Associations Of 24-hour Movement Behaviors With Cardiorespiratory Fitness In Heart Failure Patients: A Compositional Data Analysis

Heart failure (HF) patients exhibit reduced cardiorespiratory fitness (CRF), which is associated with poorer clinical outcomes. However, little is known about the relationship between 24-hour movement behaviors and CRF in this clinical population, and limited knowledge exists about potential variations by HF phenotype, HF with preserved or reduced ejection fraction (HFpEF or HFrEF). PURPOSE: To examine the 24-hour movement behaviors in relation to CRF among HF patients using compositional data analytic approach and stratified the results by HF phenotype. METHODS: The baseline data of the Heart Sleep Study, a randomized clinical trial testing the effect of cognitive behavioral therapy for insomnia among people with stable HF and insomnia, were analyzed. Final analytic sample consisted of 147 HF patients (Mean age: 62.9 yrs old; 57.1% male; 32.0% HFrEF). The Six-Minute Walk Test (6MWT) was conducted as a submaximal test of CRF. 24-hour wrist-worn actigraphy was measured for up to 27 consecutive days and actigraphy data were processed to identify sleep duration using Actiware software. Waking hour data were processed to estimate time spent in sedentary, light physical activity, and moderate-to-vigorous-intensity physical activity (MVPA). Compositional isotemporal substitution analysis was performed using linear regression models, with the behavioral compositions presented as isometric log-ratio coordinates to predict hypothetical changes in 6MWT distance, while controlling study covariates. RESULTS: HF patients spent an average of 8.18 minutes per day (0.03% of a 24-hour period) in MVPA. Proportional reallocation of time from other behaviors to MVPA was significantly associated with a longer 6MWT distance (P < .001); for instance, a 5-minute increase in MVPA, proportionally reallocated from other behaviors, was associated with a 19.6-meter increase in 6MWT distance (95% CI: 8.5-30.8). Stratified analyses by HF phenotype indicated that the reallocation effect of MVPA was more pronounced among HFpEF (P = .022) compared to HFrEF (P = .086). CONCLUSIONS: The findings underscore the importance of MVPA in improving CRF among HF patients, especially those with HFpEF. The low prevalence of MVPA in this population highlights a critical need to promote physical activity among HF patients. Supported by: The Heart Sleep Study (PI: Dr. Redeker; NCT02660385) was supported by grants R01NR016191, P20NR014126, is from National Institute of Nursing Research and UL1 TR001863 is grant to Yale Center for Clinical Investigation CTSA Grant from National Center for Advancing Translational Science.