title: Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study.
abstract: BACKGROUND
  Exercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program.
  
  
  METHODS
  A qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included.
  
  
  RESULTS
  The pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient's choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals' surveillance of patients' steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners.
  
  
  CONCLUSIONS
  Cardiac patients' motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported.
  
  
  BACKGROUND
  Current study is a part of The Teledi@log project.
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark ; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, DK-9220 Aalborg, Denmark.
authors.forename: Charlotte Brun
authors.initials: CB
authors.lastname: Thorup
authors.affiliation: Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Grønkjær
authors.affiliation: Department of Psychology and Behavioural Science, Aarhus University, Bartholins Allé 9, DK-8000 Aarhus C, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Spindler
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark.
authors.forename: Jan Jesper
authors.initials: JJ
authors.lastname: Andreasen
authors.affiliation: Laboratory for Cardio technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, DK-9220 Aalborg, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Laboratory of Assistive Technologies - Telehealth and Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Birthe Irene
authors.initials: BI
authors.lastname: Dinesen
authors.affiliation: Department of Cardiology, Vendsyssel Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Nielsen
authors.affiliation: Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark.
authors.forename: Erik Elgaard
authors.initials: EE
authors.lastname: Sørensen
keywords: Cardiac telerehabilitation; Pedometer; Physical activity; Telemedicine