Browsing by Author "Kerr, Andrew"
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- ItemThe HEART Mobile Phone Trial: The Partial Mediating Effects of Self-Efficacy on Physical Activity among Cardiac Patients.(2014-06-06) Maddison, Ralph; Pfaeffli, Leila; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Rawstorn, Jonathan; Carter, Karen; Whittaker, RobynBACKGROUND The ubiquitous use of mobile phones provides an ideal opportunity to deliver interventions to increase physical activity levels Understanding potential mediators of such interventions is needed to increase their effectiveness A recent randomized controlled trial of a mobile phone and Internet mHealth intervention was conducted in New Zealand to determine the effectiveness on exercise capacity and physical activity levels in addition to current cardiac rehabilitation CR services for people n 171 with ischemic heart disease Significant intervention effect was observed for self reported leisure time physical activity and walking but not peak oxygen uptake at 24 weeks There was also significant improvement in self efficacy OBJECTIVE To evaluate the mediating effect of self efficacy on physical activity levels in an mHealth delivered exercise CR program METHODS Treatment evaluations were performed on the principle of intention to treat Adjusted regression analyses were conducted to evaluate the main treatment effect on leisure time physical activity and walking at 24 weeks with and without change in self efficacy as the mediator of interest RESULTS Change in self efficacy at 24 weeks significantly mediated the treatment effect on leisure time physical activity by 13 but only partially mediated the effect on walking by 4 at 24 weeks CONCLUSION An mHealth intervention involving text messaging and Internet support had a positive treatment effect on leisure time physical activity and walking at 24 weeks and this effect was likely mediated through changes in self efficacy Future trials should examine other potential mediators related to this type of intervention
- ItemHEART: heart exercise and remote technologies: a randomized controlled trial study protocol.(2011-06-20) Maddison, Ralph; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoffrey; Carter, Karen H; Pfaeffli, LeilaBACKGROUND Cardiovascular disease CVD is the leading cause of death worldwide Cardiac rehabilitation CR is aimed at improving health behaviors to slow or reverse the progression of CVD disease Exercise is a central element of CR Technologies such as mobile phones and the Internet mHealth offer potential to overcome many of the psychological physical and geographical barriers that have been associated with lack of participation in exercise based CR We aim to trial the effectiveness of a mobile phone delivered exercise based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD This paper outlines the rationale and methods of the trial METHODS A single blinded parallel two arm randomized controlled trial is being conducted A total of 170 people will be randomized at 1 1 ratio either to receive a mHealth CR program or usual care Participants are identified by CR nurses from two metropolitan hospitals in Auckland New Zealand through outpatient clinics and existing databases Consenting participants are contacted to attend a baseline assessment The intervention consists of a theory based personalized automated package of text and video message components via participants mobile phones and the Internet to increase exercise behavior delivered over six months The control group will continue with usual CR Data collection occurs at baseline and 24 weeks post intervention The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks Secondary outcomes include post intervention measures on self reported physical activity IPAQ cardiovascular risk factors systolic blood pressure weight and waist to hip ratio health related quality of life SF 36 and cost effectiveness DISCUSSION This manuscript presents the protocol for a randomized controlled trial of a mHealth exercise based CR program Results of this trial will provide much needed information about physical and psychological well being and cost effectiveness of an automated telecommunication intervention If effective this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally and internationally in a very short time enhancing the translational aspect of this research It also has potential to extend to comprehensive CR nutrition advice smoking cessation medication adherence TRIAL REGISTRATION ACTRN12611000117910
- ItemA mHealth cardiac rehabilitation exercise intervention: findings from content development studies.(2012-09-17) Pfaeffli, Leila; Maddison, Ralph; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoff; Carter, Karen; Dalleck, LanceBACKGROUND Involving stakeholders and consumers throughout the content and study design ensures interventions are engaging and relevant for end users The aim of this paper is to present the content development process for a mHealth mobile phone and internet based cardiac rehabilitation CR exercise intervention METHODS An innovative mHealth intervention was developed with patient input using the following steps conceptualization formative research pre testing and pilot testing Conceptualization including theoretical and technical aspects was undertaken by experts For the formative component focus groups and interviews with cardiac patients were conducted to discuss their perceptions of a mHealth CR program A general inductive thematic approach identified common themes A preliminary library of text and video messages were then developed Participants were recruited from CR education sessions to pre test and provide feedback on the content using an online survey Common responses were extracted and compiled An iterative process was used to refine content prior to pilot testing and conduct of a randomized controlled trial RESULTS 38 CR patients and 3 CR nurses participated in the formative research and 20 CR patients participated in the content pre testing Participants perceived the mHealth program as an effective approach to inform and motivate patients to exercise For the qualitative study 100 n 41 of participants thought it to be a good idea and 11 of participants felt it might not be useful for them but would be for others Of the 20 participants who completed the online survey 17 out of 20 85 stated they would sign up to a program where they could receive information by video messages on a website and 12 out of 20 60 showed interest in a texting program Some older CR patients viewed technology as a potential barrier as they were unfamiliar with text messaging or did not have mobile phones Steps to instruct participants to receive texts and view the website were written into the study protocol Suggestions to improve videos and wording of texts were fed back to the content development team and refined CONCLUSIONS Most participants thought a mHealth exercise program was an effective way to deliver exercise based CR The results were used to develop an innovative multimedia exercise intervention A randomized controlled trial is currently underway TRIAL REGISTRATION ACTRN12611000117910
- ItemA mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.(2015-05-07) Maddison, Ralph; Pfaeffli, Leila; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoffrey; Leung, William; Dalleck, Lance; Carter, Karen; Rawstorn, JonathanAIM To determine the effectiveness and cost effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease IHD METHODS AND RESULTS In this single blind parallel two arm randomized controlled trial adults n 171 with IHD were randomized to receive a mobile phone delivered intervention HEART n 85 plus usual care or usual care alone n 86 Adult participants aged 18 years or more with a diagnosis of IHD were clinically stable as outpatients able to perform exercise able to understand and write English and had access to the Internet The HEART Heart Exercise And Remote Technologies intervention involved a personalized automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour delivered over 24 weeks All participants were able to access usual community based cardiac rehabilitation which involves encouragement of physical activity and an offer to join a local cardiac support club All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake PVO2 primary outcome self reported physical activity health related quality of life self efficacy and motivation secondary outcomes Results showed no differences in PVO2 between the two groups difference 0 21 ml kg 1 min 1 95 CI 1 1 0 7 p 0 65 at 24 weeks However significant treatment effects were observed for selected secondary outcomes including leisure time physical activity difference 110 2 min week 95 CI 0 8 221 3 p 0 05 and walking difference 151 4 min week 95 CI 27 6 275 2 p 0 02 There were also significant improvements in self efficacy to be active difference 6 2 95 CI 0 2 12 2 p 0 04 and the general health domain of the SF36 difference 2 1 95 CI 0 1 4 1 p 0 03 at 24 weeks The HEART programme was considered likely to be cost effective for leisure time activity and walking CONCLUSIONS A mobile phone intervention was not effective at increasing exercise capacity over and above usual care The intervention was effective and probably cost effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services