No abstract

No abstract

ObjectiveTo conduct a systematic review and meta-analysis to quantify habitual physical activity (PA) levels of patients with heart failure (HF) and assess the quality of reporting of device-assessed PA.MethodsEight electronic databases were searched up to 17 November 2021. Data on the study and population characteristics, method of PA measurement and PA metrics were extracted. A random-effects meta-analysis (restricted maximum likelihood with Knapp-Hartung SE adjustment) was conducted.ResultsSeventy-five studies were included in the review (n=7775 patients with HF). Meta-analysis was restricted to mean steps per day, encompassing 27 studies (n=1720 patients with HF). Pooled mean steps per day were 5040 (95% CI: 4272 to 5807). The 95% prediction interval for mean steps per day in a future study was 1262 to 8817. Meta-regression at the study level revealed that a 10-year increment in the mean age of patients was associated with 1121 fewer steps per day (95% CI: 258 to 1984).ConclusionsPatients with HF are a low-active population. These findings have implications for the way in which PA is targeted in patients with HF, and interventions should focus on addressing the age-related decline observed as well as increasing PA to improve HF symptoms and quality of life.PROSPERO registration numberCRD42020167786.

BackgroundThe benefits of increased physical activity for stroke survivors include improved walking ability, balance and mood. However, less than 30% achieve recommended levels of physical activity, and high levels of sedentary behaviour are reported. We engaged stroke survivors, informal carers and healthcare professionals (HCPs) in a co-design process to develop an evidence-informed behavioural intervention targeting physical activity and sedentary behaviour for use by stroke rehabilitation teams. MethodsIntervention Mapping was used as a framework for intervention development. Step 1 involved a systematic review, focus group discussions and a review of existing care pathways. Step 2 involved identification of social cognitive determinants of behavioural change and behavioural outcomes of the intervention. Step 3 involved linking the determinants of behavioural outcomes with specific behaviour change techniques to target the behaviours of interest. Step 4 involved the development of the intervention informed by steps 1 to 3. Subsequently, an implementation plan was developed (Step 5) followed by an evaluation plan (Step 6). ResultsSystematic review findings informed selection of nine ‘promising’ behaviour change techniques (e.g. goal setting-behaviour; problem-solving). Focus groups with stroke survivors (n=18) and HCPs (n=24) identified the need for an intervention that could be delivered at different time points within the rehabilitation pathway, tailored to individual needs and circumstances with training for HCPs delivering the intervention. Intervention delivery was considered feasible within local community stroke services. The target behaviours for the intervention were physical activity and sedentary behaviour of stroke survivors. Assessment of acceptability and usability with 11 HCPs and 21 stroke survivors/relatives identified issues around self-monitoring tools; the need for a repository of local services for physical activity; and the need for face-to-face feedback provision to HCPs following delivery of the intervention for optimisation purposes. Face-to-face training for HCPs was delivered to support faithful delivery of the intervention within community settings. A feasibility study protocol was designed to evaluate the intervention.ConclusionsA systematic development process using intervention mapping resulted in a multi-faceted evidence- and theory-informed intervention (Physical Activity Routines After Stroke - PARAS) for delivery by community stroke rehabilitation teams. Trial registration: Trial identifier: ISRCTN35516780, date of registration: 24/10/2018, URL http://www.isrctn.com/ISRCTN35516780