It is like someone holding your hand when you need it - lived experiences of patients with cardiovascular disease participating in a digital health intervention focusing on the maintenance of physical activity after cardiac rehabilitation

Physical activity targeting patients admitted to a psychiatric hospital- a mixed method feasibility study

BACKGROUND

Physical activity (PA) shows positive effects on mental illness. PA and the use of municipal rehabilitation after discharge from psychiatric hospitalisation are inconsistent. The aim of this study was to evaluate the feasibility and acceptability of an intervention consisting of structured PA during hospitalisation and the use of a personalised physical activity plan and referral for municipal rehabilitation after discharge.

METHODS

A mixed-method design was used to explore the feasibility and acceptability of the intervention. Changes in health-related quality of life and physical function were measured using a six-minute walk test, a 30-second sit-to-stand test, handgrip strength, and patient reported outcomes (SF-36 and the Patient Specific Functional Scale [PSFS]). Qualitative results were further explored through semi-structured telephone interviews with twelve participants three weeks after discharge.

RESULTS

Twenty-six participants completed the intervention (median age: 46 years old; female: 57.7%). Improvements were seen in the PSFS. For SF-36, overall improvements were observed in the subscales physical function, well-being, and social function. Participants adhered to 61.5% of the scheduled physical activity sessions, 88% received a personalised physical activity plan, and 57% received municipal rehabilitation. The clinical provider played an important role in terms of motivation, structure, and knowledge about physical activity.

CONCLUSION

Physical activity during hospitalisation, a personalised physical activity plan, and municipal rehabilitation was feasible for persons with mental illness. Positive changes were observed in the following self-reported outcomes: Quality of life, physical function, and social function, and participants reported moderate to good acceptance of the intervention.

Advancing translational research in digital cardiac rehabilitation: The preparation phase of the Multiphase Optimization Strategy

While digital cardiac rehabilitation (CR) is an effective alternative to center-based CR, its components and mechanisms of change remain poorly understood. The Multiphase Optimization Strategy (MOST) provides a framework that allows the effects of individual components of complex interventions to be studied. There is limited guidance within MOST on how to develop a conceptual model. This article describes the development of a conceptual model of digital CR. The conceptual model was developed based on several strands of evidence: (i) a systematic review of 25 randomized controlled trials to identify the behavior change techniques in digital CR interventions, (ii) a qualitative study of patients' (n = 11) perceptions of the mechanisms of digital CR, and (iii) a review of international guidelines. Tools and frameworks from behavioral science, including the Behaviour Change Wheel, Capability, Opportunity, Motivation and Behavior model, and Theoretical Domains Framework were used to integrate the findings. An initial conceptual model of digital CR was developed and then refined through discussion. The conceptual model outlines the causal process through which digital CR can enhance outcomes for patients with cardiovascular disease. The model illustrates the key intervention components (e.g. goal setting and self-monitoring, education, exercise training), targeted outcomes (e.g. physical activity, healthy eating, medication adherence), and theorized mediating variables (e.g. knowledge, beliefs about capability). The article provides an example of how behavioral science frameworks and tools can inform the preparation phase of MOST. The developed conceptual model of digital CR will inform guide decision-making in a future optimization trial.

mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study

Objective

To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme.

Methods

The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers.

Results

Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported.

Conclusion

Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.