Remote but Together: Live-video Group Exercise Via Zoom for Heart Failure Patients Has High Adherence and Satisfaction

Abstract

Introduction Palliative care can improve heart failure (HF) symptoms, however many HF patients lack access. Likewise, standard exercise programs can improve symptoms in HF patients, however participation rates are low due to poor access and patient-specific barriers, such as high symptom burden. Further, measurement of physical function at home is uncommon. It is unknown whether gentle exercise via remote live-video conferencing is feasible in patients with HF. Aims The purpose of this study, PALL-HEART was to pilot test a live, gentle exercise intervention delivered via group video-conference, compared to an education/control group, on: 1) feasibility/adherence; 2) participant satisfaction; and, 3) utility of home-based measurement of physical function. Methods This 8-week randomized controlled trial included participants (N=20) recruited from an academic health system HF clinic. Both the intervention group (IG) and the health education (HE) group received a tablet computer preloaded with HF education topics, while the IG group participated in live 60-minute gentle exercise classes via video-conference twice weekly. The HE group was instructed to explore the education resources and called weekly to ascertain office visits or hospitalizations. Outcomes measured: 1) intervention feasibility using adherence (number of attended sessions, number of minutes attended), technological issues (ease of tablet use; number of technological disruptions; 2) satisfaction with intervention; and, 3) utility of home-based physical function measures (strength [arm curls, chair stands], balance [1 leg stand], hip flexibility [sit and reach], endurance [2 minute step test], agility [timed get up and go]). Effect sizes were calculated using Cohen's d by group. Results Twenty (IG=10, HE=10) participated, with a mean age of 68.7 years (SD = 12.7), 17 (85%) male gender, 16 (80%) white, and mean BMI of 29.4 (SD = 5.1). The trial design was feasible with 100% participation in classes, 100% of minutes attended, zero technological disruptions, and 100% participant satisfaction ratings. Further, some participants joined classes more often than we instructed (>100% adherence). Physical function measures were conveniently assessed at home (within 15 minutes) with small to moderate preliminary effect sizes in the intervention group at 8 weeks on: hip flexibility (sit to reach; d = 0.25), leg strength (chair stands; d = 0.16), endurance (two-minute-step test; d = 0.13), and balance (get up and go; d = 0.31). Conclusion Our novel approach to home exercise is highly feasible with very high adherence rates, satisfaction, and easily adapted home-based physical function measures. Testing for improvements in physical function and psychological measures is now needed. These findings are especially critical now as we seek suitable platforms for remote access to health care.