-PL scores.

The findings are not yet ready to be implemented into practice, first author Jessica R. Golbus, MD, of the University of Michigan in Ann Arbor, told theheart.org | Medscape Cardiology. However, she said, they “suggest that clinicians should interpret improvements in step counts as indicative of improving health status, though should not necessarily be as concerned with reductions in step count.

“I would certainly, however, still encourage clinicians to discuss decrementing physical activity levels with their patients, though an intervention may not necessarily be warranted,” she added.

The study was published online July 26 in JACC: Heart Failure.

Nonlinear Relationship

The investigators analyzed data from the Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure (CHIEF-HF) trial, a randomized, controlled trial that enrolled participants with heart failure who had a smartphone.

Participants were given a Fitbit Versa 2 and completed serial KCCQs via the smartphone app.

The researchers assessed the relationship between daily step count and KCCQ-TS and KCCQ-PL scores at baseline, as well as changes in the scores between 2 and 12 weeks.

The study included 425 patients. The mean age was 63.5 years, 44.5% were women, and 83.3% were White; 40.9% had reduced ejection fraction, 59.1% had preserved ejection fraction, and 27.5% had type 2 diabetes.

At 2 weeks, the mean KCCQ-TS score was 62.7, and the mean KCCQ-PL score was 55.7.

KCCQ-TS scores increased by 2.5 points on average, and KCCQ-PL scores by 4 points through 12 weeks.

When categorized by 25-point ranges, the step count increased with increasing scores for both KCCQ-TS and KCCQ-PL. Those with KCCQ-TS scores of 0 to 24 averaged 2437.6 steps daily, and those with scores of 75 to 100 averaged 4870.9 steps daily.

Similarly, participants with KCCQ-PL scores of 0 to 24 averaged 2301.5 steps daily, and those with scores of 75 to 100 averaged 5351.9. The relationship remained significant after adjustment.

There were nonlinear relationships between activity and KCCQ scores: Daily step counts below 5000 steps were associated with KCCQ scores, but there was little association with counts above 5000 steps.

Compared with participants who walked 2000 steps per day, those who walked 1000 had KCCQ-TS scores that were 3.11 points lower; participants who walked 3000 had KCCQ-TS scores that were 2.89 points higher.

Similarly, participants who walked 1000 steps per day had KCCQ-PL scores that were 5.36 points lower than those who walked 2000 steps, and those who walked 3000 steps had KCCQ-PL scores that were 4.97 points higher.

After adjustment, change in daily step counts was significantly associated with a change in KCCQ-PL scores from baseline through 12 weeks; for example, participants whose step counts increased by 2000 steps per day experienced a 5.33 increase in their KCCQ-PL scores relative to participants whose step counts did not change.

“New Kid on the Block”

Frederick Ho, PhD, a lecturer in public health at the University of Glasgow, who is a volunteer spokesperson for the American Heart Association, called the study “promising.”

“The study follow-up is relatively short, so it is not known whether the association is valid longer term,” he told theheart.org | Medscape Cardiology. “It is also possible that patients with more severe symptoms became physically less active, and at the same time had worse outcomes.

“A study with longer follow-up among patients from a broader background would provide confidence on the generalizability of the findings,” said Ho, who led a recent study that showed accelerometer-measured physical activity was associated with a lower risk of heart failure. “It’d also be interesting to validate the findings using different types of wearable devices.”

Previous studies have shown that wrist-worn wearables might overestimate light-intensity activities compared to hip-worn devices, he noted. “I’d imagine that the findings would be slightly different due to different types of devices, but the overall premise should remain.”

In a related editorial, Mitchell Psotka, MD, PhD, writes that Golbus and colleagues “have thankfully moved our understanding of actigraphy forward, although it is still the new kid on the block and will require substantial further testing and validation before widespread reliable clinical and research use.”

Terminology and reporting features need to be standardized, and preferred methods of implementation need to be established, including how to wear the devices, he suggests.

Further research is needed to validate that “accelerometers and their digitally processed movement ‘counts’ actually measure activity and that this measured activity has clinical relevance.”

The study did not receive commercial funding. Golbus, Ho, and Psotka report no relevant relationships.

J Am Coll Cardiol HF. Published online July 26, 2023 Abstract, Editorial

Follow Marilynn Larkin on Twitter: @MarilynnL.

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