title: Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial.
abstract: BACKGROUND
  Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients' adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event.
  
  
  OBJECTIVE
  The purpose of this substudy was to explore cardiac patients' walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data.
  
  
  METHODS
  A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps.
  
  
  RESULTS
  Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups.
  
  
  CONCLUSIONS
  This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV).
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark. cbt@rn.dk.
authors.forename: Charlotte
authors.identifier: http://orcid.org/0000-0002-7519-2639
authors.initials: C
authors.lastname: Thorup
authors.forename: John
authors.identifier: http://orcid.org/0000-0003-4989-8117
authors.initials: J
authors.lastname: Hansen
authors.forename: Mette
authors.identifier: http://orcid.org/0000-0003-1558-7062
authors.initials: M
authors.lastname: Grønkjær
authors.forename: Jan Jesper
authors.identifier: http://orcid.org/0000-0002-2382-3734
authors.initials: JJ
authors.lastname: Andreasen
authors.forename: Gitte
authors.identifier: http://orcid.org/0000-0001-8300-1938
authors.initials: G
authors.lastname: Nielsen
authors.forename: Erik Elgaard
authors.identifier: http://orcid.org/0000-0001-6293-0447
authors.initials: EE
authors.lastname: Sørensen
authors.forename: Birthe Irene
authors.identifier: http://orcid.org/0000-0001-5893-9676
authors.initials: BI
authors.lastname: Dinesen
mesh_terms: D056044:Actigraphy; D000368:Aged; D003718:Denmark; D005260:Female; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D016032:Randomized Controlled Trials as Topic; D000069350:Telerehabilitation; D016138:Walking
keywords: heart disease; physical activity; rehabilitation; step counters; telerehabilitation