Factors Influencing Walking and Exercise Adherence in Healthy Older Adults Using Monitoring and Interfacing Technology: Preliminary Evidence

Background: Monitoring and interfacing technologies may increase physical activity (PA) program adherence in older adults, but they should account for aspects influencing older adults’ PA behavior. This study aimed at gathering preliminary wrist-based PA adherence data in free-living and relate these to the influencing factors. Methods: Ten healthy older adults (4 females, aged 70–78 years) provided health, fatigue, activity levels, attitude towards pacing, and self-efficacy information and performed a 6 min-walk test to assess their fitness. After a baseline week they followed a two-week walking and exercise intervention. Participants saw their progress via a purposely designed mobile application. Results: Walking and exercise adherence did not increase during the intervention (p = 0.38, p = 0.65). Self-efficacy decreased (p = 0.024). The baseline physical component of the Short Form Health Survey was the most predictive variable of walking adherence. Baseline perceived risk of over-activity and resting heart rate (HRrest) were the most predictive variables of exercise adherence. When the latter two were used to cluster participants according to their exercise adherence, the fitness gap between exercise-adherent and non-adherent increased after the intervention (p = 0.004). Conclusions: Risk of over-activity and HRrest profiled short-term exercise adherence in older adults. If confirmed in a larger and longer study, these could personalize interventions aimed at increasing adherence

Design and usage of the HeartCycle education and coaching program for patients with heart failure

Background: Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor. Objective: The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program. Methods: The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain. Results: Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching. Conclusions: The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program

Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme

Aims: There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. home telemonitoring (HTM) to monitor patient's symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise, and stress) and to establish which variations affect weight, blood pressure, and heart rate. Methods and results: We assessed 76 patients with heart failure (mean age 76 ± 10.8 years, 75% male, mainly in NYHA class II/III and from ischaemic aetiology cause). Patients were given a calendar of interventions scheduling activities approximately twice a week before measuring their vital signs. Eating salty food or a large meal were the activities that had a significant impact on weight gain (+0.3 kg; P < 0.001 and P = 0.006, respectively). Exercise and skipping a dose of medication other than diuretics increased heart rate (+3 bpm, P = 0.001 and almost +2 bpm, P = 0.016, respectively). Conclusions: Our HTM system was able to detect small changes in vital signs related to these activities. Further studies should assess if providing such a schedule of activities might be useful for patient education and could improve long-term adherence to recommended lifestyle changes

Do heart failure status and psychosocial variables moderate the relationship between leisure time physical activity and mortality risk among patients with a history of myocardial infarction?

Background: Leisure time physical activity (LTPA) is inversely related to mortality risk among patients with a history of myocardial infarction (MI). The aims were to explore if heart failure (HF) status and psychosocial variables moderate the association.Methods: Participants (n = 1169) were from a multi-center prospective cohort study. Information on LTPA (none, irregular,1–150, 151–300 and >300 weekly minutes), depression, social support and other prognostic indicators were collected 10–13 years after index MI. Cox regressions were conducted, adjusting for potential confounders. In case of significant moderation by HF-status or psychosocial variables, stratified analyses were performed.Results: During follow-up (M = 8.4 years), 25.6 % of the sample had died. LTPA was inversely associated with mortality (p for trend < 0.01 in all models). HF did not, but psychosocial variables did, moderate the association. In the LTPA category 1–150 weekly minutes, patients with a high level of depression had a lower mortality risk in comparison to those with a low level (hazard ratios (95 % confidence intervals) were 0.43 (0.25, 0.75) versus 0.69 (0.36, 1.32)), and patients with a low level of social support had a lower mortality risk in comparison to those with a high level (0.40 (0.21, 0.77) versus 0.71 (0.39, 1.27)). In the category >300 min, patients with a high level of social support had a lower mortality risk than those with a low level (0.38 (0.19, 0.79) versus 0.51 (0.30, 0.87)).Conclusions: LTPA was inversely related to mortality risk of post-MI patients. HF did not moderate the relationship; depression and social support partially did

MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study

BACKGROUND: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. OBJECTIVE: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. METHODS: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. RESULTS: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). CONCLUSIONS: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation

The Explanations People Give for Going to Bed Late:A Qualitative Study of the Varieties of Bedtime Procrastination

BACKGROUND/OBJECTIVE: Bedtime procrastination is a prevalent cause of sleep deprivation, but little is known about why people delay their bedtimes. In the present research, we conducted a qualitative study with bedtime procrastinators to classify their self-reported reasons for later-than-intended bedtime. PARTICIPANTS: Participants (N = 17) were selected who frequently engaged in bedtime procrastination, but whose sleep was not otherwise affected by diagnosed sleep disorders or shift work. METHOD: We conducted in-depth, semistructured interviews and used thematic analysis to identify commonly recurring themes in the interviews. RESULTS AND CONCLUSIONS: Three emerging themes were identified: deliberate procrastination, mindless procrastination, and strategic delay. For the form of procrastination we classified as deliberate procrastination, participants typically reported wilfully delaying their bedtime because they felt they deserved some time for themselves. For the category of mindless procrastination, a paradigmatic aspect was that participants lost track of the time due to being immersed in their evening activities. Finally, participants who engaged in strategic delay reported going to bed late because they felt they needed to in order to fall asleep (more quickly), which suggests that despite describing themselves as “procrastinating,” their bedtime delay may actually be linked to undiagnosed insomnia. The conceptual distinctions drawn in this paper deepen our understanding of bedtime delay and may be helpful for designing effective interventions