Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial

Kavita Radhakrishnan, Christine Julien, Tom Baranowski, Matthew O'Hair, Grace Lee, Atami Sagna De Main, Catherine Allen, Bindu Viswanathan, Edison Thomaz, Miyong Kim, Kavita Radhakrishnan, Christine Julien, Tom Baranowski, Matthew O'Hair, Grace Lee, Atami Sagna De Main, Catherine Allen, Bindu Viswanathan, Edison Thomaz, Miyong Kim

Abstract

Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF.

Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial.

Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks.

Results: A total of 38 participants with HF-intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)-were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)-IG (15/19, 79%) and CG (16/19, 84%)-had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)-IG (14/19, 74%) and CG (13/19, 68%)-participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial.

Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors.

Trial registration: ClinicalTrials.gov NCT03947983; https://ichgcp.net/clinical-trials-registry/NCT03947983.

Keywords: behaviors; digital game; heart failure; mobile phone; older adults; physical activity; self-management; sensor; weight monitoring.

Conflict of interest statement

Conflicts of Interest: MO is the owner of Good Life Games, Inc, a company that develops health games for hire, which provided the prototype game images for this study.

©Kavita Radhakrishnan, Christine Julien, Tom Baranowski, Matthew O'Hair, Grace Lee, Atami Sagna De Main, Catherine Allen, Bindu Viswanathan, Edison Thomaz, Miyong Kim. Originally published in JMIR Serious Games (https://games.jmir.org), 08.11.2021.

Figures

Figure 1
Figure 1
Knowledge embedded in the sensor-controlled digital game.
Figure 2
Figure 2
Built-in quiz in the sensor-controlled digital game.
Figure 3
Figure 3
Example of game alert messages based on real-time behavior.
Figure 4
Figure 4
Diagram of participant flow. HF: heart failure; LTFU: lost to follow-up.
Figure 5
Figure 5
Engagement in dual behaviors of weight monitoring and physical activity. CG: control group; IG: intervention group.

References

    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MS, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UK, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW, American Heart Association Council on EpidemiologyPrevention Statistics CommitteeStroke Statistics Subcommittee Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020 Mar 03;141(9):e139–596. doi: 10.1161/CIR.0000000000000757.
    1. Murad K, Goff DC, Morgan TM, Burke GL, Bartz TM, Kizer JR, Chaudhry SI, Gottdiener JS, Kitzman DW. Burden of comorbidities and functional and cognitive impairments in elderly patients at the initial diagnosis of heart failure and their impact on total mortality: the cardiovascular health study. JACC Heart Fail. 2015 Jul;3(7):542–50. doi: 10.1016/j.jchf.2015.03.004. S2213-1779(15)00216-4
    1. Lainscak M, Blue L, Clark AL, Dahlström U, Dickstein K, Ekman I, McDonagh T, McMurray JJ, Ryder M, Stewart S, Strömberg A, Jaarsma T. Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2011 Feb;13(2):115–26. doi: 10.1093/eurjhf/hfq219. doi: 10.1093/eurjhf/hfq219.hfq219
    1. Heart Failure Society of America. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun;16(6):e1–194. doi: 10.1016/j.cardfail.2010.04.004.S1071-9164(10)00173-9
    1. Jones CD, Holmes GM, Dewalt DA, Erman B, Broucksou K, Hawk V, Cene CW, Wu J, Pignone M. Is adherence to weight monitoring or weight-based diuretic self-adjustment associated with fewer heart failure-related emergency department visits or hospitalizations? J Card Fail. 2012 Jul;18(7):576–84. doi: 10.1016/j.cardfail.2012.05.004. S1071-9164(12)00173-X
    1. Jones CD, Holmes GM, DeWalt DA, Erman B, Wu J, Cene CW, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Macabasco-O'Connell A, Hawk V, Broucksou K, Pignone M. Self-reported recall and daily diary-recorded measures of weight monitoring adherence: associations with heart failure-related hospitalization. BMC Cardiovasc Disord. 2014 Jan 31;14:12. doi: 10.1186/1471-2261-14-12. 1471-2261-14-12
    1. Ismail H, McFarlane JR, Nojoumian AH, Dieberg G, Smart NA. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. JACC Heart Fail. 2013 Dec;1(6):514–22. doi: 10.1016/j.jchf.2013.08.006. S2213-1779(13)00316-8
    1. Tu R, Zeng Z, Zhong G, Wu W, Lu Y, Bo Z, He Y, Huang W, Yao L. Effects of exercise training on depression in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. Eur J Heart Fail. 2014 Jul;16(7):749–57. doi: 10.1002/ejhf.101. doi: 10.1002/ejhf.101.
    1. Piepoli MF, Conraads V, Corrà U, Dickstein K, Francis DP, Jaarsma T, McMurray J, Pieske B, Piotrowicz E, Schmid J, Anker SD, Solal AC, Filippatos GS, Hoes AW, Gielen S, Giannuzzi P, Ponikowski PP. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011 Apr;13(4):347–57. doi: 10.1093/eurjhf/hfr017. doi: 10.1093/eurjhf/hfr017.hfr017
    1. Jaarsma T, Klompstra L, Ben Gal T, Boyne J, Vellone E, Bäck M, Dickstein K, Fridlund B, Hoes A, Piepoli MF, Chialà O, Mårtensson J, Strömberg A. Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial. Eur J Heart Fail. 2015 Jul;17(7):743–8. doi: 10.1002/ejhf.305. doi: 10.1002/ejhf.305.
    1. Nieuwenhuis MM, Jaarsma T, van Veldhuisen DJ, Postmus D, van der Wal MH. Long-term compliance with nonpharmacologic treatment of patients with heart failure. Am J Cardiol. 2012 Aug 01;110(3):392–7. doi: 10.1016/j.amjcard.2012.03.039.S0002-9149(12)01055-7
    1. van der Wal MH, van Veldhuisen DJ, Veeger NJ, Rutten FH, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur Heart J. 2010 Jun;31(12):1486–93. doi: 10.1093/eurheartj/ehq091.ehq091
    1. Bos-Touwen I, Jonkman N, Westland H, Schuurmans M, Rutten F, de Wit N, Trappenburg J. Tailoring of self-management interventions in patients with heart failure. Curr Heart Fail Rep. 2015 Jun;12(3):223–35. doi: 10.1007/s11897-015-0259-3.
    1. Herrmann LK, Kim J. The fitness of apps: a theory-based examination of mobile fitness app usage over 5 months. Mhealth. 2017 Jan 30;3:2. doi: 10.21037/mhealth.2017.01.03. doi: 10.21037/-03-2017.01.03
    1. Attig C, Franke T. Abandonment of personal quantification: a review and empirical study investigating reasons for wearable activity tracking attrition. Comput Human Behav. 2020 Jan;102:223–37. doi: 10.1016/j.chb.2019.08.025.
    1. Vieira A, Gabriel J, Melo C, Machado J. Kinect system in home-based cardiovascular rehabilitation. Proc Inst Mech Eng H. 2017 Jan;231(1):40–7. doi: 10.1177/0954411916679201.0954411916679201
    1. Thompson D, Baranowski T, Buday R, Baranowski J, Thompson V, Jago R, Griffith MJ. Serious video games for health how behavioral science guided the development of a serious video game. Simul Gaming. 2010 Aug 01;41(4):587–606. doi: 10.1177/1046878108328087.
    1. Baranowski MT, Lu AS, Buday R, Lyons EJ, Schell J, Russoniello C. Stories in games for health: more pros or cons? Games Health J. 2013 Oct;2(5):256–63. doi: 10.1089/g4h.2013.0052.
    1. Marston H. Older adults as 21st century game designers. Comput Game J. 2012 May 15;1(1):90–102. doi: 10.1007/BF03392330. doi: 10.1007/bf03392330.
    1. Beale IL, Kato PM, Marin-Bowling VM, Guthrie N, Cole SW. Improvement in cancer-related knowledge following use of a psychoeducational video game for adolescents and young adults with cancer. J Adolesc Health. 2007 Sep;41(3):263–70. doi: 10.1016/j.jadohealth.2007.04.006.S1054-139X(07)00175-9
    1. Serious Games: Mechanisms and Effects. New York: Routledge; 2009.
    1. McGonigal J. Reality is Broken: Why Games Make Us Better and How They Can Change the World. Delhi, India: RHUK; 2012.
    1. Gardner B. A review and analysis of the use of 'habit' in understanding, predicting and influencing health-related behaviour. Health Psychol Rev. 2015;9(3):277–95. doi: 10.1080/17437199.2013.876238.
    1. Brox E, Fernandez-Luque L, Tøllefsen T. Healthy gaming - video game design to promote health. Appl Clin Inform. 2011 Apr 27;2(2):128–42. doi: 10.4338/ACI-2010-10-R-0060.
    1. Radhakrishnan K, Julien C, O'Hair M, Baranowski T, Lee G, Allen C, Sagna A, Thomaz E, Kim M. Usability testing of a sensor-controlled digital game to engage older adults with heart failure in physical activity and weight monitoring. Appl Clin Inform. 2020 Oct;11(5):873–81. doi: 10.1055/s-0040-1721399.
    1. Hall AK, Chavarria E, Maneeratana V, Chaney BH, Bernhardt JM. Health benefits of digital videogames for older adults: a systematic review of the literature. Games Health J. 2012 Dec;1(6):402–10. doi: 10.1089/g4h.2012.0046.
    1. Theng Y, Lee JW, Patinadan PV, Foo SS. The use of videogames, gamification, and virtual environments in the self-management of diabetes: a systematic review of evidence. Games Health J. 2015 Oct;4(5):352–61. doi: 10.1089/g4h.2014.0114.
    1. Gaming attitudes and habits of adults ages 50-plus. AARP Research. 2019. [2021-10-02]. .
    1. Dithmer M, Rasmussen JO, Grönvall E, Spindler H, Hansen J, Nielsen G, Sørensen SB, Dinesen B. "The Heart Game": using gamification as part of a telerehabilitation program for heart patients. Games Health J. 2016 Feb;5(1):27–33. doi: 10.1089/g4h.2015.0001.
    1. Radhakrishnan K, Toprac P, O'Hair M, Bias R, Kim MT, Bradley P, Mackert M. Interactive digital e-health game for heart failure self-management: a feasibility study. Games Health J. 2016 Dec;5(6):366–74. doi: 10.1089/g4h.2016.0038.
    1. Flores M, Glusman G, Brogaard K, Price ND, Hood L. P4 medicine: how systems medicine will transform the healthcare sector and society. Per Med. 2013;10(6):565–76. doi: 10.2217/pme.13.57.
    1. Dolgin M. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th edition. Philadelphia: Lippincott Williams and Wilkins; 1994.
    1. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000 Nov;15(11):1021–7. doi: 10.1002/1099-1166(200011)15:11<1021::aid-gps234>;2-6.10.1002/1099-1166(200011)15:11<1021::AID-GPS234>;2-6
    1. McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004 Mar 02;109(8):1004–9. doi: 10.1161/01.CIR.0000116764.53225.A9.01.CIR.0000116764.53225.A9
    1. Trialfacts homepage. Trialfacts. [2020-12-31]. .
    1. Fogg B. A behavior model for persuasive design. Proceedings of the 4th International Conference on Persuasive Technology; Persuasive '09: Proceedings of the 4th International Conference on Persuasive Technology; Apr 26-29, 2009; Claremont California USA. 2009.
    1. DeWalt DA, Schillinger D, Ruo B, Bibbins-Domingo K, Baker DW, Holmes GM, Weinberger M, Macabasco-O'Connell A, Broucksou K, Hawk V, Grady KL, Erman B, Sueta CA, Chang PP, Cene CW, Wu J, Jones CD, Pignone M. Multisite randomized trial of a single-session versus multisession literacy-sensitive self-care intervention for patients with heart failure. Circulation. 2012 Jun 12;125(23):2854–62. doi: 10.1161/CIRCULATIONAHA.111.081745. CIRCULATIONAHA.111.081745
    1. Heart Failure Society of America homepage. Heart Failure Society of America. [2020-12-23]. .
    1. Thompson D, Baranowski T, Buday R. Conceptual model for the design of a serious video game promoting self-management among youth with type 1 diabetes. J Diabetes Sci Technol. 2010 May 01;4(3):744–9. doi: 10.1177/193229681000400331.
    1. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010 Jun 01;152(11):726–32. doi: 10.7326/0003-4819-152-11-201006010-00232. 0003-4819-152-11-201006010-00232
    1. Withings homepage. Withings. [2020-12-31]. .
    1. Body weight and BMI Wi-Fi scale. Withings. [2020-12-31]. .
    1. Withings Health Mate: a fitness, activity and health tracker app. Withings. [2020-12-31]. .
    1. Collier SR, McCraw C, Campany M, Lubkeman A, StClair P, Ji H, Sandberg K, Morgan JW, Smith CJ. Withings body cardio versus gold standards of pulse-wave velocity and body composition. J Pers Med. 2020 Mar 11;10(1):17. doi: 10.3390/jpm10010017. jpm10010017
    1. Mercer K, Giangregorio L, Schneider E, Chilana P, Li M, Grindrod K. Acceptance of commercially available wearable activity trackers among adults aged over 50 and with chronic illness: a mixed-methods evaluation. JMIR Mhealth Uhealth. 2016 Jan 27;4(1):e7. doi: 10.2196/mhealth.4225. v4i1e7
    1. Vetrovsky T, Siranec M, Marencakova J, Tufano JJ, Capek V, Bunc V, Belohlavek J. Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure. PLoS One. 2019 Sep 13;14(9):e0222569. doi: 10.1371/journal.pone.0222569. PONE-D-19-08279
    1. Simple randomization service. Sealed Envelope. [2021-03-09]. .
    1. McAuley E, Duncan T, Tammen VV. Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: a confirmatory factor analysis. Res Q Exerc Sport. 1989 Mar;60(1):48–58. doi: 10.1080/02701367.1989.10607413.
    1. Piepenburg SM, Faller H, Gelbrich G, Störk S, Warrings B, Ertl G, Angermann CE. Comparative potential of the 2-item versus the 9-item patient health questionnaire to predict death or rehospitalization in heart failure. Circ Heart Fail. 2015 May;8(3):464–72. doi: 10.1161/CIRCHEARTFAILURE.114.001488.CIRCHEARTFAILURE.114.001488
    1. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000 Apr;35(5):1245–55. doi: 10.1016/s0735-1097(00)00531-3. S0735-1097(00)00531-3
    1. Reilly CM, Higgins M, Smith A, Gary RA, Robinson J, Clark PC, McCarty F, Dunbar SB. Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test. J Cardiovasc Nurs. 2009;24(6):500–9. doi: 10.1097/JCN.0b013e3181aff0b0. 00005082-200911000-00014
    1. Lee CS, Lyons KS, Gelow JM, Mudd JO, Hiatt SO, Nguyen T, Jaarsma T. Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure. Eur J Cardiovasc Nurs. 2013 Apr;12(2):214–8. doi: 10.1177/1474515112469316. 1474515112469316
    1. Vellone E, Riegel B, Cocchieri A, Barbaranelli C, D'Agostino F, Antonetti G, Glaser D, Alvaro R. Psychometric testing of the Self-Care of Heart Failure Index Version 6.2. Res Nurs Health. 2013 Oct;36(5):500–11. doi: 10.1002/nur.21554.
    1. Levesque CS, Williams GC, Elliot D, Pickering MA, Bodenhamer B, Finley PJ. Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health Educ Res. 2007 Oct;22(5):691–702. doi: 10.1093/her/cyl148.cyl148
    1. Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 2004 Jan;23(1):58–66. doi: 10.1037/0278-6133.23.1.58.2004-10331-007
    1. Ong MK, Romano PS, Edgington S, Aronow HU, Auerbach AD, Black JT, De Marco T, Escarce JJ, Evangelista LS, Hanna B, Ganiats TG, Greenberg BH, Greenfield S, Kaplan SH, Kimchi A, Liu H, Lombardo D, Mangione CM, Sadeghi B, Sadeghi B, Sarrafzadeh M, Tong K, Fonarow GC, Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition -- heart failure (BEAT-HF) randomized clinical trial. JAMA Intern Med. 2016 Mar;176(3):310–8. doi: 10.1001/jamainternmed.2015.7712. 2488923
    1. Faul F, Erdfelder E, Buchner A, Lang A. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009 Nov;41(4):1149–60. doi: 10.3758/BRM.41.4.1149.41/4/1149
    1. Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012 Mar;65(3):301–8. doi: 10.1016/j.jclinepi.2011.07.011.S0895-4356(11)00264-2
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77–101. doi: 10.1191/1478088706qp063oa. doi: 10.1191/1478088706qp063oa.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York: Routledge; 1988.
    1. Spertus J, Peterson E, Conard MW, Heidenreich PA, Krumholz HM, Jones P, McCullough PA, Pina I, Tooley J, Weintraub WS, Rumsfeld JS, Cardiovascular Outcomes Research Consortium Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005 Oct;150(4):707–15. doi: 10.1016/j.ahj.2004.12.010.S0002-8703(04)00906-8
    1. Butler J, Khan MS, Mori C, Filippatos GS, Ponikowski P, Comin-Colet J, Roubert B, Spertus JA, Anker SD. Minimal clinically important difference in quality of life scores for patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2020 Jun;22(6):999–1005. doi: 10.1002/ejhf.1810. doi: 10.1002/ejhf.1810.
    1. Vest AR, Upshaw JN, Dean K, Donovan E, Diakos N, Hong C, Conway L, Kiernan MS, DeNofrio D, Konstam MA. The decrease in hospitalizations for heart failure during the COVID-19 pandemic: a community and academic hospital comparison study. J Card Fail. 2020 Oct;26(10):S71. doi: 10.1016/j.cardfail.2020.09.207.
    1. Hall ME, Vaduganathan M, Khan MS, Papadimitriou L, Long RC, Hernandez GA, Moore CK, Lennep BW, McMullan MR, Butler J. Reductions in heart failure hospitalizations during the COVID-19 pandemic. J Card Fail. 2020 Jun;26(6):462–3. doi: 10.1016/j.cardfail.2020.05.005. S1071-9164(20)30469-3
    1. Tudor-Locke C, Craig CL, Brown WJ, Clemes SA, De Cocker K, Giles-Corti B, Hatano Y, Inoue S, Matsudo SM, Mutrie N, Oppert J, Rowe DA, Schmidt MD, Schofield GM, Spence JC, Teixeira PJ, Tully MA, Blair SN. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act. 2011 Jul 28;8:79. doi: 10.1186/1479-5868-8-79. 1479-5868-8-79
    1. Tigbe WW, Granat MH, Sattar N, Lean ME. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes (Lond) 2017 May;41(5):689–96. doi: 10.1038/ijo.2017.30.ijo201730
    1. Lee I, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med. 2019 Aug 01;179(8):1105–12. doi: 10.1001/jamainternmed.2019.0899. 2734709
    1. Gade JD, Spindler H, Hollingdal M, Refsgaard J, Dittmann L, Frost L, Mahboubi K, Dinesen B. Predictors of walking activity in patients with systolic heart failure equipped with a step counter: randomized controlled trial. JMIR Biomed Eng. 2020 Nov 30;5(1):e20776. doi: 10.2196/20776.
    1. Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJ, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res. 2020 Jan 01;116(1):12–27. doi: 10.1093/cvr/cvz200.5544269
    1. Klompstra L, Kyriakou M, Lambrinou E, Piepoli MF, Coats AJ, Cohen-Solal A, Cornelis J, Gellen B, Marques-Sule E, Niederseer D, Orso F, Piotrowicz E, Van Craenenbroeck EM, Simonenko M, Witte KK, Wozniak A, Volterrani M, Jaarsma T. Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021 Jan;23(1):83–91. doi: 10.1002/ejhf.2035.
    1. Sohn A, Speier W, Lan E, Aoki K, Fonarow GC, Ong MK, Arnold CW. Integrating remote monitoring into heart failure patients' care regimen: a pilot study. PLoS One. 2020 Nov 19;15(11):e0242210. doi: 10.1371/journal.pone.0242210. PONE-D-20-21712
    1. Wei KS, Ibrahim NE, Kumar AA, Jena S, Chew V, Depa M, Mayanil N, Kvedar JC, Gaggin HK. Habits heart app for patient engagement in heart failure management: pilot feasibility randomized trial. JMIR Mhealth Uhealth. 2021 Jan 20;9(1):e19465. doi: 10.2196/19465. v9i1e19465
    1. Smith B, Magnani JW. New technologies, new disparities: the intersection of electronic health and digital health literacy. Int J Cardiol. 2019 Oct 01;292:280–2. doi: 10.1016/j.ijcard.2019.05.066. S0167-5273(18)36997-3
    1. APIs for reliable SMS delivery. twilio. [2021-09-24]. .

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe