{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:33:56Z","timestamp":1792107236872,"version":"4.4.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T00:00:00Z","timestamp":1501545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The frail phenotype has gained popularity as a clinically relevant measure in adults with advanced lung disease and in critical illness survivors. Because respiratory disease and chronic illness can greatly limit physical activity, the measurement of participation in traditional leisure time activities as a frailty component may lead to substantial misclassification of frailty in pulmonary and critical care patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test and validate substituting the Duke Activity Status Index (DASI), a simple 12-item questionnaire, for the Minnesota Leisure Time Physical Activity (MLTA) questionnaire, a detailed questionnaire covering 18 leisure time activities, as the measure of low activity in the Fried frailty phenotype (FFP) instrument.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In separate multicenter prospective cohort studies of adults with advanced lung disease who were candidates for lung transplant and older survivors of acute respiratory failure, we assessed the FFP using either the MLTA or the DASI. For both the DASI and MLTA, we evaluated content validity by testing floor effects and construct validity through comparisons with conceptually related factors. We tested the predictive validity of substituting the DASI for the MLTA in the FFP assessment using Cox models to estimate associations between the FFP and delisting\/death before transplant in those with advanced lung disease and 6-month mortality in older intensive care unit (ICU) survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 618 adults with advanced lung disease and 130 older ICU survivors, the MLTA had a substantially greater floor effect than the DASI (42% vs. 1%, and 49% vs. 12%, respectively). The DASI correlated more strongly with strength and function measures than did the MLTA in both cohorts. In models adjusting for age, sex, comorbidities, and illness severity, substitution of the DASI for the MLTA led to stronger associations of the FFP with delisting\/death in lung transplant candidates (FFP-MLTA hazard ratio [HR], 1.42; 95% confidence interval [CI], 0.55\u20133.65; FFP-DASI HR, 2.99; 95% CI, 1.03\u20138.65) and with mortality in older ICU survivors (FFP-MLTA HR, 2.68; 95% CI, 0.62\u201311.6; FFP-DASI HR, 5.71; 95% CI, 1.34\u201324.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The DASI improves the construct and predictive validity of frailty assessment in adults with advanced lung disease or recent critical illness. This simple questionnaire should replace the more complex MLTA in assessing the frailty phenotype in these populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201612-1008oc","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T10:36:19Z","timestamp":1491906979000},"page":"1270-1279","source":"Crossref","is-referenced-by-count":42,"title":["Refining Low Physical Activity Measurement Improves Frailty Assessment in Advanced Lung Disease and Survivors of Critical Illness"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4670-3433","authenticated-orcid":false,"given":"Matthew R.","family":"Baldwin","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-7472","authenticated-orcid":false,"given":"Jonathan P.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Sell","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy C.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren R.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew S.","family":"Maurer","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank F.","family":"D\u2019Ovidio","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians & Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bacchetta","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians & Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Sonett","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians & Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selim M.","family":"Arcasoy","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Hays","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasleen","family":"Kukreja","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Greenland","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupal J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorriana","family":"Leard","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Morrell","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gries","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia P.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California\u2013San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Christie","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Diamond","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-0228","authenticated-orcid":false,"given":"David J.","family":"Lederer","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Physicians & Surgeons"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,8,1]]},"reference":[{"key":"2026020403000078300_bib1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/gerona\/59.3.M255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care","volume":"59","author":"Fried","year":"2004","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026020403000078300_bib2","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1100\/tsw.2001.58","article-title":"Accumulation of deficits as a proxy measure of aging","volume":"1","author":"Mitnitski","year":"2001","journal-title":"Sci World J"},{"key":"2026020403000078300_bib3","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026020403000078300_bib4","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/gerona\/61.3.262","article-title":"Phenotype of frailty: characterization in the women\u2019s health and aging studies","volume":"61","author":"Bandeen-Roche","year":"2006","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026020403000078300_bib5","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.jamcollsurg.2010.01.028","article-title":"Frailty as a predictor of surgical outcomes in older patients","volume":"210","author":"Makary","year":"2010","journal-title":"J Am Coll Surg"},{"key":"2026020403000078300_bib6","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.amjmed.2005.01.062","article-title":"Frailty, hospitalization, and progression of disability in a cohort of disabled older women","volume":"118","author":"Boyd","year":"2005","journal-title":"Am J Med"},{"key":"2026020403000078300_bib7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1177\/2150131915603202","article-title":"The frequency of frailty in ambulatory patients with chronic lung diseases","volume":"7","author":"Mittal","year":"2016","journal-title":"J Prim Care Community Health"},{"key":"2026020403000078300_bib8","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/gerona\/glv154","article-title":"Risk of frailty in elderly with COPD: a population-based study","volume":"71","author":"Lahousse","year":"2016","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026020403000078300_bib9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.amjmed.2011.06.024","article-title":"Frailty and respiratory impairment in older persons","volume":"125","author":"Vaz Fragoso","year":"2012","journal-title":"Am J Med"},{"key":"2026020403000078300_bib10","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/BF03351076","article-title":"Role of clinical frailty on long-term mortality of elderly subjects with and without chronic obstructive pulmonary disease","volume":"23","author":"Galizia","year":"2011","journal-title":"Aging Clin Exp Res"},{"key":"2026020403000078300_bib11","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1164\/rccm.201506-1150OC","article-title":"Frailty phenotypies, disability, and outcomes in adult candidates for lung transplantation","volume":"192","author":"Singer","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2026020403000078300_bib12","doi-asserted-by":"crossref","first-page":"E95","DOI":"10.1503\/cmaj.130639","article-title":"Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study","volume":"186","author":"Bagshaw","year":"2014","journal-title":"CMAJ"},{"key":"2026020403000078300_bib13","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1097\/CCM.0000000000000860","article-title":"Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study","volume":"43","author":"Bagshaw","year":"2015","journal-title":"Crit Care Med"},{"key":"2026020403000078300_bib14","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1007\/s00134-014-3253-4","article-title":"Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study","volume":"40","author":"Le Maguet","year":"2014","journal-title":"Intensive Care Med"},{"key":"2026020403000078300_bib15","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s12603-009-0051-8","article-title":"Frailty: defining and measuring of a concept","volume":"13","author":"Pel-Littel","year":"2009","journal-title":"J Nutr Health Aging"},{"key":"2026020403000078300_bib16","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.arr.2010.09.001","article-title":"Outcome instruments to measure frailty: a systematic review","volume":"10","author":"de Vries","year":"2011","journal-title":"Ageing Res Rev"},{"key":"2026020403000078300_bib17","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/0021-9681(78)90058-9","article-title":"A questionnaire for the assessment of leisure time physical activities","volume":"31","author":"Taylor","year":"1978","journal-title":"J Chronic Dis"},{"key":"2026020403000078300_bib18","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/0002-9149(89)90496-7","article-title":"A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index)","volume":"64","author":"Hlatky","year":"1989","journal-title":"Am J Cardiol"},{"key":"2026020403000078300_bib19","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1089\/15246090050147745","article-title":"Physical activity and functional capacity measurement in women: a report from the NHLBI-sponsored WISE study","volume":"9","author":"Bairey Merz","year":"2000","journal-title":"J Womens Health Gend Based Med"},{"key":"2026020403000078300_bib20","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/00008483-200207000-00014","article-title":"Criterion validity of the Duke Activity Status Index for assessing functional capacity in patients with chronic obstructive pulmonary disease","volume":"22","author":"Carter","year":"2002","journal-title":"J Cardiopulm Rehabil"},{"key":"2026020403000078300_bib21","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jcrc.2013.12.019","article-title":"The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors","volume":"29","author":"Baldwin","year":"2014","journal-title":"J Crit Care"},{"key":"2026020403000078300_bib22","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1136\/thoraxjnl-2013-204557","article-title":"Development and validation of a lung transplant-specific disability questionnaire","volume":"69","author":"Singer","year":"2014","journal-title":"Thorax"},{"key":"2026020403000078300_bib23","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1111\/j.1532-5415.2000.tb03907.x","article-title":"Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports","volume":"48","author":"Covinsky","year":"2000","journal-title":"J Am Geriatr Soc"},{"key":"2026020403000078300_bib24","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.1963.03060120024016","article-title":"Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function","volume":"185","author":"Katz","year":"1963","journal-title":"JAMA"},{"key":"2026020403000078300_bib25","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"2026020403000078300_bib26","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1152\/jappl.1999.86.6.2090","article-title":"Assessment of physical activity in older individuals: a doubly labeled water study","volume":"86","author":"Starling","year":"1999","journal-title":"J Appl Physiol"},{"key":"2026020403000078300_bib27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/archinte.166.4.418","article-title":"Transitions between frailty states among community-living older persons","volume":"166","author":"Gill","year":"2006","journal-title":"Arch Intern Med"},{"key":"2026020403000078300_bib28","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1111\/j.1532-5415.2006.00914.x","article-title":"Identifying frailty in hospitalized older adults with significant coronary artery disease","volume":"54","author":"Purser","year":"2006","journal-title":"J Am Geriatr Soc"},{"key":"2026020403000078300_bib29","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1111\/j.1532-5415.2005.53511.x","article-title":"Frailty in older Mexican Americans","volume":"53","author":"Ottenbacher","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"2026020403000078300_bib30","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1164\/rccm.201605-0939OC","article-title":"Frailty and subsequent disability and mortality among patients with critical illness","volume":"196","author":"Brummel","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2026020403000078300_bib31","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/gerona\/gls119","article-title":"Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project","volume":"68","author":"Rodr\u00edguez-Ma\u00f1as","year":"2013","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026020403000078300_bib32","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jamda.2013.03.022","article-title":"Frailty consensus: a call to action","volume":"14","author":"Morley","year":"2013","journal-title":"J Am Med Dir Assoc"},{"key":"2026020403000078300_bib33","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/j.1532-5415.2006.00745.x","article-title":"Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society\/National Institute on Aging Research Conference on Frailty in Older Adults","volume":"54","author":"Walston","year":"2006","journal-title":"J Am Geriatr Soc"},{"key":"2026020403000078300_bib34","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ecl.2013.02.006","article-title":"Frailty, sarcopenia, and hormones","volume":"42","author":"Morley","year":"2013","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2026020403000078300_bib35","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s13539-014-0132-3","article-title":"From sarcopenia to frailty: a road less traveled","volume":"5","author":"Morley","year":"2014","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"2026020403000078300_bib36","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1007\/s00198-012-1913-1","article-title":"Frailty and sarcopenia: definitions and outcome parameters","volume":"23","author":"Cooper","year":"2012","journal-title":"Osteoporosis Int"},{"key":"2026020403000078300_bib37","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3389\/fnagi.2014.00192","article-title":"Sarcopenia and physical frailty: two sides of the same coin","volume":"6","author":"Cesari","year":"2014","journal-title":"Front Aging Neurosci"},{"key":"2026020403000078300_bib38","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1007\/s00134-003-1763-6","article-title":"Quality of life on admission to the intensive care: can we query the relatives?","volume":"29","author":"Hofhuis","year":"2003","journal-title":"Intensive Care Med"},{"key":"2026020403000078300_bib39","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1111\/j.1532-5415.2011.03514.x","article-title":"Patient and proxy rating agreements on activities of daily living and the instrumental activities of daily living of acutely hospitalized older adults","volume":"59","author":"Pol","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2026020403000078300_bib40","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/j.1365-2044.1997.240-az0374.x","article-title":"Reliability of the next of kins\u2019 estimates of critically ill patients\u2019 quality of life","volume":"52","author":"Rogers","year":"1997","journal-title":"Anaesthesia"},{"key":"2026020403000078300_bib41","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1007\/s00134-006-0333-0","article-title":"Difference in reported pre-morbid health-related quality of life between ARDS survivors and their substitute decision makers","volume":"32","author":"Scales","year":"2006","journal-title":"Intensive Care Med"}],"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/14\/8\/1270\/66715139\/annalsats_14_8_1270.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/14\/8\/1270\/66715139\/annalsats_14_8_1270.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T08:00:14Z","timestamp":1770192014000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/article\/14\/8\/1270\/8453598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,1]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,8,1]]},"published-print":{"date-parts":[[2017,8,1]]}},"URL":"https:\/\/doi.org\/10.1513\/annalsats.201612-1008oc","relation":{},"ISSN":["2329-6933","2325-6621"],"issn-type":[{"value":"2329-6933","type":"print"},{"value":"2325-6621","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,8]]},"published":{"date-parts":[[2017,8,1]]}}}