CONCLUSIONS Current evidence suggests that D-PA may be useful for assessing physical activity and predicting clinical outcomes in patients with cardiovascular implantable electronic devices when combined with other device parameters .
BACKGROUND  Physical activity  is predictive of cardiovascular outcomes in patients with cardiovascular implantable electronic devices , yet it is not regularly assessed in routine care .
Current-generation cardiovascular implantable electronic devices , however , continuously monitor patient activity through a built-in accelerometer , which provides new opportunities to remotely assess patient activity , detect changes in clinical status , and incorporate these data in risk stratification models .
This review critically examines the literature on device-measured physical activity ( D-PA ) , with a focus on identifying method ological issues that may affect interpretation of study results .
Defibrillator shocks and their effect on objective and subjective patient outcomes: Results of the PainFree SST clinical trial.
BACKGROUND The effect of  implantable cardioverter-defibrillator ( ICD ) shock  on device-measured activity and patient-reported outcomes is unknown . OBJECTIVE The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data ( ie , device-based physical activity ) and subjective patient-reported outcomes ( eg , quality of life and shock anxiety ) . METHODS The PainFree Smart Shock Technology ( SST ) clinical trial included 2770 patients with a single- or dual-chamber ICD or cardiac resynchronization therapy - defibrillator device who were followed for 22 ± 9 months . Participants completed measures of quality of life ( EuroQol-5D [ EQ-5D ] question naire ) and shock anxiety ( Florida Shock Anxiety Scale ) at baseline , biannual visits , and monthly for 6 months after an ICD shock . Daily physical activity data were obtained from a built-in device accelerometer . RESULTS The average daily activity was 185.3 ± 119.4 min/d . Activity was significantly reduced after an ICD shock ( P < .0001 ) and recovered to a normal level after ∼90 days . An ICD shock was also associated with decreased quality of life ( EQ5-D health score ) and increased EQ-5D anxiety scores , but it did not affect mobility , self-care , activity , or pain . Similarly , shock anxiety ( Florida Shock Anxiety Scale ) increased in shocked patients and remained significantly elevated at 24 months , regardless of appropriate or inappropriate shock delivery . CONCLUSION ICD shocks have a long-lasting adverse effect on both objective , device-measured physical activity and subjective patient-reported outcomes of quality of life and shock anxiety . Successful management of patients with an ICD requires attention to clinical ly relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living
CONCLUSIONS Current evidence suggests that D-PA may be useful for assessing physical activity and predicting clinical outcomes in patients with cardiovascular implantable electronic devices when combined with other device parameters .
BACKGROUND  Physical activity  is predictive of cardiovascular outcomes in patients with cardiovascular implantable electronic devices , yet it is not regularly assessed in routine care .
Current-generation cardiovascular implantable electronic devices , however , continuously monitor patient activity through a built-in accelerometer , which provides new opportunities to remotely assess patient activity , detect changes in clinical status , and incorporate these data in risk stratification models .
This review critically examines the literature on device-measured physical activity ( D-PA ) , with a focus on identifying method ological issues that may affect interpretation of study results .