This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis.
Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
BackgroundIncreased physical activity and dietary protein intake are promising interventions to prevent or treat the age-related decline in physical performance in older adults. There are well-controlled exercise as well as dietary intervention studies that show beneficial effects on physical performance in older adults. In practice, however, weekly group based exercise or nutritional programs may not be as effective. To optimise these exercise programs for community dwelling older adults, a digitally supported and personalised home-based exercise training program has been designed aiming to improve physical performance in older adults. In addition, a protein intervention in combination with the training program may further improve physical performance in older adults.MethodsThe VITAMIN study will be a cluster randomised controlled trial with three parallel arms. In total, 240 community dwelling older adults (≥ 55 years) participating in weekly group exercise are randomly allocated into: 1) regular weekly exercise program (Control group, n = 80), 2) digitally supported personalised home-based exercise training program group (VITA group, n = 80) and 3) digitally supported personalised home-based exercise training program group plus dietary protein counselling (VITA-Pro group, n = 80). The VITAMIN study aims to evaluate effectiveness of the digitally supported personalised home-based exercise training program as well as the additional value of dietary protein on physical performance after 6 months. In addition, a 12 month follow-up measurement will assess the retaining effect of the interventions. Primary outcome is physical performance measured by the Modified Physical Performance Test (M-PPT) and relevant secondary and observational outcomes include habitual physical activity and dietary intake, body composition, cognitive performance, quality of life, compliance and tablet usage. Data will be analysed by Linear Mixed Models.DiscussionTo our knowledge, the VITAMIN study is the first study that investigates the impact of home-based exercise, protein intake as well as use of persuasive technology in the population of community dwelling older adults.Trial registrationNL56094.029.16 / NTR (TC = 5888; registered 03–06-2016).
Wheelchair users with a spinal cord injury (SCI) or amputation generally lead an inactive lifestyle, associated with reduced fitness and health. Digital interventions and sport and lifestyle applications (E-platforms) may be helpful in achieving a healthy lifestyle. Despite the potential positive effects of E-platforms in the general population, no studies are known investigating the effects for wheelchair users and existing E-platforms can not be used to the same extent and in the same manner by this population due to differences in physiology, body composition, exercise forms and responses, and risk injury. It is, therefore, our aim to adapt an existing E-platform (Virtuagym) within this project by using existing data collections and new data to be collected within the project. To reach this aim we intend to make several relevant databases from our network available for analysis, combine and reanalyze these existing databases to adapt the existing E-platform enabling wheelchair users to use it, evaluate and improve the use of the adapted E-platform, evaluate changes in healthy active lifestyle parameters, fitness, health and quality of life in users of the E-platform (both wheelchair users and general population) and identify determinants of these changes, identify factors affecting transitions from an inactive lifestyle, through an intermediate level, to an athlete level, comparing wheelchair users with the general population, and comparing Dutch with Brazilian individuals. The analysis of large datasets of exercise and fitness data from various types of individuals with and without disabilities, collected over the last years both in the Netherlands and Brazil, is an innovative and potentially fruitful approach. It is expected that the comparison of e.g. wheelchair users in Amsterdam vs. Sao Paulo or recreative athletes vs. elite athletes provides new insight in the factors determining a healthy and active lifestyle.
Wheelchair users with a spinal cord injury (SCI) or amputation generally lead an inactive lifestyle, associated with reduced fitness and health. Digital interventions and sport and lifestyle applications (E-platforms) may be helpful in achieving a healthy lifestyle. Despite the potential positive effects of E-platforms in the general population, no studies are known investigating the effects for wheelchair users and existing E-platforms can not be used to the same extent and in the same manner by this population due to differences in physiology, body composition, exercise forms and responses, and risk injury. It is, therefore, our aim to adapt an existing E-platform (Virtuagym) within this project by using existing data collections and new data to be collected within the project. To reach this aim we intend to make several relevant databases from our network available for analysis, combine and reanalyze these existing databases to adapt the existing E-platform enabling wheelchair users to use it, evaluate and improve the use of the adapted E-platform, evaluate changes in healthy active lifestyle parameters, fitness, health and quality of life in users of the E-platform (both wheelchair users and general population) and identify determinants of these changes, identify factors affecting transitions from an inactive lifestyle, through an intermediate level, to an athlete level, comparing wheelchair users with the general population, and comparing Dutch with Brazilian individuals. The analysis of large datasets of exercise and fitness data from various types of individuals with and without disabilities, collected over the last years both in the Netherlands and Brazil, is an innovative and potentially fruitful approach. It is expected that the comparison of e.g. wheelchair users in Amsterdam vs. Sao Paulo or recreative athletes vs. elite athletes provides new insight in the factors determining a healthy and active lifestyle.
Fysieke inactiviteit, overgewicht en een lage vitaliteit zijn een groot probleem bij rolstoelgebruikers als gevolg van een dwarslaesie of beenamputatie. In de revalidatiefase wordt aandacht besteed aan het herpakken of opbouwen van een gezonde leefstijl. Na de revalidatiefase, echter, met de rolstoelgebruikers teruggekeerd in hun eigen omgeving, is het lastig voor de professionals om deze lijn van begeleiding naar een gezonde leefstijl door te zetten. Daarom zijn professionals op zoek naar een flexibele benadering waarmee zij kunnen inspelen op de individuele wensen en behoeften van hun cliënten. Professionals zien veel potentie in de inzet van een digitale leefstijlapplicatie bij het in beweging brengen en houden van mensen met een beperking en het geven van voedings- en ontspanadvies. Dit stelt ze in staat om samen met de cliënt een stimulerend programma op te stellen, de voortgang of het gebrek daaraan te monitoren en snel in te grijpen als blijkt dat de cliënt niet op schema ligt om zijn/haar doelstellingen te bereiken. Voor aanvang van het project bestond er echter nog geen leefstijlapplicatie die gericht is op rolstoelgebruikers. In het WHEELS-project is de volgende onderzoeksvraag beantwoord: “Aan welke criteria moet een digitale leefstijlapplicatie voor rolstoelgebruikers met een dwarslaesie of beenamputatie, gericht op het bevorderen van een actieve leefstijl, een gezond voedingspatroon en de lichamelijke vitaliteit, voldoen?”. Met het beantwoorden van deze vraag hebben we op systematische wijze een digitale leefstijlapplicatie ontwikkeld aan de hand van het Intervention Mapping protocol. Dit protocol beschrijft stapsgewijs hoe je planmatig een theoretisch en empirisch onderbouwde gedragsveranderingsinterventie kan ontwikkelen. Vertegenwoordigers van de doelgroep en professionals hebben geparticipeerd in het gehele proces. Momenteel wordt de applicatie geëvalueerd. Binnen het WHEELS-project hebben we de eerste vier stappen van het Intervention Mapping (IM) protocol doorlopen: 1) we hebben de leefstijlproblematiek van de doelgroep geanalyseerd; 2) interventiedoelen opgesteld; 3) de leefstijlapp ontworpen; en 4) de leefstijlapp geproduceerd en getest in een pilotstudie. Ten behoeve van de pilotstudie hebben we de interventie kleinschalig geïmplementeerd en een evaluatieplan gemaakt (IM-stap 6). We zijn echter nog niet uitgebreid toegekomen aan IM-stap 5: het maken van een implementatieplan. Dit is echter wel van belang voor een succesvolle implementatie en doorontwikkeling van de leefstijlapp. We willen de Top-up subsidie dan ook heel graag gebruiken voor een implementatieplan dat ertoe moet leiden dat de WHEELS-app gebruikt gaat worden door alle geïnteresseerde revalidatieprofessionals en rolstoelgebruikers met een dwarslaesie of beenamputatie in Nederland. Voor het onderwijs is het WHEELS-project een mooi, aansprekend praktijkvoorbeeld van Intervention Mapping dat zowel in het curriculum van de HvA bachelor Oefentherapie als in de Inholland bachelor Sportkunde is opgenomen. Docenten die les geven op het gebied van gezondheidsbevordering hebben interesse getoond in onze uitvoerige Nederlandstalige uitwerking van de Intervention Mapping stappen. Daarom willen we de Top-up subsidie ook gebruiken om de uitvoerige Nederlandstalige uitwerking van het IM-protocol, door te vertalen naar inspirerend onderwijsmateriaal.
