Digital Health Intervention Promoting Physical Activity in Older Adults Post Cardiac Rehabilitation: Randomized Controlled Trial (Preprint)

BACKGROUND Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events that is associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating exercise capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality as well as maintaining functional capacity. Leveraging digital health strategies to increase adherence to PA is a promising approach. We sought to determine whether mobile health strategies (MOVN mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and exercise capacity over 2 months. OBJECTIVE The objectives of this study were to: 1) evaluate group differences in PA and exercise capacity; and 2) determine group differences in depression and self-efficacy to maintain exercise after CR. METHODS During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the MOVN mobile app, received supportive push-through messages on motivation and secondary prevention of cardiovascular disease (CVD) 3 times per week, and wore a Fitbit Charge 2 to track steps. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6MWT and self-reported questionnaires were collected at baseline and 2 months. RESULTS We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 66.8 ± 8.6 and 22% were female; retention rate of 85%. Our results from 51 patients who completed follow up showed the intervention group had a statistically significant higher mean daily steps count compared to the control (8,860 vs. 6,633) (P = .021). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. CONCLUSIONS Our technology-based intervention using a mobile app, push-through messages, and Fitbit proposes a low-cost, pragmatic, and contemporary approach to promote physical activity and sustain exercise capacity after completing CR. This intervention addresses a major public health initiative to promote PA in patients with CVD with the potential to improve critical PA, clinical, and psychosocial outcomes. CLINICALTRIAL “Trial Registration: ClinicalTrials.gov NCT03446313”

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Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial (Preprint)

10.2196/preprints.16665 ◽

2019 ◽

Author(s):

Heather M Young ◽

Sheridan Miyamoto ◽

Madan Dharmar ◽

Yajarayma Tang-Feldman

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Usual Care ◽

Self Efficacy ◽

Controlled Trial ◽

Intervention Group ◽

Self Management ◽

Randomized Controlled ◽

Mhealth Technology

BACKGROUND Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. OBJECTIVE This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. METHODS This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. RESULTS We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; <i>P</i><.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; <i>P</i>=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). CONCLUSIONS We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. CLINICALTRIAL ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176

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Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/16665 ◽

2020 ◽

Vol 8 (3) ◽

pp. e16665 ◽

Cited By ~ 2

Author(s):

Heather M Young ◽

Sheridan Miyamoto ◽

Madan Dharmar ◽

Yajarayma Tang-Feldman

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Usual Care ◽

Self Efficacy ◽

Controlled Trial ◽

Intervention Group ◽

Self Management ◽

Randomized Controlled ◽

Mhealth Technology

Background Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. Objective This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. Methods This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. Results We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). Conclusions We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. Trial Registration ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176

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Feasibility and Preliminary Effects of the BESMILE-HF Program on Chronic Heart Failure Patients: A Pilot Randomized Controlled Trial

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.715207 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiankun Chen ◽

Wei Jiang ◽

Thomas P. Olson ◽

Cecilia Stålsby Lundborg ◽

Zehuai Wen ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Adverse Events ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Self Efficacy ◽

Controlled Trial ◽

Intervention Group ◽

Peak Oxygen Consumption ◽

Control Group

Aims: The Baduanjin Eight-Silken-Movements wIth Self-Efficacy building for Heart Failure (BESMILE-HF) program is a contextually adapted cardiac rehabilitation program. It uses a traditional Chinese exercise, Baduanjin, to solve the unmet demand of exercise-based cardiac rehabilitation programs due to their scarcity and unaffordability in China. This pilot study assesses BESMILE-HF's feasibility and preliminary effects.Methods: Eighteen patients with chronic heart failure were included: 8 in a BESMILE-HF group (age: 67 ± 5 years, EF: 40.4 ± 13.6%) and 10 in a control group (age: 70 ± 13 years, EF: 42.9 ± 12.5%). Both received the usual medications, with the intervention group receiving additionally the BESMILE-HF program for 6 weeks. Feasibility was explored by participants' involvement in the intended intervention. Clinical outcome assessments were conducted at baseline and post-intervention, while adverse events were captured throughout the study period.Results: The BESMILE-HF program was well-received by patients, and adherence to the intervention was good. The intervention group completed all required home exercises and total home-practice time was correlated with baseline self-efficacy (r = 0.831, p = 0.011). Moreover, after 6 weeks, self-efficacy increased in the BESMILE-HF group (p = 0.028) and the change was higher than in the control [mean difference (MD): 3.2; 95% confidence interval (CI) 0.6–5.9, p = 0.004]. For the exercise capacity, the control group demonstrated a significant decline in peak oxygen consumption (p =0.018) whereas, the BESMILE-HF group maintained their exercise capacity (p = 0.063). Although the between-group difference was not statistically significance, there was clear clinical improvement in the BESMILE-HF group (1.5 mL/kg/min, 95% CI, −0.3 to 3.2 vs. minimal clinically important difference of 1 mL/kg/min). Throughout the study period, no adverse events related to the intervention were captured.Conclusions: BESMILE-HF is feasible for patients with chronic heart failure in Chinese settings. A larger sample size and a longer follow-up period is needed to confirm its benefit on clinical outcomes.Clinical Trial Registration:ClinicalTrials.gov: NCT03180320.

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Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial

JMIR Research Protocols ◽

10.2196/31855 ◽

2021 ◽

Vol 10 (10) ◽

pp. e31855

Author(s):

Oonagh M Giggins ◽

Julie Doyle ◽

Suzanne Smith ◽

Orla Moran ◽

Shane Gavin ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Digital Health ◽

Pilot Trial ◽

Intervention Group ◽

Exercise Program ◽

Study Groups ◽

Intervention Period ◽

Study Results ◽

Exercise Classes ◽

Rehabilitation Exercise

Background Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform. Methods A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID) PRR1-10.2196/31855

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Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial (Preprint)

10.2196/preprints.31855 ◽

2021 ◽

Author(s):

Oonagh M Giggins ◽

Julie Doyle ◽

Suzanne Smith ◽

Orla Moran ◽

Shane Gavin ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Digital Health ◽

Pilot Trial ◽

Intervention Group ◽

Exercise Program ◽

Study Groups ◽

Intervention Period ◽

Study Results ◽

Exercise Classes ◽

Rehabilitation Exercise

BACKGROUND Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. OBJECTIVE The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform. METHODS A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. RESULTS Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. CONCLUSIONS This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/31855

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Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness?

European Journal of Preventive Cardiology ◽

10.1177/2047487319892201 ◽

2019 ◽

Vol 27 (4) ◽

pp. 367-377 ◽

Cited By ~ 6

Author(s):

Andrea Avila ◽

Jomme Claes ◽

Roselien Buys ◽

May Azzawi ◽

Luc Vanhees ◽

...

Keyword(s):

Physical Activity ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Phase Ii ◽

Home Based ◽

Artery Disease ◽

One Year

Background Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. Objective The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. Methods Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. Results Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups ( Ptime > 0.05 for all), irrespective of the intervention ( Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity ( Ptime < 0.05). No interaction effect was found for physical activity. Conclusion Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. Trial registration ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942

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Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation

Age and Ageing ◽

10.1093/ageing/afaa050 ◽

2020 ◽

Vol 49 (5) ◽

pp. 771-778 ◽

Cited By ~ 1

Author(s):

Klaus Pfeiffer ◽

Karin Kampe ◽

Jochen Klenk ◽

Kilian Rapp ◽

Michaela Kohler ◽

...

Keyword(s):

Physical Activity ◽

Physical Performance ◽

Pelvic Fracture ◽

Self Efficacy ◽

Fear Of Falling ◽

Intervention Group ◽

Inpatient Rehabilitation ◽

Control Group ◽

Behavioural Intervention ◽

Post Intervention

Abstract Background fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention (“Step by Step”) and evaluated in a RCT. Methods one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. Results in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = −0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes “perceived ability to manage falls” (P = 0.031, d = 0.41), “physical performance” (short physical performance battery) (P = 0.002, d = 0.58) and a lower “number of falls” (P = 0.029, d = −0.45). Conclusions the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.

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