Quantitative Exercise Research Articles

What do end-users want to know about managing the performance of healthcare delivery systems? Co-designing a context-specific and practice-relevant research agenda

BackgroundDespite increasing interest in joint research priority-setting, few studies engage end-user groups in setting research priorities at the intersection of the healthcare and management disciplines. With health systems increasingly establishing performance management programmes to account for and incentivize performance, it is important to conduct research that is actionable by the end-users involved with or impacted by these programmes. The aim of this study was to co-design a research agenda on healthcare performance management with and for end-users in a specific jurisdictional and policy context.MethodsWe undertook a rapid review of the literature on healthcare performance management (n = 115) and conducted end-user interviews (n = 156) that included a quantitative ranking exercise to prioritize five directions for future research. The quantitative rankings were analysed using four methods: mean, median, frequency ranked first or second, and frequency ranked fifth. The interview transcripts were coded inductively and analysed thematically to identify common patterns across participant responses.ResultsSeventy-three individual and group interviews were conducted with 156 end-users representing diverse end-user groups, including administrators, clinicians and patients, among others. End-user groups prioritized different research directions based on their experiences and information needs. Despite this variation, the research direction on motivating performance improvement had the highest overall mean ranking and was most often ranked first or second and least often ranked fifth. The research direction was modified based on end-user feedback to include an explicit behaviour change lens and stronger consideration for the influence of context.ConclusionsJoint research priority-setting resulted in a practice-driven research agenda capable of generating results to inform policy and management practice in healthcare as well as contribute to the literature. The results suggest that end-users are keen to open the “black box” of performance management to explore more nuanced questions beyond “does performance management work?” End-users want to know how, when and why performance management contributes to behaviour change (or fails to) among front-line care providers.

Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest–Posttest Study

BackgroundA scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring.ObjectiveThe aim of this study was to investigate whether a year-long cloud platform–based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers’ health outcomes.MethodsA total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest–posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis.ResultsA total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD –0.13; CI: –1.19 to –0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: –0.72; CI –1.17 to –0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=–0.35; scientific fitness mode: MD=–0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions.ConclusionsThe observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.

An AI-Based Exercise Prescription Recommendation System

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool has been developed for digital training and decision support in cardiovascular disease patients in clinical practice. Exercise prescription recommendation systems for sub-healthy people are essential to enhance this dominant group’s physical ability as well. This study aims to construct a guided exercise prescription system for sub-healthy groups using exercise community data to train an AI model. The system consists of six modules, including three-month suggested exercise mode (3m-SEM), predicted value of rest heart rate (rest HR) difference after following three-month suggested exercise mode (3m-PV), two-month suggested exercise mode (2m-SEM), predicted value of rest HR difference after following two-month suggested exercise mode (2m-PV), one-month suggested exercise mode (1m-SEM) and predicted value of rest HR difference after following one-month suggested exercise mode (1m-PV). A new user inputs gender, height, weight, age, and current rest HR value, and the above six modules will provide the user with a prescription. A four-layer neural network model is applied to construct the above six modules. The AI-enabled model produced 95.80%, 100.00%, and 95.00% testing accuracy in 1m-SEM, 2m-SEM, and 3m-SEM, respectively. It reached 3.15, 2.89, and 2.75 BPM testing mean absolute error in 1m-PV, 2m-PV, and 3m-PV. The developed system provides quantitative exercise prescriptions to guide the sub-healthy group to engage in effective exercise programs.

The new theory CPET guides the overall plan of individualized precision exercise to effectively improve the overall functional status of "frailty"

Objective: Under the guidance of the new theory of holistic integrated physiology and medicine, the effect of individualized accurate exercise program on the overall functional state was studied according to cardiopulmonary exercise testing (CPET). Methods: Li xx, female, 31 years old, has a fast heart rate since childhood (90~100 bpm), usually feel cold, especially in autumn and winter, and general health good. CPET was performed after signing the informed consent form at Fuwai Hospital in September 2019. Peak oxygen uptake, anaerobic threshold (AT), and peak cardiac output were (69~72)% pred, respectively, and the oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency were basically normal (96~100)% pred. The resting heart rate was fast, the blood pressure was low, the blood pressure response was weak during exercise, and the heart rate was mainly increased. The holistic integrated physiology medical theory pointed out that she was in weak health and heart weakness was the main manifestation. CPET was used to guide individualized precise exercise intensity titration, combine continuous beat-by-beat blood pressure, ECG, pulse and blood glucose dynamic monitoring to formulate an holisticplan of individualized quantitative exercise .Reexamine CPET after 8 weeks' strengthening management. Results: After 8 weeks of intensive holistic management, the limbs were warm and the cold symptoms disappeared. Re-examination of CPET peak oxygen uptake, AT and peak cardiac output were (90~98)% pred, which increased by (30~36)% respectively, and the holistic weak functional status was significantly improved; basically normal oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency also increased by (10~37)% respectively; resting heart rate and blood pressure basically returned to normal, and blood pressure and heart rate response during exercise were normal. Continuous ambulatory blood glucose monitoring indicated that the average blood glucose level decreased slightly and became more stable. Repeated measurement results of continuous ECG and beat-to-beat blood pressure also indicated a decrease in heart rate and an increase in blood pressure during rest, exercise and during sleep, and radial pulse wave. The amplitude of the dicrotic wave increases and becomes more pronounced. Conclusion: The new theoretical system to guide CPET to formulate an holistic plan for individualized precision exercise can safely and effectively enhance myocardial contractility, increase stroke volume, increase blood pressure, lower heart rate, stabilize and slightly lower blood glucose, and improve holistic functional status.

Application of diversified and quantitative management model of exercise intervention in patients with gestational diabetes mellitus

Objective: The study aims to explore the application of diversified and quantitative management model of exercise intervention in patients with gestational diabetes mellitus (GDM). Methods: From January 2018 to July 2018, 150 pregnant women with GDM were recruited from HangZhou Maternity Hospital, and were randomly divided into control group (n = 75) and experimental group (n = 75). All patients were registered pregnancy exercise self-efficacy scale (P-ESES), fasting blood glucose (FBG), and 2-hour postpranational blood glucose (2hPG). Patients in control group received conventional sports, while patients in experimental group added multiple quantitative exercise intervention management mode until delivery (accumulated at least 30 min per day, the time of not less than 150 min per week). After 4 weeks of intervention, patients in both groups were measured P-ESES, FBG, and 2hPG levels. Results: A total of 12 patients dropped out of the study, was lost to follow-up or was admitted to another hospital; therefore, 138 cases (68 vs. 70) were included in analysis. There was no significant difference of P-ESES, FBG, and 2hPG of patients in baseline. After four weeks intervention, compared with the control group, the P-ESES score was significantly increased (p<.05), the overcoming movement disorder, overcoming emotional disorder, and overcoming support disorder scores were significantly improved (p<.05), and the levels of FBG and 2hPG were significantly decreased (p<.05) in experimental group. Finally, the coincidence rate of weight gain during pregnancy was increased, the rate of macrosomia delivery and cesarean section were decreased in experimental group (p<.05). Conclusion: Quantitative management model of multiform exercise therapy improved patients with GDM.

Multiple criteria decision analysis for medicine reimbursement in the Lebanese context

Abstract Objective The objective of this exploratory analysis is to reflect and discuss which criteria of multiple criteria decision analysis (MCDA) would be relevant as part of value determination when appraising healthcare interventions in the Lebanese context. Methods A workshop was conducted as part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Lebanon Chapter and included the two frameworks: Evidence and Value: Impact on Decision Making (EVIDEM) and Advance Value Framework. Thirty-seven participants expressed their individual preferences through a qualitative and a quantitative exercise. Results In the qualitative analysis of both frameworks, participants unanimously agreed on the relevance of comparative efficacy, safety, and impact of medical costs. In EVIDEM, disease severity and unmet needs were also considered to be important criteria by more than 90 percent of the participants. In the quantitative analysis of both frameworks, disease severity ranked first (a mean normalized weight of .1 in EVIDEM and .27 in Advance Value Framework), followed by the size of the population (.09), the type of therapeutic benefit at the patient level (.09) and population level (.08), and the efficacy (.07) in EVIDEM. In the Advance Value Framework, the combined unmet need/disease severity criteria were followed by direct and meaningful end points (.15), safety (.12), contraindications (.08), and indirect surrogate end points (.07). Conclusions The results were concordant with those reported in countries that have conducted similar surveys such as France, Italy, and Spain. The MCDA methodology could be used as a cornerstone to enhance evidence-based discussions among Lebanese stakeholders involved in evaluation and decision-making purposes.

Risk-Taking, Capital Allocation and Optimal Monetary Policy

We study the role of firm heterogeneity in affecting business cycle dynamics and optimal stabilization policy. Firms differ in their degree of cyclicality, and hence, exposure to aggregate risk, leading to firm-specific risk premia that influence resource allocations. The heterogeneous firm economy can be recast in a representative firm formulation, but where total factor productivity (TFP) is endogenous and depends on the resource allocation. The model uncovers a novel tradeoff between the long-run level and volatility of TFP. Inefficiencies distort this tradeoff and result in either excessive volatility or depressed output, implying a role for corrective policy. Embedding this mechanism into a workhorse New Keynesian model, we show that allocational considerations can strengthen the incentives for leaning against the wind, i.e., optimal policy is more strongly countercyclical than in an observationally equivalent economy that abstracts from heterogeneity. A quantitative exercise suggests that the losses from ignoring heterogeneity can be substantial, which stem largely from a less productive allocation of resources and so depressed TFP and output.

Constrained Efficient Borrowing with Sovereign Default Risk

Using a quantitative sovereign default model, we characterize constrained efficient borrowing by a Ramsey government that commits to income-history-contingent borrowing paths taking as given ex-post optimal future default decisions. The Ramsey government improves upon the Markov government because it internalizes the effects of borrowing decisions in period t on borrowing opportunities prior to t. We show the effect of borrowing decisions in t on utility flows prior to t can be encapsulated by two single dimensional variables. Relative to a Markov government, the Ramsey government distorts borrowing decisions more when bond prices are more sensitive to borrowing, and changes in bond prices have a larger effect on past utility. In a quantitative exercise, more than 80% of the default risk is eliminated by a Ramsey government, without decreasing borrowing. The Ramsey government also has a higher probability of completing a successful deleveraging (without defaulting), while smoothing out the fiscal consolidation.

Institutions, tax evasion, and optimal policy

The mix of inflation and income taxation that governments adopt vary considerably across countries. We take a Ramsey optimal-policy approach to explain these differences, focusing on the institutions of the country, modeled as the difficulty of tax evasion, as the key variation across countries. In the model households optimally choose the extent of informal activity and a benevolent government optimally chooses policies, both taking as given the institutions of the economy. The model matches qualitatively the observed relationships between institutions and inflation, taxes and tax evasion. In a cross-country quantitative exercise with 38 countries that have floating exchange rates, the model delivers a good fit: the correlation of data and model-generated values for inflation and taxes are 0.42 and 0.79, respectively. The quantitative exercise further provides evidence for the success of this Ramsey approach in a falsification test, as the fit of the model deteriorates significantly for countries with fixed exchange rates, where the assumptions underlying the Ramsey approach may not hold.

Macroeconomic effects of the mortgage refinance and the home equity lines of credit

I examine how the mortgage refinance and the home equity lines of credit (HELOC) impact the increase in pre-crisis mortgage debt and post-crisis mortgage defaults. Financially constrained homeowners can cash out funds through refinancing mortgages or extract home equity through HELOC. My quantitative exercise shows that prevalent usage of refinancing increases pre-crisis mortgage debt, which amplifies the post-crisis foreclosure rate. HELOC also contributes to an increase in mortgage defaults, though it negligibly impacts pre-crisis mortgage debt.

Consumer Imperfect Information and Endogenous Price Rigidity

This paper studies the propagation of monetary shocks in an economy featuring a strategic microfoundation for price rigidities. Following an aggregate shock to money, most consumers are initially uninformed. The market for goods is decentralized. Firms are better off delaying the adjustment of prices until enough consumers learn. At the same time, consumers learn from firms that have adjusted prices. The implied endogenous information diffusion follows a Bernoulli differential equation, implying a nonlinear path of learning. Nonlinear learning implies hump-shaped dynamics of output and inflation. A quantitative exercise suggests that these dynamics can be sizable and persistent. (JEL D11, D21, D40, D82, E23, E31)

Abstract No. 658 Exercise intolerance caused by chronic iliocaval venous occlusion: non-invasive quantitative assessment

Patients with chronic inferior vena cava (IVC) and bilateral iliac vein postthrombotic occlusion often report subjective decreased exercise tolerance that improves after stent reconstruction. We report preliminary results of the use of quantitative exercise testing to assess change in exercise tolerance occurring after venous reconstruction. The Institutional Review Board approved this retrospective study. Exercise testing before and after intervention was conducted in the Human Performance Laboratory (HPL): resting blood pressure, heart rate, body mass index (BMI), body composition, standard pulmonary function tests, and incremental maximal exercise testing (VO2 max test). Maximal exercise was defined as a plateau in the oxygen uptake, a respiratory exchange ratio (RER) greater than 1.1, or voluntarily termination of exercise. The VO2 max (mL/kg/min), maximum work (W) and total exercise time were analyzed. Percutaneous venous reconstruction was performed using standard techniques and stents. Results were reported as simple averages and percentages. Three male patients with chronic postthrombotic IVC and bilateral iliac venous occlusions were studied. Mean age 63 ± 8 years, mean duration of occlusion 36 ± 12 months. The interval between reconstruction and testing ranged from 2.5 to 11 months. All patients had stents in the infra-renal IVC to bilateral common femoral veins. No exercise instructions were provided to patients after stent reconstruction. Following venous reconstruction, the V02 max increased an average of 38.7%, the total work increased 74.4%, and the total exercise time increased 18.7%. Each individual lost weight, with an average decrease of 7.5%. Subjectively, all patients reported an increased exercise tolerance and decreased shortness of breath with exertion. Subjective impairment in exercise tolerance and improvement after venous reconstruction was quantitated in three patients with chronic postthrombotic occlusion of the IVC and bilateral iliac veins. HPL testing may be a useful additional objective tool in the study of patients with chronic ilio-caval occlusions.

How Unsecured Credit Policies Influence Mortgage and Unsecured Loan Defaults

AbstractBefore the global financial crisis, the proportion of households defaulting on the mortgage while remaining current on the unsecured loan was almost the same as the proportion of households current on the mortgage but defaulting on the unsecured loan. After the crisis, the former ratio became higher than the latter. By using a heterogeneous agent model with the mortgage and the unsecured loan, I examine how the order of defaults changed before and after the crisis. I then analyze the impacts of unsecured credit policies on households' mortgage and unsecured loan defaults. My quantitative exercise shows that both default rates can decrease as the cost for unsecured loan defaults increases.

GROWING LIKE SPAIN: 1995–2007

AbstractMeasured total factor productivity (TFP) fell in Spain during the boom years of 1995–2007. Using administrative data from the quasi‐universe of firms, we show that there was an increase in misallocation, which was more severe in sectors where connections with public officials are more important for business success. We write and estimate a simple model of cronyism in which heterogeneous firms invest in political connections. Our quantitative exercise concludes that the institutional decline over this period costed 1.9% growth in TFP per year and a 0.8% annual increase in the resources spent by firms in establishing political connections.

Road Capacity, Domestic Trade and Regional Outcomes

What is the impact on intra-national trade and regional economic outcomes when the quality and lane-capacity of an existing paved road network is expanded significantly? We investigate this question for the case of Turkey, which undertook a large-scale public investment in roads during the 2000s. Using spatially disaggregated data on road upgrades and domestic transactions, we estimate a large positive impact of reduced inter-provincial travel times on trade as well as regional industrial sales and employment. A quantitative exercise using a workhorse model of spatial equilibrium implies a rate of return on investment around 70 percent.

The Role of the Gender Wage Gap in Overall Wage Inequality: A Quantitative Exercise

This article presents a novel wage inequality decomposition to analyze the impact of the gender wage gap on overall wage inequality. The decomposition determines the maximum relative wage between genders allowed before it begins to increase total inequality. In addition, I present a structural model of the labor market to evaluate the impact of establishing restrictions on intra-occupational gender pay gaps within each firm. Specifically, I introduce a restriction in which the average wage of one gender cannot exceed I± times the average wage of the other gender. For I± = 2, the model predicts a 10 percent wage inequality reduction. However, with a tighter restriction of I± = 1, the inequality reduction dissipates and reverses into a wage inequality increase.

Uncertainty, Imperfect Information, and Expectation Formation Over the Firms's Life Cycle

Using a long-panel dataset of Japanese firms that contains firm-level sales forecasts, we provide evidence on firm-level uncertainty and imperfect information over their life cycle. We find that firms make non-negligible and positively correlated forecast errors. However, they make more precise forecasts and less correlated forecast errors when they become more experienced. We then build a model of heterogeneous firms with endogenous entry and exit where firms gradually learn about their demand by using a noisy signal. In our model, informational imperfections lead firms to enter the market without being fully informed. Moreover, young firms tend to wait long before entering or exiting the market faced with high uncertainty about their demand. The former learning effect, combined with the latter real-options effect, adversely affect firms’ entry decisions and thus resource allocation. Our quantitative exercise substantiates the importance of accumulation of experience for firms’ post-entry dynamics and aggregate productivity.

A Unified Model of International Business Cycles and Trade

We present a general, competitive open economy business cycle model with capital accumulation, trade in intermediate goods, production externalities in the intermediate and final goods sectors, and iceberg trade costs. Our main theoretical result shows that models developed in the modern international trade literature that feature comparative advantage, monopolistic competition and cost of entry, and firm heterogeneity and cost of exporting are isomorphic, in terms of aggregate equilibrium, to versions of this competitive dynamic model under appropriate restrictions on the externalities. In particular, the restrictions apply on the overall scale of externalities, the split of externalities between the different factors of production, and the identity of the sectors with production externalities. Our quantitative exercise assesses whether various restricted versions of the general model, in forms they are typically considered in the literature, are able to resolve the well-known aggregate empirical puzzles in international business cycle models. Our theoretical result on isomorphism between models then provides insights on why they fail to do so in many instances. We thus provide a unified theoretical and quantitative treatment of the international business cycles and trade literatures in a general dynamic framework.

Adoption of digital transaction model by micro enterprises to target millennials in India: An exploratory study

Purpose: The purpose of this paper is to understand the factors that significantly influence adoption of technology solutions by micro businesses. This study incorporates constructs from TAM (Technology Adoption Model), TPB (Theory of Planned Behaviour) and transaction cost which include variables such as perceived ease of use, perceived risk, subjective norms, and transaction cost. A confirmatory factor analysis using AMOS 20 was conducted to measure different aspects of intention to adopt digital solutions, followed by structural equation modelling. A sample of 130 micro enterprises in Mumbai was surveyed to understand intentions towards digital adoption. The study identifies perceived ease of use, peer influence and transaction costs as significant factors that drive intention to adopt digital transactions, while perceived risk was not found to be significant. The proposed model and the results of the study have useful implications, not only for marketers of digital payment solutions, but also for policy makers.Design/methodology/approach: The latent constructs were measured using standardised scales. Statistical techniques, like descriptive statistics and confirmatory factor analysis, along with structural equation modelling, were used. Two-stage research was conducted whereby stage one involved exploring the various dimensions of TAM, TPB and transaction costs through in-depth interviews. This was followed by conducting a large-scale quantitative exercise to test the proposed model.Findings: Intention to adopt was measured by willingness to recommend digital payment to others and willingness to increase digital transactions. The results show that micro businesses’ intentions to adopt technology-based solutions was determined primarily by the perceived ease of use of the technology followed by subjective norms, which indicated the role of peer influence on the choice of technology solution. Reduction in transaction costs was found to be a significant factor in adopting technology-driven solutions, while risk associated with technology use was not significant.Limitations: The study was restricted to Mumbai city. A larger sample across multiple cities could have given many more insights regarding the level of differences in intention to adopt digital transactions.Implications: Digital inclusion facilitates transaction settlement using a digital medium linked to a bank account. The transformation from digital inclusion to financial inclusion is relatively easy, and hence could be impactful in the scaling up of micro enterprises. Additionally, digital payment strategies tailored for micro enterprises can be directed towards driving customer loyalty, customer engagement, repeat purchasing, cross-selling, and up-selling opportunities for the micro enterprise segment of the market.Contribution: This study uses the micro enterprise segment, a hitherto under researched segment. The proliferation of mobile phones and their application for technology adoption makes this study extremely useful in the context of developing economies for both marketers and policy makers, especially in the micro enterprise segment.

Strategic Inattention, Inflation Dynamics, and the Non-Neutrality of Money

How does competition affect information acquisition of firms and thus the response of inflation and output to monetary policy shocks? This paper addresses these questions in a new dynamic general equilibrium model with both dynamic rational inattention and oligopolistic competition. In the model, rationally inattentive firms acquire information about the endogenous beliefs of their competitors. Moreover, firms with fewer competitors endogenously choose to acquire less information about aggregate shocks – a novel prediction of the model that is supported by empirical evidence from survey data. A quantitative exercise disciplined by firm-level survey data shows that firms' strategic inattention to aggregate shocks associated with oligopolistic competition increases monetary non-neutrality by up to 77% and amplifies the half-life of output response to monetary shocks by up to 30%. Furthermore, the model matches the relationship between the number of firms' competitors and their uncertainty about inflation as a non-targeted moment.