title: A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial The influence of a consumer-wearable activity tracker on sedentary time and prolonged sedentary bouts: secondary analysis of a randomized controlled trial Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial Use of Consumer Wearable Devices to Promote Physical Activity: A Review of Health Intervention Studies The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial Maintenance of exercise after phase II cardiac rehabilitation: a randomized controlled trial. Effects of a 12‐week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery Effectiveness of a pedometer-based program using a socio-cognitive intervention on physical activity and quality of life in a setting of cardiac rehabilitation. Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women. Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study Internet-based training of coronary artery patients: the Heart Cycle Trial Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews Reliability of the PEDro scale for rating quality of randomized controlled trials. Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation. Home-Based Versus In-Hospital Cardiac Rehabilitation After Cardiac Surgery: A Nonrandomized Controlled Study Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial. Effects of a Pedometer‐Based Intervention on Physical Activity Levels After Cardiac Rehabilitation: A RANDOMIZED CONTROLLED TRIAL Validity of pedometers for measuring exercise adherence in heart failure patients. Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation. Effects of two behavioral cardiac rehabilitation interventions on physical activity: A randomized controlled trial. Utilizing wearable technology to increase physical activity in future physicians: A randomized trial Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study
abstract: Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services Objective A recent meta- analysis surmised pedometers were a useful panacea to independently reduce sedentary time ( ST ) . To further test and exp and on this deduction , we analyzed the ability of a consumer-wearable activity tracker to reduce ST and prolonged sedentary bouts ( PSB ) . We originally conducted a 12-month r and omized control trial where 800 employees from 13 organizations were assigned to control , activity tracker  , or one of two activity tracker plus incentive groups design ed to increase step count . The primary outcome was accelerometer measured moderate-to-vigorous physical activity . Results We conducted a secondary analysis on accelerometer measured daily ST and PSB bouts . A general linear mixed model was used to examine changes in ST and prolonged sedentary bouts , followed by between-group pairwise comparisons . Regression analyses were conducted to examine the association of changes in step counts with ST and PSB . The changes in ST and PSB were not statistically significant and not different between the groups ( P < 0.05 ) . Increases in step counts were concomitantly associated with decreases in ST and PSB , regardless of intervention ( P < 0.05 ) . Caution should be taken when considering consumer-wearable activity trackers as a means to reduce sedentary behavior . Trial registration NCT01855776 Registered : August 8 , BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore Objective Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infa rct ion ( MI ) . This study aims to investigate the effect of a smartphone-based home service delivery ( Care Assessment Platform ) of CR ( CAP-CR ) on  CR  use and health outcomes compared with a traditional , centre-based programme ( TCR ) in post-MI patients . Methods In this unblinded r and omised controlled trial , post-MI patients were r and omised to TCR ( n=60 ; 55.7±10.4 years ) and CAP-CR ( n=60 ; 55.5±9.6 years ) for a 6-week CR and 6-month self-maintenance period . CAP-CR , delivered in participants ’ homes , included health and exercise monitoring , motivational and educational material delivery , and weekly mentoring consultations . CAP-CR uptake , adherence and completion rates were compared with TCR using intention-to-treat analyses . Changes in clinical outcomes ( modifiable lifestyle factors , biomedical risk factors and health-related quality of life ) across baseline , 6 weeks and 6 months were compared within , and between , groups using linear mixed model regression . Results CAP-CR had significantly higher uptake ( 80 % vs 62 % ) , adherence ( 94 % vs 68 % ) and completion ( 80 % vs 47 % ) rates than TCR ( p<0.05 ) . Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks ( TCR : 537±86–584±99 m ; CAP-CR : 510±77–570±80 m ) , which was maintained at 6 months . CAP-CR  showed slight weight reduction ( 89±20–88±21 kg ) and also demonstrated significant improvements in emotional state ( K10 : median ( IQR ) 14.6 ( 13.4–16.0 ) to 12.6 ( 11.5–13.8 ) ) , and quality of life ( EQ5D-Index : median ( IQR ) 0.84 ( 0.8–0.9 ) to 0.92 ( 0.9–1.0 ) ) at 6 weeks . Conclusions This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion . The home-based CR programme was as effective in improving physiological and psychological health outcomes  as traditional CR . CAP-CR is a viable option towards optimising use of CR services . Trial registration number ANZCTR12609000251224 Background Although many wearable devices for monitoring and tracking physical activity are available to consumers , relatively few research studies have been conducted to determine their efficacy in promoting health . Methods In this article , data on the use of consumer wearable devices in promoting healthy behaviors  are summarized based upon bibliographic search es in PubMed and Psychology and Behavioral Sciences Collection with relevant search terms through September 2016 . Results A total of 274 articles were identified in the bibliographic search es . By screening abstract s or full-text articles , six pre/post test trials and seven r and omized controlled trials were identified . In initial trials , consumer wearable devices have been shown to increase physical activity and help users lose weight . However , the number of studies completed to date is small and limited by small sample sizes , short study duration s , and uncertain generalizability of the findings . Conclusions Future studies should utilize r and omized controlled trial research design s , larger sample sizes , and longer study periods to better establish the efficacy of wearable devices in promoting physical activity . Additional research is needed to determine the feasibility and effectiveness of wearable devices in promoting physical activity and weight loss in community setting s including communities affected by health disparities . Studies focusing on children and adolescents are also needed QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Background Given the global prevalence of insufficient physical activity ( PA ) , effective interventions that attenuate age-related decline in PA levels are needed . Mobile phone interventions that positively affect health ( mHealth ) show promise ; however , their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app . Objective The aim was to determine the effects of two commercially available smartphone apps ( Zombies , Run and Get Running ) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people . A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels . Methods Apps for IMproving FITness ( AIM FIT ) was a 3-arm , parallel , r and omized controlled trial conducted in Auckl and , New Zeal and . Participants were recruited through advertisements in electronic mailing lists , local newspapers , flyers posted in community locations , and presentations at schools . Eligible young people aged 14 - 17 years were allocated at r and om to 1 of 3 conditions : ( 1 ) use of an immersive app ( Zombies , Run ) , ( 2 ) use of a nonimmersive app ( Get Running ) , or ( 3 ) usual behavior ( control ) . Both smartphone apps consisted of a fully automated 8-week training program design ed to improve fitness and ability to run 5 km ; however , the immersive app featured a game-themed design and narrative . Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks , and all regression models were adjusted for baseline outcome value and gender . The primary outcome was cardiorespiratory fitness , objective ly assessed as time to complete the 1-mile run/walk test at 8 weeks . Secondary outcomes were PA levels ( accelerometry and self-reported ) , enjoyment , psychological need satisfaction , self-efficacy , and acceptability and usability of the apps . Results A total of 51 participants were r and omized to the immersive app intervention ( n=17 ) , nonimmersive app intervention ( n=16 ) , or the control group ( n=18 ) . The mean age of participants was 15.7 ( SD 1.2 ) years ; participants were mostly NZ Europeans ( 61 % , 31/51 ) and 57 % ( 29/51 ) were female . Overall retention rate was 96 % ( 49/51 ) . There was no significant intervention effect on the primary outcome using either of the apps . Compared to the control , time to complete the fitness test was –28.4 seconds shorter ( 95 % CI –66.5 to 9.82 , P=.20 ) for the immersive app group and –24.7 seconds ( 95 % CI –63.5 to 14.2 , P=.32 ) for the nonimmersive app group . No significant intervention effects were found for secondary outcomes . Conclusions Although apps have the ability to increase reach at a low cost , our pragmatic approach using readily available commercial apps as a st and -alone instrument did not have a significant effect on fitness . However , interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness , promote PA , and consequently reduce the adverse health outcomes associated with insufficient activity . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12613001030763 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12613001030763 ( Archived by WebCite at http://www.webcitation.org/6aasfJVTJ ) BACKGROUND Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion , despite the importance of sustaining regular exercise to prevent future cardiac events . PURPOSE The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated . DESIGN An RCT was used to evaluate the intervention . Data were collected in 2005 - 2010 and analyzed in 2010 . SETTING / PARTICIPANTS One hundred thirty patients ( mean age=63.6 years [ SD=9.7 ] , 20.8 % female ) were r and omized to exercise counseling ( Maintenance Counseling group , n=64 ) or contact control ( Contact Control group , n=66 ) . INTERVENTION Maintenance Counseling group participants received a 6-month program of exercise counseling ( based on the transtheoretical model and social cognitive theory ) delivered via telephone , as well as print material s and feedback reports . MAIN OUTCOME MEASURES Assessment s of physical activity ( 7-Day Physical Activity Recall ) , motivational readiness for exercise , lipids , and physical functioning were conducted at baseline , 6 months , and 12 months . Objective accelerometer data were collected at the same time points . Fitness was assessed via maximal exercise stress tests at baseline and 6 months . RESULTS The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months ( difference of 80 minutes , 95 % CI=22 , 137 ) . Group differences in exercise at 6 months were nonsignificant . The intervention significantly increased the probability of participants ' exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months . Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months . No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months . CONCLUSIONS A telephone-based intervention can help maintain exercise , prevent regression in motivational readiness for exercise , and improve physical functioning in this patient population Background : Site‐based cardiac rehabilitation  ( CR ) provides supervised exercise , education and motivation for patients . Graduates of CR have improved exercise tolerance . However , when participation in CR ceases , adherence to regular physical activity often declines , consequently leading to worsening risk factors and clinical events . Therefore , the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR . Methods and Results : A 12‐week mHealth program was implemented using physical activity trackers and health coaching .  Twenty‐five patients were r and omized into mHealth or usual care after completing CR . The combination of a 4.7 ± 13.8 % increase in the mHealth and a 8.5 ± 11.5 % decrease in the usual care group result ed in a difference between groups ( P ≤ .05 ) for absolute peak VO2 . Usual care decreased the amount of moderate‐low physical activity minutes per week ( 117 ± 78 vs 50 ± 53 ; P < .05 ) as well as moderate‐high ( 111 ± 87 vs 65 ± 64 ; P < .05 ) . mHealth increased moderate‐high physical activity ( 138 ± 113 vs 159 ± 156 ; NS ) . The divergent changes between mHealth and usual care in moderate‐high physical activity minutes/week result ed in a difference between groups ( 21 ± 103 vs – 46 ± 36 ; P < .05 ) . Conclusions : A 12‐week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site‐based CR Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during  cardiac rehabilitation ( CR ) on exercise capacity and habitual physical activity . Design Six-year follow-up of patients who participated in a r and omised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery . Setting Outpatient CR centre in Central -South Ontario , Canada . Participants 196 Patients who participated in the original r and omised controlled trial and who attended an evaluation 1 year after CR . Interventions 6 months of home or hospital-based exercise training during CR . Main outcome measures Peak oxygen uptake ( peak Vo2 ) , Physical Activity Scale in the Elderly ( PASE ) to assess habitual activity , semi-structured interviews to assess vital status , demographic and descriptive information . Results Of the 196 eligible patients , 144 ( 75.5 % ; 74 Hospital , 70 Home ) were available for participation . Patients were predominantly male ( n=120 ; 83.3 % ) aged 70±9.5 years .  Clinical and sociodemographic outcomes were similar in both groups . While exercise performance declined over time , there were significant between-group differences in peak Vo2 ( 1506±418 ml/min vs 1393±341 ml/min ; p=0.017 ) and PASE scores ( 166.7±90.2 vs 139.7±66.5 ; p=0.001 ) at 6-year follow-up in favour of the home group . Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR . Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo2 and persistent physical activity compared with traditional hospital-based CR BACKGROUND Physical activity contributes to improve health and quality of life . However , the prevalence of sedentary lifestyle is elevated after an acute coronary syndrome . METHODS A r and omized controlled trial was performed to evaluate the impact of a pedometer-based program associated with a socio-cognitive intervention on physical activity behaviour , cardiovascular risk factors , and quality of life during the year after an acute coronary syndrome event . During hospitalization , we r and omized 32 patients to an experimental group and 33 patients to a usual care group . The experimental intervention included 6 consultations with a clinical nurse specialist during 12 months . RESULTS Groups characteristics were comparable . At baseline , the percentage of participants considered in the active range category was similar between groups ( 31 % vs 41 % ; P = 0.915 ) . However , the proportion of participants who were still active was greater in the experimental group than in the usual care group at 6 , 9 , and 12 months follow-up ( 75 % vs 41 % ; 68 % vs 36 % , and 83 % vs 55 % , respectively ; P < 0.05 ) . After 12 months , changes in overall quality of life and in health and the functioning scores were different between groups ( interaction effects [ groups by time ] P = 0.048 and P = 0.036 , respectively ) . CONCLUSIONS The use of a pedometer concomitantly with a socio-cognitive intervention improves adherence to physical activity and quality of life during the year after an acute coronary syndrome event . This finding is relevant because physical activity and quality of life are a great concern in preventive cardiology . These results support applying this innovative approach in cardiac rehabilitation programs INTRODUCTION Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools . This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention . The purpose of this study is to evaluate , within an RCT , the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women . METHODS Fifty-one inactive , postmenopausal women with BMI ≥25.0 were r and omized to a 16-week web-based self-monitoring intervention ( n=25 ) or comparison group ( n=26 ) . The Web-Based Tracking Group received a Fitbit , instructional session , and follow-up call at 4 weeks . The comparison group received a st and ard pedometer . All were asked to perform 150 minutes/week of moderate to vigorous physical activity ( MVPA ) . Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer . RESULTS Data were collected and analyzed in 2013 - 2014 . Participants were aged 60 ( SD=7 ) years with BMI of 29.2 ( 3.5 ) kg/m(2 ) . Relative to baseline , the Web-Based Tracking Group increased MVPA by 62 ( 108 ) minutes/week ( p<0.01 ) ; 10-minute MVPA bouts by 38 ( 83 ) minutes/week ( p=0.008 ) ; and steps by 789 ( 1,979 ) ( p=0.01 ) , compared to non-significant increases in the Pedometer Group ( between-group p=0.11 , 0.28 , and 0.30 , respectively ) . The Web-Based Tracking Group wore the tracker on 95 % of intervention days ; 96 % reported liking the website and 100 % liked the tracker . CONCLUSIONS The Fitbit was well accepted in this sample of women and associated with increased physical activity at 16 weeks . Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions Background Little is known about  physical activity levels in patients with coronary artery disease ( CAD ) who are not engaged in cardiac rehabilitation . We explored the trajectory of physical activity after hospitalization for CAD , and examined the effects of demographic , medical , and activity-related factors on the trajectory . Design A prospect i ve cohort study . Methods A total of 782 patients were recruited during CAD-related hospitalization .  Leisure-time activity energy expenditure ( AEE ) was measured 2 , 6 and 12 months later . Sex , age , education , reason for hospitalization , congestive heart failure ( CHF ) , diabetes , and physical activity before hospitalization were assessed at recruitment . Participation in cardiac rehabilitation was measured at follow-up .  Results AEE was 1948 ± 1450 , 1676 ± 1290 , and 1637 ± 1486 kcal/week at 2 , 6 and 12 months , respectively . There was a negative effect of time from 2 months post-hospitalization on physical activity ( P<0.001 ) . Interactions were found between age and time ( P = 0.012 ) and education and time ( P = 0.001 ) . Main effects were noted for sex ( men more active than women ; P<0.001 ) , CHF ( those without CHF more active ; P<0.01 ) , diabetes ( those without diabetes more active ; P<0.05 ) , and previous level of physical activity ( those active before hospitalization more active after ; P<0.001 ) . Coronary artery bypass graft patients were more active than percutaneous coronary intervention ( PCI ) patients ( P = 0.033 ) . Conclusions Physical activity levels declined from 2 months after hospitalization . Specific subgroups ( e.g. less educated , younger ) were at greater risk of decline and other subgroups ( e.g. women , and PCI , CHF , and diabetic patients ) demonstrated lower physical activity . These groups need tailored interventions Low adherence to cardiac rehabilitation ( CR ) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs . The main objective of this study was to evaluate the feasibility of a smartphone-guided training system ( GEX ) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease ( CAD ) . A prospect i ve , r and omized , international , multi-center study comparing CR delivered by conventional means ( CG ) or by remote monitoring ( IG ) using a new training steering/feedback tool ( GEx System ) . This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity , arrhythmias and adherence to training prescriptions  , wirelessly via the internet , to a medical team that provided feedback and adjusted training prescriptions . Exercise capacity was evaluated prior to and 6 months after intervention . 118 patients ( 58 ± 10 years , 105 men ) with CAD referred for CR were r and omized ( IG : n = 55 , CG : n = 63 ) . However , 15 patients ( 27 % ) in the IG and 18 ( 29 % ) in the CG withdrew participation and technical problems prevented a further 21 patients ( 38 % ) in the IG from participating . No training-related complications occurred . For those who completed the study , peak VO2 improved more ( p = 0.005 ) in the IG ( 1.76 ± 4.1 ml/min/kg ) compared to CG ( −0.4 ± 2.7 ml/min/kg ) . A newly design ed system for home-based CR appears feasible , safe and improves exercise capacity compared to national CR . Technical problems reflected the complexity of applying remote monitoring solutions at an international level OBJECTIVE To assess the efficacy of a strategy , based on telephone support oriented by accelerometer measurements , on the adherence to physical activity ( PA ) recommendations in cardiac patients not achieving PA recommendations . DESIGN Prospect i ve and r and omized study . SETTING A cardiac rehabilitation program ( CRP ) at a clinic . PARTICIPANTS Stable , noncompliant cardiac ( coronary artery disease , heart failure , post-cardiovascular surgery ) patients ( weekly moderate-intensity PA < 150 min ) were r and omly assigned to an intervention group ( n=19 ) or a control group ( n=10 ) . INTERVENTIONS The intervention group wore an accelerometer for 8 weeks . Every 15 days , feedback and support were provided by telephone . The control group wore the accelerometer during the 8th week of the intervention only . MAIN OUTCOME MEASURES Active energy expenditure ( EE ) ( in kilocalories ) and the time spent doing light , moderate , or intense PA ( minutes per week ) . RESULTS In the intervention group , the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week ( P=.002 ) , with 36.8 % of the sample achieving the target amount of moderate-intensity PA . During the 8th week , the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group , respectively ( P=.004 ) . CONCLUSIONS Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients . This intervention could be implemented after a CRP as an inexpensive , modern , and easy-to-use strategy Background Following publication of the PRISMA statement , the UK Centre for Review s and Dissemination ( CRD ) at the University of York in Engl and began to develop an international prospect i ve register of systematic review s with health-related outcomes . The objectives were to reduce unplanned duplication of review s and provide transparency in the review process , with the aim of minimizing reporting bias . Methods An international advisory group was formed and a consultation undertaken to establish the key items necessary for inclusion in the register and to gather views on various aspects of functionality . This article describes the development of the register , now called PROSPERO , and the process of registration . Results PROSPERO offers free registration and free public access to a unique prospect i ve register of systematic review s across all areas of health from all around the world . The dedicated web-based interface is electronically search able and available to all prospect i ve registrants . At the moment , inclusion in PROSPERO is restricted to systematic review s of the effects of interventions and strategies to prevent , diagnose , treat , and monitor health conditions , for which there is a health-related outcome .Ideally , registration should take place before the research ers have started formal screening against inclusion criteria but review s are eligible as long as they have not progressed beyond the point of completing data extraction .The required data set captures the key attributes of review design as well as the administrative details necessary for registration .Su bmi tted registration forms are checked against the scope for inclusion in PROSPERO and for clarity of content before being made publicly available on the register , rejected , or returned to the applicant for clarification . The public records include an audit trail of major changes to planned methods , details of when the review has been completed , and links to result ing publications when provided by the authors . Conclusions There has been international support and an enthusiastic response to the principle of prospect i ve registration of protocol s for systematic review s and to the development of PROSPERO .In October 2011 , PROSPERO contained 200 records of systematic review s being undertaken in 26 countries around the world on a diverse range of interventions BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To determine the effectiveness of a pedometer-based telephone intervention on the physical activity levels of cardiac patients who did not attend a CRP . METHODS A r and omised controlled trial was conducted with 215 patients referred to a CRP but who could not or chose not to attend . The 6-week intervention included self-monitoring of physical activity using a pedometer and step calendar ; and behavioural counselling and goal setting sessions . Data were collected at baseline , 6 weeks and 6 months . RESULTS Study groups did not differ significantly at baseline . After 6 weeks , improvements in total physical activity time ( p=0.027 ) , total physical activity sessions ( p=0.003 ) , walking time ( p=0.013 ) and walking sessions ( p=0.002 ) in the intervention group were significantly greater than the control group after adjusting for baseline differences , and remained significant at 6 months . CONCLUSION The findings that the pedometer-based telephone intervention was successful in increasing physical activity levels in cardiac patients who did not attend a CRP could result in major health benefits for this group of people . PRACTICAL IMPLICATION S The pedometer-based telephone intervention could be offered as an effective and accessible option for patients not attending a CRP to increase and maintain their physical activity levels after hospitalisation Background Exercise rehabilitation after cardiac surgery has beneficial effects , especially on a long-term basis . Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home . Objective The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation ( HBCR ) or in-hospital rehabilitation in patients at low to medium risk for early mortality ( EuroSCORE 0–5 ) following cardiac surgery . Design A quasi-experimental study was conducted . Methods At hospital discharge , patients were given the option to decide whether to enroll in the HBCR program .  Clinical examinations ( electrocardiography , cardiac echo color Doppler , chest radiography , blood sample s ) of patients in the HBCR group were collected during 4 weeks of rehabilitation , and exercise capacity ( assessed using the Six-Minute Walk Test [ 6MWT ] ) was assessed before and after rehabilitation . A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group . Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference . Periodic home visits by health staff also were performed . Results One hundred patients were recruited into the HBCR group . An equal number of patients was selected for the comparison group . At the end of the 4-week study , the 2 groups showed improvement from their respective baseline values only in the 6MWT . No difference was found in time × group interaction . Limitations Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center , the results of the study can not be generalized . Conclusions In patients who self-selected HBCR , the program was found to be effective and comparable to the st and ard in-hospital rehabilitative approach , indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service BACKGROUND Cardiac rehabilitation is widely recognized as a medical management procedure that reduces mortality , but the cardiovascular safety of exercise training has not been clearly established . Published data are retrospective or out date d , as patient management has substantially progressed in recent years . The aim of this prospect i ve registry was to determine the current complication rate during exercise performed in the course of cardiac rehabilitation . METHODS This study was conducted by the Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology . During a 1-year period , 65 cardiac rehabilitation centers reported that serious events had occurred during or 1 hour after an exercise stress test or a training session .  Severe cardiovascular events were vali date d by a scientific committee . RESULTS A total of 25,420 patients ( 78 % men ; mean age , 61.3 years ) were included in the study . Initial indications for cardiac rehabilitation were post-cardiac surgery ( coronary bypass , 34.3 % ; valvular surgery , 18.4 % ) ; recent percutaneous coronary intervention ( 21.6 % ) ; and other coronary ( 13.2 % ) and noncoronary ( 12.5 % ) conditions . The study population underwent 42,419 exercise stress tests and 743,471 patient-hours of exercise training . Twenty severe cardiac events were reported : 5 were related to exercise testing and 15 were related to exercise training . The event rate was 1 per 8484 exercise stress tests and 1 per 49,565 patient-hours of exercise training ; the cardiac arrest rate was 1.3 per million patient-hours of exercise . Neither fatal complications nor emergency defibrillations were reported . CONCLUSION The frequency of major cardiovascular complications during  supervised exercise training in France is quite low BACKGROUND Despite proven benefits of cardiac rehabilitation ( CR ) , adherence to CR remains suboptimal . This trial aim ed to assess the impact of the patient education ' Learning and Coping Strategies ' ( LC ) on patient adherence to an eight-week CR program . METHODS 825 patients with ischaemic heart disease or heart failure were open label r and omised to either the LC arm ( LC plus CR ) or the control arm ( CR alone ) across three hospital units in Denmark . Both arms received same amount of training and education hours . LC consisted of individual clarifying interviews , participation of experienced patients as co-educators , situational , reflective and inductive teaching . The control arm received structured deductive teaching . The primary outcomes were patient adherence to at least 75 % of the exercise training or education sessions . We tested for subgroup effects on the primary outcomes using interaction terms . The primary outcomes were compared across arms using logistic regression . RESULTS More patients in the LC arm adhered to at least 75 % of the exercise training sessions than control ( 80 % versus 73 % , adjusted odds ratio (OR):1.48 ; 95 % CI:1.07 to 2.05 , P=0.018 ) and 75 % of education sessions ( 79 % versus 70 % , adjusted OR:1.61 , 1.17 to 2.22 , P=0.003 ) . Some evidence of larger effects of LC on adherence was seen for patients with heart failure , low education and household income . CONCLUSIONS Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education . Patients with heart failure , low levels of education and household income appear to benefit most from this adherence promoting intervention . TRIAL REGISTRATION www . clinical trials.gov identifier NCT01668394 PURPOSE In Australia , patient adherence to physical activity after a cardiac rehabilitation program ( CRP ) is poor . This study evaluated the efficacy of a pedometer-based intervention to increase physical activity after CRP . METHODS Patients ( n = 110 ) who had attended a CRP were r and omized into an intervention or a control group . The 6-week intervention included self-monitored physical activity using a pedometer and step calendar and 2 behavioral counseling and goal - setting sessions .  Self-reported physical activity and psychosocial status were collected at baseline , 6 weeks , and 6 months . Participant exercise capacity was measured using a gas exchange analysis system . RESULTS Study groups were not significantly different at baseline , except for occupation . At 6 weeks and 6 months , improvements in total physical activity sessions ( P = .002 and P = .016 , respectively ) , walking minutes ( P = .013 , 6 weeks only ) , and walking sessions ( P < .001 and P = .035 ) in the intervention group were significantly greater than those in the control group after adjusting for baseline differences . At 6 months , total physical activity minutes in the intervention group also increased significantly more than those in the control group ( P = .044 ) . These self-reported behavioral changes were corroborated by improvements in cardiorespiratory fitness at 6 months in the intervention group ( P = .01 ) . There were also significant improvements in psychosocial health at 6 weeks and 6 months in the intervention group . CONCLUSION The pedometer-based intervention was successful in increasing physical activity in cardiac patients after a CRP . This intervention could be given to patients to promote adherence to physical activity guidelines after a CRP , particularly in centers where maintenance programs are not available BACKGROUND Measuring adherence to exercise is important to clinicians and research ers because inadequate adherence can adversely affect the effectiveness of an exercise program and cloud the relationship between exercise and clinical outcomes . Hence , assessment strategies for adherence to exercise , as with assessment strategies for other outcomes , must have demonstrated validity if they are to be employed with confidence . We conducted this study to determine the validity of pedometers as a measure of exercise adherence to a home-based walking program in heart failure patients . METHODS AND RESULTS  Exercise adherence  was measured using pedometers in 38 patients ( 74 % men ) age 54.1 + /- 11.7 years who participated in a 12-month home-based walking program .  A comparison of functional status as measured by the 6-minute walk distance and peak oxygen uptake ( VO2 max ) at 6 months into the exercise training program was made between 2 groups of participants who were thought to represent adherers and nonadherers : participants who demonstrated > or = 10 % change in pedometer scores ( n = 20 ) and those who showed no change in pedometer scores ( n = 18 ) from baseline to 6 months . Patients who showed improvements in their pedometer scores over 6 months had better functional status at 6 months ( 6-minute walk distance 1718 + /- 46 versus 1012 + /- 25 meters , F = 5.699 , P = .022 ; VO 2 max 17 + /- 0.7 versus 10 + /- 0.5 units , F = 7.162 , P = .011 ) when compared with patients whose pedometers reflected minimal change in distance walked ( ie , < or = 10 % ) . CONCLUSION Pedometers are inexpensive and readily available to both clinicians and research ers . The results of this study suggest that they may be a valid indicator of exercise adherence in heart failure patients who participate in a home-based walking program BACKGROUND To evaluate the long-term cost-effectiveness of two home-based cardiac rehabilitation ( CR ) interventions ( Healthy Weight ( HW ) and Physical Activity ( PA ) ) for patients with cardiovascular disease ( CVD ) , who had been referred to cardiac rehabilitation ( CR ) but had not attended . The interventions consisted of pedometer-based telephone coaching sessions on weight , nutrition and physical activity ( HW group ) or physical activity only ( PA group ) and were compared to a control group who received information brochures about physical activity . METHODS A cost-effectiveness analysis was conducted using data from two r and omised controlled trials . One trial compared HW to PA ( PANACHE study ) , and the second compared PA to usual care . A Markov model was developed which used one risk factor , body mass index ( BMI ) to determine the CVD risk level and mortality . Patient-level data from the trials were used to determine the transitions to CVD states and healthcare related costs . The model was run for separate cohorts of males and females . Univariate and probabilistic sensitivity analysis were conducted to test the robustness of the results . RESULTS Given a willingness-to-pay threshold of $ 50,000/QALY , in the long run , both the HW and PA interventions are cost-effective compared with usual care . While the HW intervention is more effective , it also costs more than both the PA intervention and the control group due to higher intervention costs . However , the HW intervention is still cost-effective relative to the PA intervention for both men and women . Sensitivity analysis suggests that the results are robust . CONCLUSION The results of this paper provide evidence of the long-term cost-effectiveness of home-based CR interventions for patients who are referred to CR but do not attend . Both the HW and PA interventions can be recommended as cost-effective home-based CR programs , especially for people lacking access to hospital services or who are unable to participate in traditional CR programs BACKGROUND St and ard cardiac rehabilitation ( CR ) is insufficient to help patients achieve an active lifestyle . The effects of two advanced and extended behavioral CR interventions on physical activity ( PA ) and sedentary behavior ( SB ) were assessed . METHODS In total , 731 patients with ACS were r and omized to 1 ) 3months of st and ard CR ( CR-only ) ; 2 ) 3months of st and ard CR with three pedometer-based , face-to-face PA group counseling sessions followed by 9months of aftercare with three general lifestyle , face-to-face group counseling sessions ( CR+F ) ;  or 3 )  3months of st and ard CR , followed by 9months of aftercare with five to six general lifestyle , telephonic counseling sessions ( CR+T ) . An accelerometer recorded PA and SB  at r and omization , 3months , 12months , and 18months . RESULTS The CR+F group did not improve their moderate-to-vigorous intensity PA ( MVPA ) or SB time compared to CR-only ( between-group difference=0.24 % MVPA , P=0.349 ; and 0.39 % SB , P=0.529 ) . However , step count ( between-group difference=513 steps/day , P=0.021 ) and time in prolonged MVPA ( OR=2.14 , P=0.054 ) improved at 3months as compared to CR-only . The improvement in prolonged MVPA was maintained at 18months ( OR=1.91 , P=0.033 ) . The CR+T group did not improve PA or SB compared to CR-only . CONCLUSIONS Adding three pedometer-based , face-to-face group PA counseling sessions to st and ard CR increased daily step count and time in prolonged MVPA . The latter persisted at 18months . A telephonic after-care program did not improve PA or SB . Although after-care should be optimized to improve long-term adherence , face-to-face group counseling with objective PA feedback should be added to st and ard CR This study examined the use of activity trackers alone or combined with weekly communication through email to improve activity and body composition over one academic year in medical students . This r and omized clinical trial conducted at the New York Institute of Technology from July 7 , 2016 through June 4 , 2017 enrolled 120 medical students . The first group ( Fitbit-Plus ) wore activity trackers and received weekly emails offering fitness challenges and lifestyle modification challenges . The second group ( Fitbit-Only ) received only activity trackers and did not receive weekly emails . The third group ( Control ) was asked not to purchase an activity tracker of any kind throughout the study . All groups had a body composition analysis prior to the start of the academic year and at the end of the first academic year . Outcome measures included step count and body composition ( body fat percentage and lean body mass ) . The results showed the overall mean daily steps were greater in the Fitbit-Plus group than the Fitbit-Only group for the academic year ( 7429 ± 2833 vs. 6483 ± 2359 ) with only months April and May showing a significant difference between the groups ( p = 0.011 ; p = 0.044 ) . Body fat percentage decreased in the Fitbit-Plus overweight women ( 2.1 ± 1.6 % ) lean body mass increased in the Fitbit-Plus group in overweight men ( 2.4 ± 4.6 lbs . ) . A subsequent finding of this study showed improved body composition in a small sub-group of over-weight students . Weekly behavioral challenges combined with an activity tracker  increased step count in medical students compared to an activity tracker alone . Clinical trials.gov Identifier : NCT02778009 Background Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults . We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments . Objective We aim ed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas . Methods To address the above evaluation goal , we carried out the “ Smart Walk ” program , a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center . We r and omly selected older adults who had enrolled in a population -based , prospect i ve cohort study of aging , the Aging Study of Pyeongchang Rural Area . The “ Smart Walk ” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching , 1 month of rest , and 6 months of self-management . We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program . We also performed intergroup analysis according to adherence of wearable devices . Results We recruited 22 participants ( 11 robust and 11 prefrail older adults ) . The two groups were similar in most of the variables , except for age , frailty index , and Short Physical Performance Battery score associated with frailty criteria . After a 6-month coaching program , the prefrail group showed significant improvement in usual gait speed ( mean 0.73 [ SD 0.11 ] vs mean 0.96 [ SD 0.27 ] , P=.02 ) , International Physical Activity Question naire scores in kcal ( mean 2790.36 [ SD 2224.62 ] vs mean 7589.72 [ SD 4452.52 ] , P=.01 ) , and European Quality of Life-5 Dimensions score ( mean 0.84 [ SD 0.07 ] vs mean 0.90 [ SD 0.07 ] , P=.02 ) , although no significant improvement was found in the robust group . The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period ( 5,584,295.83 vs 1,289,084.66 , P<.001 ) . We found that participants in the “ long-self ” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 ( SD 1.317 ) and mean 0.097 ( SD 0.513 ) , respectively , compared with the other groups . Conclusions Our “ Smart Walk ” program  improved physical fitness , anthropometric measurements , and geriatric assessment categories in a small group of older adults in rural areas with limited re sources for monitoring . Further validation through various rural public health centers and in a large number of rural older adults is required
target: There was no significant between group difference in six-minute walk test distance .
  Conclusions Our meta- analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use .
  Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count .
  WPAM with exercise prescription or advice did not change sedentary time .
background: Background Physical activity ( PA ) is a component of cardiac rehabilitation ( CR ) .
  However , life-long engagement in PA is required to maintain benefits gained .
  Wearable PA monitoring devices ( WPAM ) are thought to increase PA .
  There appear to be no review s which investigate the effect of WPAM in cardiac population s. We firstly aim ed to systematic ally review r and omised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR .
  We specifically examined the effect on cardiorespiratory fitness ( CRF ) , amount and intensity of daily PA , and sedentary time .