Tracking Physical Activity in Patients With ILD Lacks Consistency

Using activity monitors and questionnaires to measure physical activity (PA) in patients with interstitial lung disease (ILD) lacks consistency, according to a study published in European Respiratory Review.¹

The researchers noted that participation in regular PA is important for patients with ILD, as those who do not incorporate it into their daily routines have a higher risk of hospitalization and all-cause mortality. Despite this, the researchers explained that patients with ILD had reduced PA compared with healthy controls.

Although PA is crucial for patients with ILD, there is currently no uniform review of PA measurements, as some researchers use questionnaires and others use activity monitors. The study authors noted that inaccurate PA assessment “can adversely impact the advancement of PA research in ILD.”

Consequently, the researchers chose to review how studies used activity monitors and questionnaires to measure PA in patients with ILD. More specifically, they explored the types of questionnaires and activity monitors used for collecting PA data in patients with ILD, evaluated the metrics used for assessing PA, and examined the quality of reporting on data collection and processing with activity monitors. Their review also aimed to describe PA levels using each metric and to provide practical recommendations on how to measure PA and sedentary time (ST).

The researchers searched 4 databases from their inception to November 28, 2022. For each potential study, they first screened the titles and abstracts before screening the full text. For the studies that met inclusion criteria, the reviewers extracted data about patient characteristics, the methods used to measure PA, and PA metrics.

couple exercising together | Image credit: NDABCREATIVITY - stock.adobe.com.

Their search yielded 15,407 studies, 40 of which they utilized. Of the 40 studies, 31 (78%) used only activity monitors, 7 (18%) used only questionnaires, and 2 (5%) used both. In total, 33 (83%) used activity monitors and 9 (23%) used questionnaires.

They followed the checklist by Montoye et al to assess reporting quality on PA measurement.² The checklist consisted of 12 questions about data collection, accelerometer information, and processing. The researchers explained that they gave a “+1” score for a sufficiently reported item and a “–1” score for an insufficiently reported item.¹ They then added together the number of “–1” scores and gave each study a score between 0 and –12, with scores closer to 0 indicating complete reporting.

In terms of reporting quality, the researchers found the following to be well reported: the accelerometer brand and model, PA metrics, the number of days of data collected, and the number of people not meeting wear-time criteria. They also found studies poorly reported on various aspects, including the placement of the accelerometer, the minutes required for a valid day, and the number of valid days needed.

Also, the researchers found that “the pooled means (95% CI) of steps, time spent in moderate to vigorous PA (MVPA), total energy expenditure (TEE), and ST were 5215 (4640–5791) steps/day⁻¹, 82 (58-106) min/day⁻¹, 2130 (1847- 2412) kcal/day⁻¹, and 605 (323/887) min/day⁻¹, respectively, with considerable heterogeneity.”

Overall, the researchers learned that reporting quality of PA measurements was poor in most studies, measurement procedures varied, and the use of PA questionnaires was limited. They also found low-quality evidence in the pooled means of steps, TEE, MVPA, and ST, and discovered PA metrics’ types and definitions were heterogenous and influenced the PA metrics values.

The researchers acknowledged several limitations to their study, one being the use of estimated mean values for studies that did not report the mean and standard deviation of PA metrics; they recognized this could lead to biased results. In terms of future research, the researchers suggested that PA measurements in patients with ILD be conducted using validated activity monitors, encouraging clinicians and researchers to report details of PA measurements based on the checklist used in this study.

“The heterogeneity makes it difficult to interpret and pool PA data and compare results in ILD with other diseases,” the authors concluded. “Therefore, we encourage researchers and clinicians to improve the quality of PA measurements. Our recommendations could be helpful when measuring and reporting PA in patients with ILD.”

References

1. Iwakura M, Kawagoshi A, Tamaki A, Oki Y, Oshima Y, Spruit MA. Physical activity measurements in individuals with interstitial lung disease: a systematic review and meta-analysis. Eur Respir Rev. 2023;32(169):220165. doi:10.1183/16000617.0165-2022

2. Montoye AHK, Moore RW, Bowles HR, et al. Reporting accelerometer methods in physical activity intervention studies: a systematic review and recommendations for authors. Br J Sports Med. 2018;52(23):1507-1516. doi:10.1136/bjsports-2015-095947