Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study

 When I had a fitbit it assumed any 10 foot gain in elevation was a flight of stairs. Is this talking about real stairs or fitbit stairs?

Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study

• Zimin Song ¹
• Li Wan ¹
• Wenxiu Wang
• 
  
• Robert Clarke
• Lu Qi
• Tao Huang
• Show all authors
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Published:September 15, 2023DOI:https://doi.org/10.1016/j.atherosclerosis.2023.117300

Highlights

• •
  This large cohort of UK adults demonstrated that climbing more than five flights of stairs daily was associated with over a 20% lower risk of ASCVD.
• •
  The associations were broadly concordant in populations with varying susceptibilities to ASCVD.
• •
  Participants who discontinued stair climbing between the baseline and resurvey exhibited a higher risk of ASCVD in comparison to those who never engaged in stair climbing.

Abstract

Background and aims

The associations between intensity of stair climbing and atherosclerotic cardiovascular disease (ASCVD) and how these vary by underlying disease susceptibility are not fully understood. We aim to evaluate the intensity of stair climbing and risk of ASCVD types and whether these vary with the presence of ASCVD risk factors.

Methods

This prospective study used data of 458,860 adult participants from the UK Biobank. Information about stair climbing, sociodemographic, and lifestyle factors was collected at baseline and a resurvey 5 years after baseline. ASCVD was defined as coronary artery disease (CAD), ischemic stroke (IS), or acute complications. Associations between flights of stair climbing and ASCVD were examined as hazard ratios (HRs) from Cox proportional hazards models. The modification role of disease susceptibility on such associations was assessed by analyses stratified by levels of genetic risk score (GRS), 10-year risks of ASCVD, and self-reported family history of ASCVD.

Results

During a median of 12.5 years of follow-up, 39,043 ASCVD, 30,718 CAD, and 10,521 IS cases were recorded. Compared with the reference group (reported climbing stairs 0 times/day at baseline), the multivariable-adjusted HRs for ASCVD were 0.97 (95% CI, 0.93–1.01), 0.84 (0.82–0.87), 0.78 (0.75–0.81), 0.77 (0.73–0.80) and 0.81 (0.77–0.85) for stair climbing of 1–5, 6–10, 11–15, 16–20 and ≥21 times/day, respectively. Comparable results were obtained for CAD and IS. When stratified by different disease susceptibility based on the GRS for CAD/IS, 10-year risk, and family history of ASCVD, the protection association of stair climbing was attenuated by increasing levels of disease susceptibility. Furthermore, compared with people who reported no stair climbing (<5 times/d) at two examinations, those who climbed stairs at baseline and then stopped at resurvey experienced a 32% higher risk of ASCVD (HR 1.32, 95% CI:1.06–1.65).

Conclusions

Climbing more than five flights of stairs (approx 50 steps) daily was associated with a lower risk of ASCVD types independent of disease susceptibility. Participants who stopped stair climbing between baseline and resurvey had a higher risk of ASCVD compared with those who never climbed stairs.

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Fitbit - Russian Railway badge, lifetime distance of 5,772 miles in 4 years

And yet with all this walking not one bit of spasticity has lessened, the leg still swings like a log, left foot is turned out about 15 degrees. And the left foot toes are still clamping down such that on downhill walks in Portugal I was walking on the tips of my toes even with a toe crest in place.  WHOM in the world can solve, not compensate this fucking spasticity? Dr. William M. Landau should know but he happens to think that spasticity is useful in stroke. Well fuck that opinion.

Spasticity After Stroke: Why Bother? Aug. 2004 

Good stroke leadership and a strategy could have gotten around his blockade. Comeuppance would be too good for him. 

Fitbit statistics since July 2014

I could do much better if there was a running protocol after stroke. I could get 10,000 steps in in less than an hour rather than the current 2 hours it takes. But that would require that my spasticity is cured, I don't see that happening before I die.
5585.14 miles - 5585.14/1528 = 3.66 miles per day
11,679,824 steps - 11,679,824/1528 = 7644 steps per day
9313 floors - 9313/1528 = 6 floors per day
All this exercise is allowing me to maintain my weight while still having many social dinners and drinking episodes. Don't follow anything I do. Total of 1528 days.

You've earned the Great Wall badge - 5,500 miles

Started tracking in July, 2014. Only 11,521,974 steps
Yet, all that has done nothing to stop the spasticity curling my left toes, nor the 15 degree left angle of the foot as I walk, nor the free swinging of the lower leg during swing phase.  Cure my spasticity and I could walk normally in no time. My opinion is that Dr. William M. Landau poisoned the well of research with his ideas on spasticity. Good stroke leadership and a strategy could have gotten around  his blockade. Comeuppance would be too good for him. 

Spasticity After Stroke: Why Bother? Aug. 2004

FitBit - You've earned the Africa badge - walking 5,000 miles

Yet, all that has done nothing to stop the spasticity curling my left toes, nor the 15 degree left angle of the foot as I walk, nor the free swinging of the lower leg during swing phase.  Cure my spasticity and I could walk normally in no time. My opinion is that Dr. William M. Landau poisoned the well of research with his ideas on spasticity. Good stroke leadership and a strategy could have gotten around  his blockade. Comeuppance would be too good for him. 

Spasticity After Stroke: Why Bother? Aug. 2004

Does feedback on daily activity level from a Smart watch during inpatient stroke rehabilitation increase physical activity levels?

There already is this out there on Fitbit; I disagree.

Wearing a Fitbit Won't Help You Lose Weight, Experts Say | Inc.com

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2476-z

• Yun Dong,
• Dax Steins,
• Shanbin Sun,
• Fei Li,
• James D. Amor,
• Christopher J. James,
• Zhidao Xia,
• Helen Dawes,
• Hooshang Izadi,
• Yi CaoEmail author,
• Derick T. WadeEmail author and
• Smart watch activity feedback trial committee (SWAFT)

Trials201819:177

https://doi.org/10.1186/s13063-018-2476-z

©  The Author(s). 2018

Received: 13 March 2017

Accepted: 10 January 2018

Published: 9 March 2018

Open Peer Review reports

Abstract

Background

Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activity in hospital inpatients. This study’s goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility.

Methods/design

A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the Second Affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than 4 months after stroke and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to 3 weeks, ending sooner if discharged. The data to be collected in all participants include measures of daily activity (Smart watch measure); mobility (Rivermead Mobility Index and 10-metre walking time); independence in personal care (Barthel Activities of Daily Living (ADL) Index); overall activities (the World Health Organization (WHO) Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by assessors blinded to allocation of the intervention at baseline, 3 weeks or at discharge (whichever is the sooner); and a reduced data set will be collected at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality of life.

Discussion

This project is being implemented in a large city hospital with limited resources and limited research experience. There has been a pilot feasibility study using the Smart watch, which highlighted some areas needing change and these are incorporated in this protocol.

Trial registration

ClinicalTrials.gov, NCT02587585. Registered on 30 September 2015. Chinese Clinical Trial Registry, ChiCTR-IOR-15007179. Registered on 8 August 2015.

Keywords

StrokePhysical activityTechnologyGoal settingFeedback

Background

After stroke, practicing an activity and being active helps increase the speed and/or extent of recovery [1] but it is well-established that most inpatients in stroke rehabilitation settings have low levels of activity [2, 3, 4]. Increasing patients’ self-generated activity is possible through reorganizing care [5, 6] and could potentially play an important role in increasing independence.

Another way to increase activity and therefore to improve recovery of independence is to provide tailored feedback on activity and on progress towards goals. This could increase motivation, self-efficacy, and self-generated activity. Accelerometers can be used to record activity [2], and they can also be used to provide feedback; use of daily data by therapists can increase time spent walking [7]. There are several studies investigating the effect of feedback about physical activity from accelerometers to individuals. Some show no effect [8, 9] but some show beneficial effects [7, 10]. Benefits seem more likely if feedback is supported by other motivational support [11]. Most of these studies were published after the design of this project; there are many other study protocols published but not yet completed.

The primary objective of this study is to determine whether patient feedback about the amount of activity undertaken compared to their activity the previous day, provided at fixed time points during the day, will increase patient activity. We hypothesise that, compared to a control group who do not receive feedback from a Smart watch, those who receive feedback on daily activity will have increased physical activity levels, as measured by the activity scores, with no harms. We also hypothesize that this increased activity during inpatient stroke rehabilitation will result in improved mobility, and possibly cognition, arm function, independence in daily activities, and health-related quality of life. A third objective is to investigate the feasibility of setting up large-scale trials in a research-naïve setting. This protocol follows an initial pilot and feasibility study. (Lawrie S, Gong Y, Steins D, Xia Z, Esser P, Sun S, Li F, Amor J, James C, Izadi H, Chao Y, Wade DT, Dawes H: Augmented Feedback of Daily Activity on Physical Activity Levels after Acute Stroke: a pilot randomised controlled feasibility study, in preparation).

Methods

This study was originally registered with ClinicalTrials.gov on 30 September 2015 (NCT02587585). 

More at link. 

Using pedometers in a short term walking programme boosts long term activity

I bet nothing here will get your stroke doctor and hospital to prescribe pedometers.  I know my Fitbit has kept me walking more than I would without it. Only 13,410,791 steps since July, 2014. It allows me to indulge in drinking and social dinners and not gain weight. This does require that your doctor have an effective stroke protocol to get you walking normally.
https://www.alphagalileo.org/ViewItem.aspx?ItemId=184341&CultureCode=en

08 March 2018 St George's, University of London

Experts have found that people who use pedometers to count their steps as part of a 12-week walking programme, can have a healthier, more active lifestyle three to four years later.
Brisk walking for 30 minutes or more daily on most days of the week can help adults and older adults to achieve important health benefits.
Researchers at St George’s, University of London, compared adults and older adults in two 12-week walking programmes who were using pedometers, with people who did not receive the pedometers and advice. They showed that the pedometer groups were still doing more physical activity three to four years later.
Tess Harris, Professor of Primary Care Research at St George’s, University of London, led two National Institute for Health Research (NIHR) funded trials called PACE-UP and PACE-Lift which had similar components: pedometers; 12-week walking programmes based on behaviour change techniques; and physical activity diaries. The material, advice and pedometers were provided either by post or as part of practice nurse physical activity consultations.
The PACE-UP trial recruited 1023 inactive 45-75 year old primary care patients from seven London general practices. It found at three-year follow-up that those in both the postal and the nurse advice groups were still doing approximately an extra 600 steps per day and 24-28 extra minutes of moderate-to-vigorous physical activity weekly, in 10 minute bouts, than those in the comparison group who had received usual care.
The PACE-Lift trial recruited 298 primary care patients aged 60-75 years from three Oxfordshire and Berkshire GP practices. It found that at four-year follow-up, those in the nurse intervention group were doing approximately an extra 400 steps per day and an extra 33 minutes per week of moderate-to-vigorous physical activity in 10 minute bouts, compared to the group who had received usual care.
Professor Harris said, “We knew that pedometers could improve physical activity levels in the population in the short-term, but long-term health benefits require sustained increases in physical activity levels.
“What is unique about this study is that we have shown that short, simple pedometer-based walking interventions, whether delivered by post, or with advice and support from practice nurses, can lead to greater objectively measured physical activity levels three to four years later.”
The research has been published in the journal PLOS Medicine

• Full bibliographic informationTitle: “Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions:- long-term follow-up of participants from two randomised controlled trials in UK primary care” (PMEDICINE/journal.pmed.1002526)
  PLOSMedicine website: http://journals.plos.org/plosmedicine

Activity trackers: Can they really help you get fit?

I know mine helps me. If I'm short by 10pm I'll go out and get to 10,000 steps. With only eating two meals a day and this walking I've lost 20 lbs., still 15 to go.
https://www.health.harvard.edu/blog/activity-trackers-help-you-get-fit-2017102312594

FitBit - You've earned the Nile badge - walking 4,132 miles

Yet, all that has done nothing to stop the spasticity curling my left toes, nor the 15 degree left angle of the foot as I walk, nor the free swinging of the lower leg during swing phase.  Cure my spasticity and I could walk normally in no time. My opinion is that Dr. William M. Landau poisoned the well of research with his ideas on spasticity. Good stroke leadership and a strategy could have gotten around  his blockade. Comeuppance would be too good for him. 

Spasticity After Stroke: Why Bother? Aug. 2004

Fitbit statistics since July 2014

I could do much better if there was a running protocol after stroke. I could get 10,000 steps in in less than an hour rather than the current 2 hours it takes.  But that would require that my spasticity is cured, I don't see that happening before I die.
3,900.50 miles - 3,900.50/1122 = 3.476 miles per day
8,151,100 steps - 8,151,100/1122 = 7265 steps per day
6,838 floors - 6838/1122 =  6 floors per day
All this exercise is allowing me to maintain my weight while still having many social dinners and drinking episodes. Don't follow anything I do. 

Total of 1122 days. 

Accurately detecting heart attacks and strokes with Apple Watch and fitbits

Or you could do the expensive testing in the hospital. 

Accurately detecting heart attacks and strokes with Apple Watch and fitbits

Heartbeat measurement app Cardiogram and the University of California, San Francisco used the Apple Watch for 97 percent accurate detection the most common abnormal heart rhythm when paired with an AI-based algorithm.
The study involved 6,158 participants recruited through the Cardiogram app on Apple Watch. Most of the participants in the UCSF Health eHeart study had normal EKG readings. However, 200 of them had been diagnosed with paroxysmal atrial fibrillation (an abnormal heartbeat). Engineers trained a deep neural network to identify these abnormal heart rhythms from Apple Watch heart rate data.
About a quarter of strokes are caused by an abnormal heart rhythm, according to Cardiogram co-founder and data scientist for UCSF’s eHeart study Brandon Ballinger.
Two-thirds of those types of strokes are preventable with relatively inexpensive drugs.
Digital health company AliveCor and Rochester, MN-based Mayo Clinic are teaming up to glean new insights from data captured with AliveCor’s mobile ECG device.
The Mobile EKG sticks onto the back of a smartphone and uses the Kardia app to determine abnormal heart rhythm, and determined it was as good as other EKG devices used in the doctor’s office. The Mayo Clinic felt invested in AliveCor’s latest $30 million round.

Together, the Mountain View, CA-based company and Mayo will apply AliveCor’s machine learning technology to 10 million ECG recordings taken by users of the company’s Kardia product, an FDA-cleared mobile device that pairs with smartphones to measure electrical activity in the heart. The goal is to “uncover hidden physiological signals to improve heart and overall human health,” according to a press release.
In particular, the findings could lead to insights about the relationship between cardiac arrhythmias and changes in blood potassium levels, which can indicate kidney failure.
“Working with Mayo Clinic, we are hopeful that soon physicians will be turning to ECG data for the care of many types of patients, not just those with typical cardiovascular issues,” Dave Albert, MD, AliveCor’s chief medical officer, said in the press release.

A randomised controlled trial of three very brief interventions for physical activity in primary care

I bet your stroke hospital can't even justify spending a couple of bucks on a cheap pedometer. I would just demand they prescribe you a Fitbit.
https://www.ncbi.nlm.nih.gov/pubmed/27716297

Pears S^1,2, Bijker M¹, Morton K^1,3, Vasconcelos J⁴, Parker RA⁵, Westgate K⁶, Brage S⁶, Wilson E^7,2, Prevost AT^4,2, Kinmonth AL^3,2, Griffin S^3,2, Sutton S^1,2, Hardeman W^8,9,10; VBI Programme Team.

Author information

Abstract

BACKGROUND:

Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT.

METHODS:

Three hundred and ninety four adults aged 40-74 years were randomised to a Motivational (n = 83), Pedometer (n = 74), or Combined (n = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; n = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks.

RESULTS:

For the primary outcome the estimated effect sizes (95 % CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (-45.0, +85.7), +23.5 (-51.3, +98.3), and -3.1 (-69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost.

CONCLUSIONS:

Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial.

TRIAL REGISTRATION:

Current Controlled Trials ISRCTN02863077 . Retrospectively registered 05/10/2012.

FitBit - Hot Air Balloon badge - Your lifetime floor count has hit 2000

As long as my feet don't pain me too much, this walking is helping me keep my weight in check. My spasticity in my left leg still doesn't allow a smooth step upward. I would expect any PT in the world that works on stroke would know exactly how to correct that problem. But I know damn well that isn't happening.
With this series of images from Nathan Nicholson I finally got the understanding that you don't just lift the foot straight up, you  engage your hamstring to pull your leg up behind you at the same time pointing your toes down(plantarflexxing) to clear the lip of the step. I have to plan this all out on my own since most of my premotor cortex is dead. This currently is a very slow process.
1. Engage the hamstring
2. Point the toes down - plantarflexing 
3. Clear the step
4. Dorsiflex to lift the toe up
5. Straighten the leg 

FitBit New Zealand badge - You've walked 990 lifetime miles

This is since July 2014 and I'm not even trying for my 10,000 steps a day right now. The gait is still screwed up because of fucking spasticity.

Wicked cool! You've climbed 100 floors - 116 in total

That's some pretty slick stair-climbing you've been doing! By taking yourself to skyscraping heights, you've earned the Skyscraper badge.

2015 resolution

I only have one. Walking 70,000 steps a week, that should be enough to slowly reduce my weight but still allow me all my social food connections with wine and beer. I decided not to do the 10,000 steps a day because I know that there will be some days I absolutely can't accomplish that. This allows me to bank some extra steps on good days. Today went out and walked the natural area trails behind the complex. Got in 11,000 steps in 2.5 hours. I'll go out again this evening and get in 3-5,000 more steps.

Fitbit Serengeti badge - 500 miles of walking

Started using this at the beginning of July, also lost 10 lbs. in that time frame. It doesn't help that I continually go to dinner social functions and then consume wine and beer afterwards. I try to get in 10,000 steps every day which is about 5 miles.

Success at 10,000 daily steps via Fitbit

In the past week I managed to get 6 out of 7 days of more than 10,000 steps.
Weekends are not too difficult, I walk the natural area behind the apartments, depending on the loops I do I can get 3-7 thousand steps done in an hour. Weekdays I have to do 3 5-10 minutes walks during the workday and for lunch walk a half mile each way.  That usually leaves me with needing 5-6,000 steps after work. That's doable by changing into walking shoes, grabbing several cigars for smoking as I walk and purposely striding along. Cigars are necessary as that forces me to look ahead rather than down at my feet as I walk. This challenges me a lot since the trails are covered in roots, branches and leaves and you have to react to balance problems by proprioception rather than visual sight. Soon this will become even more difficult as I will be doing this in the dark. This is an incentive to get in more exercise since in the process of getting socially connected here in Michigan I joined lots of Meetup groups, with lots of dinner and drinking get togethers. As a result I'm 35 pounds over what I should weigh. At 10 o'clock I check to see if I need to make a 500 step loop around the apartments or even more.  A PT would tell me my walking does not look good and is inefficient. I'll correct that whenever the hell I get my spasticity stopped

Saturday October 18

Sunday October 19

Monday October 20, not a good day, I spent 8 hours at work solving another coworkers problem and had a 2 hour wine class immediately after work. Not enough time to get in 10,000 steps and I didn't feel like even trying.

Tuesday October 21

Wednesday October 22

Thursday October 23

Friday October 24