INVITED COMMENTARY

Commentary on ‘Physical Activity Monitoring in Patients with Peripheral Arterial Occlusive Disease: Validation of an Activity Monitor’ C. Oakley Steps Physiotherapy, 32 Southbourne Rd, Sheffield S10 2QN, UK

Despite an enormous body of evidence supporting the positive effects of exercise, physical activity levels are lower in patients with peripheral arterial disease (PAD) than in age-matched controls.1 It has been shown that walking speed is a good indicator for increased risk of cardiovascular death. In a study with over 4000 participants aged 65e85, it was found that those in the lowest third of walking speed had a 44% increased risk of death compared with those in the upper thirds.2 Walking advice alone is ineffective, as patients are usually non-compliant because of lack of support and motivation.3 With this sort of convincing data available, it is possible to see that increasing the activity of these patients is of paramount importance. Wearable activity monitors are increasingly being used to objectively monitor physical activity in research studies within the field of exercise science. Calibration and validation of these devices are vital to obtaining accurate data. Bassett and Rowlands (2012)4 compared six different activity monitors in a study where each patient wore six different monitors at a time (one of these was the Dynaport min mov), and performed an hour’s worth of activities which were then compared for accuracy. Three were found to be more accurate (the Dynaport was found to be particularly accurate at walking speeds). Tri-axial activity monitors are getting more and more sophisticated. They can track how many steps taken, stairs climbed, distance travelled, calories burned, and even quality of sleep. Some measure heart rate, and have altimeters for greater accuracy. Most sync with mobile phones or computers, and have websites to enable performance to be studied. Some have red lights that turn green when patients have reached a daily target of activity, and an algorithm that increases the amount of work they have to do to obtain a green light. The author attempts to validate the Dynaport move monitor.5 Patients were filmed during a routine hospital visit (wearing a Dynoport move monitor). Seven activities were identified and data collected. Analysis showed that the move monitor correlated best for walking activities, both real life walking and treadmill walking, and worst for ‘shuffling’ or changing position activities (low sensitivity 46.2%). The main drawback of the Dynaport move monitor is its cost. At 690 Euros it is one of the most expensive on DOI of original article: http://dx.doi.org/10.1016/j.ejvs.2014.04.003 E-mail address: [email protected] (C. Oakley). 1078-5884/$ e see front matter Ó 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejvs.2014.04.008

the market, and yet still fails to distinguish accurately between lying and sitting, sitting and standing, and shuffling activity. Most of the other monitors available vary from 75 to 200 Euros, a much more affordable amount for use with patients. Walking on a treadmill (to record claudication distance maximum walking distance) is an internationally respected gold standard exercise test for these patients, but bears little similarity to the exercise that patients experience in their daily lives. The author suggests that activity monitoring may be a more effective way of assessing the exercise capacity of these patients. There is a need for more research in this area, and this paper highlights the problems of validating these new monitoring ‘tools’. Research comparing patient compliance, looking at the use of activity monitors instead of pedometers (which have already been shown to increase patient compliance with exercise programmes6) is the next logical step. Activity monitors can give positive feedback to the patient immediately (by way of rewards using an app on mobile phones, or lights that change colour when targets are reached, and analysis of performance), and may therefore be useful as a way of motivating patients with peripheral arterial disease to take more exercise.

REFERENCES 1 Gardner AW, Montgomery PS, Scott KJ, Afaq A, Blevins SM. Patterns of ambulatory activity in subjects with and without intermittent claudication. J Vasc Surg 2007;46(6):1208e14. 2 Dumurgier J, Elbaz A, Ducimetiere P, Tavernier B, Alperovitch A, Tzourio C. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ 2009;339:b4460. 3 Cheetham DR, Burgess L, Ellis M, Williams A, Greenhalgh RM, Davies AH. Does supervised exercise offer adjuvant benefit over exercise advice alone for the treatment of intermittent claudication? A randomised trial. Eur J Vasc Endovasc Surg 2004;27(1): 17e23. 4 Bassett Jr DR, Rowlands A, Trost SG. Calibration and validation of wearable monitors. Med Sci Sports Exerc 2012;44:S32e8. 5 Teijink JA, Fokkenrood H, Verhofstad N, van den Houten MM, Wittens C, Scheltinga MM. Physical activity monitoring in patients with peripheral arterial occlusive disease: validation of an activity monitor. Eur J Vasc Endovasc Surg 2014;XX:XXX. 6 Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health e a systematic review. JAMA 2007;298(19): 2296e304.

Please cite this article in press as: Oakley C, Commentary on ‘Physical Activity Monitoring in Patients with Peripheral Arterial Occlusive Disease: Validation of an Activity Monitor’, European Journal of Vascular and Endovascular Surgery (2014), http://dx.doi.org/10.1016/j.ejvs.2014.04.008

Commentary on 'Physical activity monitoring in patients with peripheral arterial occlusive disease: validation of an activity monitor'.

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