Exercise for Special Populations - MNACVPR

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©2017 MFMER | slide-1

Thomas P. Olson, M.S., Ph.D., FACSM, FAHA Consultant – Department of Cardiovascular Medicine

Associate Professor of Medicine and Science – Mayo Clinic College of Medicine

Technological Advances for Secondary Prevention: Expanding Access to Cardiac Rehabilitation

Minnesota Association of Cardiovascular and Pulmonary Rehabilitation April 25 & 26, 2019


Presenter(s):

Thomas P. Olson, Ph.D., FACSM, FAHA

Relevant financial relationship(s) with industry:

None

References to off-label usage(s) of pharmaceuticals or instruments:

None

Disclosures


Management Prevention

Assisted Living Apps

Wellness & Fitness

Telecoaching

Lifestyle Monitoring

Medicine

Adherence

Medical Reminders

Healthcare

Information

Supported

Discharge

Vital Sign

Monitoring

Professional,

Supported Care

Self Care

Health Care Social Care

Safety Reminders

Moderated

Support Groups

Personal Alarms

GPS/Location Services

(Dementia / Alzheimer’s)

Chronic Disease

Management

Group Coaching

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Overview

•Scope of the mobile health (mHealth) ecosystem –Focus on smartphone applications (Apps)

•The role of mobile apps in Rehabilitation / Behavior Change

•Health / Fitness Gadgets and Games

•What’s next?


“There will never be another generation that does not know about the internet” – Bill Gates


Worldwide Mobile Ecosystem

April 2018 Ericsson Mobility Report

750 million mobile PCs, tablets, and

mobile router subscriptions

5.6 billion smartphone subscriptions

Mobile PCs, tablets, and

mobile router subscriptions

Smartphone subscriptions

Smartphones, mobile PCs, tablets, and

mobile routers with cellular connection

6.35 billion Mobile subscriptions

Q1 2018

5.07 billion Mobile subscriptions

World Population = 7.6 billion

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Pew Research Center 2016 Global Attitudes and Trends Survey

Mobile Technology Section

Worldwide Smartphone Use Top 15 countries with highest smartphone penetration in 2016

~235.1 Million


• As of Q4 2018

• Google Play • More than 2,600,000 apps available

• More than 90 billion downloads to date

• Apple App Store • More than 2,450,000 unique apps available

• More than 150 billion downloads to date

• All the Others • Windows Store = 669,000

• Amazon Appstore = 450,000

• Blackberry World = 234,500

• “Health and Fitness” category • ~64,000 unique apps available for download (Apple Only)

Smartphone App Use

West J. et al. J Med Internet Res. 2012;14(3):e72.

STATISTA: http://www.statista.com/statistics/270291/popular-categories-in-the-app-store/

1,353,500 total


• Lifestyle = 8.44%

• Health and Fitness = 2.97%

• Medical = 1.9%

• Total = 13.31%

Smartphone App Use

STATISTA: http://www.statista.com/statistics/270291/popular-categories-in-the-app-store/

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Track Your Workout

Eating Right

Healthy Habits

Preventive Cardiology Perspective on Apps


Diabetes

Blood Pressure Monitoring

Smoking Cessation

Preventive Cardiology Perspective on Apps


Overview

•Scope of the mobile health (mHealth) ecosystem

–Focus on smartphone applications (Apps)



•What’s next?

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Role of Apps in Behavior Change

• Effectiveness of Smartphone Apps will depend on:

1. Ability to stimulate motivation

2. Ease of use

3. Engagement of social network

4. Feedback

5. Frequency of use

6. Information content

Cowan LT et al. Health Ed Behav. 2012;40(2):133-139.


Qualities of Successful Apps

Behavior Change

Predisposing Factors

– Knowledge / Information

– Beliefs / Attitudes / Values

– Confidence or Motivation

Enabling Factors

– Teaching a Skill

– Providing a Service

– Tracking Behavior

Reinforcing Factors

– Social Network

– Encouragement / Coaching

– Self Evaluation

West JH et al. J Med Internet Res. 2012;14(3):e72.

Precede-Proceed Model



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Only 1.86% apps included all 3 factors!

Predisposing Enabling Reinforcing

West JH et al. J Med Internet Res. 2012;14(3):e72.

3,336 apps reviewed for the potential to

influence behavior change based on the

Precede-Proceed Model (PPM)

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Example of a Comprehensive App

Varnfield M et al. BMJ. 2014;100:1770-1779.




Primary reason for dropout from Traditional and Care Assessment Platform groups


Overall Findings

• CAP-CR demonstrated similar effects (equivalence): • Improving functional capacity (6MWT)

• Improving dietary intake (high fiber, low fat, low sodium)

• Reducing depression scores

• Reducing body weight and waist circumference

• CAP-CR demonstrated superior effects (superiority): • Improving psychological well being (K10 score)

• Improving program uptake (80% vs 62%)

• Improving program adherence (94% vs 68%)

• Improving program completion (80% vs 47%)



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Cardiovascular Rehabilitation Paradigm Shift

Current Paradigm

No CR

Traditional CR

“Home” CR

New Paradigm

No CR

Traditional CR

“Home” CR


Future Paradigm

No CR

New Model of

CR Delivery

Cardiovascular Rehabilitation Paradigm Shift


• Enhanced Engagement

• Compliments ongoing traditional center-based CR programming

• Enhances CR programming by providing complimentary education/training during “off” days allowing patients to continue working on risk factor modification while tracking important vital signs

• Hybrid

• Designed for patients only able to attend some traditional center-based CR sessions

• Individualized home-based program for risk factor modification

• Remote Care Management

• Patients may only be able to addend an initial CR session for orientation and basic education

• Replaces traditional center-based CR programming with home-based program

Implementing Remote Case Management

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• Theory-based interventions have shown to be an

effective rehabilitation / behavior change strategy

• Unfortunately, most current apps do not include or

only partially include theoretical constructs

• Important to recognize limitations of apps in

generating desired outcomes

• Be realistic about expectations for behavior change

• There is no “one size fits all” app currently available



Overview





•What’s next?


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Fitbit – (www.fitbit.com)

Cost Distance Steps Stairs Calories Sleep Heart

Rate App/Online Instant

Feedback

$129.99

Charge

Yes

Yes

Yes

With partner

app

Yes

Yes

On higher

end

devices

Wireless sync

to mobile

device or

computer

Yes On higher end

devices


Withings – Pulse O2

(www.withings.com)

Cost Distance Steps Stairs Calories Sleep Heart

Rate App/Online Instant

Feedback

$119.95

Yes

Yes

Yes

With partner

app

Yes

Yes

Wireless sync

to Withings

Fitness Eco-

system with

multiple

partners

Onscreen


Other “Gadgets”

Hickey AM and Freedson PS. Prog Cardiovasc Dis. 2016;58(6):613-619.

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What about Video Games? AKA – “Exergames”


What about Video Games? Nintendo Wii


What about Video Games? Microsoft Kinect (Xbox 360)

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What about Video Games? Not just for kids anymore…


Health / Fitness Gadgets and Games

• New devices and gadgets are coming out all the time – the patient/therapist/clinician needs to find what works for them (and actually use it!)

• Accuracy of “fitness” gadgets can have a large +/-. −Best when used to identify long-term trends in behavior change

within an individual OR targeted interventions.

• Video games are not just for kids anymore −Exergaming is an upcoming new strategy in rehabilitation

medicine across the ageing spectrum


Overview





•What’s next?

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“Some people will sit down and ask, ‘what is it?’ but others ask, ‘what can I do with it?’

– Steve Jobs


Electronic Patches (‘Smart Skin’)

• Stick-on electronic patch for health monitoring

• “Smart Skin” microfluidic construction bends/flexes with skin

• Stretchable Li-ion battery

• Reversible biaxial stretchability up to 300% with stable power output

• Current capabilities:

• ECG

• EMG

• Temperature

• Motion/Position/Activity

(Triaxial accelerometry)

• Wireless data transmission

University of Illinois at Urbana-Champaign / Northwestern University


Bodyguardian – Preventice

• FDA approved wireless biometric skin sensor

• ECG

• Heart rate variability

• Respiratory rate

• Motion/Position/Activity level


• Detects, records, and transmits clinical grade measurements

• Developed in conjunction with a scaleable wireless network platform for remote patient monitoring

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Blood Glucose on the Go

• Blood glucose meter plug-in for iPhone

• Free iBGCStar Diabetes Manager app

• Blood glucose (stores up to 300 test results)

• Carbohydrate intake

• Insulin dose


What about Cholesterol?


“Smart” Clothing?

• Stretchable fabric with built-in monitoring electrodes

• Machine washable

• Current capabilities:


• Smartphone app

• EMG (muscle activation score)

• Heart rate

• Motion (triaxial accelerometry)

• Balance

• Repetitions

• Cadence

• Form

Athos

http://bionicly.com/wp-content/uploads/2013/12/Screenshot-2013-12-22-10.59.06.png

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Virtual exercise studios / group classes?


Stay Current with New Technologies / Apps

• www.active.com

• www.pcmag.com

• www.digitaltrends.com

• www.wired.com


Take Home Message

• Apps / Devices / Gadgets market continuously evolving.

−Find a strategy that works for the individual and use it!

• Fitness gadgets are best when used to identify long-

term trends in behavior change or targeted interventions

within an individual.

• Each patient is unique. There is no “one size fits all”.

• In general, the App / Device / Gadget should be:

1. Easy to use

2. Capable of being individualized

3. Provide timely feedback

4. Stimulate motivation

http://www.active.com/

http://www.pcmag.com/

http://www.digitaltrends.com/

http://www.fitness-trackers.specout.com/

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Questions / Discussion

Technological Advances for Secondary Prevention: Expanding Access to Cardiac Rehabilitation

Thomas P. Olson, M.S., Ph.D., FACSM, FAHA

[email protected]

Exercise for Special Populations - MNACVPR

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