Exergaming in patients with heart failure. A pilot study of the HEART-EXERGAME (Heart-eXg) intervention

Abstract

Abstract Background Physical activity in patients with heart failure (HF) can improve physical function, quality of life, reduce rehospitalization and mortality. A new approach increase physical activity for patients with heart failure (HF) is the use of exergames (games that requires physical activity to play). An international multi-centre RCT study, called the Heart-eXg study (clinicaltrials.gov ID: NCTxxx), is developed to determine the effectiveness of 3-months exergaming for patients with HF to decrease their sedentary time. The mobile exergame is co-designed for this study, entails a farming theme, and personalized on patients exercise capacity. The aim of this pilot study was to test the protocol of the intervention, in terms of recruitment, procedures of the intervention, assessment of outcomes and adherence to exergaming. Material and methods In the pilot study, the inclusion of patients was assessed. The randomization was tested but all patients were assigned to the exergame group. To further test the procedures the time was recorded of the installation/instructions to the exergame, the telephone follow-ups (to increase motivation) and outcome assessment. Outcomes were the 6-minute walk test (exercise capacity), Fried frailty test (frailty), VAS-Score EQ5D, 0-100 (quality of life), Canadian Occupational Performance Measure (occupational performance). Adherence (walking 10 minutes every day with the exergame) was assessed during the 3 months exergaming, as the time exergaming was recorded. Results Pilot study In total 13 patients were eligible and 5 included. Mean age was 71 (±10), 2 females, 1 patient in NYHA-class II and 4 patients in NYHA-class III. One patient dropped out directly after baseline (severe disease) and 1 never exergamed (time constraints). Result of exercise capacity, quality of life and occupational performance are presented in the Table. The procedures of the intervention were feasible, the visits to the hospital took between 1 hour and 1.5 hour and the telephone follow up approximately 5-10 minutes. Test of occupational performance took longer time than calculated (30 min instead of 15 min). Of the 3 patients who exergames, 1 patient played irregularly and stopped after 4 weeks. Two patients were adherent, see Figure. Conclusion The protocol of the intervention was feasible to use. In total, 38% of patients accepted to be included in the intervention and 20% of the patients dropped out (1 out of 5) and 50% were completely adherent to the intervention. Time for installation/introduction and telephone follow-ups were appropriate. As the occupational performance assessment took more time than then expected, we decided to test this in 100 out of the 600 patients planned to be included in the RCT study.TableFigure