Clinical Trials Logo

Clinical Trial Summary

The purpose of this study is to test a home-based exergaming intervention designed to decrease frailty and fatigue and improve affective well-being, functional capacity, and immune function in individuals with advanced heart failure (HF) and multiple chronic conditions (MCC) prior to receiving either a left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT). Prior to surgery, individuals with advanced HF/MCC experience a high symptom burden that often precludes them from participating in meaningful physical activity. Pre-surgical fitness programs have been used in other critically ill populations to improve function prior to surgery. Interactive gaming systems have been successfully used to engage other seriously ill adults in low-intensity physical activity. However, exergaming interventions have not yet been applied in individuals with advanced HF/MCC as prehabilitation prior to LVAD implantation or OHT. The investigators propose that a prehabilitation exergaming intervention will not only enhance pre-surgical outcomes but will also augment postoperative outcomes. This study is designed in two-phases. Phase 1 examines intervention feasibility and phase 2 is a pilot study with a two-group design. In phase 2, participants will be randomized to a usual care group or the exergaming intervention group. The exergaming group will participate in a low-intensity exergaming intervention and additional investigator-developed educational modules that will be delivered via the Nintendo Wii U exergaming system. The investigators will evaluate pre- and post-surgical frailty, fatigue, affective well-being, and immune function as primary outcomes. The investigators expect that participation in low intensity exergaming will improve these primary outcomes pre- and post-surgically, and decrease post-surgical complications and health care utilization. Investigator-developed modules will promote self-efficacy, self-regulation, and activation. This is the first study to apply low-intensity exergaming to a pre-operative advanced HF/MCC population. The successful application of this intervention has significant implications to the pre-operative conditioning of individuals with advanced HF/MCC prior to LVAD implantation or OHT.


Clinical Trial Description

Specific Aims. The objectives of this study are two-fold: (1) To test the feasibility of a low intensity, home-based exergaming intervention in individuals with advanced HF/MCC prior to left ventricular assist device (LVAD) implantation or orthotopic heart transplantation (OHT), and (2) To examine the effectiveness of delivering a low intensity, home-based exergaming intervention to decrease frailty and fatigue and improve affective well-being, functional capacity, and immune function in individuals with advanced HF/MCC prior to receiving an LVAD or OHT. Other surgical populations who were deconditioned, fatigued, and frail before surgery have benefited from the use of pre-surgical fitness interventions (prehabilitation).3-5 Innovative interventions strategies, like the Nintendo Wii Fit exergaming system, have been successful at engaging seriously ill adults in low-intensity physical activity6,7. However, exergaming interventions have not yet been applied in individuals with advanced HF as prehabilitation prior to LVAD implantation or OHT. The investigators propose that a home-based, prehabilitation exergaming intervention will not only enhance pre-surgical outcomes but will also augment postoperative outcomes. The investigators will conduct this study in two phases. Phase 1 is designed as a feasibility study in a smaller sample (5 participants and 5 informal caregivers) to allow initial evaluation of the intervention including troubleshooting the technological components and evaluating study recruitment, retention, and intervention safety prior to initiating the larger, two-group randomized study. Phase 2 will enroll a convenience sample of 40 participants with advanced HF/MCC who are being evaluated for LVAD implantation or OHT at Nebraska Medicine and their 40 informal caregivers for a total sample of 80 enrollees (n=40 exergaming, n=40 usual care). In both phases, the exergaming group will participate in a low-intensity exergaming intervention and additional investigator-developed educational modules (e.g. symptoms while exercising, exercising with heart failure) that will be delivered via the Nintendo Wii U exergaming system. Investigator-developed modules are designed to promote self-efficacy, self-regulation, and activation. Individuals with advanced HF/MCC will be expected to participate in the exergaming intervention and the investigator-developed modules. Caregivers will be asked to be present for all training sessions and participate in the investigator-developed modules. The investigators will evaluate pre- and post-surgical frailty, fatigue, affective well-being, and immune function as primary outcomes in the individuals with advanced HF/MCC. The investigators expect that participation in low intensity exergaming will improve these primary outcomes pre- and post-surgically, and decrease post-surgical complications and health care utilization. Relationships will be examined among self-efficacy, self-regulation, and activation scores over time, and adherence to the intervention to test whether self-management mechanisms were effective in promoting adherence. Additionally, post-intervention qualitative interviews will be conducted to assess participant and caregiver experiences with the intervention. Specific aims of this study are the following: Aim 1 (Phase 1): Evaluate the feasibility of the home-based, low intensity exergaming intervention in individuals with advanced HF/MCC prior to LVAD implantation or OHT and their informal caregivers by assessing recruitment, enrollment, acceptability, adherence, subjects perception of barriers and facilitators, and implementation (delivery, fidelity, and procedures for data collection). Aim 2 (Phase 2): Evaluate the impact of home-based, low intensity exergaming on pre- and post-surgical outcomes: frailty, fatigue, affective well-being, immune function, and biomarkers of co-morbid conditions at baseline, 4 weeks, and 1 and 3 months post-surgery compared to usual care (All subjects with advanced HF/MCC). H1. Subjects in the exergaming group will have decreased frailty and fatigue and improved affective well-being and immune function compared to usual care. Aim 3 (Phase 2): Evaluate the impact of home-based, low intensity exergaming on post-surgical complications (death, infection, bleeding, and rejection) and health care utilization (emergency department visits, unplanned hospital admissions) compared to usual care (both groups of subjects). H2.a. Subjects in the exergaming group will have fewer post-surgical complications compared to usual care. H2.b. Subjects in the exergaming group will have fewer emergency department visits and hospital admissions compared to usual care. Aim 4 (Phase 2): Explore relationships among self-efficacy, self-regulation, and activation scores over time, intervention adherence, and pre- and post-surgical outcomes (Exergaming group participants and caregivers only). There is a critical need to address deconditioning, fatigue, and frailty in individuals with advanced HF/MCC prior to LVAD implantation or OHT. This innovative exergaming intervention incorporates the use of an interactive, home-based technology to improve pre-and post-surgical outcomes ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03580759
Study type Interventional
Source University of Nebraska
Contact
Status Completed
Phase N/A
Start date March 1, 2019
Completion date March 1, 2021

See also
  Status Clinical Trial Phase
Completed NCT05820399 - Guayusa Extract on Exercise Training N/A
Active, not recruiting NCT04295590 - Impact of Augmenting Exercise Intensity vs. Frequency N/A
Completed NCT05934578 - Lymphatic Function in Patients With Fontan Circulation: Effect of Physical Training N/A
Completed NCT03563430 - Effects of Different Recovery Methods on Lactic Acid Removal, Flexibility, Strength, and Endurance N/A
Completed NCT02981667 - Higher Enjoyment in Response to High Intensity Interval Training Versus Moderate Intensity Continuous Exercise N/A
Completed NCT05255497 - The Effect of Sensorial Biodex Balance Balance System Exercises in Diabetic Neuropathy N/A
Completed NCT04084535 - Effects of High Intensity Interval Training (HIIT) vs. Inspiratory Muscle Training on the Recovery After a Maximal Apnea. N/A
Completed NCT04384185 - Combined Treatment of Manual Therapy and Therapeutic Exercise in Patients With Low Back Pain N/A
Completed NCT04114175 - Spinal Stabilization Exercises in Individuals With Transtibial Amputatıon N/A
Completed NCT02958657 - Effect of Exercise on Platelet Reactivity After Myocardial Infarction N/A
Not yet recruiting NCT00808600 - Empowerment of Lung and Heart-lung Transplant Patients N/A
Completed NCT04450134 - Histamine H1/H2 Receptors and Training Adaptations N/A
Completed NCT02999139 - Analytic, Prospective Cohort Study of Athletes Enrolled in an Exercise Training Intervention
Not yet recruiting NCT04366414 - Breathing Protocol in Breath-hold Divers N/A
Recruiting NCT04311736 - Concurrent Aerobic Exercise and Cognitive Training to Prevent Alzheimer's in At-risk Older Adults N/A
Recruiting NCT03754478 - Follow-Up of Fitness in Overweight Patients Treated With Physical Activity
Completed NCT05402527 - Fish Nutrient Supplementation in High-intensity Functional Training N/A
Completed NCT06138951 - Exercise Dose-response and Protein Requirements N/A
Recruiting NCT06260579 - Home-based Exercise and Physical Activity Intervention After Kidney Transplantation: Impact of Exercise Intensity N/A
Completed NCT05396963 - Egg White Supplementation in High-Intensity Functional Training N/A