Applicability of a Web-Based, Individualized Exercise Intervention in Patients With Liver Disease, Cystic Fibrosis, Esophageal Cancer, and Psychiatric Disorders: Process Evaluation of 4 Ongoing Clinical Trials

Daniel Pfirrmann, Nils Haller, Yvonne Huber, Patrick Jung, Klaus Lieb, Ines Gockel, Krystyna Poplawska, Jörn Markus Schattenberg, Perikles Simon, Daniel Pfirrmann, Nils Haller, Yvonne Huber, Patrick Jung, Klaus Lieb, Ines Gockel, Krystyna Poplawska, Jörn Markus Schattenberg, Perikles Simon

Abstract

Background: In the primary and secondary prevention of civilization diseases, regular physical activity is recommended in international guidelines to improve disease-related symptoms, delay the progression of the disease, or to enhance postoperative outcomes. In the preoperative context, there has been a paradigm shift in favor of using preconditioning concepts before surgery. Web-based interventions seem an innovative and effective tool for delivering general information, individualized exercise recommendations, and peer support.

Objective: Our first objective was to assess feasibility of our Web-based interventional concept and analyze similarities and differences in a sustained exercise implementation in different diseases. The second objective was to investigate the overall participants' satisfaction with our Web-based concept.

Methods: A total of 4 clinical trials are still being carried out, including patients with esophageal carcinoma scheduled for oncologic esophagectomy (internet-based perioperative exercise program, iPEP, study), nonalcoholic fatty liver disease (hepatic inflammation and physical performance in patients with nonalcoholic steatohepatitis, HELP, study), depression (exercise for depression, EXDEP, study), and cystic fibrosis (cystic fibrosis online mentoring for microbiome, exercise, and diet, COMMED, study). During the intervention period, the study population had access to the website with disease-specific content and a disease-specific discussion forum. All participants received weekly, individual tailored exercise recommendations from the sports therapist. The main outcome was the using behavior, which was obtained by investigating the log-in rate and duration.

Results: A total of 20 participants (5 from each trial) were analyzed. During the intervention period, a regular contact and a consequent implementation of exercise prescription were easily achieved in all substudies. Across the 4 substudies, there was a significant decrease in log-in rates (P<.001) and log-in durations (P<.001) over time. A detailed view of the different studies shows a significant decrease in log-in rates and log-in durations in the HELP study (P=.004; P=.002) and iPEP study (P=.02; P=.001), whereas the EXDEP study (P=.58; P=.38) and COMMED study (P=.87; P=.56) showed no significant change over the 8-week intervention period. There was no significant change in physical activity within all studies (P=.31). Only in the HELP study, the physical activity level increased steadily over the period analyzed (P=.045). Overall, 17 participants (85%, 17/20) felt secure and were not scared of injury, with no major differences in the subtrials.

Conclusions: The universal use of the Web-based intervention appears to be applicable across the heterogonous collectives of our study patients with regard to age and disease. Although the development of physical activity shows only moderate improvements, flexible communication and tailored support could be easily integrated into patients' daily routine.

Trial registration: iPEP study: ClinicalTrials.gov NCT02478996; https://ichgcp.net/clinical-trials-registry/NCT02478996 (Archived by WebCite at http://www.webcitation.org/6zL1UmHaW); HELP study: ClinicalTrials.gov NCT02526732; http://www.webcitation.org/6zJjX7d6K (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL); EXDEP study: ClinicalTrials.gov NCT02874833; https://ichgcp.net/clinical-trials-registry/NCT02874833 (Archived by WebCite at http://www.webcitation.org/6zJjj7FuA).

Keywords: cystic fibrosis; depression; eHealth; esophageal cancer; exercise; nonalcoholic fatty liver disease.

Conflict of interest statement

Conflicts of Interest: None declared.

©Daniel Pfirrmann, Nils Haller, Yvonne Huber, Patrick Jung, Klaus Lieb, Ines Gockel, Krystyna Poplawska, Jörn Markus Schattenberg, Perikles Simon. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.05.2018.

Figures

Figure 1
Figure 1
The applied Web-based exercise support concept. HELP: hepatic inflammation and physical performance in patients with NASH; iPEP: internet-based perioperative exercise program; COMMED: cystic fibrosis online mentoring for microbiome, exercise, and diet; EXDEP: exercise for depression.
Figure 2
Figure 2
The home screen of the webpage with the divided disease-specific classrooms.
Figure 3
Figure 3
The support area of the home page.
Figure 4
Figure 4
The weekly exercise recommendation structure. Endurance training and strength training were assessed separately.
Figure 5
Figure 5
The flowchart of patients’ recruitment. HELP: hepatic inflammation and physical performance in patients with NASH; iPEP: internet-based perioperative exercise program; COMMED: cystic fibrosis online mentoring for microbiome, exercise, and diet; EXDEP: exercise for depression.
Figure 6
Figure 6
The development of total log-in rate during 8 weeks of intervention.
Figure 7
Figure 7
The development of total log-in durations during 8 weeks of intervention.
Figure 8
Figure 8
The development of log-in durations during 8 weeks of the intervention for each study. HELP: hepatic inflammation and physical performance in patients with NASH; iPEP: internet-based perioperative exercise program; COMMED: cystic fibrosis online mentoring for microbiome, exercise, and diet; EXDEP: exercise for depression.
Figure 9
Figure 9
The difference in log-in durations among the substudies. HELP: hepatic inflammation and physical performance in patients with NASH; iPEP: internet-based perioperative exercise program; COMMED: cystic fibrosis online mentoring for microbiome, exercise, and diet; EXDEP: exercise for depression.
Figure 10
Figure 10
The physical activity development within 8 weeks across all groups.
Figure 11
Figure 11
The physical activity development within 8 weeks in the HELP study. HELP: hepatic inflammation and physical performance in patients with NASH.
Figure 12
Figure 12
The physical activity level within the 8-week intervention period for each study. HELP: hepatic inflammation and physical performance in patients with NASH; iPEP: internet-based perioperative exercise program; COMMED: cystic fibrosis online mentoring for microbiome, exercise, and diet; EXDEP: exercise for depression.

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