Yuta Suzuki1,2,3, Ryota Matsuzawa4, Keika Hoshi5,6, Yong Mo Koh7,8, Manae Harada2, Shohei Yamamoto1,9, Keigo Imamura1, Kentaro Kamiya10, Atsuhiko Matsunaga11. 1. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan. 2. Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan. 3. Advanced Research Course, National Institute of Public Health, Saitama, Japan. 4. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Hyogo, Japan. 5. Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan. 6. Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan. 7. LightStone Corp, Tokyo, Japan. 8. Department of Economics, School of Economic, Senshu University, Tokyo, Japan. 9. Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan. 10. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan. 11. Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan. atsuhikonet@gmail.com.
Abstract
PURPOSE: We examined whether physical activity measured at starting point and its trajectory over time were simultaneously associated with vital prognosis. METHODS: This retrospective cohort study included 295 ambulatory maintenance hemodialysis patients (mean age 63.9 years; 54.6% male). We measured physical activity at index date (starting point) and its change over 1 year as predictors, and all-cause death and cardiovascular events were assessed as the outcomes. Two groups each of high versus low physical activity at starting point (based on 4000 steps per day) and no decline versus decline (based on a predicted mean slope) were created. Cox proportional-hazards regression and Fine-Gray proportional sub-distribution hazards model were used to examine associations between physical activity and its trajectory and clinical outcomes. RESULTS: Decline in physical activity over 1 year was associated with a higher risk of all-cause death and cardiovascular events, irrespective of the physical activity at starting point. Furthermore, both lower physical activity at starting point and decrease in physical activity over time were independently associated with a higher risk of all-cause death and cardiovascular events in models in which each exposure was mutually adjusted. Compared to other groups that worsened in either exposure, the lowest risk for death/cardiovascular events was observed in the high at starting point/no decline over time group. CONCLUSIONS: Both physical activity at starting point and its change over time were independently associated with vital prognosis. The assessment of both exposures provides additional prognostic information for the assessment of each exposure.
PURPOSE: We examined whether physical activity measured at starting point and its trajectory over time were simultaneously associated with vital prognosis. METHODS: This retrospective cohort study included 295 ambulatory maintenance hemodialysis patients (mean age 63.9 years; 54.6% male). We measured physical activity at index date (starting point) and its change over 1 year as predictors, and all-cause death and cardiovascular events were assessed as the outcomes. Two groups each of high versus low physical activity at starting point (based on 4000 steps per day) and no decline versus decline (based on a predicted mean slope) were created. Cox proportional-hazards regression and Fine-Gray proportional sub-distribution hazards model were used to examine associations between physical activity and its trajectory and clinical outcomes. RESULTS: Decline in physical activity over 1 year was associated with a higher risk of all-cause death and cardiovascular events, irrespective of the physical activity at starting point. Furthermore, both lower physical activity at starting point and decrease in physical activity over time were independently associated with a higher risk of all-cause death and cardiovascular events in models in which each exposure was mutually adjusted. Compared to other groups that worsened in either exposure, the lowest risk for death/cardiovascular events was observed in the high at starting point/no decline over time group. CONCLUSIONS: Both physical activity at starting point and its change over time were independently associated with vital prognosis. The assessment of both exposures provides additional prognostic information for the assessment of each exposure.
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