Get Going: Accelerometer-Based Intervention to Promote Physical Activity in Frail Older Adults
NCT ID: NCT02635477
Last Updated: 2017-02-13
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
150 participants
INTERVENTIONAL
2016-01-31
2017-11-30
Brief Summary
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Detailed Description
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Frailty, a geriatric syndrome characterized by subclinical impairments in multiple organs and decreased physiologic resiliency, is a major risk factor for unsuccessful transitions of care and adverse health outcomes. Thus, it has been suggested that interventions aimed at improving transitions of care should target frail patients. Frail individuals demonstrate a well-defined phenotype of muscle weakness and physical inactivity, readily measurable using various scales and instruments. To date, the most widely studied intervention to improve frailty and related outcomes has been physical activity.
However, fewer than 50% of patients adhere to regular physical activity programs. Enrollment in cardiac rehabilitation programs is even lower owing to multiple barriers, including lack of payer reimbursement ≤ 30 days after a hospitalization, the highest risk period for readmissions. Scientific statements have called for augmented "self-care" to assure adequate physical activity in patients with heart failure and other forms of cardiovascular disease 10. Moreover, low-intensity home-based physical activity programs can be as efficacious as higher-intensity center-based programs, strengthening the rationale for self-care.
The advent of small, portable, inexpensive accelerometer devices has emerged as a powerful tool to facilitate self-monitored physical activity. These devices are worn by patients and provide real-time feedback about the number of steps walked each day (as well as other functional parameters). This is in tune with a systematic review which found that feedback and goal setting improved adherence to physical activity in patients with heart failure. A few studies in the physical therapist literature have used accelerometers to demonstrate low baseline physical activity and boost total step counts in patients attending cardiac rehabilitation, but these patients were at least 30 days removed from their index hospitalization, and none enrolled patients in the critical post-discharge phase.
Research question: Is a portable actigraphy-based intervention more effective than standard-of-care in promoting physical activity in the first 30 days after hospital discharge among frail older adults with cardiovascular disease?
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
SINGLE
Study Groups
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Intervention Group
frail elderly patients discharged from a cardiovascular hospitalization; provided with an actigraphy device that displays an adaptive personalized daily step count goal and audible alerts to increase physical activity
Intervention
Behavioral: actigraphy device, adaptive step count algorithm
Control Group
frail elderly patients discharged from a cardiovascular hospitalization; provided with a matching actigraphy device that has a blacked-out screen and does not display step count goals or provide audible alerts (functions in silent monitoring mode only)
Intervention
Behavioral: actigraphy device, adaptive step count algorithm
Control
Behavioral: actigraphy device, step count measurement only
Interventions
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Intervention
Behavioral: actigraphy device, adaptive step count algorithm
Control
Behavioral: actigraphy device, step count measurement only
Eligibility Criteria
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Inclusion Criteria
2. at least one criteria positive on the FRAIL scale,
3. hospital discharge to an independent residence,
4. primary final discharge diagnosis of coronary disease or heart failure but not requiring cardiac surgery or TAVR during the index hospitalization,
5. able to stand and walk without assistance from another person,
6. able to carry out basic activities of daily living without assistance as per Clinical Frailty Scale rating ≤5,
7. signed informed consent from the patients, and
8. approval from the treating physician that the patient is safe and appropriate to participate in this trial.
Exclusion Criteria
2. more than one fall in the past six months, or a fall in the past three months prior to hospitalization,
3. high-risk for falls or unsteady for mobilization according to a clinical physical therapist's assessment (if performed) or as assessed during functional testing,
4. non-revascularized acute myocardial infarction within the past month (unless revascularization was not indicated) or uncorrected severe symptomatic aortic stenosis,
5. active severe symptoms of angina, dyspnea, or claudication at rest or with minimal activity (Canadian Cardiovascular Society class 4, New York Heart Association class 4, or Fontaine class 3-4, respectively),
6. referral to a structured cardiac rehabilitation program in the first 30 days after hospital discharge (not counting home-based physical therapy),
7. unable to return for follow-up visit, and
8. poor comprehension of the actigraphy device.
70 Years
100 Years
ALL
No
Sponsors
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Alliance for Academic Internal Medicine
OTHER
American College of Cardiology
OTHER
Responsible Party
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Principal Investigators
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Scott Hummel, MD
Role: PRINCIPAL_INVESTIGATOR
University of Michigan Ann Arbor, Michigan, USA
Jonathan Afilalo, MD, MSc
Role: PRINCIPAL_INVESTIGATOR
Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Locations
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Emory University
Atlanta, Georgia, United States
Boston Veterans Affairs
Boston, Massachusetts, United States
Ann Arbor Veterans Affairs
Ann Arbor, Michigan, United States
University of Michigan Health System
Ann Arbor, Michigan, United States
Beaumont Health System/Oakwood
Dearborn, Michigan, United States
St. Joseph Mercy Hospital
Ypsilanti, Michigan, United States
Mayo Clinic
Rochester, New Hampshire, United States
New York Presbyterian Hospital/Columbia
New York, New York, United States
New York Presbyterian Hospital/Cornell
New York, New York, United States
University of North Carolina
Chapel Hill, North Carolina, United States
Duke University
Durham, North Carolina, United States
Case Western Reserve University/University Hospital
Cleveland, Ohio, United States
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
University of Washington
Seattle, Washington, United States
McGill University
Montreal, Quebec, Canada
Montreal Heart Institute
Montreal, Quebec, Canada
Countries
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Central Contacts
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Facility Contacts
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David Sengstock, MD
Role: primary
Evelyn Horn, MD
Role: primary
Karen Alexander, MD
Role: primary
Richard Josephson, MD
Role: primary
References
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Goldwater DS. Geriatric cardiology: a fellow's perspective. J Am Coll Cardiol. 2014 Sep 30;64(13):1401-3. doi: 10.1016/j.jacc.2014.08.009. No abstract available.
Martin SS, Ou FS, Newby LK, Sutton V, Adams P, Felker GM, Wang TY. Patient- and trial-specific barriers to participation in cardiovascular randomized clinical trials. J Am Coll Cardiol. 2013 Feb 19;61(7):762-9. doi: 10.1016/j.jacc.2012.10.046.
Gurwitz JH. The exclusion of older people from participation in cardiovascular trials. Virtual Mentor. 2014 May 1;16(5):365-8. doi: 10.1001/virtualmentor.2014.16.05.pfor1-1405. No abstract available.
Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, Perrault LP, Alexander KP, Langlois Y, Dendukuri N, Chamoun P, Kasparian G, Robichaud S, Gharacholou SM, Boivin JF. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010 Nov 9;56(20):1668-76. doi: 10.1016/j.jacc.2010.06.039.
Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8. doi: 10.1001/jama.2010.1923.
Lindman BR, Alexander KP, O'Gara PT, Afilalo J. Futility, benefit, and transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2014 Jul;7(7):707-16. doi: 10.1016/j.jcin.2014.01.167. Epub 2014 Jun 18.
Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014 Mar 4;63(8):747-62. doi: 10.1016/j.jacc.2013.09.070. Epub 2013 Nov 27.
Forman DE, Rich MW, Alexander KP, Zieman S, Maurer MS, Najjar SS, Cleveland JC Jr, Krumholz HM, Wenger NK. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol. 2011 May 3;57(18):1801-10. doi: 10.1016/j.jacc.2011.02.014. No abstract available.
Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, Gurvitz MZ, Havranek EP, Lee CS, Lindenfeld J, Peterson PN, Pressler SJ, Schocken DD, Whellan DJ; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009 Sep 22;120(12):1141-63. doi: 10.1161/CIRCULATIONAHA.109.192628. Epub 2009 Aug 31. No abstract available.
King AC, Haskell WL, Taylor CB, Kraemer HC, DeBusk RF. Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial. JAMA. 1991 Sep 18;266(11):1535-42.
Hwang R, Marwick T. Efficacy of home-based exercise programmes for people with chronic heart failure: a meta-analysis. Eur J Cardiovasc Prev Rehabil. 2009 Oct;16(5):527-35. doi: 10.1097/HJR.0b013e32832e097f.
Tierney S, Mamas M, Woods S, Rutter MK, Gibson M, Neyses L, Deaton C. What strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies. Heart Fail Rev. 2012 Jan;17(1):107-15. doi: 10.1007/s10741-011-9252-4.
Savage PD, Ades PA. Pedometer step counts predict cardiac risk factors at entry to cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2008 Nov-Dec;28(6):370-7; quiz 378-9. doi: 10.1097/HCR.0b013e31818c3b6d.
Izawa KP, Watanabe S, Hiraki K, Morio Y, Kasahara Y, Takeichi N, Oka K, Osada N, Omiya K. Determination of the effectiveness of accelerometer use in the promotion of physical activity in cardiac patients: a randomized controlled trial. Arch Phys Med Rehabil. 2012 Nov;93(11):1896-902. doi: 10.1016/j.apmr.2012.06.015. Epub 2012 Jun 28.
Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007 Nov 21;298(19):2296-304. doi: 10.1001/jama.298.19.2296.
Vaes AW, Cheung A, Atakhorrami M, Groenen MT, Amft O, Franssen FM, Wouters EF, Spruit MA. Effect of 'activity monitor-based' counseling on physical activity and health-related outcomes in patients with chronic diseases: A systematic review and meta-analysis. Ann Med. 2013 Sep;45(5-6):397-412. doi: 10.3109/07853890.2013.810891. Epub 2013 Jul 3.
Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Brubaker PH, Osada N, Omiya K, Shimizu H. Usefulness of step counts to predict mortality in Japanese patients with heart failure. Am J Cardiol. 2013 Jun 15;111(12):1767-71. doi: 10.1016/j.amjcard.2013.02.034. Epub 2013 Mar 27.
Cyarto EV, Myers A, Tudor-Locke C. Pedometer accuracy in nursing home and community-dwelling older adults. Med Sci Sports Exerc. 2004 Feb;36(2):205-9. doi: 10.1249/01.MSS.0000113476.62469.98.
Nguyen HQ, Steele BG, Dougherty CM, Burr RL. Physical activity patterns of patients with cardiopulmonary illnesses. Arch Phys Med Rehabil. 2012 Dec;93(12):2360-6. doi: 10.1016/j.apmr.2012.06.022. Epub 2012 Jul 5.
Leidy NK, Kimel M, Ajagbe L, Kim K, Hamilton A, Becker K. Designing trials of behavioral interventions to increase physical activity in patients with COPD: insights from the chronic disease literature. Respir Med. 2014 Mar;108(3):472-81. doi: 10.1016/j.rmed.2013.11.011. Epub 2013 Nov 20.
Other Identifiers
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AAIM ASP 2015
Identifier Type: -
Identifier Source: org_study_id
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