웨어러블 활동량 센서를 활용한 일일 걸음 수 이상의 신체 건강 상태 평가

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Dec 05, 2023

웨어러블 활동량 센서를 활용한 일일 걸음 수 이상의 신체 건강 상태 평가

npj Digital Medicine 5권, 기사 번호: 164(2022) 이 기사 인용 5201 액세스 1 인용 136 Altmetric Metrics 세부 정보 신체 건강 상태는 개인의 수행 능력을 정의합니다.

npj 디지털 의학 5권, 기사 번호: 164(2022) 이 기사 인용

5201 액세스

1 인용

136 알트메트릭

측정항목 세부정보

신체 건강 상태는 일상 생활의 정상적인 활동을 수행하는 개인의 능력을 정의하며 일반적으로 임상 환경에서 설문지 및/또는 검증된 테스트(예: 시간 제한 걷기 테스트)를 통해 평가됩니다. 이러한 측정은 상대적으로 정보 함량이 낮으며 일반적으로 빈도가 제한됩니다. 활동 모니터와 같은 웨어러블 센서를 사용하면 신체 활동과 관련된 매개변수를 원격으로 측정할 수 있지만 일일 걸음 수 측정 외에는 널리 연구되지 않았습니다. 여기에서는 두 번의 병원 방문(18.4 ± 12.2주) 사이에 Fitbit 활동 모니터(Fitbit Charge HR®)를 제공받은 폐동맥고혈압(PAH) 환자 22명으로 구성된 코호트의 결과를 보고합니다. 각 임상 방문에서 최대 26개의 측정값이 기록되었습니다(범주형 19개, 연속형 7개). 분당 걸음 수와 심박수 분석을 통해 신체 활동 및 심혈관 기능과 관련된 몇 가지 지표를 도출합니다. 이러한 지표는 코호트 내의 하위 그룹을 식별하고 임상 매개변수와 비교하는 데 사용됩니다. 여러 Fitbit 지표는 지속적인 임상 매개변수와 밀접한 상관관계가 있습니다. 임계값 접근 방식을 사용하여 우리는 많은 Fitbit 지표가 신체 상태, 심혈관 기능, 폐 기능 및 혈액 검사의 바이오마커와 관련된 매개변수를 포함하여 하위 그룹 간의 임상 매개변수에 통계적으로 유의미한 차이를 가져온다는 것을 보여줍니다. 이러한 결과는 일일 걸음 수가 활동 모니터에서 파생될 수 있는 많은 지표 중 하나일 뿐이라는 사실을 강조합니다.

웨어러블 활동 센서를 사용하면 개인의 신체 활동을 원격으로 모니터링할 수 있지만 일일 평균 걸음 수 평가로만 제한되어 왔습니다. 걷기 또는 보행은 일상생활의 근본적인 움직임이며 인간의 건강을 증진시키는 중요한 지표가 되었습니다1. 예를 들어, 일일 걸음 수 증가(4000 미만에서 12,000 이상으로)는 모든 원인으로 인한 사망률 감소와 관련이 있습니다2,3. 입원한 환자의 경우 일일 걸음 수 임계값(일반적으로 하루 1000걸음 미만)은 재입원과 같은 좋지 않은 결과와 관련이 있습니다4,5,6. 보행 속도7,8,9 및 시간 제한 걷기 테스트10,11와 같은 관련 보행 매개변수도 임상적으로 관련된 결과를 예측하는 것으로 밝혀졌습니다.

역사적으로 개인의 신체 상태를 원격으로 모니터링하는 것은 어려웠지만 웨어러블 기술의 발전으로 수술 후 또는 만성 질환 환자의 진료소 방문 사이에 지속적인 평가가 가능해졌습니다. Fitbit 기기와 같은 웨어러블 관성 측정 장치(IMU)는 연결된 스마트폰 앱에서 볼 수 있는 IMU 신호(예: 수면)에서 파생된 기타 측정항목과 함께 걸음 수를 기록합니다. 또한 Fitbit과 같은 많은 웨어러블 장치에서는 광용적맥파측정을 사용하여 심박수를 측정합니다.

걸음 수, 특히 일일 걸음 수는 신체 활동의 원격 평가를 위한 가장 일반적인 지표로 남아 있지만 애플리케이션 프로그래밍 인터페이스(API)를 사용하여 분당 걸음 수와 심박수 데이터를 Fitbit 서버에서 다운로드할 수 있습니다. 따라서 Fibit을 지속적으로 착용하는 개인의 경우 일주일에 걸쳐 걸음수(단위: 분당 걸음수, SPM)와 심박수(단위: 분당 심박수, BPM)의 10,080 값을 얻을 수 있으며, 각 포인트는 평균값을 나타냅니다. 해당 분의 걸음 수와 심박수를 표시합니다. 자유로운 생활 환경과 비정형 보행 패턴을 가진 환자 집단에서 걸음 수 측정의 정확성은 여전히 ​​우려 사항으로 남아 있지만12,13 암, 심혈관 질환, 폐동맥 고혈압 및 다발성 경화증이 있는 개인을 대상으로 한 연구에 따르면 이러한 장치는 정확하고 임상적으로 관련된 데이터14,15,16,17. 마찬가지로, 비교 연구에서 Fitbit 장치의 심박수 측정은 일반적으로 휴식 중이거나 활동 수준이 낮은 개인의 심전도와 잘 일치하는 것으로 나타났습니다18,19. 그러나 피부 색소 침착과 같은 다른 요인도 측정 정확도에 영향을 미칠 수 있습니다.

 0. Red line shows a normal fit. d Weekly activity map: scatter plot showing heart rate versus step rate. Each point represents one minute where a physiological heart rate was recorded. The grey lines show the upper and lower envelopes of the activity map. The blue line shows a linear least squares fit to the data./p>5000 steps (14/22) to those with <5000 steps (8/22). This arbitrary threshold resulted in 6 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 2). Subjects with <5000 steps per day had lower 6MWD at visit 1, lower hemoglobin levels at visit 2, poorer pulmonary health (higher physician-assessed WHO FC) at visit 1, and experienced more pedal edema (Pedal Edema score) at visit 2. Two subjects had average daily step counts >10,000 steps per day (PAH 1, 19), but had no other similarities. Sensitivity analysis of threshold values and the number of statistically significant clinical parameters for all Fitbit metrics are provided in Supplementary Figs. 3 and 4./p> 0 (HR(SR = 0), i.e. active). Histograms for HR(SR = 0) (Fig. 1b) and HR(SR > 0) (Fig. 1c) were described by normal distributions, from which we obtained the mean, standard deviation, and skewness. The range of mean HR(SR = 0) was 66.2–111.8 BPM, with standard deviations of 6.4–13.7 BPM (Supplementary Fig. 5). The skewness varied from −0.75 to 2.30, highlighting a broad range of behavior with relatively large tails to the left and right of the peak (Supplementary Figs. 6 and 7)./p>82 BPM (8/22). This resulted in 8 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 8). Subjects with lower mean values of HR(SR = 0) had lower RHR at visits 1 and 2, and lower peak heart rate at visit 2, but experienced more pedal edema (Pedal Edema score) and more palpitations (Palpitation score) at visit 1, were less able to perform usual activities (lower EQ-5D Usual Activity scores) at visit 1, and experienced more pain/discomfort (lower EQ-5D pain/discomfort scores) at visit 1./p>100 BPM. Both subjects had low fitness slopes (see below), suggesting that they did not access a wide range of heart rate during daily activities. However, PAH 1 had the highest average daily step count in the dataset. We note that 3 subjects (PAH 4, 20, 27) removed the device overnight (see below), which may have resulted in higher mean HR(SR = 0) values since heart rate values during sleeping were likely not included./p>90,000 individuals over 35 weeks, reported that the RHR (assumed to be the true RHR) was dependent on age, BMI and sleep duration, with daily values of RHR from 40–108 BPM25, although 95% of men and women had RHR values between 50–80 BPM, similar to the range found here./p>1. This resulted in 4 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 9). Subjects with lower skewness values were more likely to have higher resting heart rate at visits 1 and 2, experienced less pain/discomfort (lower EQ-5D pain/discomfort scores) at visit 1 and were more likely to be in better health (higher EQ-5D Index) at visit 1. Two subjects had skewness of HR(SR = 0) values >1.9 (PAH 27, 28): both subjects also had relatively low resting heart rates, longer free-living 6MWD, and higher fitness plot slopes./p> 0 represents HR values while subjects were active. The mean values of HR(SR > 0) were 78.6–121.0 BPM (mean 94.4 BPM), and the standard deviation was 6.5–14.0 BPM (Supplementary Fig. 10). The mean values were only slightly higher than the mean values of HR(SR = 0), although the standard deviations were similar. The mean skewness values for HR(SR > 0) were from −0.57 to 1.35, similar to the range for HR(SR = 0). We compared individuals with mean values of HR(SR > 0) <95 BPM (12/22) to those with >95 BPM, resulting in 4 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 11). Subjects with lower mean values of HR(SR > 0) had lower RHR at visits 1 and 2, lower albumin levels at visit 1, and experienced more palpitations (lower Palpitation score) at visit 1./p> 0, the mean HR at SR = 0, and the fraction of time inactive (Fig. 2a). The data points for each week for most subjects were tightly clustered in distinct regions. From the loading plot (Fig. 2b), PC1 is dominated by the step rate parameters (+PC1) and the fraction of time inactive (−PC1). PC2 is dominated by the mean heart rate at SR = 0 (+PC2) and the standard deviation of the heart rate for SR > 0 (−PC2). The group of subjects in the fourth quadrant (PAH 3, 9, 12, 19, 23, 27) are characterized by high mean and standard deviation of the step rate, and a high value of the standard deviation of the heart rate at SR > 0. This implies that these individuals exhibit a wide range of step rates and a wide range of heart rates during normal activities of daily life. The group of subjects along the positive y-axis (PAH 1, 10, 14, 17) are characterized by high mean heart rate at SR = 0. High values of HR(SR = 0) imply that these individuals have a high resting heart rate and are unlikely to access a wide range of heart rates during normal activities, even if they have the capacity for moderate or high step rates. The group of subjects along the negative x-axis (PAH 2, 7, 11, 13, 20, 21, 30) are characterized by a large fraction of time inactive. Three subjects (PAH 15, 26, 28) are clustered around the origin. The PCA plot suggests a range of behavior with distinct combinations of metrics associated with heart rate and step rate. To explore these relationships in more detail, we assessed several derived parameters. Distinct groupings of subjects were found for mean HR(SR = 0) >82 BPM, skewness of HR(SR = 0) <1, ambulation product, P > 1000, and fitness slope >0.15 (Supplementary Fig. 12)./p> 0):SD is the standard deviation of the heart rate at SR > 0; SR(SR > 0):mean is the mean step count for SR>0; SR(SR>0):SD is the standard deviation of the step rate for SR > 0; time active is the fraction of minutes with SR = 0./p>0.15 (11/22) to those with slope <0.15, resulted in 3 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 13). Notably, subjects with slopes >0.15 had lower NT-proBNP levels at visits 1 and 2. B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) are biomarkers for cardiac stress, and PAH patients with NT-proBNP levels below about 300 pg L−1 are considered low risk for heart failure26. The mean levels for subjects with slope >0.15 at visits 1 and 2 were 188 ± 180 and 145 ± 165 pg mL−1, respectively. These results suggest that the fitness slope may be a useful indicator of NT-proBNP levels and risk for heart failure. Comparison of subjects with fitness intercepts above (10/22) and below (12/22) the mean (91 BPM) were similar to results for subgroups with HR(SR = 0) above and below 95 BPM./p> 1000 (12/22) to those with P < 1000, resulted in 7 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 14). An ambulation product value of 1000 was selected as it was close to the median value (1079), and represented a well-defined separation between the two groups (Fig. 4d). Subjects with P < 1000 had lower 6MWD at visits 1 and 2, and experienced more pedal edema (Pedal Edema score) at visit 1. Two subjects had ambulation product values > 5000 (PAH 9, 19). Both subjects had a high ambulation frequency and walked more than 5000 steps per day on average. Both subjects also had relatively lower resting heart rates, longer free-living 6MWD (see below), and higher fitness plot slopes. PAH 1, despite having the highest step count, ranked fourth in ambulation product value as a result of having relatively lower endurance and intensity values./p> 0) for analysis. In this study the average weekly usage was 0.44–0.97. Note that charging the device overnight (e.g. 8 h) once a week results in a weekly usage of 0.95. We also defined the maximum off-time as the longest continuous time during the week that the device was not worn, which varied from less than 1 h to more than 12 h. From heat maps of usage and the maximum off-times for all subjects (Supplementary Figs. 15 and 16) we can further infer how the device was used./p> 0. Yellow cells indicate that the device was worn continuously for the full hour. White cells indicate that the device was not worn (no HR recorded) for the full hour. a Heat map for PAH27 (13 weeks of data), showing low usage (average = 0.49) with the device not worn overnight. b The maximum off time for each week for PAH27 is consistently around 12 h overnight. Each point represents the maximum off-time for each week in the trial. c Heat map for PAH30 (22 weeks of data), showing relatively high usage (0.90), with the device removed for several hours every few days. d The maximum off time for PAH30 is typically 8–20 h and includes overnight hours. e Heat map for PAH10 (13 weeks of data), showing high usage (0.97). For the first 10 weeks the maximum off-time is less than 1 h. f The maximum off time for PAH10 is usually less than 1 h./p>0.94, which corresponds approximately to the 75th percentile. Comparison of usage, resulted in 4 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 18). Subjects with average weekly usage < 0.94 (15/22) were more likely to have more severe PAH (higher EQ VAS score) at visit 1, worse pulmonary health (higher physician assessed WHO FC score) at visit 1, and experienced more difficulty breathing (modified Borg dyspnea score) at visit 2. Two subjects had average usage < 0.5 (PAH 4, 27), however, both of these subjects removed the device overnight. The third subject who removed the device overnight (PAH 20) also had low average usage (0.60). (Changes in device usage over time are summarized in Supplementary Figs. 19 and 20)./p>320 m (PAH1, 3, 9, 10, 11, 12, 14, 17, 19, 22, 23, 26, 27, 28). Comparison of FL6MWD resulted in 6 statistically significant clinical parameters (Supplementary Table 2 and Supplementary Fig. 23). Notably, subjects with average FL6MWD < 320 m had lower 6MWD at visit 1 and visit 2, experienced more pedal edema (Pedal Edema score) at visit 2, had worse pulmonary health (higher physician-assessed WHO FC) at visit 1, and had lower hemoglobin at visit 2./p> 480 m (PAH3, 23). These subjects were in the fourth quadrant of the PCA plot, which implies that they had a wide range of step rates and heart rates during normal weekly activity, and had ambulation product P values > 1000./p> 400 m (12/22) had higher 6MWD at visit 2, lower NTpro-BNP at visit 2, experienced less chest pain (Angina score) at visit 1, and had better pulmonary health (lower physician-assessed WHO FC) at visit 2 (Supplementary Table 2 and Supplementary Fig. 24)./p>4.0 m/week) (PAH3, 10, 20), and four subjects had a large negative slope (<4.0 m/week) (PAH1, 13, 21, 23)./p> 1 but, as described previously, this subject recorded high FL6MWD values during the first 13 weeks, but then maintained a much lower value in subsequent weeks. It is evident that there is no correlation between the FL6MWD in week 1 and the predicted 6MWD (H6MWD) for an equivalent healthy individual (Fig. 7a)./p>

 0. Three subjects (PAH 30, 2, 20, 11) had health state values below 0.52 in their first and last weeks. These subjects were located along the negative x-axis of the PCA plot, characterized by a large fraction of time inactive./p> 0), ambulation P value, fitness slope. Based on the maximum Bayesian Information Criterion (BIC) (Supplementary Table 3), the subjects were categorized into three groups (Supplementary Fig. 28). Group 1 had high ambulation metrics (steps/day, ambulation product P, and FL6MWD), high HR(SR > 0), and high fitness slope (Supplementary Table 4). Group 2 were characterized by the lowest ambulation metrics (steps/day, ambulation product P, FL6MWD), the lowest HR(SR = 0) and HR(SR > 0), and the highest HR(SR = 0)sk. Group 3 had the highest HR(SR = 0) and HR(SR > 0), the lowest HR(SR = 0)sk and fitness slope. The three groups identified from LPA analysis occupied distinct regions of the PCA plot, with the exception of PAH 10 who was in Group 2 (Supplementary Fig. 29)./p> ±0.5). Albumin was correlated with HR(SR = 0) and HR(SR > 0) at visit 1 (r = 0.565 and 0.627, respectively). NT-proBNP was also correlated with HR(SR = 0) at visit 1 (r = 0.585), and was inversely correlated with fitness slope at visit 1 (r = −0.585). RHR at visits 1 and 2 were correlated with HR(SR = 0), HR(SR = 0)sk, and HR(SR > 0). 6MWD at visits 1 and 2 were correlated with FL6MWD. RVSP at visit 1 was inversely correlated with fitness slope. Notably, steps/day and ambulation P did not have strong correlations to the continuous clinical parameters./p> 0.15 had lower NT-proBNP levels, an important biomarker of cardiac stress, at visits 1 and 2. In addition, this approach may contribute to identification of individuals who would benefit from more frequent clinic visits or specific medications./p> 0), i.e. active). From the distributions of these three metrics we obtained the mean, standard deviation, and the skewness. The heart rates were fit to a normal distribution, and the step rate was fit to a log normal distribution. A scatter plot of step rate versus heart rate provided a weekly signature of cardiovascular activity for each individual. From a linear least-squares fit to the data we obtained the slope (heart rate per step rate (BPM/SPM)). The effective area of the heart rate versus step rate (HR vs. SR) plot was determined by first calculating the upper (lower) envelopes. Each point in the upper and lower envelopes represents the average of the maximum (or minimum) HR values at each value of step count in a bin width of 10 SPM. The envelope point is located at the average step rate for all values with HR values. Step rates with no HR values are omitted from the calculation. Bins with no HR values do not have an envelope point. We then performed a linear least-squares fit to the envelopes to determine the area of the HR-SC plot./p> \,1.0\) is considered large./p> 0):SD, SR(SR > 0):mean, SR(SR > 0):SD, time inactive (fraction of minutes with SR = 0). These parameters were selected to represent heart rate and ambulation metrics and to avoid redundancy. For each parameter we used the average weekly value. The variance for the first two principal components were 48.6% and 30.0%, respectively. For 100 independent runs where we randomly selected different weeks, the mean variance of PC1 and PC2 was 77.5 ± 0.58%./p> 0), ambulation P value, fitness slope, FL6MWD, and usage. LPA was performed through package ‘mclust’ (version 5.4.10) in R (version 4.2.1). The optimal number of clusters was determined based on the maximum Bayesian Information Criterion (BIC) through the function ‘mclustBIC’./p>