Effect of telerehabilitation on long-term adherence to yoga as an antihypertensive lifestyle intervention: Results of a randomized controlled trial

InterVFast-effectiveness and acceptance of intermittent fasting in cardiac rehabilitation patients: study protocol of a randomized controlled trial

BACKGROUND

Research on intermittent fasting has shown that it can improve a variety of health outcomes, including blood sugar control, blood lipid levels and blood pressure. Only few studies document longer periods of fasting, especially in rehabilitation participants. Cardiac inpatient rehabilitation follows a multidisciplinary approach including change of health behaviour to reduce patients' risk of future cardiovascular events. To date, evidence suggests that intermittent fasting can be an effective way to improve health and well-being, but more research is needed to fully understand its long-term effects and factors that promote the implementation. Therefore, the aim of the ongoing InterVFast trial is to investigate the effectiveness of intermittent fasting amongst cardiac rehabilitation patients after 4-week inpatient rehabilitation as well as 3 and 12 months subsequently including patients' perspective.

METHODS

This single-centre randomized controlled trial evaluates the effectiveness of the InterVFast intervention in weight loss (primary outcome). We also examine patients' acceptance and the effect on relevant outcomes as blood glucose and triglyceride levels, cholesterol and high-sensitivity C-reactive protein. Weight, blood samples and clinical data are collected as part of the initial and final examination during inpatient rehabilitation. During inpatient rehabilitation, participants daily note fasting intervals and meals eaten as well as practicability in a fasting diary. In addition, interviews about perceived advantages and disadvantages and acceptance are carried out with the participants in the IG. A standardized follow-up examination (weight, blood samples) will be carried out by the family doctor after 3 and 12 months (t2 and t3).

DISCUSSION

Compared to other weight-loss intervention studies, our study addresses patients with coronary heart disease and includes patients' acceptance as well as long-term maintenance. It is hypothesized that participation in the InterVfast intervention will improve relevant health outcomes in a sample of cardiac rehabilitation patients and thus constitute a behavioural prevention strategy to reduce the risk of future cardiac events and improve overall health and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov DRKS00023983. Registered on February 17, 2022.

Expectations of Tele-Yoga in Persons With Long-Term Illness: Qualitative Content Analysis

BACKGROUND

Yoga is a mind-body exercise that has demonstrated its feasibility and safety even for individuals with severe long-term illness. Engaging in yoga has the potential to yield positive effects on both physical and mental well-being. Tele-yoga is a novel approach to rehabilitation in which participants practice group yoga with a live-streamed yoga instructor digitally via a tablet. This is especially beneficial for individuals who may find it difficult to leave their homes to participate in an exercise session. As part of our ongoing evaluation of the tele-yoga intervention in individuals with long-term illness, we have undertaken an exploration of participants' expectations regarding yoga in general and tele-yoga specifically. Understanding these expectations is crucial, as they can significantly impact their satisfaction with treatment and care and influence overall intervention outcomes.

OBJECTIVE

This study aims to explore the expectations of tele-yoga among individuals with long-term illness before starting a tele-yoga intervention.

METHODS

The study employed an inductive qualitative design and is part of a process evaluation within an ongoing randomized controlled trial. A total of 89 participants were interviewed before the start of the tele-yoga intervention. The interview guide encompassed questions about their general perceptions of yoga and the specific expectations they held for the upcoming tele-yoga sessions. The interviews were transcribed and analyzed using inductive qualitative content analysis.

RESULTS

Participants expressed their expectations for tele-yoga, focusing on the anticipated improvements in physical function and overall health. These expectations included hopes for reduced respiratory issues; relief from discomfort, aches, and pains; as well as increased physical flexibility, coordination, and overall well-being. Besides, they expected to achieve improved psychological well-being and performance; to acquire strategies to manage stress, anger, and anxiety; and to have their motivational drive strengthened and influence other activities. Participants described tele-yoga as a new and exciting technical solution that would facilitate the delivery of yoga. A few participants remained a little hesitant toward the use of technology, with some expectations based on previous experiences. When asked about expectations, some had no idea about what to expect. Participants also had varying perspectives on yoga, with some finding it mysterious and difficult to understand. Participants expressed thoughts that they found the idea of tele-yoga taking place in groups exciting and enjoyable. They also had expectations that being part of a group would provide opportunities for mutual inspiration and encouragement among the group members.

CONCLUSIONS

Expectations before an intervention can provide valuable insights into understanding the factors influencing adherence to tele-yoga and its outcomes. Our findings provide a wide range of expectations for tele-yoga, spanning both physical and mental aspects. Moreover, the technology's potential to facilitate yoga delivery and the supportive nature of digital group interactions were evident from the results.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03703609; https://clinicaltrials.gov/ct2/show/NCT03703609.

The effect of an online-supervised exercise program in older people with diabetes on fasting blood sugar, psychological resilience and quality of life: A double blind randomised controlled trial

BACKGROUND

Online exercise interventions can improve physical outcomes. Online supervised exercise program is more effective than unsupervised exercise program.

OBJECTIVES

The aim of this study is to determine the effect of an online supervised exercise program on fasting blood glucose, body mass index (BMI), resilience and quality of life in older people with diabetes.

METHODS

This parallel group randomised controlled study included 70 older patients with Type 2 diabetes. Participants were divided into online supervised and unsupervised exercise training groups. Participants in the online-supervised exercise group were given an online-supervised exercise program 3 days a week for 6 weeks. Personal Information Form, Short Resilience Scale and Quality of Life Scale in Older People were used to collect data. In addition, fasting blood sugar BMI and values were measured.

RESULTS

According to the results of our study, while there was no significant difference between the pre-and post-training scores of the supervised and unsupervised groups on the Psychological Resilience Scale and Quality of Life Scale, it was observed that there was a significant difference in both groups according to time (p < .05). When the difference between the scores of the groups before and after the training was analysed according to time, a significant difference was observed between the online-supervised and unsupervised exercise groups (p < .05). In addition, it was seen that there was a significant difference in the fasting blood sugar and BMI results of the online-supervised exercise group according to time (p < .05).

CONCLUSIONS

Online supervised exercise program decreases fasting blood sugar and BMI, increases psychological resilience and quality of life of older patients with Type 2 diabetes.

IMPLICATION FOR PRACTICE

Online supervised exercise program may be an additional treatment that provides benefits for older people with diabetes who cannot participate in clinical-based rehabilitation programs.

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

Objective

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

Methods

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

Results

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

Conclusion

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review

BACKGROUND

Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM.

METHODS

Following Arksey and O'Malley's scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies.

RESULTS

Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM.

CONCLUSIONS

Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.

Impact of Physical Activity on COVID-19

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is seriously endangering human health worldwide. This study finds effective intervention modalities of physical activity on COVID-19 through a narrative review.

METHODS

In this study, 41 papers were selected for a narrative literature review after a comprehensive database search from 20 December 2019, to 30 August 2022.

RESULTS

41 articles meet the established criteria, and in this review, we comprehensively describe recent studies on exercise and COVID-19, including the impact and recommendations of exercise on COVID-19 prevention, patients with COVID-19, and noninfected populations.

CONCLUSIONS

The literature suggests that physical activity (PA) contributes to the prevention and treatment of COVID-19, can promote recovery of physical function, alleviate post-acute COVID-19 syndrome, and improve patients' psychological well-being. It is recommended to develop appropriate exercise prescriptions for different populations under the guidance of a physician.

What helps older people persevere with yoga classes? A realist process evaluation of a COVID-19-affected yoga program for fall prevention

BACKGROUND

Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants.

METHODS

Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures.

RESULTS

Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It's worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga's special properties (embodiment and mindfulness).

CONCLUSIONS

This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga's intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode.

Early mobilization and physical exercise in patients with COVID-19: A narrative literature review

BACKGROUND

Currently, little is known about early mobilization and exercise in individuals with COVID-19.

OBJECTIVE

To describe the indication and safety of early mobilization and exercises in mild to severe COVID-19 patients and to investigate the use of telerehabilitation to deliver exercise programs to these patients.

METHODS

This narrative literature review was conducted performing a comprehensive search of databases.

RESULTS

32 articles met the established criteria and the main findings were summarized and described, including indication, contraindication and recommendation for early rehabilitation and exercises prescription.

CONCLUSIONS

The literature suggests that early mobilization and physical exercise are beneficial for individuals with COVID-19. However, much of what has been published is based on expert opinion due to a lack of randomized trials, which are needed.

[Are Intensified Secondary Prevention Programmes Effective Interventions to Reduce Disability-Related Early Retirement After Cardiac Rehabilitation?]

PURPOSE

We aimed to combine follow-up data from 3 randomized controlled studies to evaluate the effectiveness of intensified (telephone-based) secondary prevention programmes on disability-related early retirement.

METHODS

Each trial (SeKoNa, Sinko and OptiHyp) compared an intensified (telephone-based) secondary prevention concept as an intervention to an untreated control group (standard management). We extracted extensive baseline data on sociodemographic, clinical and diagnostic characteristics on an individual patient level from the original trial data sets. Follow-up analysis is based on routine data of the German Pension Insurance Rhineland (obtained in August 2019). The primary outcome parameters are mortality (all causes), recurrent cardiac events, and employment status three years after rehabilitation. Here we report results regarding disability-related early retirement. Outcome data were pooled with via meta-analysis for individual patient data (Individual Patient Data Meta-Analysis IPD-MA) using classical meta-analytical techniques (one-stage approach using mixed models and 2-stage approach with inverse variance estimation as fixed effects model).

RESULTS

A total of 1058 cardiac rehabilitation patients were included in the analyses. There were no differences between the pooled intervention group (n=499) and the pooled control group (n=559) regarding any baseline parameter at discharge after 3-week cardiac rehabilitation. There are no indications of statistical heterogeneity. In the total sample incident disability-related early retirement rate was 11.8% at 3-year follow-up. Participation in an intensified secondary prevention programme reduced the risk by about 60% compared to the control group (OR: 0.43; 95% CI: 0.36-0.51).

CONCLUSION

The need for effective rehabilitation programmes is rapidly growing due to the current demographic trend with an increase in ageing working populations. Secondary prevention programmes following 3-week inpatient rehabilitation are an effective tool to sustainably support the prevention of health-related premature reduction in earning capacity pensions and therefore should complement the existing rehabilitation offer. Based on our results we conclude that secondary prevention should be provided long enough (at least one year) and in personal contact.

Meditation-Based Lifestyle Modification: Development of an Integrative Mind-Body Program for Mental Health and Human Flourishing

Mental disorders are a core health challenge in the 21st century. Integrative mental health care takes an individual, lifestyle-modifying, salutogenic approach, combining somatic, psychosocial, and spiritual perspectives from evidence-based conventional and complementary medicine. In particular, meditation and mindfulness have received growing research interest in the last decade. In this article, we present Meditation-Based Lifestyle Modification (MBLM), a new, complex mind-body intervention for mental health care. It is the first program to intensify meditation practice using classical yoga. The program (a) covers all areas of classical yoga, (b) considers ethical and spiritual aspects of daily life, (c) orients participants toward sustained lifestyle modification, and (d) is applicable in a clinical context. The scientific rationale of the program is outlined in this article, based on the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare. Further research is planned to show the clinical feasibility of MBLM and evaluate its efficacy, processes of change, and cost-effectiveness.

Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis

Background:

Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind–body exercise thought to promote psychological well-being.

Aim:

Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease.

Methods:

An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges’ g) and the 95% confidence intervals using random effects models.

Results:

A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges’ g 0.96; p=0.02, I2=94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I2=15.93) and physical health QOL (Hedges’ g=0.40; p=0.00, I2=0%); with less depression (Hedges’ g=0.69; p=0.00, I2=86.64%) and psychological distress (Hedges’ g=0.58; p=0.00, I2=0%) were found.

Conclusions:

Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.