Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
A Simple Tool for Assessing Physical Activity Levels
One question can improve mortality risk classification
Using a simple tool to assess a patient’s level of physical activity significantly improves reclassification of risk for all-cause mortality among patients who are referred for exercise testing, according to a study of 6,962 patients.
Researchers asked patients a simple yes/no question to determine if they were meeting the minimum recommendations for exercise, and found those who did not meet the activity guidelines had:
• a higher annual mortality rate (2.4% versus 1.7%)
• an age-adjusted 36% higher risk of mortality
Adding the assessment to the traditional risk factor model resulted in a net reclassification improvement of 44%.
Citation: Myers J, Nead KT, Chang P, Abella J, Kokkinos P, Leeper NJ. Improved reclassification of mortality risk by assessment of physical activity in patients referred for exercise testing. Am J Med. 2015. pii: S0002-9343(14)01152-8. doi: 10.1016/j.amjmed.2014.10.061.
Commentary: We know that there is a strong relationship between physical activity and cardiac outcomes. Those who exercise regularly have a lower risk of developing coronary disease and have lower mortality.1,2 This study adds to that evidence by showing that asking a simple question allows us to assess physical activity and that assessment adds substantially to traditional risk classifications that include hypertension, high cholesterol, smoking, and diabetes. The simple question asked was, “At least 3 times a week, do you engage in some form of regular activity such as brisk walking, jogging, bicycling, or swimming, long enough to work up a sweat, get your heart thumping, or become short of breath?” By adding this type of question to our routine histories, we can better refine our cardiac risk assessment. In addition, the answer to this question leads directly to recommendations about exercise that can improve patients’ health. –Neil Skolnik, MD
1. Kokkinos P, Myers J. Exercise and physical activity: clinical outcomes and applications. Circulation. 2010;122:1637-1648.
2. Spring B, Ockene JK, Gidding SS, et al; American Heart Association Behavior Change Committee of the Council on Epidemiology and Prevention, Council on Lifestyle and Cardiometabolic Health, Council for High Blood Pressure Research, and Council on Cardiovascular and Stroke Nursing. Better population health through behavior change in adults: a call to action. Circulation. 2013;128(19):2169-2176. doi: 10.1161/01.cir.0000435173.25936.e1.