NHS Glos. CCG: Hypertension

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

Executive Summary

Background

It is estimated that just over a quarter of adults in the UK, around 14.4 million people, have hypertension, with many individuals undiagnosed (British Heart Foundation, 2019). Physical activity has numerous benefits for people with hypertension. NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with hypertension, in order to better manage their condition and reduce the likelihood of major cardiovascular disease (CVD) related hospital admissions.

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 hypertension 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 sent out by their GP practice. 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: 171 patients started KiActiv® Health (88 females, 83 males), average age = 64 years, average body mass index (BMI) = 30.8kg/m2.
  • Completion: 140 patients (81.9%) (69 females, 71 males) have completed the 12-week programme.
  • Engagement: The use of the technology was excellent and included 89.1% of days being classed as having complete data sets.
  • PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv® Health.
    • 93.9% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health.
    • 97.0% of respondents felt confident that they could manage their physical activity for their overall health now and in the future.
    • 95.5% of patients felt that KiActiv® Health had benefitted them in some way.
    • 95.5% 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.
      • Benefits to other aspects of lifestyle such as improved sleep, reduced anxiety, and healthier eating habits.
      • 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, which has led to an improvement in quality of life.
  • Physical Activity Data: Dosage of physical activity is known to aid with reductions in systolic and diastolic blood pressure.
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 99% of patients improved their physical activity in 3+ dimensions.
    • 94% 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: +30hrs 24mins (+15%)
      • Moderate Activity: +15hrs 31mins (+34%)
      • Moderate Bouts: +13hrs 7mins (+1,360%)
      • Calorie Burn: +6,007kcals (+3%)
    • In a randomized controlled trial of 26 hypertensive patients, the intervention group completed 30-minutes of aerobic physical activity 4 times per week, for 10 weeks, equating to an additional dosage of 20hrs (Martin, Dubbert and Cushman, 1990).
      • The exercise modalities employed in this intervention most closely align to the Moderate Activity dimension of physical activity in KiActiv® Health.
      • The intervention group achieved a statistically significant reduction in diastolic blood pressure of -9.6 mmHg and a statistically significant reduction in systolic blood pressure of -6.4 mmHg.
      • As such, it could be suggested that the total dose of Moderate Activity of 15-hours and 31-minutes reported across the duration of the KiActiv® Health programme, could produce a reduction in diastolic blood pressure and systolic blood pressure of -7.4 mmHG and -5.0 mmHG, respectively.

Amongst the 31 patients who did not complete the full 12-week programme, some patients indicated that significant injury or ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology, and some stated that they lacked motivation or were simply too busy to find the time to engage with the programme.

Conclusion

Research studies have consistently demonstrated the beneficial effects of physical activity for individuals with hypertension, with greater reductions in blood pressure observed in individuals with hypertension than those with a lower blood pressure. Amongst patients with hypertension, physical activity is capable of eliciting blood pressure reductions by as much as 7 mmHg systolic and 5 mmHg diastolic (Cornelissen and Fagard, 2005).

When physical activity outcomes in this report are compared to findings from previous studies, the additional dosage of physical activity is able to elicit reductions in diastolic blood pressure and systolic blood pressure of -7.4 mmHG and -5.0 mmHG, respectively. Even modest reductions in blood pressure (2-3mmHg) achieved through physical activity can decrease coronary heart disease risk by 5% to 9%, stroke risk by 8% to 14% and all-cause mortality by 4% in the general population (Pescatello et al., 2004), and, as such, this cohort could have received even greater risk reductions and health benefits.

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 hypertension diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. This reduces carbon emissions associated with unnecessary visits to healthcare facilities. Ultimately, KiActiv® Health supports those with hypertension to optimise their physical activity for the good of their health, which can help to reduce the burden of CVD related health outcomes.

7th December 2021