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The power of movement: how physical activity can mitigate the risks of inadequate sleep
No full textThis editorial refers to 'Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry', by Y.Y. Liang et al., https://doi.org/10.1093/eurjpc/zwad060. The cardiovascular health benefits of physical activity (PA) and healthy sleep duration are well established. 1,2 In the literature, however, findings on the interaction of objectively measured PA and sleep duration have been scarce and often contradictory. 3-5 In this issue, Liang et al. provide important information about this topic through a population-based cohort study to investigate the association of accelerometer-measured PA and sleep duration with all-cause mortality, cardiovascular disease (CVD), and cancer mortality. Using the UK Biobank data, they identified 92 221 participants in whom PA and sleep duration were measured by a 7-day accelerometer recording. The results demonstrate an independent association between PA and sleep duration with mortality risk. Sleep duration (both short and long sleep duration) was associated with higher all-cause and CVD mortality. Higher moderate-to-vigorous physical activity (MVPA) was associated with a reduction of all-cause, CVD, and cancer mortality. Interestingly, the study reveals an additive and multiplicative interaction between PA and sleep duration on mortality risk. The lowest volume of PA combined with short or long sleep duration is associated with the highest risk of all-cause mortality. In contrast, a higher volume of PA seems to eliminate the risk associated with short or long sleep duration, as similar mortality risks were found in the short, normal, and long sleep duration groups.© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected]
A Digitally-Supported Shared Decision Making Approach for Patients during Cardiac Rehabilitation: Protocol for a Randomized Controlled Trial.
No full textBackground: Physical activity is a key component of cardiac rehabilitation. However, EUROASPIRE V concluded that intending 48% of coronary artery disease (CAD) patients do not intend to do physical activity in the next six months. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. Unfortunately, patients currently have only limited input in their exercise prescription. We developed SharedHeart, a digitally-supported shared decision making (SDM) approach that assists patients with heart disease and their caregivers in collaboratively setting up exercise goals and creating an exercise plan for the patient.
Objective: The aim of the study is to determine the effectiveness and cost-effectiveness of the combination of center-based CR and shared decision making based telerehabilitation. The study investigates the influence of a SDM approach supported by digital applications on the patient’s quality of life, exercise capacity, motivation to exercise, perception of rehabilitation and engagement in the shared decision making process.
Methods: The study is a prospective double-arm, randomized controlled trial that includes a usability study of the applications. In the usability study, instantaneous user friendliness and patients’ motivation will be investigated by testing the designed applications with 10 CAD patients and 5 physiotherapists. In the RCT, 80 patients will be randomized 1:1 between an intervention group and a control group. The intervention group will follow the SharedHeart approach, consisting of SDM encounters with caregivers and using the digital tools during phase II cardiac rehabilitation (i.e. 3 months). The primary outcome measure is patients’ quality of life, assessed with the HeartQoL questionnaire. Secondary outcomes are related to patients’ exercise capacity, motivation to exercise, perception of rehabilitation and engagement in the shared decision-making process.
All methods were performed in accordance with the relevant guidelines and regulations by including a statement in the Ethics approval and consent to participate section to this effect.
Discussion: This will be one of the first study to investigate the effects of a digitally-supported shared decision making approach. If the SharedHeart approach and supporting applications are found to be effective in increasing patients’ quality of life, exercise capacity, motivation to exercise, perception of rehabilitation and/or engagement in the shared decision making process, this can be a cost-effective and accessible solution to increase patient outcomes and patient involvement during cardiac rehabilitation.Funding: PD, HK, KC, WR and SEK received funding through the Horizons 2020 CoroPrevention project, project number 848056. MF received funding through the Flanders Research Foundation FWO, file number 1SE1222N.
Acknowledgements: The design of the the SharedHeart concept and the experimental design for the RCT, as well as the initial software development and usability evaluation were supported by UHasselt special research fonds (BOF PhD BOF18DOC26). Next steps in the study and the RCT are supported by H2020 CoroPrevention (grant 848056) and FWO (grant number 1SE1222N). An International Coordination Action “the EXPERT Network” (FWO-ICA G0F4220N) supports maintenance of the exercise prescription algorithm in the EXPERT tool
Digital health readiness, health literacy, and patients' awareness in cardiac (tele)rehabilitation participation.
No full textCardiac telerehabilitation is proven to be equally safe and effective as center-based cardiac rehabilitation. Nevertheless, some real-world barriers significantly impact the adoption and successful implementation of cardiac rehabilitation as well as cardiac telerehabilitationType of funding sources: Public grant(s)– EU funding. Main funding source(s): Horizons 2020 CoroPrevention project
Integrating data-driven methods and expert knowledge to develop personas: Balancing automation and multi-disciplinary validation
No full textData-driven personas are increasingly used to inform design decisions. Various methods are published to produce personas based on data collected from projects of different types and scales, each with a specific focus. This study aims to create a set of personas using data collected from a prior randomised controlled trial (RCT), which will be instrumental in designing future eHealth applications to support individuals with cardiovascular disease (CVD). Our method followed five phases for designing personas: (Phase I) expert analysis and variable selection, (Phase II) clustering, (Phase III) expert validation, (Phase IV) persona optimisation, and (Phase V) final check. To ensure that personas accurately reflected the patients, we employed the k-prototype algorithm to cluster mixed data and we focused on validation with colleagues, including medical colleagues, physiotherapists, a psychologist and Human-Computer Interaction (HCI) experts. Seven different personas resulted from the clustering. A validation step involved a multidisciplinary team that assessed the personas' realism, giving an average rating of 8.0 out of 10. Based on their feedback, three of the personas were slightly updated. The final descriptions of all seven personas incorporated the clustered data and the proposed changes after the validation. We concluded that data-driven approaches and expert-based refinement to develop personas is an effective method for understanding the target population. This study highlighted the importance of validation, revealing that creating personas cannot be fully automated, as this may result in losing essential characteristics that only experts can identify. Future research includes demonstrating the practical use of personas.Funding
This research and the SharedHeart study were supported by H2020 CoroPrevention (grant 848056). The design and development of the SharedHeart applications were supported by UHasselt Special Research Fund (grant BOF18DOC26).
Acknowledgements
The authors would like to thank all validators, including Kim Bonné and Frank Vandereyt, in addition to the co-authors, for their valuable contribution to this work, in particular for insightful discussions and valuable feedback during the validation process
Willingness to participate in cardiac telerehabilitation : results from semi-structured interviews
No full textAims Cardiac rehabilitation (CR) is indicated in patients with cardiovascular disease but participation rates remain low. Telerehabilitation (TR) is often proposed as a solution. While many trials have investigated TR, few have studied participation rates in conventional CR non-participants. The aim of this study was to identify the percentage of patients that would be willing to participate in a TR programme to identify the main perceived barriers and facilitators for participating in TR.
Methods and results Two groups of patients were recruited: CR non-participants and CR participants. Semi-structured interviews were conducted. Thirty non-participants and 30 participants were interviewed. Of CR non-participants, 33% would participate in TR and 10% would participate in a blended CR programme (combination of centre-based CR and TR). Of CR participants, 60% would participate in TR and 70% would be interested in a blended CR programme. Of those that would participate in TR, 44% would prefer centre-based CR, 33% would prefer a blended CR programme, and 11% would prefer a full TR programme. In both groups, the main facilitating aspect about TR was not needing transport and the main barrier was digital literacy.
Conclusion For CR non-participants, TR will only partly solve the problem of low participation rates and blended programmes might not offer a solution. Cardiac rehabilitation participants are more prepared to participate in TR and blended CR. Digital literacy was in both groups mentioned as an important barrier, emphasizing the challenges for healthcare and local governments to keep educating all types of patients in digital literacy.
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Identification of ICD-code misclassifications in cardiac disease using natural language processing
No full textAdherence and Performance in Cardiac Rehabilitation: The Role of Technological Innovation
No full textA digitally-supported shared decision making approach for patients during cardiac rehabilitation: a randomised controlled trial.
No full textPhysical activity is a key component of cardiac rehabilitation. However, inclusion rates in cardiac rehabilitation programs remain low and patients currently have only limited input in their exercise prescription. SharedHeart is a digitally-supported shared decision making approach that assists patients with heart disease and their caregivers in collaboratively setting up exercise goals and creating an exercise plan for the patient.Type of funding sources: Public grant(s)– EU funding. Main funding source(s): Horizons 2020 CoroPrevention project
Validity and reliability of the Chinese version of digital health readiness questionnaire among hypertension patients in rural areas of China
No full textIntroduction: Digital health has the potential to support health care in rural areas by overcoming the problems of distance and poor infrastructure, however, rural areas have extremely low use of digital health because of the lack of interaction with technology. There is no existing tool to measure digital health literacy in rural China. This study aims to test and validate the digital health readiness questionnaire for assessing digital readiness among patients in rural China.Methods: Due to the different Internet environments in China compared to Belgium, a cultural adaptation is needed to optimize the use of Digital Health Readiness Questionnaire in China. Then, a prospective single-center survey study was conducted in rural China among patients with hypertension. Confirmatory factor analysis was computed to test the measurement models.Results: A total of 330 full questionnaires were selected and included in the analysis. The model-fit measures were used to assess the model's overall goodness of fit (Chi-square/degrees of freedom = 5.060, comparative fit index = 0.889, Tucker-Lewis index (TLI) = 0.869, root mean square error of approximation (RMSEA) = 0.111, standardized root mean square residual (SRMR) = 0.0880). TLI is a little bit lower than the borderline (more than 0.9) and RMSEA is higher than it (less than 0.08 means good model fit). We deleted two items 2 and 4 and the result shows a better goodness of fit (Chi-square/degrees of freedom = 4.897, comparative fit index = 0.914, TLI = 0.895, RMSEA = 0.109, SRMR = 0.0765)Conclusion: To increase applicability and generalizability in rural areas, it should be considered to use the calculation of only the parts Digital skills, Digital literacy and Digital health literacy which are equally applicable in a Belgian population as in a rural Chinese population.This study is funded by Remote Management of Cardiovascular and Peripheral Vascular Diseases Technology and Intelligent System Development (2022YFC3601300).
We thank Dr Meidi Shen and Dr Lirong Guo for their review and value feedback on the questionnaire
Motivational communication skills to improve motivation and adherence in cardiovascular disease prevention: A narrative review
No full textLifestyle optimization is one of the most essential components of cardiovascular disease prevention. Motivational counseling provided by health care professionals could promote lifestyle modification. The purpose of the review is to identify possible evidence-based psychological principles that may be applicable to motivational counseling in the prevention of cardiovascular disease. These motivational communication skills promote behavioral change, improved motivation and adherence to cardiovascular disease prevention. A personal collection of the relevant publications. The review identified and summarized the previous evidence of implementation intentions, mental contrasting, placebo effect and nocebo effects and identity-based regulations in behavior change interventions and proposed their potential application in cardiovascular disease prevention. However, it is challenging to provide real support in sustainable CVD-risk reduction and encourage patients to implement lifestyle changes, while avoiding being unnecessarily judgmental, disrespectful of autonomy, or engaging patients in burdensome efforts that have little or no effect on the long run. Motivational communication skills have a great potential for effectuating sustainable lifestyle changes that reduce CVD-related risks, but it is also surrounded by ethical issues that should be appropriately addressed in practice. It is key to realize that motivational communication is nothing like an algorithm that is likely to bring about sustainable lifestyle change, but a battery of interventions that requires specific expertise and long term joint efforts of patients and their team of caregivers.During the preparation of the manuscript, L. X. was funded by the Special Research Fund (BOF) (grant agreement No BOF23DOCBL01). H. K., P. D., H. V. E., S. E. K. were part of the Coroprevention project that is funded by the European Union's Horizon 2020 research and innovation programme (grant agreement No 848056). M. F. received funding through the Flanders Research Foundation FWO, file number 1SE1222N
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