Physical activity in primary versus secondary prevention indication implantable cardioverter defibrillator recipients 6-12 months after implantation - a cross-sectional study with register follow up

OBJECTIVES: To describe physical activity status among patients with implantable cardioverter defibrillators (ICDs) according to the indication for ICD implant compared with international guidelines and compared with a matched healthy reference population to detect potential for improved physical outcomes; to describe patients' beliefs regarding participation in physical exercise by ICD indication; to describe factors predicting low physical activity; and to describe physical activity as a predictor of mortality.

DESIGN: National survey with register follow-up. Comparisons were made to a matched healthy reference population, and patients were followed in registers for 15 months.

SETTING: Patients are identified from national registers and questionnaires are distributed by postal mail.

PARTICIPANTS: All diagnostic profiles and indications were included as were both single-chamber ICD and biventricular ICD (N=499).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Questions regarding physical activity and the International Physical Activity Questionnaire-Short Form were used to assess physical activity.

RESULTS: The response rate was 71.7%. The mean age of participants was 65.5 years, with 82% of participants being men. Of the participants, 37% participated in a rehabilitation program, and 21% were sedentary compared with 8% in the reference population (P<.0001). Only 13% of patients followed physical exercise guidelines. Low physical activity was predicted by primary prevention indication (odds ratio [OR]=2.5; 95% confidence interval [CI], 1.3-4.7) and higher comorbidity (OR=2.1; 95% CI, 1.0-4.1; P<.05). Finally, low physical activity was associated with increased mortality (OR=3.9; 95% CI, 1.11-13.71; P<.05); however, it was not statistically significant when adjusted for age, sex, marital status, and comorbidity.

CONCLUSIONS: Guidelines for exercise and participation in rehabilitation are not met for this population, leaving a great potential for future interventions to improve the clinical outcomes, which are modifiable by exercise.