A randomized controlled trial to evaluate utilization of physical activity recommendations among patients of cardiovascular healthcare centres in Eastern Slovakia: study design and rationale of the AWATAR study

Aurel Zelko, Alena Bukova, Peter Kolarcik, Peter Bakalar, Ivan Majercak, Jana Potocnikova, Sijmen A Reijneveld, Jitse P van Dijk, Aurel Zelko, Alena Bukova, Peter Kolarcik, Peter Bakalar, Ivan Majercak, Jana Potocnikova, Sijmen A Reijneveld, Jitse P van Dijk

Abstract

Background: Guidelines on modifiable risk factors regarding cardiological patients are poorly implemented in clinical practice perhaps due to low health literacy. Several digital tools for improving lifestyle and behavioural intervention were developed. Our primary aim is to evaluate the effectiveness of a digital exercise prescription tool on the adherence to physical activity recommendations among patients with cardiovascular diseases.

Methods: A randomized controlled trial will be realized in cooperation with Cardiovascular Health Centres in Eastern Slovakia. Patients recruited through their cardiologists, will be randomised at 1:1 ratio to the three-months' experimental condition or control condition. The experimental group will receive standard lifestyle consultation leading to individually optimized prescription of physical activity. The control group will receive standard, usual-cardio-care lifestyle counselling, also in the domain of physical activity. The digital system will be used for optimized exercise prescription. The primary outcome is a change in the patient's adherence to exercise recommendations. Data will be collected in both groups prior to consultation and after 3 months.

Discussion: This study protocol presents background and design of a randomized control trial to investigate the effectiveness of a digital system-provide exercise prescription tool on the adherence to physical activity recommendations. An optimized exercise prescription that better reflects patient's diagnosis, comorbidities and medication can have a significant impact on secondary prevention of cardiovascular disease. This trial can provide important evidence about the effectiveness of digital exercise guidance in everyday practice of cardiovascular healthcare.

Trial registration: The study was registered on 1st November, 2017 and is available online at ClinicalTrials.gov (ID: NCT03329053 ).

Keywords: Cardiovascular disease; Digital exercise prescription tool; Exercise prescription.

Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the Human Research Ethics Committee of Pavol Jozef Safarik University in Kosice (approval no. PJSU-V-0825/17–1). The study protocol is registered at Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, Burns R, Rayner M, Townsend N. European cardiovascular disease statistics 2017. Brussels: European Heart Network; 2017.
    1. European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines. EACPR. Corrà U, Piepoli MF, Carré F, Heuschmann P, Hoffmann U, Verschuren M, Halcox J, Document Reviewers. Giannuzzi P, Saner H, Wood D, Piepoli MF, Corrà U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, Mcgee H, Mendes M, Niebauer J, Zwisler AD, Schmid JP. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the cardiac rehabilitation section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31(16):1967–1974. doi: 10.1093/eurheartj/ehq236.
    1. Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the lancet commission on hypertension. Lancet. 2016;388(10060):2665–2712. doi: 10.1016/S0140-6736(16)31134-5.
    1. Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques-Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur Heart J Acute Cardiovasc Care. 2017;6(4):299–310. doi: 10.1177/2048872616689773.
    1. Vigorito C, Abreu A, Ambrosetti M, Belardinelli R, Corrà U, Cupples M, Davos CH, Hoefer S, Iliou MC, Schmid JP, Voeller H, Doherty P. Frailty and cardiac rehabilitation: a call to action from the EAPC cardiac rehabilitation section. Eur J Prev Cardiol. 2017;24(6):577–590. doi: 10.1177/2047487316682579.
    1. WHO . Global action plan for the prevention and control of NCDs 2013–2020. Geneva: WHO; 2013.
    1. Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res. 2016;39(2):88–94. doi: 10.1038/hr.2015.111.
    1. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. doi: 10.1161/JAHA.112.004473.
    1. Hulkkonen J, Aatola H, Pälve K, Lehtimäki T, Hutri-Kähönen N, Viikari JS, Raitakari OT, Kähönen M. Determinants of exercise peak arterial blood pressure, circulatory power, and exercise cardiac power in a population based sample of Finnish male and female aged 30 to 47 years: the cardiovascular risk in young Finns study. BMC Cardiovasc Disord. 2014;14:35. doi: 10.1186/1471-2261-14-35.
    1. García-Ortiz L, Recio-Rodríguez JI, Puig-Ribera A, Lema-Bartolomé J, Ibáñez-Jalón E, González-Viejo N, Guenaga-Saenz N, Agudo-Conde C, Patino-Alonso MC, Gomez-Marcos MA, EVIDENT Group Blood pressure circadian pattern and physical exercise assessment by accelerometer and 7-day physical activity recall scale. Am J Hypertens. 2014;27(5):665–673. doi: 10.1093/ajh/hpt159.
    1. Kelley GA, Sharpe Kelley K. Aerobic exercise and resting blood pressure in older adults: a meta-analytic review of randomized controlled trials. J Gerontol A Biol Sci Med Sci. 2001;56(5):M298–M303. doi: 10.1093/gerona/56.5.M298.
    1. Mota MR, de Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, Simões HG, da Silva FM. Acute and chronic effects of resistive exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475–3480. doi: 10.1519/JSC.0b013e31828f2766.
    1. Brito Ade F, de Oliveira CV, Brasileiro-Santos Mdo S, Santos Ada C. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly. Clin Interv Aging. 2014;9:2151–2158.
    1. Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60(3):653–658. doi: 10.1161/HYPERTENSIONAHA.112.197780.
    1. Guimarães GV, Cruz LG, Tavares AC, Dorea EL, Fernandes-Silva MM, Bocchi EA. Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study. Blood Press Monit. 2013;18(6):342–345. doi: 10.1097/MBP.0000000000000000.
    1. Ashor AW, Lara J, Siervo M, Celis-Morales C, Oggioni C, Jakovljevic DG, Mathers JC. Exercise modalities and endothelial function: a systematic review and dose-response meta-analysis of randomized controlled trials. Sports Med. 2015;45(2):279–296. doi: 10.1007/s40279-014-0272-9.
    1. Farah C, Nascimento A, Bolea G, Meyer G, Gayrard S, Lacampagne A, Cazorla O, Reboul C. Key role of endothelium in the eNOS-dependent cardioprotection with exercise training. J Mol Cell Cardiol. 2017;102:26–30. doi: 10.1016/j.yjmcc.2016.11.008.
    1. Guo Y, Ledesma RA, Peng R, Liu Q, Xu D. The beneficial effects of cardiac rehabilitation on the function and levels of endothelial progenitor cells. Heart Lung Circ. 2017;26(1):10–17. doi: 10.1016/j.hlc.2016.06.1210.
    1. Walsh JH, Yong G, Cheetham C, Watts GF, O'Driscoll GJ, Taylor RR, Green DJ. Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects. Eur Heart J. 2003;24(18):1681–1689. doi: 10.1016/S0195-668X(03)00384-1.
    1. Pearson MJ, Smart NA. Effect of exercise training on endothelial function in heart failure patients: a systematic review meta-analysis. Int J Cardiol. 2017;231:234–243. doi: 10.1016/j.ijcard.2016.12.145.
    1. DeSouza CA, Shapiro LF, Clevenger CM, Dinenno FA, Monahan KD, Tanaka H, Seals DR. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation. 2000;102(12):1351–1357. doi: 10.1161/01.CIR.102.12.1351.
    1. de Moraes AC, Fernández-Alvira JM, Carvalho HB, Meirhaeghe A, Dallongeville J, Kafatos A, Marcos A, Molnar D, Manios Y, Ruiz JR, Labayen I, Widhalm K, Breidenassel C, Gonzalez-Gróss M, Moreno LA. Physical activity modifies the associations between genetic variants and blood pressure in European adolescents. J Pediatr. 2014;165(5):1046–9.e1-2. doi: 10.1016/j.jpeds.2014.07.007.
    1. Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56(2):242–251. doi: 10.1007/s00125-012-2774-z.
    1. Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med. 2014;44(2):211–221. doi: 10.1007/s40279-013-0110-5.
    1. Sarzynski MA, Burton J, Rankinen T, Blair SN, Church TS, Després JP, Hagberg JM, Landers-Ramos R, Leon AS, Mikus CR, Rao DC, Seip RL, Skinner JS, Slentz CA, Thompson PD, Wilund KR, Kraus WE, Bouchard C. The effects of exercise on the lipoprotein subclass profile: a meta-analysis of 10 interventions. Atherosclerosis. 2015;243(2):364–372. doi: 10.1016/j.atherosclerosis.2015.10.018.
    1. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355–1361. doi: 10.1056/NEJM200011093431902.
    1. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. American Heart Association Council on Clinical Cardiology. American College of Sports Medicine Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on nutrition, physical activity, and metabolism and the council on clinical cardiology. Circulation. 2007;115(17):2358–2368. doi: 10.1161/CIRCULATIONAHA.107.181485.
    1. Fagard RH, Björnstad HH, Børjesson M, Carré F, Deligiannis A, Vanhees L, European Society of Cardiology ESC study Group of Sports Cardiology recommendations for participation in leisure-time physical activities and competitive sports for patients with hypertension. Eur J Cardiovasc Prev Rehabil. 2005;12(4):326–331. doi: 10.1097/01.hjr.0000174827.79645.f5.
    1. ESC Study Group of Sports Cardiology. Börjesson M, Assanelli D, Carré F, Dugmore D, Panhuyzen-Goedkoop NM, Seiler C, Senden J, Solberg EE. ESC study Group of Sports Cardiology: recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease. Eur J Cardiovasc Prev Rehabil. 2006;13(2):137–149. doi: 10.1097/01.hjr.0000199494.46708.5a.
    1. Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffmann A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. Eur J Cardiovasc Prev Rehabil. 2006;13(3):293–299.
    1. Pelliccia A, Corrado D, Bjørnstad HH, Panhuyzen-Goedkoop N, Urhausen A, Carre F, Anastasakis A, Vanhees L, Arbustini E, Priori S. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil. 2006;13(6):876–885. doi: 10.1097/01.hjr.0000238393.96975.32.
    1. Heidbüchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A, Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil. 2006;13(4):475–484. doi: 10.1097/01.hjr.0000216543.54066.72.
    1. Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A, Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil. 2006;13(5):676–686. doi: 10.1097/01.hjr.0000239465.26132.29.
    1. Vanhees L, De Sutter J, GeladaS N, Doyle F, Prescott E, Cornelissen V, Kouidi E, Dugmore D, Vanuzzo D, Börjesson M, Doherty P, EACPR Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (part I) Eur J Prev Cardiol. 2012;19(4):670–686. doi: 10.1177/2047487312437059.
    1. Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Z, Cornelissen V, Adamopoulos S, Prescott E, Börjesson M, Bjarnason-Wehrens B, Björnstad HH, Cohen-Solal A, Conraads V, Corrado D, De Sutter J, Doherty P, Doyle F, Dugmore D, Ellingsen Ø, Fagard R, Giada F, Gielen S, Hager A, Halle M, Heidbüchel H, Jegier A, Mazic S, McGee H, Mellwig KP, Mendes M, Mezzani A, Pattyn N, Pelliccia A, Piepoli M, Rauch B, Schmidt-Trucksäss A, Takken T, van Buuren F, Vanuzzo D. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19(5):1005–1033. doi: 10.1177/1741826711430926.
    1. Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M, Writing Group, EACPR Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (part III) Eur J Prev Cardiol. 2012;19(6):1333–1356. doi: 10.1177/2047487312437063.
    1. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Authors/Task Force Members 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & rehabilitation (EACPR) Eur Heart J. 2016;37(29):2315–2381. doi: 10.1093/eurheartj/ehw106.
    1. Liakos CI, Grassos CA, Babalis DK, European Society of Hypertension; European Society of Cardiology 2013 ESH/ESC guidelines for the management of arterial hypertension: what has changed in daily clinical practice? High Blood Press Cardiovasc Prev. 2015;22(1):43–53. doi: 10.1007/s40292-014-0071-2.
    1. Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, Amouyel P, Bruthans J, Castro Conde A, Cífková R, Deckers JW, De Sutter J, Dilic M, Dolzhenko M, Erglis A, Fras Z, Gaita D, Gotcheva N, Goudevenos J, Heuschmann P, Laucevicius A, Lehto S, Lovic D, Miličić D, Moore D, Nicolaides E, Oganov R, Pajak A, Pogosova N, Reiner Z, Stagmo M, Störk S, Tokgözoğlu L, Vulic D, EUROASPIRE Investigators EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016;23(6):636–648. doi: 10.1177/2047487315569401.
    1. Berben L, Dobbels F, Engberg S, Hill MN, De Geest S. An ecological perspective on medication adherence. West J Nurs Res. 2012;34(5):635–653. doi: 10.1177/0193945911434518.
    1. Cramm JM, Nieboer AP. The importance of productive patient-professional interaction for the well-being of chronically ill patients. Qual Life Res. 2015;24(4):897–903. doi: 10.1007/s11136-014-0813-6.
    1. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834. doi: 10.1097/MLR.0b013e31819a5acc.
    1. McKenna VB, Sixsmith J, Barry MM. The relevance of context in understanding health literacy skills: findings from a qualitative study. Health Expect. 2017;20(5):1049–1060. doi: 10.1111/hex.12547.
    1. van Schaik TM, Jørstad HT, Twickler TB, Peters RJG, Tijssen JPG, Essink-Bot ML, Fransen MP. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Neth Heart J. 2017;25(7–8):446–454. doi: 10.1007/s12471-017-0963-6.
    1. Institute of Medicine (US) Committee on Health Literacy. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington: National Academies Press (US); 2004.
    1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. doi: 10.7326/0003-4819-155-2-201107190-00005.
    1. Geboers B, de Winter AF, Luten KA, Jansen CJ, Reijneveld SA. The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators. J Health Commun. 2014;19(Suppl 2):61–76. doi: 10.1080/10810730.2014.934933.
    1. Koh HK, Brach C, Harris LM, Parchman ML. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care. Health Aff (Millwood) 2013;32(2):357–367. doi: 10.1377/hlthaff.2012.1205.
    1. Zullig LL, McCant F, Melnyk SD, Danus S, Bosworth HB. A health literacy pilot intervention to improve medication adherence using Meducation® technology. Patient Educ Couns. 2014;95(2):288–291. doi: 10.1016/j.pec.2014.02.004.
    1. Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, McKibben RA, Michos ED, Ndumele CE, Ratchford EV, Coresh J, Blaha MJ. mActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015;4(11) 10.1161/JAHA.115.002239.
    1. Franklin NC, Lavie CJ, Arena RA. Personal health technology: a new era in cardiovascular disease prevention. Postgrad Med. 2015;127(2):150–158. doi: 10.1080/00325481.2015.1015396.
    1. Hansen D, Dendale P, Coninx K, Vanhees L, Piepoli MF, Niebauer J, Cornelissen V, Pedretti R, Geurts E, Ruiz GR, Corrà U, Schmid JP, Greco E, Davos CH, Edelmann F, Abreu A, Rauch B, Ambrosetti M, Braga SS, Barna O, Beckers P, Bussotti M, Fagard R, Faggiano P, Garcia-Porrero E, Kouidi E, Lamotte M, Neunhäuserer D, Reibis R, Spruit MA, Stettler C, Takken T, Tonoli C, Vigorito C, Völler H, Doherty P. The European Association of Preventive Cardiology Exercise Prescription in everyday practice and rehabilitative training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol. 2017;24(10):1017–1031. doi: 10.1177/2047487317702042.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Authors/Task Force Members. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Additional Contributor: Simone Binno (Italy) Document Reviewers. De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GY, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention & rehabilitation (EACPR) Eur J Prev Cardiol. 2016;23(11):NP1–NP96. doi: 10.1177/2047487316653709.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Arredondo EM, Mendelson T, Holub C, Espinoza N, Marshall S. Cultural adaptation of physical activity self-report instruments. J Phys Act Health. 2012;9(Suppl 1):S37–S43. doi: 10.1123/jpah.9.s1.s37.
    1. Sperber AD, Devellis RF, Boehlecke B. Cross-cultural translation: methodology and validation. J Cross-Cult Psychol. 1994;25(4):501–524. doi: 10.1177/0022022194254006.
    1. Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ) BMC Public Health. 2013;13:658. doi: 10.1186/1471-2458-13-658.
    1. Kolarcik P, Cepova E, Madarasova Geckova A, Elsworth GR, Batterham RW, Osborne RH. Structural properties and psychometric improvements of the health literacy questionnaire in a Slovak population. Int J Public Health. 2017;62(5):591–604. doi: 10.1007/s00038-017-0945-x.
    1. Cicero AF, D'Addato S, Santi F, Ferroni A, Borghi C. Brisighella heart study. Leisure-time physical activity and cardiovascular disease mortality: the Brisighella heart study. J Cardiovasc Med (Hagerstown) 2012;13(9):559–564. doi: 10.2459/JCM.0b013e3283516798.
    1. Savela S, Koistinen P, Tilvis RS, Strandberg AY, Pitkälä KH, Salomaa VV, Miettinen TA, Strandberg TE. Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men. Eur J Epidemiol. 2010;25(9):619–625. doi: 10.1007/s10654-010-9483-z.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere