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Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial.

Thorup C, Hansen J, Grønkjær M, Andreasen JJ, Nielsen G, Sørensen EE, Dinesen BI - J. Med. Internet Res. (2016)

Bottom Line: It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients.The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04).Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark. cbt@rn.dk.

ABSTRACT

Background: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients' adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event.

Objective: The purpose of this substudy was to explore cardiac patients' walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data.

Methods: A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps.

Results: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups.

Conclusions: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.

Trial registration: ClinicalTrials.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV).

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Related in: MedlinePlus

Grand mean steps per day and standard deviation (length of whiskers) at different days for both users and nonusers.
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figure3: Grand mean steps per day and standard deviation (length of whiskers) at different days for both users and nonusers.

Mentions: The grand mean for all patients for all active days was 5899 (SD 3151) steps per day. The grand mean steps per day were as follows: day 7: mean 5191, SD 3198; day 30: mean 6362, SD 3834; day 90: mean 6186, SD 3013; day 180: mean 6794, SD 3518; day 270: mean 8235, SD 4220; and day 365: mean 7890, SD 2629 steps per day indicating an increase in walking activity over time (Table 2). Knowing that the increase in walking activity could be a result of the low activity patients’ termination of step counter use, the week mean of nonusers (the last determined) was calculated (Figure 3) together with the increase in patients’ grand mean. In addition, a linear regression revealed a significant relationship between termination of step counter use and low week mean steps at different weeks (P=.004) (Table 2). Despite the slight increase in nonusers’ weekly means, it cannot be ruled out that the increase in steps per week over the year might be due to the dropping out of those patients with low walking activity.


Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial.

Thorup C, Hansen J, Grønkjær M, Andreasen JJ, Nielsen G, Sørensen EE, Dinesen BI - J. Med. Internet Res. (2016)

Grand mean steps per day and standard deviation (length of whiskers) at different days for both users and nonusers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835668&req=5

figure3: Grand mean steps per day and standard deviation (length of whiskers) at different days for both users and nonusers.
Mentions: The grand mean for all patients for all active days was 5899 (SD 3151) steps per day. The grand mean steps per day were as follows: day 7: mean 5191, SD 3198; day 30: mean 6362, SD 3834; day 90: mean 6186, SD 3013; day 180: mean 6794, SD 3518; day 270: mean 8235, SD 4220; and day 365: mean 7890, SD 2629 steps per day indicating an increase in walking activity over time (Table 2). Knowing that the increase in walking activity could be a result of the low activity patients’ termination of step counter use, the week mean of nonusers (the last determined) was calculated (Figure 3) together with the increase in patients’ grand mean. In addition, a linear regression revealed a significant relationship between termination of step counter use and low week mean steps at different weeks (P=.004) (Table 2). Despite the slight increase in nonusers’ weekly means, it cannot be ruled out that the increase in steps per week over the year might be due to the dropping out of those patients with low walking activity.

Bottom Line: It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients.The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04).Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark. cbt@rn.dk.

ABSTRACT

Background: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients' adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event.

Objective: The purpose of this substudy was to explore cardiac patients' walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data.

Methods: A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps.

Results: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups.

Conclusions: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.

Trial registration: ClinicalTrials.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV).

Show MeSH
Related in: MedlinePlus