Technology use among patients with cardiovascular disease: an assessment of patient need for a technology enabled behavioural change intervention.

Effective Cardiac Rehabilitation (CR) can significantly improve mortality and morbidity rates in relation to cardiovascular disease; however, uptake of traditional community-based long-term is very low. PATHway (Physical Activity Towards Health) will provide individualized rehabilitation programs, through an internet-enabled sensor-based home exercise platform that allows remote participation. The purpose of this study was to assess the level of interest and use of technology by individuals living with CVD in order to inform the design of a technology-enabled CR programme. Method: A technology usage questionnaire based on a previous study investigating the role of technology and mHealth in a CVD population was used (Dale et al., 2014) to ascertain the current level of technology use. All patients attending the Phase Four community cardiac rehabilitation HeartSmart programme (MedEx) were recruited (N=67; 66.2 years, SD= 8.55, Males =76.1%, Females=20.9%). Results: Technology usage was high with 60% of participants owning a smartphone and 85% accessing the internet (54% of whom access it everyday). Participants endorsed the idea of technology enabled cardiac rehabilitation, indicating that they found the idea ‘ appealing’. 79% were interested in receiving ongoing CR support via their smartphones, 79% were interested in receiving CR via the internet. It was found that 52% of patients found the idea of a virtual rehabilitation class appealing. Conclusion: This study provides support for the patient need for a technology enabled behavioural change intervention, specifically through the provision of an internet-enabled sensor-based home exercise platform that allows remote participation in CR exercise programs

A genetic predisposition score for muscular endophenotypes predicts the increase in aerobic power after training: the CAREGENE study

<p>Abstract</p> <p>Background</p> <p>It is widely accepted that genetic variability might explain a large part of the observed heterogeneity in aerobic capacity and its response to training. Significant associations between polymorphisms of different genes with muscular strength, anaerobic phenotypes and body composition have been reported. Muscular endophenotypes are positively correlated with aerobic capacity, therefore, we tested the association of polymorphisms in twelve muscular related genes on aerobic capacity and its response to endurance training.</p> <p>Methods</p> <p>935 Coronary artery disease patients (CAD) who performed an incremental exercise test until exhaustion at baseline and after three months of training were included. Polymorphisms of the genes were detected using the invader assay. Genotype-phenotype association analyses were performed using ANCOVA. Different models for a genetic predisposition score (GPS) were constructed based on literature and own data and were related to baseline and response VO₂scores.</p> <p>Results</p> <p>Carriers of the minor allele in the R23K polymorphism of the glucocorticoid receptor gene (<it>GR</it>) and the ciliary neurotrophic factor gene (<it>CNTF</it>) had a significantly higher increase in peakVO₂after training (p < 0.05). Carriers of the minor allele (C34T) in the adenosine monophosphate deaminase (<it>AMPD1</it>) gene had a significantly lower relative increase (p < 0.05) in peakVO₂. GPS of data driven models were significantly associated with the increase in peakVO₂after training.</p> <p>Conclusions</p> <p>In CAD patients, suggestive associations were found in the <it>GR, CNTF </it>and the <it>AMPD1 </it>gene with an improved change in aerobic capacity after three months of training. Additionally data driven models with a genetic predisposition score (GPS) showed a significant predictive value for the increase in peakVO₂.</p

PATHway: decision support in exercise programmes for cardiac rehabilitation

Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach

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

Landowners’ Сolonization of Bashkiria

The “closed city” practice, exercised in Ufa province before 1735, together with the unfavourable political situation led to the bad crisis of estate landownership of the Ufa district. The population polls of the mid-XVII — beginning of XVIII cc. justify the fact that Ufa noblemen had to succumb to the fate of socially deprived Siberian nobility, practically devoid of serf peasants. The beginning of the largest-scale Bashkir insurrection of 1735–1736 made the administration review its attitude to the former ban on Bashkir estate lands sale. In the history of Bashkir landowners’ colonization the edict dated February 11th, 1736, allowing the local officers and officials to buy lands from Bashkir communities, was of principal importance. This procedure was exercised simultaneously with the establishment of the Russian government military control over the south-eastern border, separating Bashkir estate lands from Kazakh migratory tribes. From this moment on there is a stop in diplomatic contacts of the Bashkir elite with the governors of the Middle Asia, Kazakhstan and Turkey that meant the complete loss of political subjection by the Bashkirs. Bashkir communities become active participants of economic relations with Russian landowners, plant owners and the state institutions. Russian government preserved estate dynastic rights with the Bashkirs and refused from large-scale operations on the expropriation of Bashkir lands, transferring the mission of colonization to private persons, who had to arrange the issue with the local communities by themselves. The permission to sell estate lands forced landowners to active participation in the system of Russian legal relations, to contact the Russian government and customers

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

Cardiorespiratory fitness in outpatients with bipolar disorder versus matched controls: An exploratory study

AbstractBackground Patients with bipolar disorder (BD) are approximately twice as likely to die prematurely due cardiovascular diseases (CVD) than the general population. Cardiorespiratory fitness (CRF) is an important health outcome measure, predictive for CVD and premature mortality. Aims The aim of the current study was to compare the CRF of outpatients with BD versus age-, gender-, and body mass index (BMI)-matched healthy controls (HC). A secondary aim was to assess potential correlates of CRF. Methods All participants underwent a maximal incremental exercise test to measure the maximum oxygen uptake (VO2max, the golden standard assessment of cardiorespiratory fitness), wore a Body Sensewear Armband for 5 subsequent days to assess their physical activity behavior and completed the Positive-and-Negative-Affect-Schedule (PANAS). Results Outpatients with BD (n=20; 47.8±7.6years) had a significantly lower VO2max compared with HC (n=20; 47.8±7.6years) (26.0±7.3 versus 30.4±6.5 ml/min/kg, P=0.047). A higher VO2max was correlated with younger age, higher active energy expenditure, higher PANAS positive and lower PANAS negative affect scores and a lower antipsychotic medication dose. Limitations The limited sample and cross-sectional design preclude definitive conclusions. Conclusions Compared with HC, outpatients with BD have reduced CRF levels of approximately 4.4 ml/min/kg. In the general population such reductions are associated with a 20% increased premature mortality risk. Interventions targeting CRF in BD are required. Although more research is needed, clinicians should consider the utility of objective assessments of CRF for risk stratification in outpatient settings

Verslag Harpa-infosessie op 13/02 2016 met Prof. Luc Vanhees

status: publishe

Een blik op het onderzoek in de cardiovasculaire revalidatie, KU Leuven. Resveratrol

status: publishe