Costs of an exergame intervention for patients with heart failure

Background

Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programmes involving traditional modes of physical activity. It is important to gain insights into aspects related to costs to in order to compare with other costs for rehabilitation and make priorities.

Purpose

To gain insights into aspects related to the costs of an exergame intervention for patients with heart failure and their willingness to pay for such an intervention.

Method

In a randomised controlled trial, the HF-Wii study, the intervention group (n=305) received an introduction to the exergame, the exergame was installed at home and technical and practical support was available when needed for three months. Patients received telephone follow-ups after the installation. The control group (n=300) received activity advice and telephone follow-ups. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs and conducted interviews to establish willingness to pay in a subset of patients.

Results

No significant differences were found between the exergame group (n=300) vs. the control group (n=305) in hospital use or costs (one-year number of hospitalisations p=0.60, costs p=0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros (see Table 1). Of the total estimated costs for the intervention, 288 Euros, patients were willing to pay, on average, 58%. Satisfaction level regarding the exergame intervention was significantly correlated with patients' willingness to pay (rs=0.47, p=0.01).

Conclusion

Although the costs of developing a exergame can be high, this study shows that the cost for the implementation of exergaming in an individual for practice was only 288 Euro per patient. Patients were willing to pay more than half of the exergame intervention and patients with higher satisfaction levels were willing to pay more than those with lower satisfaction levels.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council

Changes in self-care maintenance during quarantine in patients with heart failure

Background

Patients with heart failure (HF) experience challenges in self-care that contribute to poor quality of life and high health care utilization. The COVID-19 pandemic required HF patients, especially living in countries with strict lockdowns and quarantines, to change their lifestyle including health promoting behaviors.

Purpose

To assess changes in self-care maintenance in patients with HF changed during quarantine compared to before quarantine. We hypothesized that the self-care maintenance behavior physical activity was most effected during quarantine.

Method

This is a cross-sectional survey study. From the medical chart, patients' disease severity (NYHA-class), ejection fraction and comorbidities were collected. Self-care maintenance was assessed using subscale Self-Care of Heart Failure Index 6.2. The total score ranges from 0–100, where 70 or higher is seen as having good self-care maintenance. With all the questions in the self-care maintenance scale a question was added: Did this change due to the COVID-19 pandemic? Patients could answer yes or no. When patients answered yes, they were asked the elaborate. Patients self-reported physical activity, before and during the pandemic, using the International Physical Activity Questionnaire (short form). Descriptive analyses were used for self-care maintenance, content analysis was applied for the qualitative data. Paired sample t-test were performed to assess the change in the total physical activity.

Results

In total, 120 patients with HF were included in this study (mean age was 79±13, 39% female, 78% NYHA-class I/II). Patients had a mean self-care maintenance of 32 (±6). No participant had good self-care maintenance (score of 70 or higher). Patients were non-adherent to regular physical activity (77%, n=92), keeping weight down (74%, n=89) and weighing themselves (66%, n=79) during quarantine (Figure). Behaviors which changed the most included keeping medical appointments (81%) and regular exercise (82%). Significantly higher levels of physically active was noticed before quarantine (776 Mets-minutes) compared to during quarantine (106 Mets-minutes) (p<0.01). The change in self-care maintenance was explained by change in motivation and self-confidence. Because of the pandemic and the quarantine, patients reported not being able to rely on health care and their usual social support system. Patients tried to create new habits when trying to maintain their self-care.

Conclusion

Patients with HF reported experiencing low self-care maintenance during quarantine due to not being able to go to medical appointments and decrease in physical activity. Public health policies during crisis events such as a pandemic should strive to provide support in coping with these changes and offer alternative ways of maintaining their self-care maintenance, especially with physical activity.

Funding Acknowledgement

Type of funding sources: None.

Interests and preferences towards technology-based cardiac rehabilitation in men and women with coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have demonstrated the effectiveness of telemedicine programmes in patients with coronary artery disease (CAD). However, the development of these programmes is driven from a technical point of view and does not usually take into account the needs and expectations of patients. Thus, we found a need to study the interests and preferences towards technology-based cardiac rehabilitation (CR) in patients with CAD.

Purpose

The aim of this study was to compare the interests and preferences towards technology-based CR in men and women with CAD.

Method

A cross-sectional study was conducted. A total of 70 subjects with CAD (84.28% male) were included. Participants' interests and preferences were measured using the Technology Usage Questionnaire, which includes items on digital health and technology usage.

Results

On the one hand, men showed a greater interest in receiving CR counselling via mobile phone (p=0.022), would sign up for a free technology-based CR programme (p=0.034) and would like to receive less than 1-2 messages a week (p=0.010). On the other hand, women showed greater interest in receiving information about the different components included in the CR programme (receiving healthy meal/recipe ideas (p=0.002), reminders to take medication (p=0.039) and showed greater interest in meeting other people with heart disease (p=0.034). No differences were found by gender in type of communication that participants would like to receive through their mobile phone (p=0.154) or through the Internet (p=0.648), interest in receiving treatment through the Internet (p=0.454), interest in receiving an exercise-based CR program using virtual reality (p=0.810), nor usefulness of a virtual CR session (p=0.801).

Conclusions

In subjects with CAD, gender appears to be a determinant of interest. Men showed a greater interest in receiving CR counselling via mobile phone, would sign up for a technology-based CR programme and would like to receive fewer notifications. Women were more interested in receiving information about different components of the CR programme.

Physical activity and technology usage performed by patients with coronary artery disease: a gender approach

Funding Acknowledgements

Type of funding sources: None.

Background

Recent studies show that cardiac telerehabilitation, including exercise and lifestyle modification, is effective in reducing cardiovascular risk factors in patients with coronary artery disease (CAD). Thus, physical activity and technology usage of patients with CAD are important key points in order to create technology-based cardiac rehabilitation programs to improve physical patients´ condition and reduce cardiovascular risk.

Purpose

The aim of this study was to compare the physical activity and the technological usage of women and men with CAD.

Methods

A cross-sectional study in patients with CAD was performed. Sociodemographic data, physical activity (measured with the International Physical Activity Questionnaire, IPAQ) and the technology usage (measured with the Technology use subscale of the Technology Usage Questionnaire) were collected. Descriptive and inferential analyzes were performed to explore the differences between men and women with CAD.

Results

A total of 70 participants were included (84.28% men, mean age=59±8.54 years). Regarding the IPAQ, men significantly reported higher walking time (99.31±95.22 METS vs. 33.28±37.42 METS, p=0.001, respectively) and higher total physical activity (4164.91±4164.91 METS vs. 1390.68±1609.05 METS, p&lt;0.001, respectively) than women. In relation to technology usage, the entire sample used a mobile phone, whilst there were no significant gender differences in the functions/applications used (phone calls, text messages, camera, receive videos/photos, internet searches, apps, instant messages, social media, games) (p=0.068). Although the majority of the participants (85.71%) had regular access to internet, men used their phone more frequently than women (81.10% vs. 37.50%, p=0.005, respectively). Comparison by gender showed no significant differences in the type of device used for internet searches (computer, tablet, mobile phone) (p=0.169), familiarization with technology-based physical activity games (p=0.801), use of heart rate monitors (p=0.193), preference to monitor heart rate when exercising (p=0.664), nor use of other devices to monitor physical activity (pedometer, etc.) (p=0.193).

Conclusion

Based on the results obtained, we conclude that men with CAD were more physical active and used the Internet more often than women, whilst there were no differences by gender in the rest of variables. Assessment of physical activity and technology usage should be implemented in patients with CAD, in order to adapt and improve the design of technology-based telerehabilitation programs

Development of a mobile exergame for increasing physical activity in patients with heart failure

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Vetenskapsrådet

Background

A 10-minute increase a day in physical activity (PA) in patients with heart failure (HF) can have beneficial effects on symptoms, mortality, and hospitalisation risk. Many patients are physically inactive and find it challenging to leave home to participate in physical activity programs, due to symptoms, lack of easily accessible facilities or fear for being exposed to infection (during the pandemic or during flu season).

Developing PA interventions that are tailored to the needs and preferences is challenging, as it needs an interdisciplinary approach and active collaboration with patients. A new approach to increase PA is the use of exergames. An exergame is defined as games that requires participants to be physically active or exercise where player’s body motion controls the game.

Objective

To develop a mobile exergame (called Heart Farming), test the usability of the exergame, and investigate the feasibility for increasing PA in patients with HF.

Methods

The study included three phases: (1) Development of a prototype of the exergame; (2) Usability testing and developing, and (3) Assess feasibility of using the exergame in a PA intervention for patients with HF.

Results

A prototype of an exergame was developed which has as main goal to walk 10 minutes more a day. Game elements such as goal setting, providing feedback, and social connectivity are included to motivate patients. The patients can play the exergame according to their needs and wishes, e.g., competition, strategic playing, and social interaction. The exergame was created (Figure), tested and refined through an iterative developmental process and by multidisciplinary team with game designers, HF specialists, user representatives and researchers.

During usability testing, eight patients within the heart and lung patient organization were invited to test the exergame. Most patients found the game easy to play and enjoyable and thought the game could be helpful to increase their daily walking. The researchers observed that the patients needed support to be able to play the exergame. Proper familiarization and coaching are needed when introducing the game to patients with HF and this was included as an important part in the exergame intervention. The exergame is further developed iteratively by the multidisciplinary team with increased number of user representatives testing the game and giving feedback.

In a feasibility study we will test how feasible the exergame is for a PA intervention in patients with HF. Ten patients will receive the game with structured familiarisation and telephone follow-up including coaching for one month. The results of this feasibility testing will be presented during the conference.

Conclusion

The exergame Heart Farming seems to be easy and enjoyable to play but needs proper familiarisation and coaching. The results of the feasibility study will show if this exergame can be used in a PA intervention for patients with HF.

Exercise motivation in patients with heart failure

Background

Being physically active is important for patients with heart failure (HF) to improve clinical outcome, however, adherence to exercise is low (&lt;50%). To tailor intervention that increase physical activity, it is important to know what motivates HF patients to exercise. Therefore, the aim of the study is to describe motivations of HF patients to exercise and describe variables that are related to their exercise motivation.

Methods

This is a cross-sectional analysis of baseline data of 605 patients with HF (mean age 67±12, 71% male, 60%NYHA I/II) who were included in the HF-Wii study. Stepwise regression modelling was used with exercise motivation as dependent variable. Exercise motivation was measured with the Exercise Motivation Index, including 15 statements with answers ranging from 0 (not important) to 4 (extremely important), with 3 subscales (physical, psychological and social motivation).

Based on previous research the following predictors were included in the model: quality of life (MLwHFQ), self-efficacy (Exercise self-efficacy scale), cognition (MoCA), depression (HADs), sleeping difficulties (MISS), HF symptoms (fatigue, shortness of breath), age, gender, NYHA-class, comorbidity and educational level.

Results

Mean total motivation to exercise was 2.3±0.9 and physical and psychological motivation were rated as the more important (2.7±0.9 and 2.5±0.9) than social motivation (1.8±1.1). Motivation statements that were considered extremely important were being healthier (55% rated 4), slow down the ageing process (38% rated 4) and increasing well-being (31% rated 4). From the multiple linear regression model lower quality of life (β=−0.31, P&lt;0.0001), lower self-efficacy (β=0.16, P&lt;0.0001), experiencing shortness of breath (β=−0.28, P&lt;0.0001), having COPD (β=−0.14, P=0.001) and low educational level (β=−0.09, P&lt;0.028) were predictors related to lower motivation. This model explained 17% of the exercise motivation variability (p&lt;0.0001). Cognition, sleeping difficulties, age, gender, NYHA-class and experiencing fatigue were not significantly related to motivation.

Conclusion

Lower quality of life, lower self-efficacy, experiencing shortness of breath, having COPD and lower educational level, decreases the motivation to exercise and may therefore be considered as barriers for exercise. These barriers should be assessed and considered when motivating patients to become more physically active.

Funding Acknowledgement

Type of funding source: None

P6328Relationship between exercise capacity and muscle function in adult patients with heart failure

Introduction

Physical fitness is a multidimensional concept and is of great importance to assess in heart failure (HF) patients, due to that HF is associated with exercise intolerance, dyspnea and fatigue. Some measures of physical fitness have been associated to HF severity, rehospitalization and mortality risk.

Purpose

The aim of this study was to explore the relationship between two different measures of physical fitness in patients with HF: exercise capacity and muscle function.

Methods

This is a secondary analysis performed on the baseline data of a multi-centre RCT study aimed at exploring the effect of exergame access to improving exercise capacity in HF patients. Physical fitness was assessed by two different measures: exercise capacity assessed by the 6-minute walk test (6MWT), and muscle function assessed by 3 different isometric tests of upper and lower limbs. Descriptive statistics, Spearman correlation and principal component analysis were used to analyse the data.

Results

In total, 605 HF patients were included in this analysis (mean age 67±12, 29% women, 90% NYHA II/III). Exercise capacity (6MWT) was correlated with all of the muscle function tests, with correlation-coefficients ranging from r=0.23 to r=0.50 (p<0.001). Principal component analysis showed a bi-dimensional nature of physical fitness, with the first dimension including the lower body strength and the second dimension including the upper body strength and exercise capacity. These two dimensions explained 71% of the total variance of the measured variables.

Correlation matrix (n=605) 6MWT Right Heel-Lift Left Heel-Lift Shoulder abduction Right Shoulder Flexion Left Shoulder Flexion 6MWT 1 Right Heel-Lift 0.23** 1 Left Heel-Lift 0.26** 0.86** 1 Shoulder abduction 0.40** 0.30** 0.34** 1 Right Shoulder Flexion 0.47** 0.51** 0.48** 0.52** 1 Left Shoulder Flexion 0.50** 0.49** 0.48** 0.52** 0.83** 1 **p<0.001.

Principal Component Analysis

Conclusions

Although strong correlations between exercise capacity and muscle function tests, the measures loaded on two different factors. The results suggest that upper body strength and exercise capacity had a stronger relationship than with lower body strength. This may imply that muscle function tests for upper and lower limbs and exercise capacity represent different aspects of physical fitness and to attain a more complete assessment of physical fitness all three tests are important.

Acknowledgement/Funding

Swedish National Science Council, The Swedish Heart and Lung Association, The Swedish Heart and Lung Association, Swedish Heart-Lung Foundation