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Effectiveness of Internet-Based Method to Adhere Home-Based Physical Activity on Symptoms and General Health in Older Adults With Heart Failure

Machiko R. Tomita, Department of Rehabilitation Science, University at Buffalo, State University of New York; Bruce J. Naughton, Department of Medicine, University at Buffalo, Geriatric Division at Kaleida Health; Fisher M. Nadine, Department of Rehabilitation Science, University at Buffalo, State University of New York, USA

The positive effects of exercise are well known; however, home-based exercise programs appear to have little benefit due to low adherence rates. The purpose of this study was to develop and evaluate a tool for promoting adherence to an exercise program among adults with heart failure.

Exercise was not recommended to HF patients until 10 years ago. An exercise protocol for patients with HF was developed and made available in CD-ROM and streaming video-enabled Web site formats. The secure Web-based tool provided a means of recording exercise performed. Records were monitored and feedback was sent to participants via e-mail every month. Hypotheses were adults with HF with access to the Web-based tool (the treatment group; 1) will increase their amount of exercise; (2) will improve their illness-specific symptoms such as dyspnea, fatigue, and emotional function; and (3) will improve their general health in areas such as days ill, weight loss, and blood pressure (BP) control.

We conducted a randomized controlled trial with a 1-year intervention. Three assessments, 6 months apart, were made at participants’ homes: baseline, 6 and 12 months. Forty adults with NYHA Class II and III HF in the western New York area who lived in their homes participated in the study. The mean age of participants was 75 and both groups were comparable at baseline for demographic and health characteristics. Initially both groups were advised to do breathing exercises, stretching, walking, and mild exercise such as biking, swimming, or golf. Treatment group participants (n = 16) received a computer with an Internet connection. Control group participants (n = 24) received a booklet with the exercise protocol.

During the yearlong intervention, 5 control participants dropped out due to HF and 3 treatment participants dropped out for reasons other than HF. The treatment group recorded their exercise activities approximately 85% of the time during the intervention period. Over the year the control group did not show any change in exercise behavior. Dividing participants into nonexercisers (<2-3 ×/week) and exercisers (2-3 ×/week or more), the treatment group exercisers increased their breathing and stretching exercises from 23% to 92%, 23-54% for mild exercise, and 54-100% for walking; all variables except mild exercise were statistically significant (p < .004).

Improvements in dyspnea, fatigue, and emotional function were observed in the treatment group after 1 year with statistical significance (all p < .005), while control group participants either remained the same or worsened. For the number of days ill and BP (systolic and diastolic), the treatment group showed statistically significant improvements (p < .001) over the year. In the control group, systolic BP become significantly higher and diastolic BP significantly lower; and number of days ill remained the same. Weight reduction was suggested for both groups at baseline, but only women in the treatment group lost weight (p < .001). A Web-based recording and feedback system is a feasible and effective method of improving exercise adherence and subsequently, the health, of older adults with HF.


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