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Presentation given to outline an ongoing research study which is evaluating “The Nike+ Fuelband as a motivational tool to encourage adherence to exercise prescription for the teenager with congenital heart disease”.
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HYPOTHESIS: The Nike+ FuelBand is a motivational tool for exercise prescription in the teenager with congenital heart disease
Dr AG Stuart, Cardiologist Sports Cardiology UK
EXERCISE & SPORT
“ Exercise is bunk. If you are healthy, you don’t need it,if you are sick, you shouldn’t take it. ”
Henry Ford
EXERCISE & SPORT
“ If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health. ”
Regimen (Book 1)Hippocrates 460-370 BC
REGULAR EXERCISE
Regular exercise
Incidence
General health benefits
• Diabetes mellitus • Lipid profile • Colon cancer• Osteoporosis • Anxiety / depression • Dementia• Hypertension
Specific benefits in heart disease
“Exercise is one of the cheapest- and most effective- interventions for reducing the morbidity and mortality of cardiovascular disease.”
Booth J Appl Physiol 2000;88:774-787
AHA Scientific Statement April 2013 Promotion of Physical Activity in Children and Adults with Congenital Heart Disease
Longmuir et al Circulation 2013 DOI:10.1161/CIR.0b013e318293688F
“Most patients with congenital heart defects are relatively sedentary”
“counselling to encourage daily participation in appropriate physical activity should be a core component of every patient encounter….”
REGULAR EXERCISE
HOW DOES EXERCISE HELP?
Q: HOW DOES EXERCISE HELP?
• Improving endothelial function• Improving cardiac function• Improving skeletal muscle function
A: MULTIFACTORIAL
HEART FAILURE AND EXERCISE
“Chronic heart failure is associated with skeletal muscle abnormalities which cause fatigue / lactic acidosis”
Hambrecht et al JACC 1997;29:1067-73
Muscle biopsy 41% increase in mitochondrial density,
shift from type 11 to type 1 fibres
Exercise testsfemoral venous lactate related to
mitochondrial density not leg blood flow
Regular physical exercise increased oxidative enzyme activity in skeletal muscle
vs inactive controls6 months exercise training(18 patients)
WHY IS EXERCISE PRESCRIPTION NOT USED?
Q: WHY IS EXERCISE PRESCRIPTION NOT USED?A1: MOST CARDIOLOGISTS DO NOT KNOW HOW TO PRESCRIBE EXERCISE*
*Swan 2000, Lewin 2002
< 20% patients given exercise advice (Swan, 2000)< 20% units had exercise program (Lewin, 2002)
A1: MOST CARDIOLOGISTS DO NOT KNOW HOW TO PRESCRIBE EXERCISE*
*Swan 2000, Lewin 2002
Q: WHY IS EXERCISE PRESCRIPTION NOT USED?A2: MOST EXERCISE PRESCRIPTIONS ARE INEFFECTIVE IN TEENAGERS**
**Metcalf 2012
Physical activity interventions have only a small effect in children’s overall activity levels. Approx 4 mins walking /running per day. (Metcalf 2012)
A2: MOST EXERCISE PRESCRIPTIONS ARE INEFFECTIVE IN TEENAGERS**
**Metcalf 2012
TEENAGERS DON’T LIKE BEING TOLD WHAT TO DO...
GAMIFICATION “The use of game thinking and game mechanics in a non-game context to engage users and solve problems. Used to improve user engagement.”*
* Marczwski 2012
THE NIKE+ FUELBAND• 3 axis wrist worn accelerometer• 3 sizes / 2 colours • Set up using • Links to mobile phone / computer• Output :
• calories• Nike Fuel Points• steps
THE NIKE+ FUELBAND
1.Setup (age / height / weight)
THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)
THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)
3.Join Nike+
THE NIKE+ FUELBAND
1.Setup (age / height / weight)
2.Set Goal (say 2,000 points?)
3.Join Nike+4.Sync (phone / computer)
THE NIKE+ FUELBAND
CHARTS OF PROGRESS
REWARDS & SOCIAL CAPITAL
Exercise prescription in the teenager with congenital heart diseaseTHE STUDY
Q1: DOES THE USE OF THE NIKE FUELBAND INCREASE PHYSICAL ACTIVITY IN THE STUDY GROUP?
THE STUDY
Q2: DO ‘FUEL POINTS’ CORRELATE WITH MEASUREMENTS OF PHYSICAL ACTIVITY USING A CONVENTIONAL UNIAXIAL ACCELEROMETER?
Q1: DOES THE USE OF THE NIKE FUELBAND INCREASE PHYSICAL ACTIVITY IN THE STUDY GROUP?
Exercise prescription in the teenager with congenital heart disease
• Prospective, intervention study• Adolescents attending BCHC
• Identified Heartsuite database• Consent obtained via routine OP review• n =30 ; 13-18yrs old• All requiring long term follow up• Exclusions: learning disability / lack of computer access /
recent surgical intervention (<6 months)
Exercise prescription in the teenager with congenital heart diseaseTHE STUDY
• Prospective, intervention study• 3 symptom categories
• asymptomatic / NYHA 2 / NYHA 3 or 4• 3 measures of activity
• Actigraph• FuelBand• Non weartime diary
Exercise prescription in the teenager with congenital heart diseaseTHE STUDY
MEASURES OF ACTIVITY
Actigraph 7164 •“Hip worn”•7 day activity counts•10hrs for 4 days minimum
Nike FuelBand Non-weartime diary•“Wrist worn”•Daily activity counts•Gamified & social aspects
•Enables capture of activity when no accelerometer is being worn
Exercise prescription in the teenager with congenital heart disease
• Recruitment
Exercise prescription in the teenager with congenital heart disease
• Consent• Haemodynamic and clinical
assessment• Advised to exercise “as much
as possible” up to 60 mins /day
PRE LAUNCH
STUDY SCHEDULE
• Recruitment• Baseline assessment
Exercise prescription in the teenager with congenital heart disease
• Actigraph issued• Wear 7 days (not water!)• Record diary• Calculate Fuelpoints (target
750/1500/2500)
WEEK 1
STUDY SCHEDULE
• Recruitment• Baseline assessment• FuelBand intervention
Exercise prescription in the teenager with congenital heart disease
• FuelBand issued• Points prescribed• Link to study Facebook &
WEEK 2 - 9
STUDY SCHEDULE
• Recruitment• Baseline assessment• FuelBand intervention• Reassesssment
Exercise prescription in the teenager with congenital heart disease
• Actigraph issued • FuelBand used• Comparison actigraph/
Fuelband
WEEK 10
STUDY SCHEDULE
• Recruitment• Baseline assessment• FuelBand intervention• Reassessment• Data Analysis
Exercise prescription in the teenager with congenital heart disease
• Actisoft software v3.2• Total FuelBand point/week• Statistical tests
WEEK 10
Repeated measures ANOVA between groups at baseline and follow-up. Paired T tests for assessment of change in PA between baseline and Fuelband intervention stage. Bland Altman used to correlate levels of physical activity between FuelBand and Actigraph.
STUDY SCHEDULE
EXPECTED RESULTS AND ANTICIPATED VALUE OF STUDYAnticipated significant increase in activity associated with FuelBand intervention. This will enable self and peer motivation of exercise participation. Potential for significant health benefit, self efficacy and development of “exercise habit”.
LIMITATIONS OF STUDY Requirement to use expensive device and need for internet and computer/smartphone access and competent IT skills. Social media use may not be acceptable in younger patients. Benefit may be time limited. Hand based exercise only assessed.
Funding identified ( GUCH Research Fund). Study adopted by UHBristol (4 months delay).
Submitted for IRAS and ethics approval – awaited.
FINAL HYPOTHESIS: The Nike+ FuelBand is a motivational tool for exercise prescription in the teenager with congenital heart disease