Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing

Jonathan Myers, Kevin T. Nead, Peter Chang, Joshua Abella, Peter Kokkinos, Nicholas J. Leeper

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Inability to meet minimal guidelines on physical activity is associated with poor health outcomes, but quantifying activity can be complex. We studied whether a simple question regarding participation in regular activity improves risk classification for all-cause mortality. Methods Maximal exercise testing was performed in 6962 patients (mean age, 58.9 ± 11 years) for clinical reasons. Subjects also were assessed for participation in regular activity using a simple yes/no response to meeting minimal recommendations on activity. The incremental value of adding a simple physical activity assessment to clinical, demographic, and exercise test information to predict mortality was determined using Cox proportional hazards models, net reclassification improvement, and integrated discrimination index during a mean follow-up of 9.7 ± 4 years. Results Subjects who did not meet the minimal guidelines on activity had a lower exercise capacity (7.4 ± 4.3 vs 9.1 ± 3.6 metabolic equivalents, P <.0001) and a higher annual mortality rate (2.42% vs 1.71%, P <.001). Not meeting activity guidelines was associated with an age-adjusted 36% higher risk of mortality (hazard ratio, 1.36; 95% confidence interval, 1.22-1.51, P <.0001). Among clinical and exercise test variables, fitness had the highest C-index for predicting mortality (0.72, P <.001). The addition of physical activity classification to a model including traditional risk factors resulted in a net reclassification improvement of 22.8% (P <.001); adding fitness to the traditional risk factor model resulted in a net reclassification improvement of 43.5% (P <.001). Conclusions The addition of a simple assessment of physical activity status significantly improves reclassification of risk for all-cause mortality among patients who are referred for exercise testing.

Original languageEnglish (US)
Pages (from-to)396-402
Number of pages7
JournalAmerican Journal of Medicine
Volume128
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Exercise
Mortality
Guidelines
Exercise Test
Metabolic Equivalent
Proportional Hazards Models
Demography
Confidence Intervals
Health

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Myers, Jonathan ; Nead, Kevin T. ; Chang, Peter ; Abella, Joshua ; Kokkinos, Peter ; Leeper, Nicholas J. / Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing. In: American Journal of Medicine. 2015 ; Vol. 128, No. 4. pp. 396-402.
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abstract = "Background Inability to meet minimal guidelines on physical activity is associated with poor health outcomes, but quantifying activity can be complex. We studied whether a simple question regarding participation in regular activity improves risk classification for all-cause mortality. Methods Maximal exercise testing was performed in 6962 patients (mean age, 58.9 ± 11 years) for clinical reasons. Subjects also were assessed for participation in regular activity using a simple yes/no response to meeting minimal recommendations on activity. The incremental value of adding a simple physical activity assessment to clinical, demographic, and exercise test information to predict mortality was determined using Cox proportional hazards models, net reclassification improvement, and integrated discrimination index during a mean follow-up of 9.7 ± 4 years. Results Subjects who did not meet the minimal guidelines on activity had a lower exercise capacity (7.4 ± 4.3 vs 9.1 ± 3.6 metabolic equivalents, P <.0001) and a higher annual mortality rate (2.42{\%} vs 1.71{\%}, P <.001). Not meeting activity guidelines was associated with an age-adjusted 36{\%} higher risk of mortality (hazard ratio, 1.36; 95{\%} confidence interval, 1.22-1.51, P <.0001). Among clinical and exercise test variables, fitness had the highest C-index for predicting mortality (0.72, P <.001). The addition of physical activity classification to a model including traditional risk factors resulted in a net reclassification improvement of 22.8{\%} (P <.001); adding fitness to the traditional risk factor model resulted in a net reclassification improvement of 43.5{\%} (P <.001). Conclusions The addition of a simple assessment of physical activity status significantly improves reclassification of risk for all-cause mortality among patients who are referred for exercise testing.",
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Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing. / Myers, Jonathan; Nead, Kevin T.; Chang, Peter; Abella, Joshua; Kokkinos, Peter; Leeper, Nicholas J.

In: American Journal of Medicine, Vol. 128, No. 4, 01.04.2015, p. 396-402.

Research output: Contribution to journalArticle

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AU - Myers, Jonathan

AU - Nead, Kevin T.

AU - Chang, Peter

AU - Abella, Joshua

AU - Kokkinos, Peter

AU - Leeper, Nicholas J.

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N2 - Background Inability to meet minimal guidelines on physical activity is associated with poor health outcomes, but quantifying activity can be complex. We studied whether a simple question regarding participation in regular activity improves risk classification for all-cause mortality. Methods Maximal exercise testing was performed in 6962 patients (mean age, 58.9 ± 11 years) for clinical reasons. Subjects also were assessed for participation in regular activity using a simple yes/no response to meeting minimal recommendations on activity. The incremental value of adding a simple physical activity assessment to clinical, demographic, and exercise test information to predict mortality was determined using Cox proportional hazards models, net reclassification improvement, and integrated discrimination index during a mean follow-up of 9.7 ± 4 years. Results Subjects who did not meet the minimal guidelines on activity had a lower exercise capacity (7.4 ± 4.3 vs 9.1 ± 3.6 metabolic equivalents, P <.0001) and a higher annual mortality rate (2.42% vs 1.71%, P <.001). Not meeting activity guidelines was associated with an age-adjusted 36% higher risk of mortality (hazard ratio, 1.36; 95% confidence interval, 1.22-1.51, P <.0001). Among clinical and exercise test variables, fitness had the highest C-index for predicting mortality (0.72, P <.001). The addition of physical activity classification to a model including traditional risk factors resulted in a net reclassification improvement of 22.8% (P <.001); adding fitness to the traditional risk factor model resulted in a net reclassification improvement of 43.5% (P <.001). Conclusions The addition of a simple assessment of physical activity status significantly improves reclassification of risk for all-cause mortality among patients who are referred for exercise testing.

AB - Background Inability to meet minimal guidelines on physical activity is associated with poor health outcomes, but quantifying activity can be complex. We studied whether a simple question regarding participation in regular activity improves risk classification for all-cause mortality. Methods Maximal exercise testing was performed in 6962 patients (mean age, 58.9 ± 11 years) for clinical reasons. Subjects also were assessed for participation in regular activity using a simple yes/no response to meeting minimal recommendations on activity. The incremental value of adding a simple physical activity assessment to clinical, demographic, and exercise test information to predict mortality was determined using Cox proportional hazards models, net reclassification improvement, and integrated discrimination index during a mean follow-up of 9.7 ± 4 years. Results Subjects who did not meet the minimal guidelines on activity had a lower exercise capacity (7.4 ± 4.3 vs 9.1 ± 3.6 metabolic equivalents, P <.0001) and a higher annual mortality rate (2.42% vs 1.71%, P <.001). Not meeting activity guidelines was associated with an age-adjusted 36% higher risk of mortality (hazard ratio, 1.36; 95% confidence interval, 1.22-1.51, P <.0001). Among clinical and exercise test variables, fitness had the highest C-index for predicting mortality (0.72, P <.001). The addition of physical activity classification to a model including traditional risk factors resulted in a net reclassification improvement of 22.8% (P <.001); adding fitness to the traditional risk factor model resulted in a net reclassification improvement of 43.5% (P <.001). Conclusions The addition of a simple assessment of physical activity status significantly improves reclassification of risk for all-cause mortality among patients who are referred for exercise testing.

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