Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements (Preprint)

BACKGROUND Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. OBJECTIVE Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. METHODS Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. RESULTS Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. CONCLUSIONS In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability.

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Modello di riabilitazione cardiologica teleguidata durante pandemia da COVID-19

CARDIOLOGIA AMBULATORIALE ◽

10.17473/1971-6818-2020-4-6 ◽

2020 ◽

pp. 271-275

Author(s):

Giovanni Pasanisi ◽

Biagio Sassone ◽

Jonathan Myers ◽

Giorgio Chiaranda ◽

Andrea Raisi ◽

...

Keyword(s):

Physical Activity ◽

Cardiac Rehabilitation ◽

Physical Activity Intervention ◽

Rehabilitation Program ◽

Physical And Mental Health ◽

Rehabilitation Programs ◽

Home Based ◽

Video Tutorials ◽

Rapid Spread ◽

Collateral Effects

Background. The COVID-19 pandemic has induced many governments to promote national lockdowns. Despite a period of quarantine is the best option and recommendation to stop the rapid spread of infections, this may have collateral effects on other dimensions of the isolated patients’ physical and mental health. Physical activity is the major component of cardiac rehabilitation programs that have been abruptly discontinued. Aims. To counteract physical inactivity during the COVID-19 outbreak we propose an home cardiac rehabilitation program under telemonitoring guidance, the home-bAsed physiCal acTivity Intervention during cOvid-19 quaraNtine (ACTION) study, testing its feasibility. Methods and results. ACTION is an observational study in cardiac outpatients referred to an exercise-based cardiac rehabilita-tion program. A program consisting of aerobic recommendations combined with a selection of strength and balance exercises is recommended. Video tutorials providing details of the workouts will be sent to patients. Selected patients can be followed during the home-sessions via video connection using current smartphone applications. Conclusions. The ACTION study could provide applicable results for safe and effective exercise therapy in outpatients with car-diovascular disease, while preventing the COVID-19 outbreak from generating adverse health consequences due to acute cessa-tion of physical activity. Findings from the ACTION study can also be useful after the end of COVID-19 outbreak for patients who cannot participate in traditional center- or home-based cardiac rehabilitation programs.

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Lessons learned from community- and home-based physical activity programs: A narrative review of factors influencing women’s participation in cardiac rehabilitation

European Journal of Preventive Cardiology ◽

10.1177/2047487320907748 ◽

2020 ◽

pp. 204748732090774 ◽

Cited By ~ 2

Author(s):

Sol Vidal-Almela ◽

Brenna Czajkowski ◽

Stephanie A Prince ◽

Daniele Chirico ◽

Kimberley L Way ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Cardiac Rehabilitation ◽

Physical Function ◽

Narrative Review ◽

Large Female ◽

Activity Levels ◽

Home Based ◽

Physical Activity Levels ◽

Physical Activity Programs

Background Cardiovascular disease remains a leading cause of death in women. Despite the well-known benefits of cardiac rehabilitation, it remains underutilized, especially among women. Physical activity programs in the community, however, attract a large female population, suggesting that they overcome barriers to physical activity encountered by women. The characteristics of interventions that extend beyond the traditional cardiac rehabilitation model and promote physical activity merit examination. Objectives This narrative review aimed to: (a) summarize women’s barriers to attend cardiac rehabilitation; (b) examine the characteristics of community- and home-based physical activity or lifestyle coaching interventions; and (c) discuss which barriers may be addressed by these alternative programs. Methods Studies were included if they: (a) were published within the past 10 years; (b) included ≥70% women with a mean age ≥45 years; (c) implemented a community- or home-based physical activity intervention or a lifestyle education/behavioral coaching program; and (d) aimed to improve physical activity levels or physical function. Results Most interventions reported high (≥70%) participation rates and significant increases in physical activity levels at follow-up; some improved physical function and/or cardiovascular disease risk factors. Community- and home-based interventions address women’s cardiac rehabilitation barriers by: implementing appealing modes of physical activity (e.g. dancing, group-walking, technology-based balance exercises); adapting the program to meet participants’ needs; offering flexible options regarding timing and setting (e.g. closer to home, the workplace or faith-based institutions); and promoting social interactions. Conclusion Cardiac rehabilitation can be enhanced by understanding the specific needs of women; novel elements such as program offerings, convenient settings and opportunities for socialization should be considered when designing cardiac rehabilitation programs.

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

10.2196/preprints.13972 ◽

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.

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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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Cost-analysis of gym-based versus home-based cardiac rehabilitation programs

Australian Health Review ◽

10.1071/ah010051 ◽

2001 ◽

Vol 24 (1) ◽

pp. 51 ◽

Cited By ~ 16

Author(s):

Louisa Collins ◽

Paul Scuffham ◽

Sue Gargett

Keyword(s):

Cost Analysis ◽

Cardiac Rehabilitation ◽

Average Cost ◽

Lower Cost ◽

Baseline Data ◽

Cost Data ◽

Rehabilitation Services ◽

Rehabilitation Programs ◽

Home Based ◽

Rural Patients

A cost-analysis of an existing gym-based program was compared with a proposed home-based program for deliveringcardiac rehabilitation services in West Moreton, Queensland. Cost and baseline data were collected on 95 cardiacrehabilitation patients living in Ipswich and West Moreton. Cost data included costs to the program funders andpatients. The average cost per patient rehabilitated was $1,933 in the gym-based program and $1,169 in the home-basedprogram. Adopting the lower cost home-based program would allow the services to be provided to many morepatients. The relevance of home-based rehabilitation programs for rural patients facing barriers accessing traditionalhospital- or gym-based programs is significant.

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Que Fatores Determinam os Níveis de Atividade Física após Programa de Reabilitação Cardíaca?

Acta Médica Portuguesa ◽

10.20344/amp.1742 ◽

2013 ◽

Vol 26 (6) ◽

pp. 689

Author(s):

Diogo Soares ◽

Sofia Viamonte ◽

Sandra Magalhães ◽

Maria Miguel Ribeiro ◽

Ana Barreira ◽

...

Keyword(s):

Physical Activity ◽

Regression Analysis ◽

Cardiac Rehabilitation ◽

International Physical Activity Questionnaire ◽

Linear Regression Analysis ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Physical Activity Questionnaire ◽

Rehabilitation Programs ◽

Activity Questionnaire

Introduction: The Cardiac Rehabilitation Programs have gained tremendous importance in the prevention of cardiovascular disease and it’s a challenge to ensure the practice of regular exercise during and after the supervised program. The aim of this study was to determine the factors that influence the physical activity habits at 12 months after the Cardiac Rehabilitation Program.Material and Methods: Prospective study, including 580 patients with ischemic heart disease who were consecutively oriented for Cardiac Rehabilitation Program at Cardiovascular Prevention and Rehabilitation Unit of Centro Hospitalar do Porto, between January 2008 and June 2011. Physical activity levels were measured with International Physical Activity Questionnaire which was calculated at the beginning of the program, 3 and 12 months later. The following variables were chosen and tested as potential determinants of physical activity habits of 12 months after program: age; sex; modifiable risk factors; functional capacity (achieved in treadmill stress test); laboratory analysis (HbA1c, lipid profile, C-Reactive Protein and Brain Natriuretic Peptide). A linear regression analysis was carried to identify the significant determinants and to find the best model adjustment.Results: Advanced age, female gender, functional capacity and low levels of physical activity prior to the Cardiac Rehabilitation Program, as well as a weak evolution of the International Physical Activity Questionnaire during the program were the best univariable predictors of a less favourable evolution of the International Physical Activity Questionnaire during 12 months of follow-up. A multivariable linear regression analysis showed that the best explanatory model included age, gender and evolution of the International Physical Activity Questionnaire during the supervised program (R2 Adj. = 0.318; f = 60.62, p < 0.001).Conclusion: The identification of certain subgroups of patients with lower tendency toward physical activity is beneficial to enable timely and individualized strategies to maximize the therapeutic and preventive potential of the Cardiac Rehabilitation Programs.

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Physical Activity in Cardiac Rehabilitation: Towards Citizen-Centered Digital Evidence-Based Interventions

Studies in Health Technology and Informatics - Integrated Citizen Centered Digital Health and Social Care ◽

10.3233/shti200730 ◽

2020 ◽

Author(s):

Johanna Gutenberg ◽

Stefan Tino Kulnik ◽

Rada Hussein ◽

Thomas Stütz ◽

Josef Niebauer ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Cardiac Rehabilitation ◽

Exploratory Study ◽

Survey Methods ◽

Digital Evidence ◽

Evidence Based ◽

Activity Levels ◽

Physical Activity Levels

Physical activity is a vital part of cardiac rehabilitation (CR). However, heart-healthy physical activity levels in people with cardiovascular disease drop significantly after CR. This exploratory study employs qualitative and survey methods within a co-creation approach. The aim is to understand the mechanisms of healthy behavior and habit formation in order to create a novel evidence-based (post-)rehabilitation approach that employs digital means to sustain long-term physical activity levels in people with cardiovascular disease.

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Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00268.2020 ◽

2020 ◽

Vol 318 (6) ◽

pp. H1441-H1446 ◽

Cited By ~ 33

Author(s):

Tiago Peçanha ◽

Karla Fabiana Goessler ◽

Hamilton Roschel ◽

Bruno Gualano

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Sedentary Behavior ◽

Social Isolation ◽

Physical Inactivity ◽

Global Burden ◽

Activity Levels ◽

Home Based ◽

Physical Activity Levels

Emerging data indicate a substantial decrease in global physical activity levels during the period of social isolation adopted worldwide to contain the spread of the coronavirus disease 2019 (COVID-19). Confinement-induced decreases in physical activity levels and increases in sedentary behavior may provoke a rapid deterioration of cardiovascular health and premature deaths among populations with increased cardiovascular risk. Even short-term (1–4 wk) inactivity has been linked with detrimental effects in cardiovascular function and structure and increased cardiovascular risk factors. In this unprecedented and critical scenario, home-based physical activity programs arise as a clinically relevant intervention to promote health benefits to cardiac patients. Many studies have demonstrated the feasibility, safety, and efficacy of different models of home-based exercise programs in the primary and secondary prevention of cardiovascular diseases and major cardiovascular events among different populations. This body of knowledge can inform evidence-based policies to be urgently implemented to counteract the impact of increased physical inactivity and sedentary behavior during the COVID-19 outbreak, thereby alleviating the global burden of cardiovascular disease.

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Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Cardiology Research and Practice ◽

10.1155/2020/1236968 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Niramayee V. Prabhu ◽

Arun G. Maiya ◽

Nivedita S. Prabhu

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Cardiac Rehabilitation ◽

Functional Capacity ◽

Coronary Revascularization ◽

Activity Levels ◽

Home Based ◽

Related Quality ◽

Health Related

Background. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. These outcomes are paramount in predicting morbidity and mortality after these procedures. Cardiac rehabilitation (CR) focuses on incrementing cardiovascular endurance, exercise capacity, muscle strength, levels of physical activity, and quality of life through health education and lifestyle modification in post-coronary revascularization patients. Objective. To review the impact of cardiac rehabilitation on functional capacity, levels of physical activity, and health related quality of life in patients following coronary revascularization. Methods. A structured literature search in PubMed, Scopus, CINAHL, and ProQuest for studies focused on CR and its effects on functional capacity, physical activity, and quality of life after coronary revascularization. Results. A total of 2,010 studies were retrieved. Deduplication and eligibility screening included 190 studies after the application of filters. A sum of 21 studies were considered for this review. Most studies reported that exercise and physical activity programs were centre-based and home-based and via telerehabilitation. Treadmill and cycle ergometry training with callisthenics and flexibility exercises in phase 2 CR exhibited significant improvement in functional capacity and physical activity levels in patients after coronary revascularization procedures. Conclusion. Although centre-based supervised CR programs do improve functional capacity after coronary revascularization, home-based or telerehabilitation-based CR programs are feasible, improve patient compliance in improving physical activity, and thereby increase functional capacity. Patient education improves levels of physical activity, health related quality of life, and adherence to home- and centre-based CR programs.

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