Utilizing mobile technologies to improve physical activity and medication adherence in patients with heart failure and diabetes mellitus: Rationale and design of the TARGET-HF-DM Trial

Sharma, Abhinav; Mentz, Robert J.; Granger, Bradi B.; Heitner, John F.; Cooper, Lauren B.; Banerjee, Dipanjan; Green, Cynthia L.; Majumdar, Maulik D.; Eapen, Zubin J.; Hudson, Lori L.; Felker, G. Michael

doi:10.1016/j.ahj.2019.01.007

Cited by 42 publications

(32 citation statements)

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“…Although evaluating the shortterm response to simple prompts is useful, future studies with longer followup are warranted. 30 Considering that no dose response was observed for the four interventions, the exact mechanism via which the interventions alter user behaviour remains unclear.…”

Section: Discussionmentioning

confidence: 99%

The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study

Shcherbina

Hershman

Lazzeroni

et al. 2019

The Lancet Digital Health

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Background Smartphone apps might enable interventions to increase physical activity, but few randomised trials testing this hypothesis have been done. The MyHeart Counts Cardiovascular Health Study is a longitudinal smartphone-based study with the aim of elucidating the determinants of cardiovascular health. We aimed to investigate the effect of four different physical activity coaching interventions on daily step count in a substudy of the MyHeart Counts Study. Methods In this randomised, controlled crossover trial, we recruited adults (aged ≥18 years) in the USA with access to an iPhone smartphone (Apple, Cupertino, CA, USA; version 5S or newer) who had downloaded the MyHeart Counts app (version 2.0). After completion of a 1 week baseline period of interaction with the MyHeart Counts app, participants were randomly assigned to receive one of 24 permutations (four combinations of four 7 day interventions) in a crossover design using a random number generator built into the app. Interventions consisted of either daily prompts to complete 10 000 steps, hourly prompts to stand following 1 h of sitting, instructions to read the guidelines from the American Heart Association website, or e-coaching based upon the individual's personal activity patterns from the baseline week of data collection. Participants completed the trial in a free-living setting. Due to the nature of the interventions, participants could not be masked from the intervention. Investigators were not masked to intervention allocation. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in the modified intention-to-treat analysis set, which included all participants who had completed 7 days of baseline monitoring and at least 1 day of one of the four interventions. This trial is registered with ClinicalTrials.gov, NCT03090321. Findings Between Dec 12, 2016, and June 6, 2018, 2783 participants consented to enrol in the coaching study, of whom 1075 completed 7 days of baseline monitoring and at least 1 day of one of the four interventions and thus were included in the modified intention-to-treat analysis set. 493 individuals completed the full set of assigned interventions. All four interventions significantly increased mean daily step count from baseline (mean daily step count 2914 [SE 74]): mean step count increased by 319 steps (75) for participants in the American Heart Association website prompt group (p<0·0001), 267 steps (74) for participants in the hourly stand prompt group (p=0·0003), 254 steps (74) for participants in the clusterspecific prompts group (p=0·0006), and by 226 steps (75) for participants in the 10 000 daily step prompt group (p=0·0026 vs baseline).Interpretation Four smartphone-based physical activity coaching interventions significantly increased daily physical activity. These findings suggests that digital interventions delivered via a mobile app have the ability to increase shortterm physical activity levels in a free-living cohort.

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Section: Discussionmentioning

confidence: 99%

The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study

Shcherbina

Hershman

Lazzeroni

et al. 2019

The Lancet Digital Health

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“…In the context of FHS and primary care, digital technologies can assuage health care discrepancy, enabling the provision of integrated information on disease management, especially hypertension [44][45][46] . Using m-Health technologies represents an attractive option to improve health behaviors and outcomes given the widespread use of these technologies [47][48][49] . Feedback, workshops, and primary care offered by the FHS can be enhanced by using m-Health.…”

Section: Discussionmentioning

confidence: 99%

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Debon

Bellei

Biduski

et al. 2020

Sci Rep

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Brazil's Family Health Strategy (FHS) leads public health policies and actions regarding community health, addressing arterial hypertension (AH) in primary care settings. In this scenario, the use of communication technologies becomes appropriate for the monitoring of patients with AH. To preliminary verify the intervention approach and the effects of using an m-Health application on the health conditions of patients with AH for a future study, we conducted a non-randomized, controlled, non-blind trial (N = 39), comparing the use of a mobile health app (m-Health) with conventional AH monitoring over 3 months. During the study, we promoted health information workshops to engage patients from both intervention and control groups. Pre and post-intervention, we compared measurements of systolic and diastolic blood pressure; food frequency questionnaire; Appraisal of Self-Care Agency Scale; blood tests of hemogram, creatinine, uric acid, sodium, potassium, lipid profile, and glycemia. Improvements were identified in both groups due to the workshops, including the reduction in total and non-HDL cholesterol, healthier consumption of salads and sugary drinks, and increased selfcare scores. Exclusively in the intervention group, which used the m-Health app, there was a change in systolic and diastolic pressure towards more adequate levels. In addition, the intervention group had improved levels of glucose and HDL cholesterol and reduced consumption of ultra-processed foods. In conclusion, the use of an m-Health app had positive effects on the health conditions of patients with AH under treatment within FHS, especially when combined with health information. On the context of FHS, the use of technology is encouraging supporting better health conditions. Arterial hypertension (AH) is one of the main modifiable risk factors for diseases of the circulatory system. With a high prevalence, AH is considered one of the most important public health problems. The World Health Organization estimates that about 600 million people have AH and, annually, 7.1 million individuals die from this disease, substantially burdening health systems 1. Among the AH modifiable factors, either by medication or by altering habits and behavior, there is obesity, sedentary lifestyle, eating habits, and stress. Controlling blood pressure can still be a challenge since, with everyday activities and lack of time, many people do not bother to maintain their normal blood pressure levels 2. Among the main non-medicinal recommendations that should be followed, there are healthy eating, physical activity, reduction of sodium and alcohol consumption, and non-consumption of tobacco 3 .

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“…In other chronic diseases such as heart failure, chronic lung disease, or cardiovascular disease, mHealth technologies have demonstrated potential for facilitating adherence to chronic disease management [ 31 ], as well as improving lipid levels and weight control [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial

Lee¹,

Yoo²,

Min³

et al. 2020

JMIR Mhealth Uhealth

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Background The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283

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Utilizing mobile technologies to improve physical activity and medication adherence in patients with heart failure and diabetes mellitus: Rationale and design of the TARGET-HF-DM Trial

Cited by 42 publications

References 57 publications

The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study

The effect of digital physical activity interventions on daily step count: a randomised controlled crossover substudy of the MyHeart Counts Cardiovascular Health Study

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial

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