Cardiac Rehabilitation Sustainability by Utilization of Accelerometer and Low-Frequency Text Messaging (Preprint)

2020 ◽  
Author(s):  
Susan Rodder ◽  
Venessa Gonzalez ◽  
Theresa Harris
Keyword(s):  
Cardiac Rehabilitation ◽  
Phase Ii ◽  
Mobile Health ◽  
High Frequency ◽  
Text Messaging ◽  
Low Frequency ◽  
Text Messages ◽  
Phase Iii ◽  
Dietary Compliance ◽  
Frequency Group

BACKGROUND Participation in outpatient cardiac rehabilitation (CR) Phase II reduces morbidity, mortality, and improves the quality of life. After Phase II, patients enter Phase III where they attempt to maintain the heart-healthy lifestyle learned during CR Phase II. Despite the benefits of CR Phase II, adherence to lifestyle recommendations can be challenging to sustain in Phase III. The use of mobile health (mHealth) technologies (accelerometer, text messaging, self-monitoring, etc.) can impact adherence and cardiovascular health; however, the impact of utilization frequency of text messaging on CR sustainability should be assessed. OBJECTIVE This trial aimed to determine CR sustainability, at 12 weeks post CR Phase II, by utilization of i) accelerometer, and ii) text messaging either at a) low-frequency with minimal supportive content or b) high-frequency with enhanced supportive content. METHODS The trial was a single-blinded randomized controlled trial with a 2-arm parallel group design. 42 participants were randomized to receive text messaging either a) bi-monthly (low-frequency group; N=22), with text messages being reminders of study participation and the date for the 12-week assessment; or b) tri-weekly (high-frequency group; N=20), with text messages being educational (nutrition, exercise, medication compliance) or supportive (encouragement). All participants were instructed to track steps using accelerometers (Fitbit, Smartphone, Smartwatch, etc.). A 6-minute walk test was used to determine physical fitness as measured by metabolic equivalents (METs). Rate Your Plate (RYP) scores, body mass index (BMI), weight, and waist-to-hip ratio (W:H) were used to assess dietary compliance. RESULTS Two-way repeated measure of analysis of variance found that the high-frequency and low-frequency group had similar sustainability (no decline), with no significant difference in METs (P = .62), RYP scores (P = .15), or BMI (P = .73). However, the high-frequency group did average significantly more steps per week vs. the low-frequency group (52,542  2,611 vs. 43,077  1,550; P = .002). CONCLUSIONS This trial showed that CR sustainability at 12-weeks can be achieved with a simple utilization of mobile health (mHealth) technology (accelerometer and low-frequency text messaging), thus eliminating the decline in fitness and dietary compliance often seen at 12-weeks post-CR Phase II. CLINICALTRIAL IRBNet ID: 957218-2

scholarly journals New Insights Into Vertigo Attack Frequency as a Predictor of Ischemic Stroke

2020 ◽  
Vol 11 ◽  
Author(s):  
Dongxu Qiu ◽  
Lei Zhang ◽  
Jun Deng ◽  
Zhiwei Xia ◽  
Jingfeng Duan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Frequency ◽  
Low Frequency ◽  
Medical Intervention ◽  
Emergency Department Visits ◽  
Arterial Stenosis ◽  
Clinical Parameters ◽  
Ischemic Infarction ◽  
Frequency Group ◽  
Attacks Of Vertigo

Background: Recurrent attacks of vertigo account for 2.6 million emergency department visits per year in the USA, of which more than 4% are attributable to ischemic infarction. However, few studies have investigated the frequency of attacks of vertigo before an ischemic stroke.Methods: We conducted this retrospective analysis and manually screened the medical records of 231 patients who experienced recurrent attacks of vertigo prior to an ischemic stroke. Patients were divided into four different groups based on the frequency of vertigo attacks as well as the region of ischemic infarction. Those with ≤2 attacks of vertigo preceding the ischemic stroke were defined as the low-frequency group. Those with ≥3 attacks were defined as the high-frequency group. Clinical parameters, including vascular risk factors, average National Institutes of Health Stroke Scale (NIHSS) score, and infarction volume, were compared between the groups.Results: On analysis, we found that patients with posterior infarction in the high-frequency group exhibited a higher prevalence of vertebral artery stenosis. However, the incidence of diabetes mellitus (DM) was higher in the low-frequency group. In addition, patients with posterior infarction in the low-frequency group were more active in seeking medical intervention after an attack of vertigo. Notably, the brain stem, especially the lateral medullary region, had a higher probability of being involved in posterior infarction in the high-frequency group. However, the cerebellum was more commonly involved in posterior infarction in the low-frequency group.Conclusions: Our findings indicate that the clinical parameters, including arterial stenosis, DM, and magnetic resonance imaging (MRI) findings, differed between the low- and high-frequency groups. We also found that patients in the low-frequency group were more willing to seek medical intervention after the attacks of vertigo. These findings could be valuable for clinicians to focus on specific examination of the patients according to the frequency of vertigo attacks.

Optimal frequency of whole body vibration training for improving balance and physical performance in the older people with chronic stroke: A randomized controlled trial

2021 ◽  
pp. 026921552110505
Author(s):  
Ning Wei ◽  
Mengying Cai
Keyword(s):  
Older People ◽  
Physical Performance ◽  
High Frequency ◽  
Low Frequency ◽  
Chronic Stroke ◽  
Whole Body ◽  
Timed Up And Go ◽  
Stand Test ◽  
Sit To Stand ◽  
Frequency Group

Objective To explore the optimal frequency of whole-body vibration training for improving the balance and physical performance in older people with chronic stroke. Design a single-blind randomized controlled trial. Setting Two rehabilitation units in the Wuhan Brain Hospital in China. Participants A total of 78 seniors with chronic stroke. Interventions Low-frequency group (13 Hz), high-frequency group (26 Hz), and zero-frequency group (Standing on the vibration platform with 0 Hz) for 10 sessions of side-alternating WBV training. Main measures The timed-up-and-go test, five-repetition sit-to-stand test, 10-metre walking test, and Berg balance scale were assessed pre- and post-intervention. Results Significant time × group interaction effects in five-repetition sit-to-stand test (p = 0.014) and timed-up-and-go test at self-preferred speed (p = 0.028) were observed. The high-frequency group outperformed the zero-frequency group in both five-repetition sit-to-stand test (p = 0.039) and timed-up-and-go test at self-preferred speed (p = 0.024) after 10-sessions training. The low-frequency group displayed only a significant improvement in five-repetition sit-to-stand test after training (p = 0.028). No significant within- or between-group changes were observed in the Berg balance scale and walking speed (p > 0.05). No significant group-difference were found between low-frequency and high-frequency groups. No adverse events were reported during study. Conclusions Compared with 13 Hz, 26 Hz had no more benefits on balance and physical performance in older people with chronic stroke.

Abstract P310: Predictors of Phase III Enrollment in Participants Completing Phase II Cardiac Rehabilitation in a Large Urban Cardiac Rehabilitation Center

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Harsha V Ganga ◽  
Jennifer Jantz ◽  
Gaurav Choudhary ◽  
Wen-Chih Wu
Keyword(s):  
Weight Loss ◽  
Logistic Regression ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Phase Ii ◽  
Temporal Trends ◽  
College Education ◽  
Phase Iii ◽  
Metabolic Equivalents ◽  
Multivariable Logistic Regression

Background: Short duration of outpatient Phase II cardiac rehabilitation (CR) program is not sufficient to sustain benefits of CR. Participation in long-term Phase III CR improves exercise capacity and lipoprotein profile. Hypothesis: We examined the factors predicting Phase III CR enrollment in those who have successfully completed Phase II CR in a large urban CR center. Methods: 4714 participants who completed structured 36-session Phase II CR program from the year 2000 to 2014 were included in this retrospective study. Multivariable logistic regression model was used to identify demographic, socio-economic factors predicting Phase III CR enrollment. The Cochran-Armitage test was used to assess temporal trends in Phase III CR enrollment. Results: A total of 901, out of 4714 participants completing Phase II CR, enrolled into Phase III CR. Mean age was 65 years and 31% were females. Univariate predictors include age, race, education, occupation, income, return to work obligation, insurance status, weight loss, depression and anxiety, exercise duration, and metabolic equivalents (METs). On multivariable logistic regression, those with at least college education (Odds Ratio [OR] 1.5,95% confidence interval [CI], 1.07-2), depression (OR,1.5, 95% CI, 1.07-1.96), weight loss (OR, 1.03, 95% CI, 1.01-1.05) and attending more Phase II sessions (OR,1.06, 95% CI, 1.02-1.10) were more likely to enroll whereas those living > 30 minutes from CR center (OR, 0.40, 95% CI, 0.20-0.75), with higher METs (OR,0.93, 95% CI, 0.87-0.99) and exercising longer (OR, 0.96, 95% CI, 0.93-0.99) were less likely to enroll. There is significantly increased temporal trend for Phase III CR enrollment (Z=11.34, P<0.0001). Conclusion: In participants completing Phase II CR, higher education, depression and weight loss predict increased Phase III CR enrollment whereas increased distance from CR center or better exercise capacity predict decreased Phase III CR enrollment.

scholarly journals The Impact of Physical Environment and Regional Image on Tourist’s Experiential Values and Feelings: An Example of Nanzhuang Area in Taiwan

2015 ◽  
Vol 10 (11) ◽  
pp. 94
Author(s):  
Shwu-Ing Wu ◽  
Li Chia Huang
Keyword(s):  
Significant Influence ◽  
Physical Environment ◽  
High Frequency ◽  
Low Frequency ◽  
Equation Modeling ◽  
Independent Variables ◽  
Frequency Group ◽  
Experiential Value ◽  
The Impact ◽  
Two Independent Variables

With the booming global tourism activities, many countries around the world are actively promoting regional tourism. Thus, understanding the tourists’ needs is important in developing tourism promotion strategies. With Nanzhuang Township, Miaoli County as the case study, this paper discusses the influence of the two independent variables, the tangible physical environment and the intangible regional image, tourists’ experiential value and the feelings after tourism. This study conducted a questionnaire survey on tourists who have visited Nanzhuang Township, Miaoli County, by convenience sampling, in order to construct the model of regional experience marketing effect. A total of 743 effective samples were retrieved. After analysis by structural equation modeling (SEM), it is found that: (1) the physical environment has a positive and significant influence on the tourists’ experiential value; (2) regional image has a positive and significant influence on the tourist’s experiential value; (3) the experiential value has a positive and significant influence on satisfaction; (4) satisfaction has a positive and significant influence on trust and commitment; (5) trust has no significant influence on commitment. Regarding the two independent variables, regional image has more influence. In addition, after comparing the group models by clustering with the high and low frequency of the number of visits, it is found that there are some differences between the high frequency group and the low frequency group, where the regional image of the high frequency group has a greater influence on the experiential value and the physical environment of the low frequency group has a greater influence on the experiential value. The findings can serve as reference for the local government and the tourism operators to develop regional marketing strategies.

Mobile Health and Exposures to Health and Risk Messages

2017 ◽  
Author(s):  
Jessica Fitts Willoughby
Keyword(s):  
Health Information ◽  
Mobile Health ◽  
Text Messaging ◽  
Cell Phone ◽  
The United States ◽  
Text Messages ◽  
Target Audience ◽  
Portable Devices ◽  
Attitudes And Behaviors ◽  
And Behaviors

People who communicate health and risk information are often trying to determine new and innovative ways to reach members of their target audience. Because of the nearly ubiquitous use of mobile phones among individuals in the United States and the continued proliferation of such devices around the world, communicators have turned to mobile as a possible channel for disseminating health information. Mobile health, often referred to as mHealth, uses mobile and portable devices to communicate information about health and to monitor health issues. Cell phones are one primary form of mHealth, with the use of cell phone features such as text messaging and mobile applications (apps) often used as a way to provide health information and motivation to target audience members. Text messaging, or short message service (SMS), is a convenient form for conveying health information, as most cell phone owners regularly send and receive text messages. mHealth offers benefits over other channels for communicating health information, such as convenience, portability, interactivity, and the ability to personalize or tailor messages. Additionally, mHealth has been found to be effective at changing attitudes and behaviors related to health. Research has found mobile to be a tool useful for promoting healthy attitudes and behaviors related to a number of topic areas, from increased sexual health to decreased alcohol consumption. Literature from health communication and research into mHealth can provide guidance for health communicators looking to develop an effective mHealth intervention or program, but possible concerns related to the use of mobile need to be considered, such as concerns about data security and participant privacy.

PM088 Workload Behavior in Cycle Ergometer Training at Phase II End and at 3 Subsequent Phase III Sessions in a Cardiac Rehabilitation Program

Global Heart ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e85
Author(s):  
M.-D. Rius ◽  
J. Sarabia-Orozco ◽  
R. Robert-Cervantes ◽  
M.E.F. Ojeda ◽  
H. Ilarraza-Lomeli ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Phase Ii ◽  
Rehabilitation Program ◽  
Cycle Ergometer ◽  
Phase Iii ◽  
Cardiac Rehabilitation Program ◽  
Subsequent Phase

Response of the diaphragm muscle to electrical stimulation of the phrenic nerve

1983 ◽  
Vol 58 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Thomas E. Ciesielski ◽  
Yoshitaka Fukuda ◽  
William W. L. Glenn ◽  
Jack Gorfien ◽  
Kathryn Jeffery ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Phrenic Nerve ◽  
High Frequency ◽  
Low Frequency ◽  
Diaphragm Muscle ◽  
Diaphragm Pacing ◽  
Frequency Group ◽  
Low Frequency Stimulation ◽  
Frequency Stimulation

✓ The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.

scholarly journals A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study

10.2196/18583 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e18583
Author(s):  
Natalie Nardone ◽  
Jeremy Giberson ◽  
Judith J Prochaska ◽  
Shonul Jain ◽  
Neal L Benowitz
Keyword(s):  
Pilot Study ◽  
Mobile Health ◽  
Secondhand Smoke ◽  
Text Messaging ◽  
Text Message ◽  
Preliminary Evidence ◽  
Text Messages ◽  
Urinary Cotinine ◽  
Mhealth Intervention ◽  
Shs Exposure

Background Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful.

scholarly journals Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study

2021 ◽  
Author(s):  
Phat Luong ◽  
Thomas J. Glorioso ◽  
Gary K. Grunwald ◽  
Pamela Peterson ◽  
Larry A. Allen ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Phase I ◽  
Phase Ii ◽  
Text Messaging ◽  
Care Delivery ◽  
Text Message ◽  
Text Messages ◽  
Medication Refill ◽  
The Impact

Background: Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging. Methods: Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications. Results: Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P =0.12) and all gapping medications (17.8% versus 10.0%; P =0.27). Conclusions: It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03973931.

scholarly journals A Comparison of the Online Shopping Behavior Patterns of Consumer Groups with Different Online Shopping Experiences

2017 ◽  
Vol 9 (3) ◽  
pp. 24 ◽  
Author(s):  
Shwu-Ing Wu ◽  
Hsin-Ti Tsai
Keyword(s):  
Consumer Behavior ◽  
High Frequency ◽  
Online Shopping ◽  
Low Frequency ◽  
Positive Influence ◽  
Consumption Patterns ◽  
Shopping Behavior ◽  
Behavior Patterns ◽  
Frequency Group ◽  
Online Shopping Behavior

The appearance of Internet does not only bring changes to consumption patterns, but also to the business modes of companies, as a result of which Internet has become a perfect sales channel. When a consumer shops online, s/he might be influenced by a huge variety of factors. In this study, ABC model of attitude was adopted to investigate empirically the influences of website characteristics and external stimulus on consumers’ online shopping behavior. A relationship model was also established to compare the differences of consumer groups with different online shopping experiences.Using convenience sampling, a total of 818 valid questionnaires were collected for the purpose of this study. Based on their online shopping experiences, consumers were divided into high frequency and low frequency groups in order to compare their consumption patterns as a group. According to the results, the two groups with different online shopping experiences were significantly different in three relational paths. To be specific: (1) Compared to the low frequency group, consumers in the high frequency group is more significantly positively influenced by website characteristics along the affection path during their online shopping. (2) Compared to the high frequency group, consumers in the low frequency group are more significantly positively influenced by website characteristics along the attitude path during their online shopping. (3) Compared with the low frequency group, a more significant positive influence is found among consumers in the high frequency group between consumer affection and consumer behavior path. These differences in the consumer behavior patterns of groups with different online shopping experiences according to the research results, therefore, could be used as references for online shopping business owners in their formulation of strategies.

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