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Asadi-Aliabadi M, Karimi SM, Mirbaha-Hashemi F, Tehrani-Banihashemi A, Janani L, Babaee E, Nojomi M, Moradi-Lakeh M. The effect of results-based motivating system on metabolic risk factors of non-communicable diseases: A field trial study. PLoS One 2024; 19:e0311507. [PMID: 39418251 DOI: 10.1371/journal.pone.0311507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/08/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. METHODS A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected. A survey of 30 to 70-year-old was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages. RESULTS The average age of participants in both surveys was 49 years. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). CONCLUSIONS Involving non-physician health workers and having action plans based on the health needs of the covered population can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia.
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Affiliation(s)
- Mehran Asadi-Aliabadi
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed M Karimi
- Department of Health Management & System Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Fariba Mirbaha-Hashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
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Ibeneme SC, Mah J, Omeje C, Fortwengel G, Nwosu AO, Irem FO, Ibeneme GC, Myezwa H, Nweke M. Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis. BMC Geriatr 2024; 24:516. [PMID: 38872081 PMCID: PMC11177376 DOI: 10.1186/s12877-024-05069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults? METHOD Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects. RESULTS The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes. CONCLUSION Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals. TRIAL REGISTRATION Registration Number: INPLASY202230118.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa.
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Juliet Mah
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Enugu, Nigeria
| | - Chidimma Omeje
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Gerhard Fortwengel
- Faculty III, Hochschule Hannover University of Applied Sciences & Arts, 30159, Hannover, Lower Saxony, Germany
| | - Akachukwu Omumuagwula Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Frank Onyemaechi Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Health Sciences, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria
- Department of Nursing Science, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Bulto LN, Hendriks JM. The role of nurse-led interventions to empower patients in cardiovascular care. Eur J Cardiovasc Nurs 2024; 23:e17-e19. [PMID: 37698936 DOI: 10.1093/eurjcn/zvad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042 SA, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042 SA, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, 5001 SA, Australia
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Qiu X. Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review. BMC Nurs 2024; 23:6. [PMID: 38163878 PMCID: PMC10759353 DOI: 10.1186/s12912-023-01422-6] [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: 07/15/2022] [Accepted: 07/26/2023] [Indexed: 01/03/2024] Open
Abstract
Coronary artery disease (CAD) is one among the major causes of mortality in patients all around the globe. It has been reported by the World Health Organization (WHO) that approximately 80% of cardiovascular diseases could be prevented through lifestyle modifications. Management of CAD involves the prevention and control of cardiovascular risk factors, invasive and non-invasive treatments including coronary revascularizations, adherence to proper medications and regular outpatient follow-ups. Nurse-led clinics were intended to mainly provide supportive, educational, preventive measures and psychological support to the patients, which were completely different from therapeutic clinics. Our review focuses on the involvement and implication of nurses in the primary and secondary prevention and management of cardiovascular diseases. Nurses have a vital role in Interventional cardiology. They also have major roles during the management of cardiac complications including congestive heart failure, atrial fibrillation and heart transplantation. Today, the implementation of a nurse-led tele-consultation strategy is also gaining positive views. Therefore, a nurse-led intervention for the management of patients with cardiovascular diseases should be implemented in clinical practice. Based on advances in therapy, more research should be carried out to further investigate the effect of nurse-led clinics during the long-term treatment and management of patients with cardiovascular diseases.
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Affiliation(s)
- Xiaoqin Qiu
- Department of Nursing, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Qingxiu, Nanning, Guangxi, 530022, P.R. China.
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Affiliation(s)
- Geraldine A Lee
- Advanced Clinical Practice, Division of Applied Technology for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Vetrovsky T, Borowiec A, Juřík R, Wahlich C, Śmigielski W, Steffl M, Tufano JJ, Drygas W, Stastny P, Harris T, Małek Ł. Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis. Br J Sports Med 2022; 56:1366-1374. [DOI: 10.1136/bjsports-2021-105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine the net effect of different physical activity intervention components on step counts in addition to self-monitoring.DesignA systematic review with meta-analysis and meta-regression.Data sourcesFive databases (PubMed, Scopus, Web of Science, ProQuest and Discus) were searched from inception to May 2022. The database search was complemented with backward and forward citation searches and search of the references from relevant systematic reviews.Eligibility criteriaRandomised controlled trials comparing an intervention using self-monitoring (active control arm) with an intervention comprising the same treatment PLUS any additional component (intervention arm).Data extraction and synthesisThe effect measures were mean differences in daily step count. Meta-analyses were performed using random-effects models, and effect moderators were explored using univariate and multivariate meta-regression models.ResultsEighty-five studies with 12 057 participants were identified, with 75 studies included in the meta-analysis at postintervention and 24 at follow-up. At postintervention, the mean difference between the intervention and active control arms was 926 steps/day (95% CI 651 to 1201). At a follow-up, the mean difference was 413 steps/day (95% CI 210 to 615). Interventions with a prescribed goal and involving human counselling, particularly via phone/video calls, were associated with a greater mean difference in the daily step count than interventions with added print materials, websites, smartphone apps or incentives.ConclusionPhysical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. Some forms of counselling, particularly remote phone/video counselling, outperformed other intervention components, such as websites and smartphone apps.PROSPERO registered numberCRD42020199482.
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Stephen C, Halcomb E, Fernandez R, McInnes S, Batterham M, Zwar N. Nurse-led interventions to manage hypertension in general practice: A systematic review and meta-analysis. J Adv Nurs 2022; 78:1281-1293. [PMID: 35244944 DOI: 10.1111/jan.15159] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023]
Abstract
To evaluate the impact of general practice nurse-led interventions for blood pressure control and cardiovascular disease risk factor reduction in patients with hypertension. Systematic review and meta-analysis of randomized control trials. CINAHL, Medline and Scopus databases were searched to identify peer-reviewed studies published between 2000 and 2021. A systematic review of randomized control trials was conducted using a structured search strategy. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise study quality. Meta-analysis and narrative synthesis were performed to determine the effectiveness of the included interventions. Eleven trials comprising of 4454 participants were included in the review. Meta-analysis showed significant reductions in both systolic and diastolic blood pressure in trials with 6 months or less follow-up. Improvements were also demonstrated in reducing blood lipids, physical activity, general lifestyle measures and medication adherence. Evidence for dietary improvements and reduction in alcohol and smoking rates was inconclusive. Nurse-led interventions for patients with hypertension are heterogeneous in terms of the nature of the intervention and outcomes measured. However, nurse-led interventions in general practice demonstrate significant potential to improve blood pressure and support cardiovascular disease risk factor reduction. Future research should be directed towards elucidating the successful elements of these interventions, evaluating cost-effectiveness and exploring translation into usual care. This review provides evidence that nurses in general practice could enhance current hypertension management through nurse-led interventions.
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Affiliation(s)
- Catherine Stephen
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia.,Centre for Research in Nursing and Health, Level 1 Research and Education Building, St George Hospital, Sydney, New South Wales, Australia
| | - Susan McInnes
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- Statistical Consulting Centre, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nick Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Rossen J, Larsson K, Hagströmer M, Yngve A, Brismar K, Ainsworth B, Åberg L, Johansson UB. Effects of a three-armed randomised controlled trial using self-monitoring of daily steps with and without counselling in prediabetes and type 2 diabetes-the Sophia Step Study. Int J Behav Nutr Phys Act 2021; 18:121. [PMID: 34496859 PMCID: PMC8424865 DOI: 10.1186/s12966-021-01193-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This aimed to evaluate the effects of self-monitoring of daily steps with or without counselling support on HbA1c, other cardiometabolic risk factors and objectively measured physical activity (PA) during a 2-year intervention in a population with prediabetes or type 2 diabetes. METHODS The Sophia Step Study was a three-armed parallel randomised controlled trial. Participants with prediabetes or type 2 diabetes were recruited in a primary care setting. Allocation (1:1:1) was made to a multi-component intervention (self-monitoring of steps with counselling support), a single-component intervention (self-monitoring of steps without counselling support) or standard care. Data were collected for primary outcome HbA1c at baseline and month 6, 12, 18 and 24. Physical activity was assessed as an intermediate outcome by accelerometer (ActiGraph GT1M) for 1 week at baseline and the 6-, 12-, 18- and 24-month follow-up visits. The intervention effects were evaluated by a robust linear mixed model. RESULTS In total, 188 subjects (64, 59, 65 in each group) were included. The mean (SD) age was 64 (7.7) years, BMI was 30.0 (4.4) kg/m2 and HbA1c was 50 (11) mmol/mol, 21% had prediabetes and 40% were female. The dropout rate was 11% at 24 months. Effect size (CI) for the primary outcome (HbA1c) ranged from -1.3 (-4.8 to 2.2) to 1.1 (-2.4 to 4.6) mmol/mol for the multi-component vs control group and from 0.3 (-3.3 to 3.9) to 3.1 (-0.5 to 6.7) mmol/mol for the single-component vs control group. Effect size (CI) for moderate-to-vigorous physical activity ranged from 8.0 (0.4 to 15.7) to 11.1 (3.3 to 19.0) min/day for the multi-component vs control group and from 7.6 (-0.4 to 15.6) to 9.4 (1.4 to 17.4) min/day for the single-component group vs control group. CONCLUSION This 2-year intervention, including self-monitoring of steps with or without counselling, prevented a decrease in PA but did not provide evidence for improved metabolic control and cardiometabolic risk factors in a population with prediabetes or type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02374788 . Registered 2 March 2015-Retrospectively registered.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
| | - Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Agneta Yngve
- Department of Nutrition, Dietetics and Food Studies, Uppsala University, Uppsala, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Ainsworth
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Zhu B, Yin Y, Shi C, Chaiard J, Park CG, Chen X, Izci-Balserak B. Feasibility of sleep extension and its effect on cardiometabolic parameters in free-living settings: a systematic review and meta-analysis of experimental studies. Eur J Cardiovasc Nurs 2021; 21:9-25. [PMID: 34279625 DOI: 10.1093/eurjcn/zvab055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Inadequate sleep is a global health issue and has been associated with an increased risk for cardiovascular diseases. As a part of sleep hygiene, intentional lengthening of night-time sleep duration (i.e. sleep extension) might be a behavioural intervention to improve cardiometabolic health. To examine the feasibility of sleep extension and its effects on cardiometabolic parameters in free-living settings. METHODS AND RESULTS This review was registered in PROSPERO (CRD42019146174). Five databases were searched. Only experimental studies conducted in adults without a diagnosis of sleep disorder were included. The pooled mean difference was calculated by the inverse variance method. Narrative summaries were also used. Thirteen studies from 11 trials were included. The intervention ranged from 3 days to 6 weeks. Sleep extension increased total sleep time by 51 min [95% confidence interval (CI) 39-63]. Overall, sleep extension did not result in significant changes in blood pressure. However, sub-group analysis revealed that when 24 h mean blood pressure was obtained among those with pre-hypertension or Stage 1 hypertension, sleep extension reduced systolic (weighted mean difference = -7.8 mm/Hg; 95% CI -10.6 to -4.9), and diastolic blood pressure (weighted mean difference = -4.2 mm/Hg; 95% CI -6.7 to -1.8). The pooled effects on fasting glucose and insulin resistance were not significant. The effect of sleep extension on other parameters (e.g. heart rate) was not consistent. CONCLUSION Sleep extension is feasible and could increase sleep in free-living settings. Sleep extension shows promise for reducing 24 h mean blood pressure among those with pre-hypertension or hypertension. More large-scale studies are needed to examine its long-term effects.
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - You Yin
- Department of Endocrinology, Changzheng Hospital, Second Military Medical University of China, 415 Fengyang Rd, Shanghai 200003, China
| | - Changgui Shi
- Department of Endocrinology, Changzheng Hospital, Second Military Medical University of China, 415 Fengyang Rd, Shanghai 200003, China
| | | | - Chang G Park
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S Damen Ave., Chicago, 60612, IL, USA
| | - Xiangfang Chen
- Department of Endocrinology, Changzheng Hospital, Second Military Medical University of China, 415 Fengyang Rd, Shanghai 200003, China
| | - Bilgay Izci-Balserak
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, 845 S Damen Ave., Chicago, 60612, IL, USA
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillian B, Bower P, Panagioti M. Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2116382. [PMID: 34283229 PMCID: PMC9387744 DOI: 10.1001/jamanetworkopen.2021.16382] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Importance Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. Objective To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. Data Sources For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. Study Selection Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. Data Extraction and Synthesis The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. Main Outcomes and Measures The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. Results A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32). Conclusions and Relevance In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health,
Brighton and Sussex Medical School, University of Brighton, Brighton, United
Kingdom
| | - Brian McMillian
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research, School
for Primary Care Research, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
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Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094861. [PMID: 34063298 PMCID: PMC8124154 DOI: 10.3390/ijerph18094861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022]
Abstract
This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.
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Usability and Acceptability of a Novel Secondary Prevention Initiative Targeting Physical Activity for Individuals after a Transient Ischaemic Attack or "Minor" Stroke: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238788. [PMID: 33256087 PMCID: PMC7730453 DOI: 10.3390/ijerph17238788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
Behavioural interventions that address cardiovascular risk factors such as physical inactivity and hypertension help reduce recurrence risk following a transient ischaemic attack (TIA) or "minor" stroke, but an optimal approach for providing secondary prevention is unclear. After developing an initial draft of an innovative manual for patients, aiming to promote secondary prevention following TIA or minor stroke, we aimed to explore views about its usability and acceptability amongst relevant stakeholders. We held three focus group discussions with 18 participants (people who had experienced a TIA or minor stroke (4), carers (1), health professionals (9), and researchers (4). Reflexive thematic analysis identified the following three inter-related themes: (1) relevant information and content, (2) accessibility of format and helpful structure, and (3) strategies to optimise use and implementation in practice. Information about stroke, medication, diet, physical activity, and fatigue symptoms was valued. Easily accessed advice and practical tips were considered to provide support and reassurance and promote self-evaluation of lifestyle behaviours. Suggested refinements of the manual's design highlighted the importance of simplifying information and providing reassurance for patients early after a TIA or minor stroke. Information about fatigue, physical activity, and supporting goal setting was viewed as a key component of this novel secondary prevention initiative.
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