B&NES Pilot: Employee Wellbeing Evaluation Report

9 March 2022

University of Bath: Novel approaches to evaluating continuous free-living physical activity data

25 February 2022

Liverpool University Hospitals NHS Trust: Cardiac Rehabilitation Study

25 February 2022

St George’s University Hospitals NHS: Lymphoedema & Lipodema

3 February 2022

Sirona Care and Health & West England AHSN: Moving to Better Health

3 February 2022

Executive Summary

Coming Soon.

NHS Glos. CCG: Type 2 Diabetes & Prediabetes

3 February 2022

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Physical activity is fundamental to the treatment of Type 2 Diabetes and should be prescribed by a healthcare professional at initial diagnosis, prior to medications (Nathan et al., 2009), and continue throughout the management of the condition (Duclos et al., 2015; Andrews et al., 2011). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with Type 2 Diabetes and Prediabetes, in order to better manage their condition and reduce the likelihood of further complications.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients diagnosed with Type 2 Diabetes or Prediabetes to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter or email sent out by their GP practice, or through community services. Once enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® mentor. Data was analysed from a range of sources: the KiActiv® Health platform, and KiActiv® Mentor calls.

Key Findings

  • Demographics: 554 patients started KiActiv® Health (241 females, 313 males), average age = 63 years, average body mass index (BMI) = 32.5kg/m2.
  • Completion: 422 patients (76.2%) (173 females, 249 males) have completed the 12-week programme and 11 (2.0%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 92.5% of days being classed as having complete data.
  • Patient Reported Benefits:
    • Weight Loss average of 3.2kg over the 12 weeks.
    • Improvements in HbA1c and a reduction in blood glucose levels to pre-diabetic levels.
    • Reduction in diabetes-specific medication use.
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
    • Benefits to other aspects of lifestyle such as improved sleeping patterns and healthier eating habits.
    • Feelings of empowerment, autonomous choice and support from the KiActiv® Mentor, which promoted sustainable behaviour change.
    • Improvements in quality of life.
    • Reduced Fatigue.
    • Improved Mental Health.
  • Physical Activity Data:
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 100% of patients improved their physical activity in 3+ dimensions.
    • 88% of patients improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +29hrs 43mins (+16%)
      • Moderate Activity: +13hrs 24mins (+40%)
      • Moderate Bouts: +9hrs 22mins (+851%)
      • Calorie Burn: +5,867kcals (+3%)
    • 86.7% of the group achieved physical activity levels exceeding 150 mins of Moderate Activity per week, which is associated with reductions in HbA1c of 0.89% (Umpierre et al., 2011).

Amongst the 121 patients who did not complete the full 12-week programme, some patients indicated that ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they were simply too busy to find the time to engage with the programme.

Conclusion

It is widely accepted that physical activity is an effective method for managing Type 2 Diabetes and is recommended in the NICE Guidelines (NICE NG17, 2015; NICE NG28, 2015). Physical activity has been shown to directly improve glycaemic control (Kujala, 2009) as well as reducing body weight, which is crucial for the control of Type 2 Diabetes (Wilding, 2014). The physical activity improvements demonstrated by this cohort are associated with reductions in HbA1c that are comparable to those seen with oral antidiabetic medication (Sherifali et al., 2010).

KiActiv® Health increased self-management skills and participants received person-centred care along with tailored individual advice on optimising their daily physical activity to improve self-management of their diabetes and any comorbidities. The remote nature of KiActiv® Health overcomes the travel barrier, ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions but reducing our reliance on transport to receive care will also reduce carbon emissions, supporting the vision for a healthier planet. Ultimately, KiActiv® Health provides support to those diagnosed with Type 2 Diabetes to optimise their physical activity for the good of their health, which can help to reduce the burden of further associated health complications in the future.

29th November 2021

Liverpool University Hospitals NHS: Cardiac Rehabilitation

3 February 2022

Professor Michael Fisher, Dr Tom Rayner, iBSc. (Hons), MBChB., Kirstie Tew, MSc.

Executive Summary

Background

During the COVID-19 pandemic, the provision of face-to-face cardiac rehabilitation (CR) has been scaled back due to national lockdowns and social distancing rules. The clinical team felt that KiActiv® Health could be a valuable tool in addressing this service disruption to support eligible patients and empower them to optimise their recovery and prevent significant unintended long-term consequences.

Innovation

KiActiv® Health is a personalised and guided online behaviour change intervention that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

The aim of this pilot study, was to provide a digital support service to patients who were not able to access CR, with the goal of promoting positive behaviour change and optimising physical activity in the context of their condition.

Methodology

Between September 2020 and April 2021, adult patients referred for CR at LUH were introduced to KiActiv® Health at their initial assessment by either a clinician or specialist CR Nurse who confirmed their eligibility and provided an activity monitor. The patient was then contacted by KiActiv® to ensure that they were eligible to take up the service, complete the enrolment process and arrange a start date. The 12-week KiActiv® Health programme began with a set-up call with a KiActiv® Mentor.

In addition to collecting objective physical activity data and qualitative data from 2-hours of Mentor calls, patients also completed validated self-report questionnaires (HADS and Dartmouth COOP) at their initial and final assessments.

Key Findings

  • Demographic: 17 people started the programme (14 Males, 3 Females), average age = 58 years, average BMI = 29.4 kg/m2, range of diagnoses leading to CR referral, range of comorbidities.
  • Completion: 82% of patients completed the 12-week programme.
  • Engagement: The use of the technology was excellent and included 92% of days being classed as having complete data sets. 79% of patients continued to engage with their KiActiv® technology beyond the initial 12-week programme.
  • PROMS: Statistically significant improvements were seen in self-reported Physical Fitness and Overall Health measured using the Dartmouth Coop Charts.
    • Improvements were seen in 8 of the 9 domains.
    • 100% of patients improved in at least 1 domain.
  • Mental Wellbeing:
    • 56% of patients showed an improvement in their scores for anxiety and 56% in their scores for depression, assessed using the HADS score.
    • The mean symptom scores improved for both anxiety and depression, despite the majority of people being categorised as “normal” at baseline.
  • Physical Activity Data: A large proportion of participants were able to improve their physical activity.
    • 93% of people improved their physical activity in 1+ dimension
    • 79% of people improved their physical activity in 3+ dimensions
    • 64% of people improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +58hrs 10mins (+32%)
      • Moderate Activity: +33hrs 43mins (+69%)
      • Moderate Bouts: +31hrs 27mins (+1004%)
      • Calorie Burn: +12,002kcals (+6%)
    • Based on the scientific evidence, the total dose of Moderate Activity of 33-hours and 43-mins reported here could produce changes in cardiorespiratory fitness (CRF) of 1.10 to 2.92 metabolic equivalents (METs). A 1 MET increase in CRF reduces all-cause and Coronary Heart Disease (CHD)/Cardiovascular Disease (CVD) mortality by 13% and 15%, respectively (Kodama et al., 2009), and as such, the improvement shown in the present analysis could equate to reductions in all-cause and CHD/CVD mortality anywhere from 14.3% to 38.0% and from 16.5% to 43.8%, respectively.
  • Patient reported benefits included:
    • An increased awareness of physical activity and the value of everyday movement, with many clients shifting their perspective away from solely focusing on traditional exercise and recognise the importance of everyday movement too. Understanding the accessibility of everyday physical activity, where many had previously disregarded activity as unachievable and daunting.
    • Feelings of empowerment, autonomous choice and self-management, which promote sustainable behaviour.
    • Motivation to improve other health behaviours including improvements to their diet and consequential weight loss

Amongst the 3 patients who did not complete the full 12-week programme, 1 chose to withdraw stating that they did not have the want nor motivation to engage with the system. Two patients disengaged and did not respond to contact.

Conclusion

This pilot demonstrates the effectiveness of KiActiv® Health as a tool for supporting and encouraging patients to optimise their physical activity and recovery in the wake of a cardiac event, and to improve the management of heart failure.

The disruption caused by the COVID-19 pandemic to usual CR services has highlighted the appeal and accessibility to patients of this remote service, which suggests that it may similarly engage those patients unable or unwilling to attend current provisions going forward. The pilot was offered to phase-3 CR patients only but the results suggest that it can be equally successful with those requiring phase-4 CR and managing heart failure. The programme delivers person centred care at home and without the need to travel.

The 12-week KiActiv® Health programme is currently employed by the NHS in multiple pathways and can be scaled immediately across the country to offer eligible patients the support they need and deserve, as well as helping to manage growing waiting lists and reduce mounting pressure on CR services.

1st November 2021

NHS Glos. CCG: Pulmonary Rehabilitation

3 February 2022

Kirstie Tew, MSc., Abby Barton, BSc., Sophie Middleton

Executive Summary

Background

Physical activity has numerous benefits for people with pulmonary conditions and is the cornerstone of Pulmonary Rehabilitation (PR). During the COVID-19 pandemic, healthcare practitioners were unable to provide their usual offering of group-based face-to-face PR, leading to rapidly growing waiting lists. NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who were waiting to receive traditional PR, in order to better manage their condition and ease pressures on growing waiting lists.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/Objective

To provide an accessible supplementary service to traditional PR for those who were unable to attend in-person PR due to the COVID-19 pandemic, with the aim of helping to manage growing waiting lists.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter sent from the Gloucestershire PR team. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire (completed pre- and post-intervention). 

Key Findings

  • Demographics: 80 patients started KiActiv® Health as part of the first cohort (44 females, 36 males), average age = 70 years, average body mass index (BMI) = 28.6kg/m2.
  • Completion: 42 patients (53%) (22 females, 20 males) have completed the 12-week programme. 18 patients (23%) are currently within their 12-week KiActiv® Health programme.
  • Engagement: The use of the technology was excellent and included 92% of days being classed as having complete data sets.
  • PROM’s: All values reported as mean (±SD) unless otherwise stated.
    • Patients experienced statistically significant improvements in their COPD Assessment Test (CAT).
      • The average CAT score decreased in response to KiActiv® Health, by 1.94 points, from a mean of 24.75 (±7.27) at baseline to 22.81 (±7.53) post-intervention (p=0.008).
      • A reduction of 2 points or more on the scale is deemed clinically meaningful (Kon et al., 2014).
      • Those most at-risk saw the greatest improvement in CAT scores, with the 9 patients who started at ‘Very high’ health impact reducing by a mean of 5.20 (±3.51) points.
      • Overall, 78.1% of patients decreased their CAT scores across the 12-weeks.
    • Patients experienced a statistically significant improvement to their average knowledge score.
      • Responses improved from a mean of 2.75 (±0.57) at baseline to 3.28 (±0.52) post-intervention (p=0.0002).
      • Patients were responding to the following statement: “I know how to take appropriate steps to improve my physical activity levels.”
      • Post-intervention, 96.8% of respondents answered either ‘Agree’ or ‘Strongly Agree’ to this question.
    • Patients experienced a statistically significant improvement to their average confidence score.
      • Responses improved from a mean of 2.31 (±0.69) at baseline to 2.69 (±0.64) post intervention (p=0.04).
      • 31.3% of respondents answered ‘Agree’ or ‘Strongly Agree’ at baseline, compared to 59.4% after 12-weeks.
      • Patients were responding to the following statement: “I feel confident in my ability to perform physical activity”.
  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity.
    • Feelings of empowerment, autonomous choice and support from the KiActiv® Mentor, which promoted sustainable behaviour change.
    • The ability to plan, self-manage, and improve daily physical activities.
    • A sense of control around how everyday physical activities affect their health and wellbeing.
  • Physical Activity Data: In their 2020 Cochrane Review, Burge and colleagues found that, in comparison to no intervention, the mean difference in time spent in moderate to vigorous intensity physical activity following pulmonary rehabilitation was 4-minutes per day. On average, KiActiv® Health participants increased in the same dimension by a total of 12-hours 31-minutes over 69 complete days, which is equivalent to 11-minutes per day of the intervention.
    • 100% of patients improved their physical activity in 3+ dimensions
    • 68% of patients improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 69 complete days were:
      • Non-Sedentary Time: +22hrs 50mins (+14%)
      • Moderate Activity: +12hrs 31mins (+33%)
      • Moderate Bouts: +6hrs 36mins (+587%)
      • Calorie Burn: +4,318kcals (+2%)

Amongst the 20 patients who did not complete the full 12-week programme, some patients indicated that ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they were simply too busy to find the time to engage with the programme.

Conclusion

Previous research with COPD patients indicates that without an intervention, physical activity levels over a 16-week period remain stable in less severe stages (Global Initiative for Chronic Obstructive Lung Disease 2011 Group [GOLD] A, B and C; Agarwal et al., 2012) and declined in those with the most severe COPD (GOLD D). When observed over a period of 18 months to 3 years, physical activity has been shown to substantially decrease across all severity stages of COPD (Durheim et al., 2015; Waschki et al., 2015)

On average, KiActiv® Health participants increased in the same dimension by a total of 12-hours 31-minutes over 69 complete days, which is equivalent to 11-minutes per day of the intervention. This demonstrates a near 3-fold improvement on current care.

KiActiv® Health increased self-management skills and participants received person-centred care along with tailored individual advice on managing their daily activity to best support their respiratory diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. This helps reduce carbon emissions, by reducing the number of unnecessary visits to healthcare facilities. It may also provide a good alternative to face-to-face PR for those who are unwilling or unable to access the traditional service.

31st January 2022

NHS Glos. CCG: Long COVID

3 February 2022

Kirstie Tew, MSc., & Sophie Middleton

Executive Summary

Background

Since the COVID-19 pandemic began in early 2020, almost 600,000 people in the UK have been hospitalised after contracting COVID-19, with up to 4,000 patients receiving treatment in the intensive therapy unit (ITU) at any one time (GOV.UK, 2021). Many other individuals who have received a COVID-19 diagnosis, whether they have been hospitalised or not, are suffering from a novel condition referred to as long COVID, which is commonly associated with ongoing symptoms including chronic fatigue and shortness of breath. NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals suffering with the ongoing effects of long COVID to improve self-management.

Innovation

KiActiv® Health is a personalised and guided online service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients suffering with long COVID to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® Mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire. 

Key Findings:

  • Demographics: 25 patients started KiActiv® Health (13 females, 12 males), average age = 49 years, average body mass index (BMI) = 28.8kg/m2.

  • Completion: 12 patients (7 females, 5 males) have completed the 12-week programme to date. 13 patients are within the 12-week programme.

  • Engagement: The use of the technology was excellent and included 99% of days worn within programme, of which 90% of days were classed as having complete data sets.

  • PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv® Health.
    • 80.0% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health.
    • 80.0% of respondents felt confident that they could manage their physical activity for their overall health now and in the future.
    • 80.0% of patients felt that KiActiv® Health had benefitted them in some way.
    • 80.0% of patients stated that they would recommend KiActiv® Health to a family member or friend.

  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
    • Improved pulmonary symptoms (i.e., reduced breathlessness, improved lung capacity).
    • Benefits to other aspects of lifestyle such as improved sleep, feeling fitter, stronger and more energised.
    • The ability to set realistic goals, self-manage, and improve daily physical activities.
    • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall QoL.

  • Physical Activity Data: Increasing physical activity is not always the primary goal for people recovering from hospitalisation due to COVID-19 or for those living with long COVID. However, 11 clients (91.7%) expressed that they wanted to increase their physical activity levels, yet many wanted to be cautious and not risk doing too much.
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 100% of patients improved their physical activity in 3+ dimensions.
    • 73% of patients improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +23hrs 52mins (+12%)
      • Moderate Activity: +10hrs 35mins (+100%)
      • Moderate Bouts: +1hr 7mins (+2,068%)
      • Calorie Burn: +5,167kcals (+2%)

Seven clients (58.3%) reported experiencing breathlessness similar to other pulmonary conditions such as COPD. Additional Moderate Activity carried out above baseline during the programme for these 7 individuals was 6-hours and 29-minutes across 68 complete days, equivalent to 5.7-minutes extra per day. A 2020 Cochrane Review found that following pulmonary rehabilitation, participants improved by an average of 4-minutes per day (Burge et al., 2020). As such, the cohort in this report likely received greater benefits than those experienced following a course of pulmonary rehabilitation.

Conclusion

KiActiv® Health proved effective amongst this cohort in part due to the accessibility of everyday physical activity, shifting the narrative away from structured exercise, instead adopting a more personalised approach to everyday physical activity, where the individual is able to self-manage their physical activity to determine what works best for them. This is important within this group, physical activity is often avoided by individuals with long COVID and those recovering from hospitalisation due to COVID-19 given the effect of physical exertion on cognitive and physical fatigue (Rudrofff et al., 2020). Despite such perceptions, maintaining and improving physical activity is extremely important as it has been shown to reduce breathlessness, as well as increase muscle strength and exercise capacity (Lan et al., 2013; Torres-Sánchez et al., 2017).

KiActiv® Health also provided patients with the tools to optimise physical activity to better manage fatigue levels. This is important given that COVID-19 rehabilitation and long COVID management must be tailored to the individual, accounting for their personal experiences of fatigue symptoms and post-exertional malaise (Nijs et al., 2004; Larun and Malterud, 2011; Humphreys et al., 2021). The one client who did not aim to increase their physical activity was able to identify and maintain an optimum level of physical activity to better self-manage their fatigue.

KiActiv® Health increased self-management skills and participants received person-centered care along with tailored individual advice on managing their daily activity to best support their rehabilitation from hospitalisation due to COVID-19 or ongoing management of long COVID symptoms. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions, reducing our reliance on transport to receive healthcare will also reduce carbon emissions, supporting the vision for a greener, healthier planet.

These results should also be reviewed in the context of our recently published pilot for patients with CFS/ME undertaken on behalf of the NHS, which included enrolments during the pandemic and highlight valuable comparisons.

23rd December 2021

Wiltshire Health and Care & West England AHSN: Keeping Active During COVID-19

3 February 2022

Rosie Brown, Emily Bull, Nikie Catchpool, Claire Fox, Anne Johnson, Alex Leach, Hayley McBain, Tommy Parker, Kirstie Tew, Sam Tuvey

Executive Summary

Background

During the COVID-19 pandemic Wiltshire Health and Care (WHC) were unable to provide group face-to-face Pulmonary Rehabilitation (PR). The clinical team and commissioners felt that KiActiv® Health could be a valuable tool to support isolated, vulnerable people living with a respiratory condition to better manage their condition and prevent deterioration.

Innovation

This pilot evaluated KiActiv® Health, a personalised and guided online behaviour change intervention that empowers participants to optimise their everyday physical activity in the context of the condition. KiActiv® Health provides an interactive personalised dashboard to display accurate physical activity data and is supported remotely by phone calls with a dedicated Mentor over 12-weeks. At the end of the 12-weeks, participants retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

As WHC was unable to provide group face-to-face PR, the clinical team and commissioners felt that KiActiv® Health could be useful for those patients who would normally be referred for PR. The main objective of this pilot was to offer a remote solution to support isolated, vulnerable patients who are living with a respiratory condition. 

Methodology

Patients were assessed by the WHC respiratory team, and 29 people with a respiratory diagnosis and a Medical Research Council Dyspnoea Scale score of 3 or more were invited to pilot KiActiv® Health. Data for this pilot was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, a self-administered online questionnaire (completed pre- and post-intervention) and a post-intervention questionnaire provided by the WHC clinical team. 

Not all participants had completed their 12-weeks when the published report was written and no physical activity was included. Subsequent to the final participant completing we have now analysed and evaluated their physical activity in the context of the condition pathway, which is available to view.

Key Findings

  • Uptake: All 29 people who were offered KiActiv® Health contacted KiActiv® to express their interest, and 28 of those completed their enrolment (97%).
  • Completion: 89% of people who enrolled completed the 12-week programme.
  • Engagement: The use of the technology was excellent and included 80% of days being classed as having complete data sets.
  • PROMS: A statistically significant number of participants reported that they felt more confident in their ability to be physically activity following KiActiv® Health
    • More people responded that they “Agree” or “Strongly agree” with the following statements at the end of 12-weeks compared to baseline:
      • ‘I know how to take appropriate steps to improve my physical activity levels’
      • ‘I feel confident in my ability to manage my condition’
      • ‘I feel supported and connected when it comes to managing my health’
    • On completion of the 12-week programme, 85% of people that responded felt that KiActiv® Health had met their expectations and included:
      • improved breathing
      • a better understanding of physical activity and health
      • improved overall health
    • 61% of people expressed feeling better as a result of their participation in KiActiv® Health, with reported benefits being both physical and mental.
      • This was despite the reported negative impact of the Covid-19 restrictions and other external factors such as illness and injury.
    • Patient reported benefits included:
      • An increased awareness of all movement, not just exercise
      • Understanding the accessibility of everyday physical activity
      • Feelings of empowerment, autonomous choice and self-management, which promoted sustainable behaviour change
      • The ability to undertake physical activities which they had previously stopped (i.e., climbing the stairs, walking for longer without the need for a walking stick)
  • Physical Activity Data: A statistically significant number of participants showed a clinically meaningful improvement in physical activity.
    • 100% of people improved their physical activity in 3+ dimensions
    • 68% of people improved their physical activity in 4+ dimensions
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 70 complete days were:
      • Non-Sedentary Time: +20hrs 35mins (+11%)
      • Moderate Activity: +8hrs 41mins (+225%)
      • Moderate Bouts: +5hrs 19mins (+269%)
      • Calorie Burn: +3,676kcals (+2%)

Amongst the 3 patients who did not complete the full 12-week programme, one did not attend their first mentor session. The other 2 patients chose to withdraw, without citing a specific reason.

Conclusion

Previous research with COPD patients indicates that without an intervention, physical activity levels over a 16-week period remain stable in less severe stages (GOLD A, B and C; Agarwal et al., 2012) and declined in those with the most severe COPD (Global Initiative for Chronic Obstructive Lung Disease 2011 Group [GOLD] D). When observed over a period of 18 months to 3 years, physical activity has been shown to substantially decrease across all severity stages of COPD (Durheim et al., 2015; Waschki et al., 2015).

In their 2020 Cochrane Review, Burge and colleagues found that, in comparison to no intervention, the mean difference in time spent in moderate to vigorous intensity physical activity following pulmonary rehabilitation was 4-minutes per day.

On average, KiActiv® Health participants increased in the same dimension by a total of 521-minutes over 70 complete days, which is equivalent to 7.4-minutes per day of the intervention.

The pilot met its objectives which suggests that KiActiv® facilitates increased self-management skills and participants in the project received person-centred care along with tailored individual advice on managing their daily activity to best support their respiratory diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants were supported from the safety of their own homes. It may also provide a good alternative to face-to-face PR for those who are unwilling or unable to access the traditional service.

August 2021

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