scholarly journals Determinants of achieving the minimum clinically important difference for the Incremental Shuttle Walk Test in a cardiac rehabilitation population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Alotaibi ◽  
P Doherty ◽  
P Doherty
Keyword(s):  
Physical Activity ◽  
Physical Fitness ◽  
Cardiac Rehabilitation ◽  
Minimum Clinically Important Difference ◽  
Study Data ◽  
Walk Test ◽  
National Audit ◽  
Physical Activity Recommendation ◽  
Main Study ◽  
Clinically Important Difference

Abstract   The primary aim of this study was to identify the determinants of achieving the minimum clinically important difference (MCID) for the Incremental Shuttle Walk Test (ISWT) in the CR population. The secondary aim was to examine whether achieving MCID in ISWT at the end of the CR programme is associated with the likelihood of patients meeting the physical activity recommendation or whether it is associated with the patients' self-reported physical fitness (Dartmouth COOP tool) at the end of the CR programmme. Method Routine clinical data related to patients who undertook ISWT as a pre- and post-CR functional capacity assessment were taken from National Audit of Cardiac Rehabilitation (NACR) during the 2013 to 2016 and retrospectively analysed. A sub-analysis was conducted to address the secondary aim. Logistic regression approaches, taking account of potential confounders were constructed. Results For the main study, data from 9,786 patients (mean age of 63.9±10.7), 77.5% of whom were male, were analysed. Sixteen determinants for achieving the MCID for ISWT in CR patients were identified. A sub-analysis was also conducted on 7,950 to address the secondary aim. Patients who achieved the MCID were 30% more likely to meet the physical activity recommendation and 60% more likely to rate themselves positively on the self-reported physical fitness Dartmouth COOP scale. Funding Acknowledgement Type of funding source: None

scholarly journals Are physical fitness outcomes in patients attending cardiac rehabilitation determined by the mode of delivery?

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000822 ◽  
Author(s):  
Alexander S Harrison ◽  
Lars Tang ◽  
Patrick Doherty
Keyword(s):  
Physical Fitness ◽  
Cardiac Rehabilitation ◽  
Older Patients ◽  
Statistical Significance ◽  
Mode Of Delivery ◽  
Evidence Base ◽  
The Self ◽  
Clinical Population ◽  
Walk Test ◽  
National Audit

BackgroundCardiac rehabilitation (CR) is a well-evidenced and effective secondary intervention proven to reduce mortality and readmission in patients with cardiovascular disease. Improving physical fitness outcomes is a key target for CR programmes, with supervised group-based exercise dominating the mode of the delivery. However, the method of traditional supervised CR fails to attract many patients and may not be the only way of improving physical fitness.MethodsUsing real-world routine clinical data from the National Audit of Cardiac Rehabilitation across a 5-year period, this study evaluates the extent of association between physical fitness outcomes, incremental shuttle walk and 6 min walk test, and mode of delivery, delivered as traditional supervised versus facilitated self-delivered.ResultsThe proportion of patients receiving each mode were 80.6% supervised with 19.4% to self-delivered. The study analysis comprised of 10 142 patients who were included in the two models. The self-delivered group contained a greater proportion of females and older patients. The regression model showed no clinical or statistical significance between mode of delivery and post-CR physical fitness outcomes.ConclusionsThis study is unique as it has identified through a routine clinical population that regardless of the mode of delivery of rehabilitation, patients improve their physical fitness outcomes at meaningful levels. This study provides a strong evidence base for patients to be offered greater choice in the mode of CR delivery as improvements in physical fitness are comparable.

Effectiveness of mHealth Interventions on Physical Activity and Physical Fitness in Outpatient and Home-Based Cardiac Rehabilitation Programs: A Systematic Review (Preprint)

2019 ◽  
Author(s):  
Sheeba Nadarajah ◽  
Susan Buchholz ◽  
Kristen Dickins
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Physical Fitness ◽  
Cardiac Rehabilitation ◽  
Text Messaging ◽  
English Language ◽  
Rehabilitation Program ◽  
Cardiac Rehabilitation Program ◽  
Mixed Effect ◽  
Home Based

BACKGROUND Globally, cardiovascular disease is the leading cause of death. Cardiovascular mortality can be decreased by participation in cardiac rehabilitation. Researchers are exploring the use of mHealth technology in cardiac rehabilitation. OBJECTIVE The aim of this systematic review is to examine the effectiveness of randomized controlled trials that use a mHealth intervention as a part of an outpatient and/or home-based cardiac rehabilitation program on improving physical activity and physical fitness outcomes. METHODS For this systematic review, mHealth interventions were limited to text messaging, mobile apps, and use of a mobile phone network for data transmission, used to deliver cardiac rehabilitation program. Using six databases, the search strategy included published English language studies through 2016. Data was extracted independently by two reviewers, and then synthesized. RESULTS The initial search yielded 149 articles, of which 15 articles that represented nine studies met inclusion criteria. Articles were published from 2010 to 2016 and came from two continents. The majority (84%) of participants were male. Generally, the participant mean age was late 50s to early 60s. Text messaging was the most frequently used intervention. The results of the physical activity and physical fitness findings were mixed. Effect sizes for intervention as measured by the 6-minute walk test ranged from 0.46 to 0.58 and peak VO2 ranged from 0.03 to 1.35. CONCLUSIONS Globally, use of mHealth in outpatient and/or home-based cardiac rehabilitation is being studied with greater attention. However, these studies are limited by geography, gender, and age. Therefore, further research in the area of cardiac rehabilitation and mHealth is recommended, especially in developing countries, among women, and older adults.

scholarly journals Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study

10.2196/14435 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14435 ◽  
Author(s):  
Yoon Kim ◽  
Jinserk Seo ◽  
So-Yeon An ◽  
Dong Hyun Sinn ◽  
Ji Hye Hwang
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Body Composition ◽  
Physical Fitness ◽  
Exercise Program ◽  
Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk ◽  
Rehabilitation Exercise

Background Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants’ physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results Of the 37 patients, 31 (84%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy.

scholarly journals Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study (Preprint)

2019 ◽  
Author(s):  
Yoon Kim ◽  
Jinserk Seo ◽  
So-Yeon An ◽  
Dong Hyun Sinn ◽  
Ji Hye Hwang
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Body Composition ◽  
Physical Fitness ◽  
Exercise Program ◽  
Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk ◽  
Rehabilitation Exercise

BACKGROUND Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. OBJECTIVE The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. METHODS A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants’ physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. RESULTS Of the 37 patients, 31 (84%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. CONCLUSIONS Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy.

scholarly journals Screening for physical inactivity among adults: the value of distance walked in the six-minute walk test. A cross-sectional diagnostic study

2016 ◽  
Vol 134 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Evandro Fornias Sperandio ◽  
Rodolfo Leite Arantes ◽  
Rodrigo Pereira da Silva ◽  
Agatha Caveda Matheus ◽  
Vinícius Tonon Lauria ◽  
...  
Keyword(s):  
Physical Activity ◽  
Logistic Regression ◽  
Physical Fitness ◽  
Body Fat ◽  
Physical Inactivity ◽  
Activity Levels ◽  
Walk Test ◽  
Six Minute Walk Test ◽  
Physical Activity Levels ◽  
Minute Walk

ABSTRACT: CONTEXT AND OBJECTIVES: Accelerometry provides objective measurement of physical activity levels, but is unfeasible in clinical practice. Thus, we aimed to identify physical fitness tests capable of predicting physical inactivity among adults. DESIGN AND SETTING: Diagnostic test study developed at a university laboratory and a diagnostic clinic. METHODS: 188 asymptomatic subjects underwent assessment of physical activity levels through accelerometry, ergospirometry on treadmill, body composition from bioelectrical impedance, isokinetic muscle function, postural balance on a force platform and six-minute walk test. We conducted descriptive analysis and multiple logistic regression including age, sex, oxygen uptake, body fat, center of pressure, quadriceps peak torque, distance covered in six-minute walk test and steps/day in the model, as predictors of physical inactivity. We also determined sensitivity (S), specificity (Sp) and area under the curve of the main predictors by means of receiver operating characteristic curves. RESULTS: The prevalence of physical inactivity was 14%. The mean number of steps/day (≤ 5357) was the best predictor of physical inactivity (S = 99%; Sp = 82%). The best physical fitness test was a distance in the six-minute walk test and ≤ 96% of predicted values (S = 70%; Sp = 80%). Body fat > 25% was also significant (S = 83%; Sp = 51%). After logistic regression, steps/day and distance in the six-minute walk test remained predictors of physical inactivity. CONCLUSION: The six-minute walk test should be included in epidemiological studies as a simple and cheap tool for screening for physical inactivity.

Abstract 279: Outcomes From Integrating Stroke Survivors Into Cardiac Rehabilitation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Elizabeth W Regan ◽  
Reed Handlery ◽  
Sara Wilcox ◽  
Jill Stewart ◽  
Joseph L Pearson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiac Rehabilitation ◽  
Outcome Expectation ◽  
Stroke Survivors ◽  
Walk Test ◽  
Six Minute Walk Test ◽  
Increased Risk ◽  
The Impact ◽  
Minute Walk

Purpose: Lack of physical activity after stroke results in increased risk of stroke recurrence and other health problems. While some survivors receive physical therapy (PT), it is often discontinued within a year. Cardiac Rehabilitation (CR) is a community exercise program for people with cardiac dysfunction; however, stroke is not a covered diagnosis despite high cardiovascular risk. CR for stroke survivors is an opportunity to bridge the gap between PT and community physical activity. The study evaluated the impact of CR participation on stroke survivors. Materials and Methods: A pilot study was completed at a phase 3 CR facility. Participants were screened for eligibility and entered the CR program (3 x per week for 12 weeks) with an aerobic fitness focus. Individual outcomes were taken pre- and post-program, and 6-months follow up. Program impact was measured by paired t-tests (24 participants) and repeated measures ANOVA (18 participants) for 6-month follow up. Results: Twenty-four participants completed the study. Participants were 79% (19/24) male with an average age of 62.2 years old (range 33.5 -81.5) with a time since stroke of 29.7 months (range 3-123). Most participants (20/24) were community ambulators at the start of the study (six-minute walk test (6MWT) > 288 m). Pre-Post Program: The six-minute walk test (6MWT) (endurance) improved by 62 ± 66 m (p<0.005). The five times sit to stand test (5xSS) (strength) improved by 3.8 ± 5.8 sec (P=0.004). The Stroke Impact Scale Mobility Subscale improved by 7.3% ± 11.8%, (p=0.006), the Activities of Daily Living Subscale improved by 6.2% ± 9.9%, (p=0.006) and the Memory Subscale by 6.4% ± 14.7%, (p=0.043). Fast Walking Speed, Self-Efficacy and Exercise Outcome Expectation Scales improved with statistical significance but lacked clinical significance. No other outcomes had statistically significant changes. Six-month Follow up: At 6-month follow up, 89.5% (16/18) of participants were still exercising at least once a week. The CR program elicited statistically significant participant improvements over time in the 6MWT (p=0.001) and 5xSS (p<0.001). Post-hoc analysis revealed a statistically significant improvement from pre-program to 6-month follow up in 6MWT distance (66.52 ± 53.73m, p=0.013), 5xSS (-3.44 ± 2.20s, p=0.003) but not post-program to 6 months follow up 6MWT (-5.2 ± 26.4m, p=1.00) and 5xSS (-0.24 ± 1.69s, p=1.00) demonstrating maintenance of gains, but no additional gains. Conclusions: CR elicited meaningful improvements for stroke survivors (exceeding minimal clinically important differences) in walking endurance, strength, perceived memory and perceived mobility with gains maintained for endurance and strength at 6-month follow up. CR enhances exercise habits and physical activity through structured exercise after discharge from PT and may improve community participation.

scholarly journals Improved Physical Fitness Induced by Physiotherapist-led Exercise in Patients With Permanent Atrial Fibrillation Disappears and Health-related Quality of Life Is Impaired After Detraining – A 3 Months Follow-up

2020 ◽  
Author(s):  
Maria Borland ◽  
Lennart Bergfeldt ◽  
Åsa Cider ◽  
Agneta Rosenkvist ◽  
Marika Jakobsson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Atrial Fibrillation ◽  
Physical Fitness ◽  
Cardiac Rehabilitation ◽  
Health Related Quality ◽  
Permanent Atrial Fibrillation ◽  
Related Quality ◽  
Health Related

Abstract Background: Atrial fibrillation negatively impact physical fitness and health-related quality of life in patients. We recently showed that physiotherapist-led exercise-based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation, however little is known about the effect of detraining after finishing an exercise period. The purpose of the study was to examine the impact of 3 months of detraining on physical fitness, physical activity level and health-related quality of life among patients with permanent atrial fibrillation, after ending a randomized comparison of physiotherapist-led exercise-based cardiac rehabilitation versus physical activity on prescription.Methods: Prospective 3-month follow-up study after a randomized multi-centre study. Of the 87 patients completing the intervention study, 80 (92%) participated in the detraining part (22 women; age 74 ± 5 years), 38 from the physiotherapist-led exercise-based cardiac rehabilitation group and 42 from the physical activity on prescription group. All patients were asked to refrain from organised exercise during the 3-months period of detraining. The primary outcome measure was maximal exercise capacity using an exercise tolerance test. Secondary outcomes measures were muscle function, physical activity level, and health-related quality of life using a muscle endurance tests, Short Form-36, and physical activity assessments (questionnaire and accelerometer), as in the intervention study. We used the Mann-Whitney U-test and X2 test to analyse differences between the groups, and Cohen’s d to determine the effect size. A mixed effect model analysis was used to identify predictors of change in physical fitness.Results: Compared to the physical activity on prescription, physiotherapist-led exercise-based cardiac rehabilitation showed a significantly decreased exercise capacity (−9 ± 11 vs. −2 ± 12 W, P < .0001), reduction in shoulder flexion repetitions (−4 ± 8 vs. 2 ± 7 repetitions, P = .001), and reduced health-related quality of life in the Short Form-36 dimension Role Emotional (−13 ± 39 vs. 6 ± 27 points, P = .006). Conclusion: In elderly patients with permanent atrial fibrillation detraining negatively impacted previously achieved improvements from physiotherapist-led exercise-based cardiac rehabilitation in physical fitness and reduce health-related quality of life. The importance of continued exercise is emphasized and should be part of the strategy. Retrospectively registred in ClinicalTrials.gov Identifier: NCT02493400. First posted July 9, 2015

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