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Home-based EXercise and motivAtional programme before and after Liver Transplantation (EXALT): study protocol for phase II two-centre, randomised controlled trial. BMJ Open Gastroenterol 2024; 11:e001410. [PMID: 39231548 DOI: 10.1136/bmjgast-2024-001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/07/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Physical frailty is associated with increased mortality and poor quality of life (QoL) before and after liver transplantation (LT). Evidence is lacking on how to tailor exercise and behavioural techniques in this patient population. METHODS AND ANALYSIS Home-based EXercise and motivAtional programme before and after Liver Transplantation (EXALT) is a phase 2b, open-label, two-centre randomised controlled clinical trial designed to investigate whether a remotely monitored 'home-based exercise and theory-based motivation support programme (HBEP)' before and after LT improves QoL in LT recipients. Adult patients awaiting a primary LT will be assessed for eligibility at two LT centres (Birmingham, Royal Free London). Participants will be randomly assigned (1:1) to receive either an HBEP while on the LT waiting list through to 24 weeks after LT (Intervention) or a patient exercise advice leaflet (Control). Using a standard method of difference in means (two-sided significance level 0.05; power 0.90) and accounting for a 35% attrition/withdrawal rate, a minimum of 133 patients will be randomised to each treatment group. The primary outcome measure will be assessed using intention-to-treat analysis of the difference in the Physical Component Score of Short form-36 version 2.0 health-related QoL questionnaire between the groups at 24 weeks post-LT. ETHICS AND DISSEMINATION The protocol was approved by the South Central-Hampshire A National Research Ethics Committee. Recruitment into the EXALT trial started in May 2022 and is due to end in June 2024, with 217/266 patients randomised to date. The intervention follow-up is due to finish in May 2026. The findings of this trial will be disseminated through peer-reviewed publications, conferences and social media. TRIAL REGISTRATION NUMBER ISRCTN13476586.
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Cox NS, Lee JYT, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study. Chest 2022:S0012-3692(22)04344-6. [PMID: 36574926 DOI: 10.1016/j.chest.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging. RESEARCH QUESTION To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program? STUDY DESIGN AND METHODS Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes. RESULTS One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss. INTERPRETATION Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear. TRIAL REGISTRY ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne.
| | - Joanna Y T Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne; Respiratory and Sleep Medicine Clinic, Melbourne; Faculty of Medicine, Melbourne
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne; Melbourne
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia; Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Austin Health, Melbourne
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne
| | | | | | - Kathryn Barker
- Community Based Rehabilitation Service, Western Health, Melbourne
| | - Hayley Crute
- Physiotherapy Service, Wimmera Health Care Group, Horsham
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Pawel Czupryn
- Physiotherapy Service, West Wimmera Health Service, Nhill, VIC
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
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Heissel A, Pietrek A, Schwefel M, Abula K, Wilbertz G, Heinzel S, Rapp M. STEP.De study-a multicentre cluster-randomised effectiveness trial of exercise therapy for patients with depressive symptoms in healthcare services: study protocol. BMJ Open 2020; 10:e036287. [PMID: 32295779 PMCID: PMC7200038 DOI: 10.1136/bmjopen-2019-036287] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Although exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study is a multicentre cluster-randomised effectiveness trial that aims to compare the effectiveness and cost efficiency of exercise therapy and psychotherapy as antidepressant treatment. METHODS AND ANALYSIS 480 patients (aged 18-65) with an International Classification of Diseases diagnosis associated with depressive symptoms are recruited. Up to 30 clusters (psychotherapists) are randomly assigned to allocate patients to either an exercise or a psychotherapy treatment as usual in a 2:1 ratio. The primary outcome (depressive symptoms) and the secondary outcomes (work and social adjustment, quality of life) will be assessed at six measurement time points (t0: baseline, t1: 8 weeks after treatment initiation, t2: 16 weeks after treatment initiation, t3/4/5: 2, 6, 12 months after treatment). Linear regression analyses will be used for the primary endpoint data analysis. For the secondary endpoints, mixed linear and logistic regression models with fixed and random factors will be added. For the cost efficiency analysis, expenditures in the 12 months before and after the intervention and the outcome difference will be compared between groups in a multilevel model. Recruitment start date was 1 July 2018 and the planned recruitment end date is 31 December 2020. ETHICS AND DISSEMINATION The study protocol was approved by the ethics committee of the University of Potsdam (No. 17/2018) and the Freie Universität Berlin (No. 206/2018) and registered in the ISRCTN registry. Informed written consent will be obtained from all participants. The study will be reported in accordance with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials statements. The results will be published in peer-reviewed academic journals and disseminated to the public. TRIAL REGISTRATION NUMBER ISRCTN28972230.
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Affiliation(s)
- Andreas Heissel
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Anou Pietrek
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Melanie Schwefel
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Kahar Abula
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Gregor Wilbertz
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Michael Rapp
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
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Heissel A, Zech P, Rapp MA, Schuch FB, Lawrence JB, Kangas M, Heinzel S. Effects of exercise on depression and anxiety in persons living with HIV: A meta-analysis. J Psychosom Res 2019; 126:109823. [PMID: 31518734 DOI: 10.1016/j.jpsychores.2019.109823] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to examine the effects of exercise on depression and anxiety in people living with HIV (PLWH), and to evaluate, through subgroup analysis, the effects of exercise type, frequency, supervision by exercise professionals, study quality, and control group conditions on these outcomes. METHOD A literature search was conducted through four electronic databases from inception to February 2019. Considered for inclusion were randomized controlled trials (RCTs) investigating exercise interventions and depression or anxiety as outcomes in people living with HIV (≥ 18 years of age). Ten studies were included (n = 479 participants, 49.67% females at baseline), and the standardized mean difference (SMD) and heterogeneity were calculated using random-effect models. An additional pre-post meta-analysis was also conducted. RESULTS A large effect in favor of exercise when compared to controls was found for depression (SMD = -0.84, 95%CI = [-1.57, -0.11], p = 0.02) and anxiety (SMD = -1.23, 95%CI = [-2.42, -0.04], p = 0.04). Subgroup analyses for depression revealed large effects on depression for aerobic exercise only (SMD = -0.96, 95%CI = [-1.63, -0.30], p = 0.004), a frequency of ≥3 exercise sessions per week (SMD = -1.39, 95%CI = [-2.24, -0.54], p < 0.001), professionally supervised exercise (SMD = -1.40, 95%CI = [-2.46, -0.17], p = 0.03]), and high-quality studies (SMD = -1.31, 95%CI = [-2.46, -0.17], p = 0.02). CONCLUSION Exercise seems to decrease depressive symptoms and anxiety in PLWH, but other larger and high-quality studies are needed to verify these effects.
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Affiliation(s)
- Andreas Heissel
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany.
| | - Philipp Zech
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Felipe B Schuch
- Departamento de métodos e técnicas desportivas, Universidade Federal de Santa Maria, Brazil
| | - Jimmy B Lawrence
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Germany
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