Exercise Adherence Clinical Trial
Official title:
Effectiveness of a Smartphone App in Promoting Zero-time Exercise and Fitness in Patients With Coronary Heart Disease: a Pilot Randomized Controlled Trial
Background Physical activity (PA), is an effective means of protecting against cardiovascular
disease (CVD) development. PA refers to any skeletal muscle bodily movement that requires
energy expenditure. Research shows that low- to moderate-intensity muscle endurance exercise,
such as walking or brisk walking for about 15-20 minutes per day, is associated with a
significantly lower CVD risk regardless of body mass index. Mobile technologies such as
smartphone physical exercise apps offer a potentially cost-effective platform for
facilitating regular exercise, allowing individuals to set goals, receiving feedback on
achievements and health information for facilitating regular exercise. "Zero-time Exercise"
(ZTE) is a new concept for physical activities (PA) and exercise promotion and can easily
attract attention especially when most people believe that extra time is needed to do
exercise. ZTE can be done easily during most time of day, while sitting, standing, walking or
waiting. These include simple movements, such as stretching and resistance (endurance)
movements of the head, neck and shoulders, chest and abdominal muscles and the upper and
lower limbs. When ZTE is integrated into daily life and sustained with increasing intensity,
the effects could be substantial, especially for those who are sedentary and have
difficulties to meet the minimal requirements of 150 minutes of at least moderate PA per
week. The term is also intended to motivate people to start with simple exercises (the
'Foot-in-the-door' approach), change the mindset (that exercises need much time, money and
sweats) and overcome the inertia from a sedentary lifestyle to become more active. It could
also be a way to promote mental health (such as increasing happiness) through PA or exercises
and enjoying the fun and satisfaction from the rapid improvements in fitness performances.
Having brought some easily observable benefits quickly to those who are willing to try for a
few days, ZTE might lead to more intensive or vigorous exercises requiring extra time for
greater benefits.
Objective:
To test the feasibility [recruitment, dropout, and adherence to PA] of using whatsapp as an
inertia reminder to promote the adherence of Zero-time Exercises (ZTE) in patients with CHD.
Methods:
A 12-week single-blind randomised control design pilot study. 100 participants aged 18-69
years or above with proven stabilized acute coronary heart disease, physical inactive and
having own smartphone with adequate internet technology literacy to operate the smartphone
app and able to read and understand Chinese were recruited from the outpatient Cardiac Clinic
in 3 hospitals.
The intervention group will be asked to practise ZTE either using the smartphone app or a
zerotime exercise booklet with a focus on exercise adherence to at least 20-30 minutes per
day, and on most and preferably all days of the week. The control group (CON) were asked to
do deep breathing exercise at least 20 minutes daily. The exercise adherence of 25
participants in each EXP and CON groups are measured by activity trackers.
A mobile electronic whatsapp message was used as an anti- inertia reminder (AIR) to promote
ZTE adherence. We used pictures with simple exercises to remind the participants in
intervention group (EXP) to do ZTE regularly. Whatsapp reminders on deep breathing exercises
are sent to CON. The frequency, format, whatsapp feedback and response to enquiry are the
same as for EXP.
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