Clinical trial NCT06239831: Postoperative Respiratory and Activity Monitoring
Official title: Postoperative Respiratory and Activity Monitoring
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Hypoventilation
Hypoxemia
Postoperative Pulmonary Complications
Keywords: hypoventilation
postoperative activity
abdominal surgery
mobilization
predicted minute ventilation (MVPred)
accelerometer
chest monitor
postoperative pulmonary complications
surgical outcomes
Lead sponsor: University of Colorado, Denver
Sponsor class: OTHER
Collaborators: name: Brigham and Women's Hospital
First posted: 2024-02-02
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients over the age of 18 undergoing abdominal surgery at the University of Colorado Health Hospital (UCHealth) that it high-risk for postoperative pulmonary complications (PPCs).

Brief summary: This study plans to learn more about specific breathing and activity recommendations for patients after surgery. Participants will be monitored after abdominal surgery to identify what activities help them breathe better and reduce complications after surgery.

Detailed description: Investigators will study adults undergoing elective abdominal surgery with at least moderate risk for postoperative pulmonary complications.

Participants will be monitored on their chest and thigh with devices that record their breathing pattern (breath volume and frequency) and body position and movements. These monitors will be placed on their skin in the Post-Anesthesia Care Unit (PACU) and will stay on for three days, or until the patient is able to ambulate freely or until their hospital discharge, whichever comes earlier. Investigators will analyze the association between the frequency, duration and intensity of various activities (e.g., sitting, walking) and breathing and other clinical complications, in combination with medications received and other hospital course events.

Eligibility criteria: Inclusion Criteria:

* Must be 18 or older
* Must be undergoing abdominal surgery
* Must be high-risk for PPCs (ARISCAT score equal to or greater than 26)

Exclusion Criteria:

* Anyone under 18
* Anyone not undergoing abdominal surgery
* Anyone that is not high-risk for PPCs (ARISCAT score less than 26)

Primary outcomes:
measure: Hypoventilation
timeFrame: First 3 postoperative days
Secondary outcomes:
measure: Variability of MV
timeFrame: Through postoperative day 3
measure: Variability of VT
timeFrame: Through postoperative day 3
measure: Variability of RR
timeFrame: Through postoperative day 3
measure: Events of Low MV
timeFrame: Through postoperative day 3
measure: Events of Low VT
timeFrame: Through postoperative day 3
measure: Events of Low RR
timeFrame: Through postoperative day 3
measure: Percentage of time free of low or high MV
timeFrame: Through postoperative day 3
measure: Percentage of time free of low or high VT
timeFrame: Through postoperative day 3
measure: Percentage of time free of low or high RR
timeFrame: Through postoperative day 3
measure: Duration of low MV
timeFrame: Through postoperative day 3
measure: Duration of low VT
timeFrame: Through postoperative day 3
measure: Duration of low RR
timeFrame: Through postoperative day 3
measure: Duration of high MV
timeFrame: Through postoperative day 3
measure: Duration of high TV
timeFrame: Through postoperative day 3
measure: Duration of high RR
timeFrame: Through postoperative day 3
measure: Postoperative Pulmonary Complication (PPC) Incidence
timeFrame: Through postoperative day 7
measure: Postoperative Pulmonary Complication (PPC) Severity
timeFrame: Through postoperative day 7
measure: Time After Surgery to Sitting
timeFrame: Through postoperative day 3
measure: Time After Surgery to Ambulating
timeFrame: Through postoperative day 3
measure: Total Minutes Walking
timeFrame: Through postoperative day 3
measure: Total Walking Distance
timeFrame: Through postoperative day 3
measure: Frequency of Ambulation
timeFrame: Through postoperative day 3
measure: Time Spent in Bed
timeFrame: Through postoperative day 3
measure: Time Spent in Sitting
timeFrame: Through postoperative day 3
measure: Time Spent Standing
timeFrame: Through postoperative day 3
measure: Time Spent Walking
timeFrame: Through postoperative day 3
measure: Average Speed of Ambulation
timeFrame: Through postoperative day 3
measure: First Postoperative Day Achieving Independent Ambulation
timeFrame: Through postoperative day 3
measure: Metabolic Equivalent of Task (MET) Score of Physical Activity
timeFrame: Through postoperative day 3
measure: Other complications
timeFrame: Through postoperative day 7
measure: Adverse events
timeFrame: Through postoperative day 7
Other outcomes:
Locations:
city: Aurora
country: United States
facility: UC Health
state: Colorado
Study officials:
affiliation: University of Colorado Anschutz Medical Campus, University of Colorado Health Hospital
name: Ana Fernandez-Bustamante, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Fernandez-Bustamante A, Parker RA, Sprung J, Eikermann M, Gama de Abreu M, Ferrando C, Thompson BT, Vidal Melo MF. An anesthesia-centered bundle to reduce postoperative pulmonary complications: The PRIME-AIR study protocol. PLoS One. 2023 Apr 6;18(4):e0283748. doi: 10.1371/journal.pone.0283748. eCollection 2023.
citation: Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med. 1995 Dec;10(12):671-8. doi: 10.1007/BF02602761.
citation: Fernandez-Perez ER, Sprung J, Afessa B, Warner DO, Vachon CM, Schroeder DR, Brown DR, Hubmayr RD, Gajic O. Intraoperative ventilator settings and acute lung injury after elective surgery: a nested case control study. Thorax. 2009 Feb;64(2):121-7. doi: 10.1136/thx.2008.102228. Epub 2008 Nov 6.
citation: Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabate S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010 Dec;113(6):1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a.
citation: Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med. 2011 Sep;39(9):2163-72. doi: 10.1097/CCM.0b013e31821f0522.
citation: Nijbroek SG, Schultz MJ, Hemmes SNT. Prediction of postoperative pulmonary complications. Curr Opin Anaesthesiol. 2019 Jun;32(3):443-451. doi: 10.1097/ACO.0000000000000730.
citation: Kor DJ, Lingineni RK, Gajic O, Park PK, Blum JM, Hou PC, Hoth JJ, Anderson HL 3rd, Bajwa EK, Bartz RR, Adesanya A, Festic E, Gong MN, Carter RE, Talmor DS. Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study. Anesthesiology. 2014 May;120(5):1168-81. doi: 10.1097/ALN.0000000000000216.
citation: Sabate S, Mazo V, Canet J. Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol. 2014 Apr;27(2):201-9. doi: 10.1097/ACO.0000000000000045.
citation: Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, Eikermann M. Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology. 2013 Jun;118(6):1276-85. doi: 10.1097/ALN.0b013e318293065c.
citation: LAS VEGAS investigators. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol. 2017 Aug;34(8):492-507. doi: 10.1097/EJA.0000000000000646.
citation: Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37. doi: 10.1056/NEJMoa1301082.
citation: PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology; Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9;384(9942):495-503. doi: 10.1016/S0140-6736(14)60416-5. Epub 2014 Jun 2.
citation: Milot J, Perron J, Lacasse Y, Letourneau L, Cartier PC, Maltais F. Incidence and predictors of ARDS after cardiac surgery. Chest. 2001 Mar;119(3):884-8. doi: 10.1378/chest.119.3.884.
citation: Blum JM, Stentz MJ, Dechert R, Jewell E, Engoren M, Rosenberg AL, Park PK. Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology. 2013 Jan;118(1):19-29. doi: 10.1097/ALN.0b013e3182794975.
citation: Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, Lee JW, Henderson WG, Moss A, Mehdiratta N, Colwell MM, Bartels K, Kolodzie K, Giquel J, Vidal Melo MF. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017 Feb 1;152(2):157-166. doi: 10.1001/jamasurg.2016.4065.
citation: Sun Z, Sessler DI, Dalton JE, Devereaux PJ, Shahinyan A, Naylor AJ, Hutcherson MT, Finnegan PS, Tandon V, Darvish-Kazem S, Chugh S, Alzayer H, Kurz A. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015 Sep;121(3):709-715. doi: 10.1213/ANE.0000000000000836.
citation: Bartels K, Kaizer A, Jameson L, Bullard K, Dingmann C, Fernandez-Bustamante A. Hypoxemia Within the First 3 Postoperative Days Is Associated With Increased 1-Year Postoperative Mortality After Adjusting for Perioperative Opioids and Other Confounders. Anesth Analg. 2020 Aug;131(2):555-563. doi: 10.1213/ANE.0000000000004553.
citation: Bojesen RD, Fitzgerald P, Munk-Madsen P, Eriksen JR, Kehlet H, Gogenur I. Hypoxaemia during recovery after surgery for colorectal cancer: a prospective observational study. Anaesthesia. 2019 Aug;74(8):1009-1017. doi: 10.1111/anae.14691. Epub 2019 May 17.
citation: Belcher AW, Khanna AK, Leung S, Naylor AJ, Hutcherson MT, Nguyen BM, Makarova N, Sessler DI, Devereaux PJ, Saager L. Long-Acting Patient-Controlled Opioids Are Not Associated With More Postoperative Hypoxemia Than Short-Acting Patient-Controlled Opioids After Noncardiac Surgery: A Cohort Analysis. Anesth Analg. 2016 Dec;123(6):1471-1479. doi: 10.1213/ANE.0000000000001534.
citation: Zeng C, Lagier D, Lee JW, Vidal Melo MF. Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms. Anesthesiology. 2022 Jan 1;136(1):181-205. doi: 10.1097/ALN.0000000000003943.
citation: Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010 Jun;24(2):157-69. doi: 10.1016/j.bpa.2009.12.002.
citation: Brooks-Brunn JA. Postoperative atelectasis and pneumonia: risk factors. Am J Crit Care. 1995 Sep;4(5):340-9; quiz 350-1.
citation: Hewlett AM, Branthwaite MA. Postoperative pulmonary function. Br J Anaesth. 1975 Feb;47(2):102-7. doi: 10.1093/bja/47.2.102. No abstract available.
citation: Zwillich C, Kryger M, Weil J. Hypoventilation: consequences and management. Adv Intern Med. 1978;23:287-306. No abstract available.
citation: Craig DB, Wahba WM, Don HF, Couture JG, Becklake MR. "Closing volume" and its relationship to gas exchange in seated and supine positions. J Appl Physiol. 1971 Nov;31(5):717-21. doi: 10.1152/jappl.1971.31.5.717. No abstract available.
citation: Noba L, Rodgers S, Chandler C, Balfour A, Hariharan D, Yip VS. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis. J Gastrointest Surg. 2020 Apr;24(4):918-932. doi: 10.1007/s11605-019-04499-0. Epub 2020 Jan 3.
citation: Ripolles-Melchor J, Ramirez-Rodriguez JM, Casans-Frances R, Aldecoa C, Abad-Motos A, Logrono-Egea M, Garcia-Erce JA, Camps-Cervantes A, Ferrando-Ortola C, Suarez de la Rica A, Cuellar-Martinez A, Marmana-Mezquita S, Abad-Gurumeta A, Calvo-Vecino JM; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg. 2019 Aug 1;154(8):725-736. doi: 10.1001/jamasurg.2019.0995.
citation: Lillemoe HA, Aloia TA. Enhanced Recovery After Surgery: Hepatobiliary. Surg Clin North Am. 2018 Dec;98(6):1251-1264. doi: 10.1016/j.suc.2018.07.011. Epub 2018 Aug 24.
citation: Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.
citation: Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007635. doi: 10.1002/14651858.CD007635.pub2.
citation: Castelino T, Fiore JF Jr, Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery. 2016 Apr;159(4):991-1003. doi: 10.1016/j.surg.2015.11.029. Epub 2016 Jan 21.
citation: Lumb AB, Nunn JF. Respiratory function and ribcage contribution to ventilation in body positions commonly used during anesthesia. Anesth Analg. 1991 Oct;73(4):422-6. doi: 10.1213/00000539-199110000-00010.
citation: Meyers JR, Lembeck L, O'Kane H, Baue AE. Changes in functional residual capacity of the lung after operation. Arch Surg. 1975 May;110(5):576-83. doi: 10.1001/archsurg.1975.01360110122020.
citation: Ceylan B, Khorshid L, Gunes UY, Zaybak A. Evaluation of oxygen saturation values in different body positions in healthy individuals. J Clin Nurs. 2016 Apr;25(7-8):1095-100. doi: 10.1111/jocn.13189. Epub 2016 Feb 16.
citation: Hardie JA, Morkve O, Ellingsen I. Effect of body position on arterial oxygen tension in the elderly. Respiration. 2002;69(2):123-8. doi: 10.1159/000056314.
citation: van der Leeden M, Huijsmans R, Geleijn E, de Lange-de Klerk ES, Dekker J, Bonjer HJ, van der Peet DL. Early enforced mobilisation following surgery for gastrointestinal cancer: feasibility and outcomes. Physiotherapy. 2016 Mar;102(1):103-10. doi: 10.1016/j.physio.2015.03.3722. Epub 2015 May 7.
citation: Haines KJ, Skinner EH, Berney S; Austin Health POST Study Investigators. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy. 2013 Jun;99(2):119-25. doi: 10.1016/j.physio.2012.05.013. Epub 2012 Sep 23.
citation: Jonsson LR, Ingelsrud LH, Tengberg LT, Bandholm T, Foss NB, Kristensen MT. Physical performance following acute high-risk abdominal surgery: a prospective cohort study. Can J Surg. 2018 Feb;61(1):42-49. doi: 10.1503/cjs.012616. Epub 2017 Dec 1.
citation: Cassidy MR, Rosenkranz P, McCabe K, Rosen JE, McAneny D. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg. 2013 Aug;148(8):740-5. doi: 10.1001/jamasurg.2013.358.
citation: Oliver CM, Warnakulasuriya S, McGuckin D, Singleton G, Martin P, Santos C, Bedford J, Wagstaff D, Sahni A, Gilhooly D, Wilson J, Edwards K, Baumber R, Vindrola-Padros C, Dorey J, Leeman I, Boyd-Carson H, Vohra R, Singh P, Bedford M, Vallance A, Aresu G, Tucker O, Swart M, Mythen MG; PQIP project delivery team; Moonesinghe SR; PQIP collaborative. Delivery of drinking, eating and mobilising (DrEaMing) and its association with length of hospital stay after major noncardiac surgery: observational cohort study. Br J Anaesth. 2022 Jul;129(1):114-126. doi: 10.1016/j.bja.2022.03.021. Epub 2022 May 12.
citation: Grass F, Pache B, Martin D, Addor V, Hahnloser D, Demartines N, Hubner M. Feasibility of early postoperative mobilisation after colorectal surgery: A retrospective cohort study. Int J Surg. 2018 Aug;56:161-166. doi: 10.1016/j.ijsu.2018.06.024. Epub 2018 Jun 20.
citation: Fiore JF Jr, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn O, Liberman S, Charlebois P, Stein B, Carli F, Mayo NE, Feldman LS. Ensuring Early Mobilization Within an Enhanced Recovery Program for Colorectal Surgery: A Randomized Controlled Trial. Ann Surg. 2017 Aug;266(2):223-231. doi: 10.1097/SLA.0000000000002114.
citation: Balvardi S, Pecorelli N, Castelino T, Niculiseanu P, Alhashemi M, Liberman AS, Charlebois P, Stein B, Carli F, Mayo NE, Feldman LS, Fiore JF Jr. Impact of Facilitation of Early Mobilization on Postoperative Pulmonary Outcomes After Colorectal Surgery: A Randomized Controlled Trial. Ann Surg. 2021 May 1;273(5):868-875. doi: 10.1097/SLA.0000000000003919.
citation: Pottenger BC, Pronovost PJ, Kreif J, Klein L, Hobson D, Young D, Hoyer EH. Towards improving hospital workflows: An evaluation of resources to mobilize patients. J Nurs Manag. 2019 Jan;27(1):27-34. doi: 10.1111/jonm.12644. Epub 2018 Aug 16.
citation: Schumann R, Kwater AP, Bonney I, Ladd D, Kim J, Gupta A, Gumbert SD, Pivalizza EG. Respiratory volume monitoring in an obese surgical population and the prediction of postoperative respiratory depression by the STOP-bang OSA risk score. J Clin Anesth. 2016 Nov;34:295-301. doi: 10.1016/j.jclinane.2016.04.029. Epub 2016 Jun 1.
citation: Mehta JH, Cattano D, Brayanov JB, George EE. Assessment of perioperative minute ventilation in obese versus non-obese patients with a non-invasive respiratory volume monitor. BMC Anesthesiol. 2017 Apr 26;17(1):61. doi: 10.1186/s12871-017-0352-0.
citation: Cella D, Choi SW, Condon DM, Schalet B, Hays RD, Rothrock NE, Yount S, Cook KF, Gershon RC, Amtmann D, DeWalt DA, Pilkonis PA, Stone AA, Weinfurt K, Reeve BB. PROMIS(R) Adult Health Profiles: Efficient Short-Form Measures of Seven Health Domains. Value Health. 2019 May;22(5):537-544. doi: 10.1016/j.jval.2019.02.004.
citation: Atkinson DB, Sens BA, Bernier RS, Gomez-Morad AD, Imsirovic J, Nasr VG. The Evaluation of a Noninvasive Respiratory Volume Monitor in Mechanically Ventilated Neonates and Infants. Anesth Analg. 2022 Jan 1;134(1):141-148. doi: 10.1213/ANE.0000000000005562.
citation: Gomez-Morad AD, Cravero JP, Harvey BC, Bernier R, Halpin E, Walsh B, Nasr VG. The Evaluation of a Noninvasive Respiratory Volume Monitor in Pediatric Patients Undergoing General Anesthesia. Anesth Analg. 2017 Dec;125(6):1913-1919. doi: 10.1213/ANE.0000000000002029.
citation: Gonzalez Castro LN, Mehta JH, Brayanov JB, Mullen GJ. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor. PLoS One. 2017 Feb 24;12(2):e0172750. doi: 10.1371/journal.pone.0172750. eCollection 2017.
citation: Ebert TJ, Middleton AH, Makhija N. Ventilation monitoring during moderate sedation in GI patients. J Clin Monit Comput. 2017 Feb;31(1):53-57. doi: 10.1007/s10877-015-9809-1. Epub 2015 Dec 1.
citation: van den Bosch OFC, Alvarez-Jimenez R, Stam MMH, den Boer FC, Loer SA. Variations in respiratory rate do not reflect changes in tidal volume or minute ventilation after major abdominal surgery. J Clin Monit Comput. 2021 Aug;35(4):787-796. doi: 10.1007/s10877-020-00538-3. Epub 2020 Jun 1.
citation: Williams GW 2nd, George CA, Harvey BC, Freeman JE. A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpiron Noninvasive Respiratory Volume Monitor Versus the Capnostream Capnometer. Anesth Analg. 2017 Jan;124(1):120-126. doi: 10.1213/ANE.0000000000001395.
citation: O'Brien CM, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS, Metsios GS, Fenton SAM. Measurement of sedentary time and physical activity in rheumatoid arthritis: an ActiGraph and activPAL validation study. Rheumatol Int. 2020 Sep;40(9):1509-1518. doi: 10.1007/s00296-020-04608-2. Epub 2020 May 29.
citation: Crowley P, Skotte J, Stamatakis E, Hamer M, Aadahl M, Stevens ML, Rangul V, Mork PJ, Holtermann A. Comparison of physical behavior estimates from three different thigh-worn accelerometers brands: a proof-of-concept for the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS). Int J Behav Nutr Phys Act. 2019 Aug 16;16(1):65. doi: 10.1186/s12966-019-0835-0.
citation: Rosenberger ME, Buman MP, Haskell WL, McConnell MV, Carstensen LL. Twenty-four Hours of Sleep, Sedentary Behavior, and Physical Activity with Nine Wearable Devices. Med Sci Sports Exerc. 2016 Mar;48(3):457-65. doi: 10.1249/MSS.0000000000000778.
citation: Lyden K, John D, Dall P, Granat MH. Differentiating Sitting and Lying Using a Thigh-Worn Accelerometer. Med Sci Sports Exerc. 2016 Apr;48(4):742-7. doi: 10.1249/MSS.0000000000000804.
citation: Steeves JA, Bowles HR, McClain JJ, Dodd KW, Brychta RJ, Wang J, Chen KY. Ability of thigh-worn ActiGraph and activPAL monitors to classify posture and motion. Med Sci Sports Exerc. 2015 May;47(5):952-9. doi: 10.1249/MSS.0000000000000497.
citation: Creasy SA, Crane TE, Garcia DO, Thomson CA, Kohler LN, Wertheim BC, Baker LD, Coday M, Hale L, Womack CR, Wright KP, Melanson EL. Higher amounts of sedentary time are associated with short sleep duration and poor sleep quality in postmenopausal women. Sleep. 2019 Jul 8;42(7):zsz093. doi: 10.1093/sleep/zsz093.
citation: Ostendorf DM, Lyden K, Pan Z, Wyatt HR, Hill JO, Melanson EL, Catenacci VA. Objectively Measured Physical Activity and Sedentary Behavior in Successful Weight Loss Maintainers. Obesity (Silver Spring). 2018 Jan;26(1):53-60. doi: 10.1002/oby.22052. Epub 2017 Nov 1.
citation: Carney MJ, Weissler JM, Fox JP, Tecce MG, Hsu JY, Fischer JP. Trends in open abdominal surgery in the United States-Observations from 9,950,759 discharges using the 2009-2013 National Inpatient Sample (NIS) datasets. Am J Surg. 2017 Aug;214(2):287-292. doi: 10.1016/j.amjsurg.2017.01.001. Epub 2017 Jan 12.