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Akinosun AS, Kamya S, Watt J, Johnston W, Leslie SJ, Grindle M. Cardiovascular disease behavioural risk factors in rural interventions: cross-sectional study. Sci Rep 2023; 13:13376. [PMID: 37591952 PMCID: PMC10435574 DOI: 10.1038/s41598-023-39451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
This study aims to (1) assess the distribution of variables within the population and the prevalence of cardiovascular disease (CVD) behavioural risk factors in patients, (2) identify target risk factor(s) for behaviour modification intervention, and (3) develop an analytical model to define cluster(s) of risk factors which could help make any generic intervention more targeted to the local patient population. Study patients with at least one CVD behavioural risk factor living in a rural region of the Scottish Highlands. The study used the STROBE methodology for cross-sectional studies. Demographic and clinical data of patients (n = 2025) in NHS Highlands hospital were collected at the point of admission for PCI between 04.01.2016 and 31.12.2019. Collected data distributions were analysed by CVD behavioural risk factors for prevalence, associations, and direction of associations. Cluster definition was measured by assignment of a unit score each for the overall level of prevalence and significance of associations, and general logistics modelling for direction and significance of the risk. The mean (SD) age was 69.47(± 10.93) years [95% CI (68.99-69.94)]. The key risk factors were hyperlipidaemia, hypertension, and elevated body mass index (BMI). Approximately 40% of the population have multiple risk factor counts of two. Analytical measures revealed a population risk factor cluster with elevated BMI [77.5% (1570/2025)] that is mostly either hyperlipidaemic [9.43%, co-eff. (17), P = 0.007] or hypertensive [22.72%, co-eff. (17), P = 0.99] as key risk factor clusters. Carefully modelled analyses revealed clustered risk associated with elevated BMI. This information would support a strategy for targeting risk factor clusters in novel interventions to improve implementation efficiency. Exposure to and outcome of an elevated BMI is linked more to the population's socio-economic outcomes rather than to regional rurality or urbanity.
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Affiliation(s)
- Adewale Samuel Akinosun
- Digital Health, Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, UK.
| | - Sylvia Kamya
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Jonathan Watt
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - William Johnston
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Stephen J Leslie
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Mark Grindle
- Digital Health, Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, UK
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2
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Aji M, Glozier N, Bartlett DJ, Grunstein RR, Calvo RA, Marshall NS, White DP, Gordon C. The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial. Behav Sleep Med 2022; 20:570-583. [PMID: 34415819 DOI: 10.1080/15402002.2021.1967157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. PARTICIPANTS AND METHODS One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group; n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. RESULTS There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen's d= 0.7, p= .061). The dBTi+wearable group showed greater improvements in WASO (d= 0.8, p = .005) and TST (d= 0.3, p= .049) compared to the dBTi group. Significantly greater engagement (sleep diary entries) was observed in the dBTi+wearable group (mean = 22.4, SD = 10.0) compared to the dBTi group (mean = 14.1, SD = 14.2) (p = .010). CONCLUSIONS This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.
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Affiliation(s)
- Melissa Aji
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CRC for Alertness, Safety and Productivity, Melbourne, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Charles Perkins Centre-RPA Clinic, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - David P White
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Christopher Gordon
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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3
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Verhoeven E, Rouadi P, Jaoude EA, Abouzakouk M, Ansotegui I, Al-Ahmad M, Al-Nesf MA, Azar C, Bahna S, Cuervo-Pardo L, Diamant Z, Douagui H, Maximiliano Gómez R, Díaz SG, Han JK, Idriss S, Irani C, Karam M, Klimek L, Nsouli T, Scadding G, Senior B, Smith P, Yáñez A, Zaitoun F, Hellings PW. Digital tools in allergy and respiratory care. World Allergy Organ J 2022; 15:100661. [PMID: 35784945 PMCID: PMC9243254 DOI: 10.1016/j.waojou.2022.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/13/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Patient care in the allergy and respiratory fields is advancing rapidly, offering the possibility of the inclusion of a variety of digital tools that aim to improve outcomes of care. Impaired access to several health care facilities during the COVID-19 pandemic has considerably increased the appetite and need for the inclusion of e-health tools amongst end-users. Consequently, a multitude of different e-health tools have been launched worldwide with various registration and access options, and with a wide range of offered benefits. From the perspective of both patients and healthcare providers (HCPs), as well as from a legal and device-related perspective, several features are important for the acceptance, effectiveness,and long-term use of e-health tools. Patients and physicians have different needs and expectations of how digital tools might be of help in the care pathway. There is a need for standardization by defining quality assurance criteria. Therefore, the Upper Airway Diseases Committee of the World Allergy Organization (WAO) has taken the initiative to define and propose criteria for quality, appeal, and applicability of e-health tools in the allergy and respiratory care fields from a patient, clinician, and academic perspective with the ultimate aim to improve patient health and outcomes of care.
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Affiliation(s)
- Elisabeth Verhoeven
- Department of Otorhinolaryngology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Philip Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye & Ear University Hospital, Beirut, Lebanon
| | - Eliane Abou Jaoude
- Department of Allergy, Asthma and Clinical Immunology, Georgetown University School of Medicine, Washington DC, USA
| | - Mohamed Abouzakouk
- Department of Clinical Immunology and Allergy, Cleveland Clinic, Ohio, USA
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Erandio, Spain
| | - Mona Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Maryam Ali Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, Qatar
| | - Cecilio Azar
- Clinical Associate, American University of Beirut Medical Center, Beirut, Lebanon
- Consultant Gastroenterologist, Clemenceau Medical Center, Beirut, Lebanon
| | - Sami Bahna
- Department of Allergy and Immunology, Louisiana State University School of Medicine, Shreveport, USA
| | - Lyda Cuervo-Pardo
- Department of Rheumatology, Allergy and Clinical Immunology, University of Florida, Florida, USA
| | - Zuzana Diamant
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund, Sweden
- Department of Clinical Pharmacy and Pharmacology, UMCG, Groningen, the Netherlands
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Habib Douagui
- Department of Pneumology and Allergology, University Hospital of Benimessous, Algiers, Algeria
| | - R. Maximiliano Gómez
- Department of Allergy and Clinical Immunology, School of Health Sciences, Catholic University of Salta, Argentina
| | - Sandra González Díaz
- Department of Allergology and Immunology, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Joseph K. Han
- Department of Rhinology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Samar Idriss
- Department of Otolaryngology, Head and Neck Surgery, Holy Spirit University of Kaslik, Eye and Ear Hospital, Beirut, Lebanon
- Department of Audiology and Neurotology, Edouard Herriot Hospital, Lyon, France
| | - Carla Irani
- Department of Internal Medicine and Clinical Immunology. Hotel Dieu de France, St Joseph University, Beirut, Lebanon
| | - Marilyn Karam
- Department of Allergy, Immunology and Rheumatology, American University of Beirut, Lebanon
- Department of Internal Medicine, American Hospital Dubai, United Arab Emirates
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Talal Nsouli
- Department of Allergy, Asthma and Clinical Immunology, Georgetown University School of Medicine, Washington DC, USA
| | - Glenis Scadding
- Department of Otorhinolaryngology, RNENT Hospital London, London, UK
- Division of Immunity and Infection, Medical Sciences UCL, London, UK
| | - Brent Senior
- Department of Otolaryngology and Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Pete Smith
- Department of Allergology, Clinical Medicine Griffith University of Queensland, Griffith, Australia
| | - Anahí Yáñez
- Department of Allergy and Respiratory Medicine, InAER, Buenos Aires, Argentina
| | - Fares Zaitoun
- Department of Allergy and Otolaryngology, Lebanese-American University Medical Center, Beirut, Lebanon
| | - Peter W. Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Microbiology and Immunology, Laboratory of Clinical Immunology, KU Leuven, Leuven, Belgium
- EUFOREA, European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
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4
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Akinosun AS, Polson R, Diaz-Skeete Y, De Kock JH, Carragher L, Leslie S, Grindle M, Gorely T. Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2021; 9:e21061. [PMID: 33656444 PMCID: PMC7970167 DOI: 10.2196/21061] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/08/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. OBJECTIVE The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. METHODS This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. RESULTS Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at -0.29 [-0.44, -0.15], P<.001; high-density lipoprotein SMD at -0.09 [-0.19, 0.00], P=.05; low-density lipoprotein SMD at -0.18 [-0.33, -0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at -0.37 [-1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at -0.06 [-0.20, 0.08], P=.43; systolic BP SMD at -0.03 [-0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at -0.16 [-1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. CONCLUSIONS Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c).
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Affiliation(s)
- Adewale Samuel Akinosun
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Rob Polson
- Highland Health Sciences Library, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Yohanca Diaz-Skeete
- School of Health and Science, Dundalk Institute of Technology, Dundalk, Ireland
| | - Johannes Hendrikus De Kock
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Lucia Carragher
- School of Health and Science, Dundalk Institute of Technology, Dundalk, Ireland
| | - Stephen Leslie
- Cardiology Unit, Raigmore Hospital, NHS Highlands, Inverness, United Kingdom
| | - Mark Grindle
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Martinez E, Lyons EJ. Effect of Electronic Activity Monitors and Pedometers on Health: Results from the TAME Health Pilot Randomized Pragmatic Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186800. [PMID: 32961834 PMCID: PMC7559399 DOI: 10.3390/ijerph17186800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
Background: Brief counseling and self-monitoring with a pedometer are common practice within primary care for physical activity promotion. It is unknown how high-tech electronic activity monitors compare to pedometers within this setting. This study aimed to investigate the outcomes, through effect size estimation, of an electronic activity monitor-based intervention to increase physical activity and decrease cardiovascular disease risk. Method: The pilot randomized controlled trial was pre-registered online at clinicaltrials.gov (NCT02554435). Forty overweight, sedentary participants 55–74 years of age were randomized to wear a pedometer or an electronic activity monitor for 12 weeks. Physical activity was measured objectively for 7 days at baseline and follow-up by a SenseWear monitor and cardiovascular disease risk was estimated by the Framingham risk calculator. Results: Effect sizes for behavioral and health outcomes ranged from small to medium. While these effect sizes were favorable to the intervention group for physical activity (PA) (d = 0.78) and general health (d = 0.39), they were not favorable for measures. Conclusion: The results of this pilot trial show promise for this low-intensity intervention strategy, but large-scale trials are needed to test its efficacy.
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Affiliation(s)
- Zakkoyya H. Lewis
- College of Science, Department of Kinesiology and Health Promotion, California State Polytechnic University Pomona, 3801 West Temple Ave., Pomona, CA 91768, USA
- Correspondence:
| | - Kenneth J. Ottenbacher
- School of Health Professions, Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Steve R. Fisher
- School of Health Professions, Department of Physical Therapy, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Kristofer Jennings
- Department of Biostatistics, MD Anderson Cancer Center, 1400 Pressler St., Unit 1411, Houston, TX 77030-4008, USA;
| | - Arleen F. Brown
- School of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon, Ave., Los Angeles, CA 90095, USA;
| | - Maria C. Swartz
- Department of Pediatrics, Division of Pediatrics, MD Anderson Cancer Center, 7777 Knight Rd., Houston, TX 77054, USA;
| | - Eloisa Martinez
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Elizabeth J. Lyons
- School of Health Professions, Department of Nutrition and Metabolism, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
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Piera-Jiménez J, Winters M, Broers E, Valero-Bover D, Habibovic M, Widdershoven JWMG, Folkvord F, Lupiáñez-Villanueva F. Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial. J Med Internet Res 2020; 22:e17351. [PMID: 32720908 PMCID: PMC7420510 DOI: 10.2196/17351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/20/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques. OBJECTIVE This study aimed to provide evidence to understand the financial consequences of implementing the "Do Cardiac Health: Advanced New Generation Ecosystem" (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease. METHODS The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities). RESULTS The Do CHANGE 2 intervention was less costly in Spain (incremental cost was -€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan. CONCLUSIONS In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305.
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Affiliation(s)
- Jordi Piera-Jiménez
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of R&D, Badalona Serveis Assistencials, Badalona, Spain
| | | | - Eva Broers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jos W M G Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Meng Y, Speier W, Shufelt C, Joung S, E Van Eyk J, Bairey Merz CN, Lopez M, Spiegel B, Arnold CW. A Machine Learning Approach to Classifying Self-Reported Health Status in a Cohort of Patients With Heart Disease Using Activity Tracker Data. IEEE J Biomed Health Inform 2020; 24:878-884. [PMID: 31199276 PMCID: PMC6904535 DOI: 10.1109/jbhi.2019.2922178] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Constructing statistical models using personal sensor data could allow for tracking health status over time, thereby enabling the possibility of early intervention. The goal of this study was to use machine learning algorithms to classify patient-reported outcomes (PROs) using activity tracker data in a cohort of patients with stable ischemic heart disease (SIHD). A population of 182 patients with SIHD were monitored over a period of 12 weeks. Each subject received a Fitbit Charge 2 device to record daily activity data, and each subject completed eight Patient-Reported Outcomes Measurement Information Systems short form at the end of each week as a self-assessment of their health status. Two models were built to classify PRO scores using activity tracker data. The first model treated each week independently, whereas the second used a hidden Markov model (HMM) to take advantage of correlations between successive weeks. Retrospective analysis compared the classification accuracy of the two models and the importance of each feature. In the independent model, a random forest classifier achieved a mean area under curve (AUC) of 0.76 for classifying the physical function PRO. The HMM model achieved significantly better AUCs for all PROs (p < 0.05) other than Fatigue and Sleep Disturbance, with a highest mean AUC of 0.79 for the physical function-short form 10a. Our study demonstrates the ability of activity tracker data to classify health status over time. These results suggest that patient outcomes can be monitored in real time using activity trackers.
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8
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Radhakrishnan K, Baranowski T, Julien C, Thomaz E, Kim M. Role of Digital Games in Self-Management of Cardiovascular Diseases: A Scoping Review. Games Health J 2019; 8:65-73. [PMID: 30199275 PMCID: PMC6909707 DOI: 10.1089/g4h.2018.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Examine research on the use of digital games to improve self-management (SM) behaviors in patients diagnosed with cardiovascular diagnoses of hypertension, coronary artery disease, heart failure, or myocardial infarction. MATERIALS AND METHODS For this scoping review, the CINAHL, PubMed, and Web of Science databases were searched for studies published from January 1, 2008 to December 20, 2017 using terms relevant to digital games and cardiovascular diseases (CVDs). RESULTS Eight articles met the inclusion/exclusion criteria, seven of which presented studies with participants 50 years or older. Five of the eight studies assessed physical activity. Only two studies included a control group. Digital games significantly improved exercise capacity and energy expenditure but did not affect quality of life, self-efficacy, anxiety, or depression. Digital games were found enjoyable by 79%-93% of participants, including those with lower education or age; however, barriers to game use included being tired or bored, lack of interest in digital games, poor perception of fitness through games, sensor limitations, conflicts with daily life routine, and preferences for group exercise. Average adherence ranged from 70% to 100% over 2 weeks to 6 months of study duration, with higher adherence rates in studies that included human contact through supervision or social support. CONCLUSION Paucity of studies about digital games for CVD SM behaviors precludes the need to undertake a full systematic review. Future studies examining digital games should include larger sample sizes, longer durations, game-design guided by behavioral change theoretical frameworks, and CVD SM behaviors in addition to physical activity behaviors.
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Affiliation(s)
| | - Thomas Baranowski
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | - Christine Julien
- Mobile and Pervasive Computing Laboratory, Department of Electrical and Computer Engineering, The University of Texas–Austin, Austin, Texas
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, School of Information, The University of Texas–Austin, Austin, Texas
| | - Miyong Kim
- School of Nursing, The University of Texas–Austin, Austin, Texas
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9
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Hawkins J, Charles JM, Edwards M, Hallingberg B, McConnon L, Edwards RT, Jago R, Kelson M, Morgan K, Murphy S, Oliver EJ, Simpson SA, Moore G. Acceptability and Feasibility of Implementing Accelorometry-Based Activity Monitors and a Linked Web Portal in an Exercise Referral Scheme: Feasibility Randomized Controlled Trial. J Med Internet Res 2019; 21:e12374. [PMID: 30924791 PMCID: PMC6460312 DOI: 10.2196/12374] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 01/22/2023] Open
Abstract
Background Exercise referral schemes (ERSs) are recommended for patients with health conditions or risk factors. Evidence points to the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, but effects often diminish over time. Techniques such as goal setting, self-monitoring, and personalized feedback may support motivation for physical activity and maintenance of effects. Wearable technologies could provide an opportunity to integrate motivational techniques into exercise schemes. However, little is known about acceptability to exercise referral populations or implementation feasibility within exercise referral services. Objective To determine the feasibility and acceptability of implementing an activity-monitoring device within the Welsh National ERS to inform a decision on whether and how to proceed to an effectiveness trial. Methods We conducted a feasability randomized controlled trial with embedded mixed-methods process evaluation and an exploratory economic analysis. Adults (N=156) were randomized to intervention (plus usual practice; n=88) or usual practice only (n=68). Usual practice was a 16-week structured exercise program. The intervention group additionally received an accelerometry-based activity monitor (MyWellnessKey) and associated Web platform (MyWellnessCloud). The primary outcomes were predefined progression criteria assessing acceptability and feasibility of the intervention and proposed evaluation. Postal questionnaires were completed at baseline (time 0:T0), 16 weeks (T1), and 12 months after T0 (T2). Routine data were accessed at the same time-points. A subsample of intervention participants and scheme staff were interviewed following the initiation of intervention delivery and at T2. Results Participants were on average aged 56.6 (SD 16.3) years and mostly female (101/156, 64.7%) and white (150/156, 96.2%). Only 2 of 5 progression criteria were met; recruitment and randomization methods were acceptable to participants, and contamination was low. However, recruitment and retention rates (11.3% and 67.3%, respectively) fell substantially short of target criteria (20% and 80%, respectively), and disproportionally recruited from the least deprived quintile. Only 57.4% of intervention participants reported receipt of the intervention (below the 80% progression threshold). Less than half reported the intervention to be acceptable at T2. Participant and staff interviews revealed barriers to intervention delivery and engagement related to the device design as well as context-specific technological challenges, all of which made it difficult to integrate the technology into the service. Routinely collected health economic measures had substantial missing data, suggesting that other methods for collecting these should be used in future. Conclusions To our knowledge, this is the first study to evaluate short- and long-term feasibility and acceptability of integrating wearable technologies into community-based ERSs. The findings highlight device- and context-specific barriers to doing this in routine practice, with typical exercise referral populations. Key criteria for progression to a full-scale evaluation were not met. Trial Registration ISRCTN Registry ISRCTN85785652; http://www.isrctn.com/ISRCTN85785652
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Affiliation(s)
- Jemma Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Michelle Edwards
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Britt Hallingberg
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Linda McConnon
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Mark Kelson
- Institute for Data Science and Artificial Intelligence, School of Mathematics, University of Exeter, Exeter, United Kingdom
| | - Kelly Morgan
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, United Kingdom
| | - Sharon A Simpson
- Medical Research Council and Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Graham Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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10
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Valenzuela Espinoza A, Steurbaut S, Dupont A, Cornu P, van Hooff RJ, Brouns R, Putman K. Health Economic Evaluations of Digital Health Interventions for Secondary Prevention in Stroke Patients: A Systematic Review. Cerebrovasc Dis Extra 2019; 9:1-8. [PMID: 30616238 PMCID: PMC6489060 DOI: 10.1159/000496107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the first 5 years after their stroke, about a quarter of patients will suffer from a recurrent stroke. Digital health interventions facilitating interactions between a caregiver and a patient from a distance are a promising approach to improve patient adherence to lifestyle changes proposed by secondary prevention guidelines. Many of these interventions are not implemented in daily practice, even though efficacy has been shown. One of the reasons can be the lack of clear economic incentives for implementation. We propose to map all health economic evidence regarding digital health interventions for secondary stroke prevention. SUMMARY We performed a systematic search according to PRISMA-P guidelines and searched on PubMed, Web of Science, Cochrane, and National Institute for Health Research Economic Evaluation Database. Only digital health interventions for secondary prevention in stroke patients were included and all study designs and health economic outcomes were accepted. We combined the terms "Stroke OR Cardiovascular," "Secondary prevention," "Digital health interventions," and "Cost" in one search string using the AND operator. The search performed on April 20, 2017 yielded 163 records of which 26 duplicates were removed. After abstract screening, 20 articles were retained for full-text analysis, of which none reported any health economic evidence that could be included for analysis or discussion. Key Messages: There is a lack of evidence on health economic outcomes on digital health interventions for secondary stroke prevention. Future research in this area should take health economics into consideration when designing a trial and there is a clear need for health economic evidence and models.
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Affiliation(s)
- Alexis Valenzuela Espinoza
- Vrije Universiteit Brussel (VUB), Interuniversity Center for Health Economics Research (I-CHER), Brussels, Belgium,
| | - Stephane Steurbaut
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Alain Dupont
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Pieter Cornu
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Robbert-Jan van Hooff
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Brussels, Belgium
- Neurovascular Center, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Raf Brouns
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Brussels, Belgium
- Department of Neurology, Hospital ZorgSaam, Terneuzen, The Netherlands
| | - Koen Putman
- Vrije Universiteit Brussel (VUB), Interuniversity Center for Health Economics Research (I-CHER), Brussels, Belgium
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11
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Phillips SA, Ali M, Modrich C, Oke S, Elokda A, Laddu D, Bond S. Advances in Health Technology Use and Implementation in the Era of Healthy Living: Implications for Precision Medicine. Prog Cardiovasc Dis 2018; 62:44-49. [PMID: 30597149 DOI: 10.1016/j.pcad.2018.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/24/2022]
Abstract
Much of the focus of precision medicine has been directed toward genomics, despite the fact that "lifestyle and behavioral factors" are included in the description of precision medicine. Numerous structured diet and PA interventions have demonstrated success in preventing and/or reducing chronic-disease risk. The use of personal health technologies has expanded exponentially in the health care arena; there are a number of consumer-based technologies yielding health information to individual users. The explosion in technology use provides an opportunity for broader dissemination of health care services and products. In addition, tracking cardiovascular disease risk and lifestyle and behavioral aspects of healthy living (HL) profiles in those products may be an important leveraging interface for precision medicine. This review will discuss and present an overview of current health technologies, their use in promotion of HL metrics and how this data may be integrated into venues that support HL and precision medicine.
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Affiliation(s)
- Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Mohamed Ali
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Charles Modrich
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shariwa Oke
- Department of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Samantha Bond
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois, Chicago, IL, USA
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12
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Arena R, Ozemek C, Laddu D, Campbell T, Rouleau CR, Standley R, Bond S, Abril EP, Hills AP, Lavie CJ. Applying Precision Medicine to Healthy Living for the Prevention and Treatment of Cardiovascular Disease. Curr Probl Cardiol 2018; 43:448-483. [DOI: 10.1016/j.cpcardiol.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Speier W, Dzubur E, Zide M, Shufelt C, Joung S, Van Eyk JE, Bairey Merz CN, Lopez M, Spiegel B, Arnold C. Evaluating utility and compliance in a patient-based eHealth study using continuous-time heart rate and activity trackers. J Am Med Inform Assoc 2018; 25:1386-1391. [PMID: 29850807 PMCID: PMC6188512 DOI: 10.1093/jamia/ocy067] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Telemedicine has been used to remotely diagnose and treat patients, yet previously applied telemonitoring approaches have been fraught with adherence issues. The primary goal of this study was to evaluate the adherence rates using a consumer-grade continuous-time heart rate and activity tracker in a mid-risk cardiovascular patient population. As a secondary analysis, we show the ability to utilize the information provided by this device to identify information about a patient's state by correlating tracker information with patient-reported outcome survey scores. We showed that using continuous-time activity trackers with heart rate monitors can be effective in a telemonitoring application, as patients had a high level of adherence (90.0% median usage) and low attrition (0.09% decrease per day) over a 90-day period. Furthermore, data collected correlated significantly with clinically relevant patient surveys (r2=0.15 for PROMIS global health scores, p < .00001), and therefore might provide an effective signal for identifying patients in need of intervention.
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Affiliation(s)
- William Speier
- Medical Imaging and Informatics Group, Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Eldin Dzubur
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mary Zide
- Medical Imaging and Informatics Group, Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sandy Joung
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jennifer E Van Eyk
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Institute, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Mayra Lopez
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan Spiegel
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Corey Arnold
- Medical Imaging and Informatics Group, Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
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14
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Zelko A, Bukova A, Kolarcik P, Bakalar P, Majercak I, Potocnikova J, Reijneveld SA, van Dijk JP. A randomized controlled trial to evaluate utilization of physical activity recommendations among patients of cardiovascular healthcare centres in Eastern Slovakia: study design and rationale of the AWATAR study. BMC Public Health 2018; 18:454. [PMID: 29618329 PMCID: PMC5885358 DOI: 10.1186/s12889-018-5349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background Guidelines on modifiable risk factors regarding cardiological patients are poorly implemented in clinical practice perhaps due to low health literacy. Several digital tools for improving lifestyle and behavioural intervention were developed. Our primary aim is to evaluate the effectiveness of a digital exercise prescription tool on the adherence to physical activity recommendations among patients with cardiovascular diseases. Methods A randomized controlled trial will be realized in cooperation with Cardiovascular Health Centres in Eastern Slovakia. Patients recruited through their cardiologists, will be randomised at 1:1 ratio to the three-months’ experimental condition or control condition. The experimental group will receive standard lifestyle consultation leading to individually optimized prescription of physical activity. The control group will receive standard, usual-cardio-care lifestyle counselling, also in the domain of physical activity. The digital system will be used for optimized exercise prescription. The primary outcome is a change in the patient’s adherence to exercise recommendations. Data will be collected in both groups prior to consultation and after 3 months. Discussion This study protocol presents background and design of a randomized control trial to investigate the effectiveness of a digital system-provide exercise prescription tool on the adherence to physical activity recommendations. An optimized exercise prescription that better reflects patient’s diagnosis, comorbidities and medication can have a significant impact on secondary prevention of cardiovascular disease. This trial can provide important evidence about the effectiveness of digital exercise guidance in everyday practice of cardiovascular healthcare. Trial registration The study was registered on 1st November, 2017 and is available online at ClinicalTrials.gov (ID:NCT03329053).
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Affiliation(s)
- Aurel Zelko
- Institute of Physical Education and Sport, P. J. Safarik University, Ondavska 21, 040 11, Kosice, Slovakia. .,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.
| | - Alena Bukova
- Institute of Physical Education and Sport, P. J. Safarik University, Ondavska 21, 040 11, Kosice, Slovakia
| | - Peter Kolarcik
- Department of Health Psychology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.,Olomouc University Society and Health Institute, Palacky University Olomouc, Krizkovskeho 8, 771 47, Olomouc, Czech Republic
| | - Peter Bakalar
- Institute of Physical Education and Sport, P. J. Safarik University, Ondavska 21, 040 11, Kosice, Slovakia
| | - Ivan Majercak
- First Department of Internal Medicine, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia
| | - Jana Potocnikova
- Institute of Physical Education and Sport, P. J. Safarik University, Ondavska 21, 040 11, Kosice, Slovakia
| | - Sijmen A Reijneveld
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700, Groningen, RB, Netherlands
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11, Kosice, Slovakia.,Olomouc University Society and Health Institute, Palacky University Olomouc, Krizkovskeho 8, 771 47, Olomouc, Czech Republic.,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700, Groningen, RB, Netherlands
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15
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Claes J, Buys R, Woods C, Briggs A, Geue C, Aitken M, Moyna N, Moran K, McCaffrey N, Chouvarda I, Walsh D, Budts W, Filos D, Triantafyllidis A, Maglaveras N, Cornelissen VA. PATHway I: design and rationale for the investigation of the feasibility, clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform. BMJ Open 2017; 7:e016781. [PMID: 28667228 PMCID: PMC5726129 DOI: 10.1136/bmjopen-2017-016781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) independently alters the clinical course of cardiovascular diseases resulting in a significant reduction in all-cause and cardiac mortality. However, only 15%-30% of all eligible patients participate in a phase 2 ambulatory programme. The uptake rate of community-based programmes following phase 2 CR and adherence to long-term exercise is extremely poor. Newer care models, involving telerehabilitation programmes that are delivered remotely, show considerable promise for increasing adherence. In this view, the PATHway (Physical Activity Towards Health) platform was developed and now needs to be evaluated in terms of its feasibility and clinical efficacy. METHODS AND ANALYSIS In a multicentre randomised controlled pilot trial, 120 participants (m/f, age 40-80 years) completing a phase 2 ambulatory CR programme will be randomised on a 1:1 basis to PATHway or usual care. PATHway involves a comprehensive, internet-enabled, sensor-based home CR platform and provides individualised heart rate monitored exercise programmes (exerclasses and exergames) as the basis on which to provide a personalised lifestyle intervention programme. The control group will receive usual care. Study outcomes will be assessed at baseline, 3 months and 6 months after completion of phase 2 of the CR programme. The primary outcome is the change in active energy expenditure. Secondary outcomes include cardiopulmonary endurance capacity, muscle strength, body composition, cardiovascular risk factors, peripheral endothelial vascular function, patient satisfaction, health-related quality of life (HRQoL), well-being, mediators of behaviour change and safety. HRQoL and healthcare costs will be taken into account in cost-effectiveness evaluation. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the director and clinical director of the PATHway study and by the ethical committee of each participating site. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses and events. TRIAL REGISTRATION NUMBER NCT02717806. This trial is currently in the pre-results stage.
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Affiliation(s)
- Jomme Claes
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Andrew Briggs
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, Scotland
| | - Claudia Geue
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, Scotland
| | - Moira Aitken
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, Scotland
| | - Niall Moyna
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Kieran Moran
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Noel McCaffrey
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Ioanna Chouvarda
- Centre for Research and Technology, Institute of Applied Biosciences, Hellas, Greece
| | - Deirdre Walsh
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Werner Budts
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Dimitris Filos
- Centre for Research and Technology, Institute of Applied Biosciences, Hellas, Greece
| | | | - Nicos Maglaveras
- Centre for Research and Technology, Institute of Applied Biosciences, Hellas, Greece
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16
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Liu S, Feng W, Chhatbar PY, Liu Y, Ji X, Ovbiagele B. Mobile health as a viable strategy to enhance stroke risk factor control: A systematic review and meta-analysis. J Neurol Sci 2017; 378:140-145. [PMID: 28566151 DOI: 10.1016/j.jns.2017.04.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge evidence-treatment gaps in stroke prevention. We aimed to evaluate the effectiveness of mHealth for stroke risk factor control through a systematic review and meta-analysis. METHODS We searched PubMed from January 1, 2000 to May 17, 2016 using the following keywords: mobile health, mHealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed a sustained (at least 6months) effect of mHealth. RESULTS Of 78 articles identified, 13 met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater Hemoglobin A1c reduction at 6months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P=0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74, -0.04], P=0.03). mHealth also lead to relatively higher smoking abstinence rates at 6months (7 studies; 9514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P<0.0001). CONCLUSIONS Our meta-analysis supports that use of mHealth improves glycemic control and smoking abstinence rates.
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Affiliation(s)
- Shimeng Liu
- Department of Neurology, Medical University of South Carolina, SC, USA; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, SC, USA
| | - Pratik Y Chhatbar
- Department of Neurology, Medical University of South Carolina, SC, USA
| | - Yumei Liu
- Department of Neurology, Medical University of South Carolina, SC, USA; Vascular Ultrasound Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, SC, USA.
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Abstract
Health care consumers are taking control of their health information and desire a greater role in managing their health. Approximately 77% of Americans now own a smartphone and the use of health apps have doubled over the past two years. These effects are particularly notable in patients with chronic disease, now representing half the adult population and responsible for 86% of United States health care (HC) costs and 70% of deaths. New opportunities exist as a result of recent advances in home-based wireless devices, apps, wearables, and interactive systems enabling health delivery systems to monitor, advise and treat disease near real time and engage patients in healthy living medicine. These technologies will provide a new framework for patient engagement and care delivery that will enhance clinical outcomes and generate precision interventions that ultimately reduce HC costs.
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18
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Sagner M, McNeil A, Puska P, Auffray C, Price ND, Hood L, Lavie CJ, Han ZG, Chen Z, Brahmachari SK, McEwen BS, Soares MB, Balling R, Epel E, Arena R. The P4 Health Spectrum – A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan. PROGRESS IN PREVENTIVE MEDICINE 2017. [DOI: 10.1097/pp9.0000000000000002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Sagner M, Arena R, McNeil A, Brahmam GN, Hills AP, De Silva HJ, Karunapema RPP, Wijeyaratne CN, Arambepola C, Puska P. Creating a pro-active health care system to combat chronic diseases in Sri Lanka: the central role of preventive medicine and healthy lifestyle behaviors. Expert Rev Cardiovasc Ther 2016; 14:1107-17. [DOI: 10.1080/14779072.2016.1227703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Hernández-Vicente A, Santos-Lozano A, De Cocker K, Garatachea N. Validation study of Polar V800 accelerometer. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:278. [PMID: 27570772 DOI: 10.21037/atm.2016.07.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The correct quantification of physical activity (PA) and energy expenditure (EE) in daily life is an important target for researchers and professionals. The objective of this paper is to study the validity of the Polar V800 for the quantification of PA and the estimation of EE against the ActiGraph (ActiTrainer) in healthy young adults. METHODS Eighteen Caucasian active people (50% women) aged between 19-23 years wore an ActiTrainer on the right hip and a Polar V800 on the preferred wrist during 7 days. Paired samples t-tests were used to analyze differences in outcomes between devices, and Pearson's correlation coefficients to examine the correlation between outcomes. The agreement was studied using the Bland-Altman method. Also, the association between the difference and the magnitude of the measurement (heteroscedasticity) was examined. Sensitivity, specificity and area under the receiver operating characteristic curve (ROC-AUC value) were calculated to evaluate the ability of the devices to accurately define a person who fulfills the recommendation of 10,000 daily steps. RESULTS The devices significantly differed from each other on all outcomes (P<0.05), except for Polar V800's alerts vs. ActiTrainer's 1 hour sedentary bouts (P=0.595) and Polar V800's walking time vs. ActiTrainer's lifestyle time (P=0.484). Heteroscedasticity analyses were significant for all outcomes, except for Kcal and sitting time. The ROC-AUC value was fair (0.781±0.048) and the sensitivity and specificity was 98% and 58%, respectively. CONCLUSIONS The Polar V800 accelerometer has a comparable validity to the accelerometer in free-living conditions, regarding "1 hour sedentary bouts" and "V800's walking time vs. ActiTrainer's lifestyle time" in young adults.
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Affiliation(s)
| | - Alejandro Santos-Lozano
- GIDFYS, European University Miguel de Cervantes, Valladolid, Spain; ; Research Institute of Hospital 12 de Octubre ("i+12"), Madrid, Spain
| | - Katrien De Cocker
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Nuria Garatachea
- Faculty of Health and Sport Science, University of Zaragoza, Huesca, Spain; ; GENUD, University of Zaragoza, Zaragoza, Spain
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Sagner M, McNeil A, Puska P, Auffray C, Price ND, Hood L, Lavie CJ, Han ZG, Chen Z, Brahmachari SK, McEwen BS, Soares MB, Balling R, Epel E, Arena R. The P4 Health Spectrum - A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan. Prog Cardiovasc Dis 2016; 59:506-521. [PMID: 27546358 DOI: 10.1016/j.pcad.2016.08.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023]
Abstract
Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often 'silent' chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as "P4" holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a 'P4 Health Continuum' model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.
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Affiliation(s)
- Michael Sagner
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute.
| | - Amy McNeil
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Pekka Puska
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, Paris and Lyon, France
| | | | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Ze-Guang Han
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhu Chen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Samir Kumar Brahmachari
- Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Bruce S McEwen
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA
| | | | - Rudi Balling
- Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Ross Arena
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute
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22
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Milani RV, Bober RM, Lavie CJ. The Role of Technology in Chronic Disease Care. Prog Cardiovasc Dis 2016; 58:579-83. [PMID: 26772623 DOI: 10.1016/j.pcad.2016.01.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA.
| | - Robert M Bober
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Lyons EJ. Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients. JMIR Res Protoc 2016; 5:e59. [PMID: 27129602 PMCID: PMC4867768 DOI: 10.2196/resprot.5454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users. OBJECTIVE The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer. METHODS Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders. RESULTS The study started recruitment in October 2015 and is scheduled to be completed by October 2016. CONCLUSIONS This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level. TRIAL REGISTRATION ClinicalTrials.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT).
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Affiliation(s)
- Zakkoyya H Lewis
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, United States.
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24
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Hickey AM, Freedson PS. Utility of Consumer Physical Activity Trackers as an Intervention Tool in Cardiovascular Disease Prevention and Treatment. Prog Cardiovasc Dis 2016; 58:613-9. [PMID: 26943981 DOI: 10.1016/j.pcad.2016.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
Consumer activity trackers have grown in popularity over the last few years. These devices are typically worn on the hip or wrist and provide the user with information about physical activity measures such as steps taken, energy expenditure, and time spent in moderate to vigorous physical activity. The consumer may also use the computer interface (e.g. device websites, smartphone applications) to monitor and track achievement of PA goals and compete with other users. This review will describe some of the most popular consumer devices and discuss the user feedback tools. We will also present the limited evidence available about the accuracy of these devices and highlight how they have been used in cardiovascular disease management. We conclude with some recommendations for future research, focusing on how consumer devices might be used to assess effectiveness of various cardiovascular treatments.
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Affiliation(s)
- Amanda M Hickey
- Department of Kinesiology, University of Massachusetts, Amherst, MA
| | - Patty S Freedson
- Department of Kinesiology, University of Massachusetts, Amherst, MA.
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25
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Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women. Prog Cardiovasc Dis 2016; 58:595-604. [PMID: 26908050 DOI: 10.1016/j.pcad.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022]
Abstract
Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group.
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Arena R, Lavie CJ, Hivert MF, Williams MA, Briggs PD, Guazzi M. Who will deliver comprehensive healthy lifestyle interventions to combat non-communicable disease? Introducing the healthy lifestyle practitioner discipline. Expert Rev Cardiovasc Ther 2015; 14:15-22. [DOI: 10.1586/14779072.2016.1107477] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Arena R, Lavie CJ, Cahalin LP, Briggs PD, Guizilini S, Daugherty J, Chan WM, Borghi-Silva A. Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease. Expert Rev Cardiovasc Ther 2015; 14:23-36. [DOI: 10.1586/14779072.2016.1107475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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28
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Shay CM, Gooding HS, Murillo R, Foraker R. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health. Prog Cardiovasc Dis 2015; 58:41-9. [PMID: 25958016 DOI: 10.1016/j.pcad.2015.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal.
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Affiliation(s)
- Christina M Shay
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Holly S Gooding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Rosenda Murillo
- Department of Psychological, Health and Learning Sciences, College of Education, University of Houston, Houston, TX, USA
| | - Randi Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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29
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Recent Publications by Ochsner Authors. Ochsner J 2015; 15:206-12. [PMID: 26130990 PMCID: PMC4482569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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