Have You Met Your METs? – Enhancing Patient Motivation to Achieve Physical Activity Targets in Cardiac Tele-rehabilitation

Physical exercise is a primary component of cardiac rehabilitation. Interpreting exercise targets and being aware of the expected effort while rehabilitating independently at home is challenging for patients. Our work aims to assist cardiac patients in understanding their condition better and motivating them to achieve their exercise targets in a tele-rehabilitation setting. We introduce a patient-centric intelligible visualization approach to present prescribed rehabilitation targets to patients based on Metabolic Equivalent of Tasks (METs). We assessed efficacy of intelligible visualizations on patients’ comprehension in a lab study. We evaluated the impact on patient motivation and health outcomes in field studies. Patients were able to manage their prescribed activities, monitor their progress, and gained understanding on how their physical activities contribute to their rehabilitation targets. Patients confirmed that the intelligible visualizations motivated them to achieve their targets better. We observed an improvement in overall physical activity levels and health outcomes of patients.

Content

Author and article information

Contributors

Supraja Sankaran

Kris Luyten

Dominique Hansen

Paul Dendale

Karin Coninx

Conference

Publication date: July 2018

Publication date (Print): July 2018

Pages: 1-12

Affiliations

[1 ] Hasselt University-tUL-Expertise Center for Digital Media

Diepenbeek, Belgium

[2 ] Hasselt University-tUL- Flanders Make

Expertise Center for Digital Media

Diepenbeek, Belgium

[3 ] Hasselt University- REVAL-BIOMED

Heart Center, Hasselt, Belgium

[4 ] Hasselt University- Faculty of Medicine and Life Sciences; Department of Cardiology, Jessa Hospital, Hasselt, Belgium

Article

DOI: 10.14236/ewic/HCI2018.48

SO-VID: d33414d8-8960-475c-959e-7c2603429e3d

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This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Conference name: Proceedings of the 32nd International BCS Human Computer Interaction Conference

Conference acronym: HCI

Conference number: 32

Conference location: Belfast, UK

Conference date: 4 - 6 July 2018

Conference sponsor: Electronic Workshops in Computing (eWiC)

Conference theme: Human Computer Interaction Conference

History

Product

1477-9358 BCS Learning & Development

Self URI (article page): https://www.scienceopen.com/hosted-document?doi=10.14236/ewic/HCI2018.48

Self URI (journal page): https://ewic.bcs.org/

REFERENCES

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M. AltiniJ. PendersR. VullersO. Amft 2013 Combining wearable accelerometer and physiological data for activity and energy expenditure estimation in: Proceedings of the 4th Conference on Wireless Health - WH ‟13 ACM Press, New York, New York, USA 1 8 http://doi.org/10.1145/2534088.2534106
V. BellottiK. Edwards 2001 Intelligibility and Accountability: Human Considerations in Context-Aware Systems Human-Computer Interact 16 193 212 http://doi.org/10.1207/S15327051HCI16234_05
R. CampbellM. EvansM. TuckerB. QuiltyP. DieppeJ.L. Donovan 2001 Why Don‟t Patients Do Their Exercises? Understanding Non-Compliance with Physiotherapy in Patients with Osteoarthritis of the Knee J. Epidemiol. Community Heal 55 132 138
C.A. Celis-MoralesF. Perez-BravoL. IbañezC. SalasM.E.S. BaileyJ.M.R. Gill 2012 Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers PLoS One 7 e36345
Clinical Exercise Physiology 2013
S. FaisalA. BlandfordH.W.W. Potts 2012 Making sense of personal health information?: Challenges for information visualization http://doi.org/10.1177/1460458212465213
I. FrederixN. Van DriesscheD. HansenJ. BergerK. BonneT. AldersP. Dendale 2013 Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Eur. J. Prev. Cardiol. http://doi.org/10.1177/2047487313514018
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D. HansenP. DendaleK. ConinxL. VanheesM.F. PiepoliJ. NiebauerV. CornelissenR. PedrettiE. GeurtsG.R. RuizU. CorràJ.-P. SchmidH. Vö Ller 35P. Doherty 2017 The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease Concept . Eur. J. Prev. Cardiol. 24 1017 1031 http://doi.org/10.1177/2047487317702042
D. HansenP. DendaleA. RaskinA. SchoonisJ. BergerI. VlassakR. Meeusen 2010 Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume Clin Rehabil 24 319 327 http://doi.org/10.1177/0269215509353262
D. HarrisonP. MarshallN. Bianchi-BerthouzeJ. Bird 2015 Activity tracking, in: Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ‟15 ACM Press, New York, New York, USA 617 621 http://doi.org/10.1145/2750858.2805832
M. JettéK. SidneyG. Blümchen 1990 Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity Clin. Cardiol. 13 555 565 http://doi.org/10.1002/clc.4960130809
N. KurtzeV. RangulB. Hustvedt 2008 Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study ( HUNT ) population of men 9 1 9 http://doi.org/10.1186/1471-2288-8-63
B.Y. LimA.K. Dey 2013 Evaluating Intelligibility Usage and Usefulness in a Context-Aware Application Springer Berlin Heidelberg 92 101 http://doi.org/10.1007/978-3-642-39342-6_11
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S. SankaranI. FrederixM. HaesenP. DendaleK. LuytenK. Coninx 2016 A Grounded Approach for Applying Behavior Change Techniques in Mobile Cardiac Tele-Rehabilitation in: Proceedings of the 9th ACM International Conference on PErvasive Technologies Related to Assistive Environments - PETRA ‟16 ACM Press, New York, New York, USA 1 8 http://doi.org/10.1145/2910674.2910680
Y. SchutzR.L. WeinsierG.R. HunterR.L. Weinsier 2001 Assessment of Free-Living Physical Activity in Humans?: An Overview of Currently Available and Proposed New Measures 9
K. StawarzA.L. CoxA. Blandford 2015 Beyond Self-Tracking and Reminders?: Designing Smartphone Apps That Support Habit Formation CHI ‟15 Proc. 33rd Annu. ACM Conf. Hum. Factors Comput. Syst. 2653 2662 http://doi.org/10.1145/2702123.2702230
D.P. SwainMedicine., A.C. of S., Medicine., A.C. of S. 2014 ACSM‟s resource manual for Guidelines for exercise testing and prescription Wolters Kluwer Health/Lippincott Williams & Wilkins Philadelphia
R. TavellaK. O‟TooleR. TirimaccoA. LloydK. PenningtonS. DrillingV. PoulsenN. BerryR. ClarkC. AstleyW. Keech 2015 Cardiac rehabilitation referral and completion: results from the South Australian minimum dataset for cardiac rehabilitation programs Hear. Lung Circ. 24 S451 S452 http://doi.org/10.1016/j.hlc.2015.06.786
I. UsesI. Instruments 2005 Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire ( IPAQ ) – Short and Long Forms 1 15
L. VanheesN. GeladasD. HansenE. KouidiJ. NiebauerŽ. ReinerV. CornelissenS. AdamopoulosE. PrescottM. Börjesson 2012 Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (Part II) Eur. J. Prev. Cardiol. 19 1005 1033 http://doi.org/10.1177/1741826711430926
D.L. WaltersA. SarelaA. FairfullK. NeighbourC. CowenB. StephensT. SellwoodB. SellwoodM. SteerM. AustR. FrancisC. LeeS. HoffmanG. BrealeyM. Karunanithi 2010 A mobile phone-based care model for outpatient cardiac rehabilitation?: the care assessment platform ( CAP )

Comments

Comment on this article

[1] B. AINSWORTHW. HASKELLM. WHITTM. IRWIN 2000 Compendium of Physical Activities: an update of activity codes and MET intensities

[2] M. AltiniJ. PendersR. VullersO. Amft 2013 Combining wearable accelerometer and physiological data for activity and energy expenditure estimation in: Proceedings of the 4th Conference on Wireless Health - WH ‟13 ACM Press, New York, New York, USA 1 8 http://doi.org/10.1145/2534088.2534106

[3] V. BellottiK. Edwards 2001 Intelligibility and Accountability: Human Considerations in Context-Aware Systems Human-Computer Interact 16 193 212 http://doi.org/10.1207/S15327051HCI16234_05

[4] R. CampbellM. EvansM. TuckerB. QuiltyP. DieppeJ.L. Donovan 2001 Why Don‟t Patients Do Their Exercises? Understanding Non-Compliance with Physiotherapy in Patients with Osteoarthritis of the Knee J. Epidemiol. Community Heal 55 132 138

[5] C.A. Celis-MoralesF. Perez-BravoL. IbañezC. SalasM.E.S. BaileyJ.M.R. Gill 2012 Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers PLoS One 7 e36345

[6] Clinical Exercise Physiology 2013

[7] S. FaisalA. BlandfordH.W.W. Potts 2012 Making sense of personal health information?: Challenges for information visualization http://doi.org/10.1177/1460458212465213

[8] I. FrederixN. Van DriesscheD. HansenJ. BergerK. BonneT. AldersP. Dendale 2013 Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Eur. J. Prev. Cardiol. http://doi.org/10.1177/2047487313514018

[9] H. GjoreskiB. KalužaM. GamsR. MilićM. Luštrek 2013 Ensembles of multiple sensors for human energy expenditure estimation in: Proceedings of the 2013 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ‟13 ACM Press, New York, New York, USA 359 http://doi.org/10.1145/2493432.2493517

[10] D. HansenP. DendaleK. ConinxL. VanheesM.F. PiepoliJ. NiebauerV. CornelissenR. PedrettiE. GeurtsG.R. RuizU. CorràJ.-P. SchmidH. Vö Ller 35P. Doherty 2017 The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease Concept . Eur. J. Prev. Cardiol. 24 1017 1031 http://doi.org/10.1177/2047487317702042

[11] D. HansenP. DendaleA. RaskinA. SchoonisJ. BergerI. VlassakR. Meeusen 2010 Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume Clin Rehabil 24 319 327 http://doi.org/10.1177/0269215509353262

[12] D. HarrisonP. MarshallN. Bianchi-BerthouzeJ. Bird 2015 Activity tracking, in: Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ‟15 ACM Press, New York, New York, USA 617 621 http://doi.org/10.1145/2750858.2805832

[13] M. JettéK. SidneyG. Blümchen 1990 Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity Clin. Cardiol. 13 555 565 http://doi.org/10.1002/clc.4960130809

[14] N. KurtzeV. RangulB. Hustvedt 2008 Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study ( HUNT ) population of men 9 1 9 http://doi.org/10.1186/1471-2288-8-63

[15] B.Y. LimA.K. Dey 2013 Evaluating Intelligibility Usage and Usefulness in a Context-Aware Application Springer Berlin Heidelberg 92 101 http://doi.org/10.1007/978-3-642-39342-6_11

[16] C. LimA.B. BerryL., T. HirschA.L. HartzlerE.H. WagnerE. LudmanJ.D. Ralston 2016 "It just seems outside my health" in: Proceedings of the 2016 ACM Conference on Designing Interactive Systems - DIS ‟16 ACM Press, New York, New York, USA 1172 1184 http://doi.org/10.1145/2901790.2901866

[17] W.M. Mampuya 2012 Cardiac rehabilitation past, present and future: an overview Cardiovasc. Diagn. Ther. 2 38 49 http://doi.org/10.3978/j.issn.2223-3652.2012.01.02

[18] A.A. O‟KaneH. Mentis 2012 Sharing medical data vs. health knowledge in chronic illness care in: Proceedings of the 2012 ACM Annual Conference Extended Abstracts on Human Factors in Computing Systems Extended Abstracts - CHI EA ‟12 ACM Press, New York, New York, USA 2417 http://doi.org/10.1145/2212776.2223812

[19] Patrick D. SavageBonnie K. SandersonTodd M. BrownK. BerraP.A.A. 2012 Clinical Research in Cardiac Rehabilitation and Secondary Prevention: Looking Back and Moving Forward 31 333 341 http://doi.org/10.1097/HCR.0b013e31822f0f79.Clinical

[20] S.A. PrinceK.B. AdamoM.E. HamelJ. HardtS.C. GorberM. Tremblay 2008 A comparison of direct versus self-report measures for assessing physical activity in adults?: a systematic review 24 http://doi.org/10.1186/1479-5868-5-56

[21] B. RauchC.H. DavosP. DohertyD. SaureM.-I. MetzendorfA. SalzwedelH. Vö LlerK. JensenJ.-P. Schmid 2016 The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies – The Cardiac Rehabilitation Outcome Study (CROS) Eur. J. Prev. Cardiol. 23 1914 1939 http://doi.org/10.1177/2047487316671181

[22] S. SankaranI. FrederixM. HaesenP. DendaleK. LuytenK. Coninx 2016 A Grounded Approach for Applying Behavior Change Techniques in Mobile Cardiac Tele-Rehabilitation in: Proceedings of the 9th ACM International Conference on PErvasive Technologies Related to Assistive Environments - PETRA ‟16 ACM Press, New York, New York, USA 1 8 http://doi.org/10.1145/2910674.2910680

[23] Y. SchutzR.L. WeinsierG.R. HunterR.L. Weinsier 2001 Assessment of Free-Living Physical Activity in Humans?: An Overview of Currently Available and Proposed New Measures 9

[24] K. StawarzA.L. CoxA. Blandford 2015 Beyond Self-Tracking and Reminders?: Designing Smartphone Apps That Support Habit Formation CHI ‟15 Proc. 33rd Annu. ACM Conf. Hum. Factors Comput. Syst. 2653 2662 http://doi.org/10.1145/2702123.2702230

[25] D.P. SwainMedicine., A.C. of S., Medicine., A.C. of S. 2014 ACSM‟s resource manual for Guidelines for exercise testing and prescription Wolters Kluwer Health/Lippincott Williams & Wilkins Philadelphia

[26] R. TavellaK. O‟TooleR. TirimaccoA. LloydK. PenningtonS. DrillingV. PoulsenN. BerryR. ClarkC. AstleyW. Keech 2015 Cardiac rehabilitation referral and completion: results from the South Australian minimum dataset for cardiac rehabilitation programs Hear. Lung Circ. 24 S451 S452 http://doi.org/10.1016/j.hlc.2015.06.786

[27] I. UsesI. Instruments 2005 Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire ( IPAQ ) – Short and Long Forms 1 15

[28] L. VanheesN. GeladasD. HansenE. KouidiJ. NiebauerŽ. ReinerV. CornelissenS. AdamopoulosE. PrescottM. Börjesson 2012 Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (Part II) Eur. J. Prev. Cardiol. 19 1005 1033 http://doi.org/10.1177/1741826711430926

[29] D.L. WaltersA. SarelaA. FairfullK. NeighbourC. CowenB. StephensT. SellwoodB. SellwoodM. SteerM. AustR. FrancisC. LeeS. HoffmanG. BrealeyM. Karunanithi 2010 A mobile phone-based care model for outpatient cardiac rehabilitation?: the care assessment platform ( CAP )

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