Date of Award

Fall 12-16-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Dr Bunny Pozehl

Abstract

Background Although the use of internet-based exercise interventions to improve physical activity has become popular and useful, such approaches to improve exercise adherence in patients with heart failure (HF) are lacking. It is also unknown whether the delivery of objective feedback on physical activity can impact exercise adherence.

Purpose The purpose of the Move on Virtual Engagement (MOVE-HF) study was to i) test the feasibility of delivering an internet-based face-to-face group discussion/education intervention using a software called “Vidyo” and monitoring of physical activity using the Fitbit Charge HR (FCHR) in community dwelling patients with heart failure; ii) compare the MOVE-HF intervention group and the control group on adherence to recommended exercise guidelines (150 minutes of moderate intensity exercise) from baseline to 8 weeks; iii) compare intention to adhere to exercise, functional status, self-efficacy for exercise and perceived social isolation between the groups at baseline and 8 weeks.

Methods Thirty HF patients, aged 64.7±11.5 years, were randomly assigned to an experimental or comparison group. Participants were stable HF patients belonging to NYHA Class I-III and were required to have an iPad/cell phone/laptop/desktop with internet connectivity. Participants in both groups were provided with a Fitbit Charge HR, assistance in set-up and training, and were asked to wear the Fitbit all day from awakening until going to bed at night. All participants were provided with a handout on self-care in HF, an exercise routine and asked to record their exercise sessions using the Fitbit and exercise diaries.

The 15 participants in the experimental group were subdivided into 3 cohorts of 5 participants each. These subjects were provided with Vidyo software, assistance in set-up and training. Each cohort met once a week, for 8 weeks, for a 45 min face-to-face online group discussion/education session.

Data Analysis: Repeated measure ANOVA was done to compare group differences in adherence, intention to adhere and functional status across time. A non-parametric Mann-Whitney U test with change score was done to compare changes in group scores for self-efficacy for exercise and perceived social isolation at baseline and at 8 weeks.

Results Overall Vidyo session attendance was 68% with 73% of participants attending 5 or more group meeting sessions. Adherence to exercise was 58.8% in the experimental group and 57.3% in the comparison group (NS). Intention to adhere, functional status, self-efficacy and perceived social isolation were not significantly different between the groups. The experimental group participants anecdotally reported perceptions of receiving social support through the face-to-face group meetings but due to a small sample size and lack of adequate power, no significant impact on exercise adherence was observed.

Conclusion An internet based group face-to-face intervention is feasible and feedback on exercise and physical activity can play an important role in adherence to exercise in patients with HF. HF patients may have unique barriers to overcome and interventions using the internet are feasible to use in patients with heart failure.

Available for download on Thursday, December 07, 2017

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