Cardiorespiratory Fitness And The Reallocation Of Time Between Daily Movement Behaviors In Heart Failure

Adults with heart failure with preserved ejection fraction (HFpEF) have high sedentary time (ST), low sleep, and low physical activity (PA), which are associated with cardiorespiratory fitness (CRF). However, increasing time in one movement behavior results in a proportional decrease in other behaviors. PURPOSE: To examine the CRF predictions of time reallocations between daily movement behaviors in adults with HFpEF via compositional data analysis. METHODS: Adults with HFpEF (n = 22, mean age = 61.5 y, mean BMI = 36.9 kg/m2, % Female = 86.4, % Black = 40.9) underwent symptom-limited cardiopulmonary exercise testing, and movement behaviors were measured in a free-living environment for seven days. Measures included 24 h activity (ST, light-intensity PA [LPA], moderate-to vigorous-intensity PA [MVPA], and sleep) derived from a wrist-worn Actigraph GT9X accelerometer, CRF measured as VO2peak, and covariates (demographic and anthropometric). Log-ratio multiple linear regression models were used to predict CRF for the mean movement behavior composition, and for new compositions where proportional minutes of time was reallocated from one behavior to another while holding the remaining behaviors constant and adjusting for age, gender, and BMI. RESULTS: Replacing 15 minutes of ST, sleep, or LPA with 15 minutes of MVPA predicted a numerically greater CRF, although the increase was not clinically significant (Δ predicted VO2peak = 0.5, 0.4, and 0.4 mL/kg/min, respectively). In contrast, replacing 15 minutes of MVPA with ST, sleep, or LPA resulted in an asymmetrical decrease in predicted CRF (Δ predicted VO2peak = -0.7, -0.7, and -0.7 mL/kg/min, respectively). Further improvements in predicted CRF were observed from larger durations of time reallocation. Replacing 35 minutes of ST, sleep, or LPA with 35 minutes of MVPA predicted a numerically greater CRF (Δ predicted VO2peak = 1.0, 0.9, and 0.8 mL/kg/min, respectively) that may have clinical significance. CONCLUSIONS: These early findings reinforce the importance of MVPA for CRF in adults with HFpEF. Future prospective randomized controlled trials are necessary to determine whether changes in ST, Sleep and LPA for MVPA can prospectively modify CRF. FUNDING: Career Development Award (19CDA34660318) from the AHA (Salvatore Carbone); NIH CTSAP (UL1TR002649) at VCU