An integrative review of physical activity/exercise intervention effects on function and health-related quality of life in older adults with heart failure

This paper reviews randomized, controlled trials (RCTs) that have used a physical activity/exercise intervention in older adults with heart failure and reported outcomes of physical function and/or health-related quality of life. An integrative review was necessary because a literature search indicated no reviews have been done regarding these outcomes which are deemed very important by the older adult population. Computerized database search strategies by authors between 2002 and 2015 resulted in 163 studies, with 12 meeting inclusion criteria. Interventions were performed in clinic and home-based, group and/or individual settings with durations from three to 12 months. Interventions were varied. Common methodological weaknesses of the studies include lack of theory guiding the intervention, small sample and low minority representation. Strengths included detailed intervention methods. There was a moderate effect of interventions with no reported adverse effects. Further work is essential to identify successful strategies to support older adults with heart failure to increase their physical activity levels

Patients experience of fatigue in advanced heart failure

Aims: To explore the experience of fatigue and living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth in-person interviews were conducted with participants from November 2012 to June 2013. Participant responses to open-ended questions were analysed using thematic content analysis. Inclusion criteria were: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction by a consultant cardiologist, and able to participate in conversational-style interviews in their own language. Major exclusion criteria was cognitive deficit identified by Abbreviated Mental Test Score. Twenty-three adults participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female, 17/23 New York Heart Association class III, and 6/23 class IV) identified experiencing fatigue almost daily with over 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. 9/23 identified fatigue as their second-worst symptom. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. The three themes however combine to influence a patients well-being and we suggest need to be acknowledged when planning self-care management. Conclusion: As heart failure progresses fatigue influences patients’ daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations. Understanding the patient experience of fatigue and living with fatigue is important to optimize health management strategies

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program

Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available in U.S. hospitals. STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) is a supervised walking program for hospitalized older adults that fills this important gap in clinical care. This paper describes how STRIDE works and how it is being disseminated to other hospitals using the Replicating Effective Programs (REP) framework. Guided by REP, we define core components of the program and areas where the program can be tailored to better fit the needs and local conditions of its new context (hospital). We describe key adaptations made by four hospitals who have implemented the STRIDE program and discuss lessons learned for successful implementation of hospital mobility programs

STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled trial

Background: Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions. Methods / Design: Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA. Discussion: STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA

Tailored Physical Activity Behaviour Change Interventions : Challenges and Opportunities

Background: A physically active lifestyle provides innumerable benefits, yet few individuals are physically active enough to reap those benefits. Tailored physical activity interventions may address low rates of physical activity by offering individualized strategies that consider a person’s characteristics, needs, preferences, and/or context, rather than the traditional one-size-fits-all approach. However, the tailoring methodology is in its nascency, and an understanding of how best to develop such interventions is needed. Purpose: In this commentary, we identify future directions to enhance the impact of tailored interventions designed to increase physical activity participation. Methods: An international collaborative was established to review the literature and discuss an agenda for future research. Results: Two overarching research opportunities are suggested for improving the development of tailored, behavioural physical activity interventions: 1) optimize the engagement of diverse knowledge users in intervention co-design and 2) examine ethical considerations that may impact the use of technology to support tailored physical activity delivery. Specifically, there is a need for better reporting and evaluation of knowledge user involvement alongside targeting diversity in the inclusion of knowledge users. Furthermore, while technology boasts many opportunities to increase the scale and precision of interventions, examinations of how it impacts recipients’ experiences of and participation in tailored interventions are needed to ensure the positives of the technology outweigh the negatives. Conclusion: A better understanding of these research areas will help ensure the diverse needs of individuals are met, technology is appropriately used to support tailoring, and ultimately improve the effectiveness of tailored physical activity interventions.Education, Faculty ofMedicine, Faculty ofPharmaceutical Sciences, Faculty ofNon UBCFamily Practice, Department ofKinesiology, School ofPhysical Therapy, Department ofReviewedFacultyPostdoctoralGraduat