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

Background: Exercise and physical activity are an essential part of contemporary coronary artery disease (CAD) management. However, evidence shows that patients experience clear difficulties in maintaining a physically active lifestyle following completion of a structured and supervised phase II exercise-based CR program. Home-based (HB) interventions have been shown to enhance a patient’s self-efficacy and might facilitate the lifelong uptake of a physically active lifestyle. Yet, data on the long-term effectiveness of HB exercise training on physical activity (PA) and exercise capacity (EC) are scarce. Objective: The main purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of the implementation of a short HB phase III exercise program with telemonitoring guidance to a prolonged center-based (CB) phase III program in patients with CAD. Primary outcome measure was exercise capacity. Secondary outcome measures included physical activity behaviour, cardiovascular risk profile and health related quality of life. Methods: Ninety CAD patients were randomized to three months of HB (=30), CB (=30) or a control group (CG) (=30) on a 1:1:1 basis after completion of their phase II ambulatory CR program. Outcome measures were assessed at discharge of the phase II program and after one year. Results: Eighty patients (91%, 72 men and mean age 62.6 years old) completed the one-year follow-up measurements. Exercise capacity (VO2P), cardiovascular risk factors and health related quality of life were preserved in all three groups (p-time >0.05 for all), irrespective of the intervention (p-interaction >0.05 for all). 85 % of patients met the international guidelines for PA (p-time < 0.05). No interaction effect was found for PA (steps, amount of active time, and amount of sedentary time) over the one-year period after discharge of a phase II program. Conclusion: Although exercise capacity remained stable over time, our HB exercise intervention did not result in higher levels of fitness or PA at one year of FU compared to the other two interventions

The development and co-design of the PATHway intervention: a theory-driven eHealth platform for the self-management of cardiovascular disease.

Background Cardiovascular diseases (CVD) are a leading cause of premature death and disability and an economic burden worldwide. International guidelines recommend routine availability and delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based CR programmes is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes, and yet are not readily available. Purpose The aim of the current study was to develop the PATHway intervention (Physical Activity Towards Health) for the self-management of cardiovascular disease. Increasing physical activity in individuals with CVD was the primary behaviour. Methods The PATHway intervention was theoretically informed by the Behaviour Change Wheel (BCW) and Social Cognitive Theory (SCT). All relevant intervention functions, behaviour change techniques (BCTs) and policy categories were identified and translated into intervention content. Furthermore, a person-centred approach was adopted involving an iterative co-design process and extensive user-testing. Results Education, enablement, modelling, persuasion, training and social restructuring were selected as appropriate intervention functions. Twenty-two BCTs, linked to the 6 intervention functions and 3 policy categories were identified for inclusion and translated into PATHway intervention content. Conclusions This paper details the use of the BCW and SCT within a person-centred framework to develop an eHealth intervention for the self-management of CVD. The systematic and transparent development of the PATHway intervention will facilitate the evaluation of intervention effectiveness and future replication. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery

Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: A systematic review and meta-analysis

Background: Exercise-based cardiovascular rehabilitation (CR) improves exercise capacity (EC), lowers cardiovascular risk profile and increases physical functioning in the short term. However, uptake of and adherence to a physically active lifestyle in the long run remain problematic. Home-based (HB) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity (PA). The current systematic review and meta-analysis aimed to compare the longer-term effects of HB exercise programmes with usual care (UC) or centre-based (CB) CR in patients referred for CR. Design: Systematic review and meta-analysis. Methods: Non-randomised controlled trials (RCTs) or randomised trials comparing the effects of HB exercise programmes with UC or CB rehabilitation on EC and/or PA, with a follow-up period of ≥12 months and performed in coronary artery disease patients, were searched in four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled trials (CENTRAL)) from their inception until September 7, 2016. Standardised mean differences (SMDs) were calculated and pooled by means of random effects models. Risk of bias, publication bias and heterogeneity among trials were also assessed. Results: Seven studies could be included in the meta-analysis on EC, but only two studies could be included in the metaanalysis on PA (total number of 1440 patients). The results showed no significant differences in EC between HB rehabilitation and UC (SMD 0.10, 95% confidence interval (CI) -0.13 to 0.33). There was a small but significant difference in EC in favour of HB compared to CB rehabilitation (SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37, 95% CI -0.18 to 0.92). Conclusions: HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC. The small number of studies warrants the need for more RCTs evaluating the long-term effects of different CR interventions on EC and PA behaviour, as this is the ultimate goal of CR

PATHway: User validation of a technology-enabled behavior change intervention for patients with cardiovascular disease

status: publishe

Validity of heart rate measurements by the Garmin Forerunner 225 at different walking intensities

The accuracy of wrist worn heart rate monitors based on photoplethysmography (PPG) is not fully clinically accepted. Therefore, we aimed to validate heart rate measurements of a commercially available PPG heart rate monitor, i.e. the Garmin Forerunner(®) 225. Twelve healthy volunteers (six women; mean age: 28 years) performed a treadmill protocol consisting of: five minutes sitting, five minutes standing, 10 minutes walking at 4 km/h, 10 minutes walking at a gradient of 5% and intensity of 4-6 metabolic equivalents (METs), 10 minutes walking at a gradient of 8% and intensity of seven METs or more. Walking speeds were individually determined. Walking bouts were separated by a standardised five minute rest period. Heart rate was measured as the average of the last three minutes standing and of each walking bout. A three lead patch-based electrocardiogram (ECG; Zensor(®)) was used as criterion method. Statistical analyses included Pearson's correlation (r), paired t-tests, root mean squared error (RMSE) and Bland?Altman plots. The mean values per three minutes of every condition did not differ significantly between the Garmin Forerunner(®) 225 and the Zensor(®). RMSE was 3.01 beats per minute (bpm) or 2.89%. The Bland-Altman bias was 1.57 bpm. Limits of agreement (LoA) were wide, ranging from 32.53 to 29.40 bpm. However, Pearson's r ranged from 0.650 to 0.868 suggesting moderate to strong validity. Generally, mean heart rates, r values, RMSE and the Bland-Altman bias indicated good overall agreement in this sample of healthy adults, but wide LoA are making it difficult to trust individual measurements.status: publishe

The test-retest reliability and criterion validity of the Sensewear mini and Actiheart in two climatologically different countries

status: publishe

Computerised decision support in physical activity interventions: A systematic literature review

BACKGROUND: The benefits of regular physical activity for health and quality of life are unarguable. New information, sensing and communication technologies have the potential to play a critical role in computerised decision support and coaching for physical activity. OBJECTIVES: We provide a literature review of recent research in the development of physical activity interventions employing computerised decision support, their feasibility and effectiveness in healthy and diseased individuals, and map out challenges and future research directions. METHODS: We searched the bibliographic databases of PubMed and Scopus to identify physical activity interventions with computerised decision support utilised in a real-life context. Studies were synthesized according to the target user group, the technological format (e.g., web-based or mobile-based) and decision-support features of the intervention, the theoretical model for decision support in health behaviour change, the study design, the primary outcome, the number of participants and their engagement with the intervention, as well as the total follow-up duration. RESULTS: From the 24 studies included in the review, the highest percentage (n = 7, 29%) targeted sedentary healthy individuals followed by patients with prediabetes/diabetes (n = 4, 17%) or overweight individuals (n = 4, 17%). Most randomized controlled trials reported significantly positive effects of the interventions, i.e., increase in physical activity (n = 7, 100%) for 7 studies assessing physical activity measures, weight loss (n = 3, 75%) for 4 studies assessing diet, and reductions in glycosylated hemoglobin (n = 2, 66%) for 3 studies assessing glycose concentration. Accelerometers/pedometers were used in almost half of the studies (n = 11, 46%). Most adopted decision support features included personalised goal-setting (n = 16, 67%) and motivational feedback sent to the users (n = 15, 63%). Fewer adopted features were integration with electronic health records (n = 3, 13%) and alerts sent to caregivers (n = 4, 17%). Theoretical models of decision support in health behaviour to drive the development of the intervention were not reported in most studies (n = 14, 58%). CONCLUSIONS: Interventions employing computerised decision support have the potential to promote physical activity and result in health benefits for both diseased and healthy individuals, and help healthcare providers to monitor patients more closely. Objectively measured activity through sensing devices, integration with clinical systems used by healthcare providers and theoretical frameworks for health behaviour change need to be employed in a larger scale in future studies in order to realise the development of evidence-based computerised systems for physical activity monitoring and coaching.status: publishe

Integrative Interpretation of Cardiopulmonary Exercise Tests for Cardiovascular Outcome Prediction: A Machine Learning Approach

Integrative interpretation of cardiopulmonary exercise tests (CPETs) may improve assessment of cardiovascular (CV) risk. Here, we identified patient phenogroups based on CPET summary metrics and evaluated their predictive value for CV events. We included 2280 patients with diverse CV risk who underwent maximal CPET by cycle ergometry. Key CPET indices and information on incident CV events (median follow-up time: 5.3 years) were derived. Next, we applied unsupervised clustering by Gaussian Mixture modeling to subdivide the cohort into four male and four female phenogroups solely based on differences in CPET metrics. Ten of 18 CPET metrics were used for clustering as eight were removed due to high collinearity. In males and females, the phenogroups differed significantly in age, BMI, blood pressure, disease prevalence, medication intake and spirometry. In males, phenogroups 3 and 4 presented a significantly higher risk for incident CV events than phenogroup 1 (multivariable-adjusted hazard ratio: 1.51 and 2.19; p ≤ 0.048). In females, differences in the risk for future CV events between the phenogroups were not significant after adjustment for clinical covariables. Integrative CPET-based phenogrouping, thus, adequately stratified male patients according to CV risk. CPET phenomapping may facilitate comprehensive evaluation of CPET results and steer CV risk stratification and management

The development and co-design of the PATHway intervention: a theory-driven eHealth platform for the self-management of cardiovascular disease

no ISSN/isbnstatus: publishe

Co-design and user validation of a technology-enabled behaviour change intervention for individuals with cardiovascular disease: Preliminary findings

Purpose: Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe. Effective exercise-based cardiac rehabilitation (CR) can improve mortality and morbidity rates, yet uptake of community-based CR is low (1). PATHway (Physical Activity Towards Health) is a technology-enabled lifestyle behaviour change intervention designed to enhance patient self-management of CVD through adherence to physical activity and other health behaviours. This paper explains the co-design and user validation process that is being employed for the development of the PATHway platform. Methods: CVD patients from a) hospital-based CR and b) community-based CR across two sites (Dublin, Ireland; Leuven, Belgium) are invited to participate in the study. To facilitate an iterative process, three separate rounds of semi-structured interviews, a total of twelve focus groups (4 groups x 3 rounds) are planned between February and April 2016. In round one interviews, participants were exposed to the PATHway intervention and system designed by the research team, and feedback was elicited. Interviews were audio-recorded, transcribedand content analysed. Key recommendations regarding technical and intervention content were identified and are currently being used by the research team to improve the PATHway system. Completion of the interviews is due for April 2016 Results: Round one data indicated that i) tailoring intervention content for exercise prescription and health behaviour change was important; ii) further health information and monitoring through the system was valuable, and iii) the potential for patients to be connected with their healthcare professionals was appealing. Technical recommendations included amending the avatar display to reflect an average BMI and be ‘more human-like’. Additional behaviour change recommendations included stressing the importance of positive reinforcement even when a participant is not meeting set goals. Conclusions: An iterative co-design and user validation process can be a vital component of the development of complex behavioural interventions for CVD patients. This project has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation Action under Grant Agreement no. 643491. PATHway: Technology enabled behavioural change as a pathway towards better self-management of CVD (www.pathway2health.eu