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Physical Activity Measured by Hip-Anchored Accelerometry in Pediatric Pulmonary Hypertension: Association With
Mark-Jan Ploegstra1, Rosaria J Ferreira2, Chantal Lokhorst2
1Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Pediatrics, Frisius Medical Center, Leeuwarden, The Netherlands.
Insights
Physical activity (PA) accelerometry is a reliable measure of disease severity in pediatric pulmonary hypertension (PH). This study provides minimally important difference (MID) estimates for PA accelerometry, crucial for improving clinical trial design in pediatric PH.
Area of Science:
- Pediatric cardiology
- Pulmonary medicine
- Biomedical engineering
Background:
- Pediatric pulmonary hypertension (PH) is a severe, incurable condition with limited treatment options and poor prognosis.
- Current clinical trials for pediatric PH are hindered by a lack of age-appropriate endpoints.
- This research investigates physical activity (PA) accelerometry as a potential trial endpoint in pediatric PH.
Purpose of the Study:
- To determine the association between PA accelerometry and disease severity in pediatric PH.
- To establish minimally important differences (MIDs) for PA accelerometry based on disease severity in pediatric PH.
Main Methods:
- Accelerometer data from 54 children with confirmed PH were analyzed.
- Cross-sectional and longitudinal analyses assessed the relationship between PA accelerometry (counts per minute [CPMs] and percentage of time in moderate-to-vigorous PA [%MVPA]) and disease severity indices (6-minute walk distance [6MWD] z scores, World Health Organization functional class [WHO-FC], N-terminal pro-B-type natriuretic peptide [NT-proBNP], and tricuspid annular plane systolic excursion [TAPSE] z scores).
- Anchor-based MID estimations were performed using 6MWD z scores and WHO-FC as anchors.
Main Results:
- Significant associations were found between CPM z scores and WHO-FC, 6MWD z scores, and NT-proBNP levels.
- %MVPA z score was significantly associated with WHO-FC and 6MWD z score.
- Longitudinal analyses confirmed these associations throughout the disease course, with anchor-based MIDs ranging from 0.3 to 0.7 z score units for CPMs and 0.4 to 0.6 z score units for %MVPA.
Conclusions:
- PA accelerometry demonstrates a robust correlation with disease severity in pediatric PH.
- This study provides essential anchor-based MID estimates for hip-anchored PA accelerometry.
- These findings address a critical need in pediatric PH trial design, aiding in the evaluation of treatment efficacy.
Background:
Pediatric pulmonary hypertension (PH) is a severe incurable disease with a poor prognosis. In pediatric PH, trial design is hampered by the absence of age-appropriate trial end points. This study evaluated physical activity (PA) measured by hip-anchored accelerometry as a potential trial end point in pediatric PH.
Research Question:
Is PA accelerometry associated with disease severity, and based on this association, what minimally important differences (MIDs) correspond to meaningful changes in disease severity in pediatric PH?
Study Design And Methods:
Accelerometer outputs from 54 children with hemodynamically confirmed PH were analyzed. Univariable linear regression and mixed-effect models were used for cross-sectional and longitudinal analyses, respectively, (1) to evaluate the association between z scores of PA accelerometry counts per minute (CPMs) and of percentage of time spent in moderate to vigorous PA and disease severity indices 6-minute walk distance (6MWD) z scores, World Health Organization functional class (WHO-FC), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and tricuspid annular plane systolic excursion z scores; and (2) to perform anchor-based MID estimations for CPMs and percentage of time spent in moderate to vigorous PA accelerometry intensity level (%MVPA) z scores, using defined clinical functional impairment levels (6MWD z scores and WHO-FC) as reference anchors.
Results:
When assessing the association between disease severity and PA accelerometry cross-sectionally, we found significant associations between CPM z scores and WHO-FC, 6MWD z scores, and NT-proBNP levels. %MVPA z score was associated significantly with WHO-FC and 6MWD z score. In longitudinal analysis, these associations were confirmed throughout the disease course. MID estimations, expressed in z score units, resulted in mean MIDs of 0.3 to 0.4 CPM z score when anchored to 6MWD z scores, 0.7 CPM z score when anchored to WHO-FC, 0.4 to 0.5 %MVPA z score when anchored to 6MWD z scores, and 0.5 to 0.6 %MVPA z scores when anchored to WHO-FC.
Interpretation:
This study underscored the robust relationship between PA accelerometry and disease severity in children with PH and fills a critical gap in pediatric PH trial design and evaluation of treatment efficacy by providing anchor-based MID estimates for hip-anchored PA accelerometry.
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