title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  National survey with register follow-up. Comparisons were made to a matched healthy reference population, and patients were followed in registers for 15 months.
  
  
  METHODS
  Patients are identified from national registers and questionnaires are distributed by postal mail.
  
  
  METHODS
  All diagnostic profiles and indications were included as were both single-chamber ICD and biventricular ICD (N=499).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: selina@rh.dk.
authors.forename: Selina Kikkenborg
authors.initials: SK
authors.lastname: Berg
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Lau Caspar
authors.initials: LC
authors.lastname: Thygesen
authors.affiliation: The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; The Danish National Research Foundation Center for Cardiac Arrhythmia, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.affiliation: The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne Vinggaard
authors.initials: AV
authors.lastname: Christensen
authors.affiliation: The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Holbæk Hospital, Holbæk, Denmark.
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable; D003718:Denmark; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006331:Heart Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D012042:Registries; D055502:Secondary Prevention; D011795:Surveys and Questionnaires
keywords: Exercise; Implantable cardioverter-defibrillators; Mortality; Rehabilitation