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

Filed Under

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

Filed Under

NHS Glos. CCG: Obesity

3 February 2022

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

Executive Summary

Background

Reducing body weight is crucial for obese individuals to lower their risk of many co-morbidities alongside gaining other physiological and psychological health benefits that come with losing weight. Physical activity is key for weight loss as it increases metabolic rate, which results in increased energy expenditure and thus, negative energy balance (Van Baak, 1999). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support obese individuals with a body mass index (BMI) greater than 30.0 kg/m2, in order to better self-manage their condition and reduce the likelihood of complications which could lead to hospital admission.

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 obese patients 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: 393 patients started KiActiv® Health (208 females, 185 males), average age = 59 years, average body mass index (BMI) = 36.4kg/m2.
  • Completion: 303 patients (77.1%) (161 females, 142 males) have completed the 12-week programme.
  • Engagement: The use of the technology was excellent and included 91% 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.
    • 96.1% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health
    • 92.1% of respondents felt confident that they could manage their physical activity for their overall health now and in the future
    • 86.8% of patients felt that KiActiv® Health had benefitted them in some way
    • 93.4% 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
    • Weight loss (for those who set out to achieve this)
    • Benefits to other aspects of lifestyle such as improved sleep, and healthier eating habits.
    • Reduced blood sugar levels
    • The ability to plan, self-manage, and improve daily physical activities
    • The desire to sustain the positive changes that have been made to their lifestyle
  • Weight Loss:
    • Of the patients who reported their weight pre- and post-programme, 80% reported a weight loss
    • The average weight loss recorded was 3.8 kg, equivalent to an average reduction of 3.6% of overall body weight
    • 27.3% of people who reported a weight loss were able to lose at least 5% of their body weight during the 12-weeks
  • Physical Activity Data:
    • 100% of patients improved their physical activity in 1+ dimensions
    • 100% of patients improved their physical activity in 3+ dimensions
    • 86% 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 66 complete days were:
      • Non-Sedentary Time: +27hrs 28mins (+14%)
      • Moderate Activity: +12hrs 12mins (+31%)
      • Moderate Bouts: +9hrs 34mins (+843%)
      • Calorie Burn: +6,203kcals (+3%)

Amongst the 90 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

It is essential to incorporate physical activity into everyday life as it increases metabolic rate, which results in increased energy expenditure (Van Baak, 1999). For some patients, weight loss was a key goal for them whilst on the programme. Of those who did report weight pre- and post-programme, 80% of patients reported an average weight loss of 3.8 kg. 27.3% of people who reported a weight loss were able to lose at least 5% of their body weight during the 12-weeks.

Having said this, physical activity is a recommended intervention under the NICE guidelines for people with obesity, even if they do not lose weight as a result, because of the other health benefits it can bring (NICE CG189). Therefore, the impressive level of physical activity behaviour change amongst this cohort will carry tangible health benefit. Patients also displayed a remarkable appetite to self-manage their physical activity, demonstrated by the high levels of engagement for all aspects of KiActiv® Health.

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 condition. 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 care will also reduce carbon emissions, supporting the vision for a healthier planet.

26th January 2022

Filed Under

Bath Centre for Fatigue Services & West England AHSN: Replenish-ME

3 February 2022

Executive Summary

Background

The “Replenish-ME” project, was co-designed to use the KiActiv® Health self-management programme in parallel with NHS current services for patients living with Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME). The clinical team felt that KiActiv® Health could be a valuable tool to provide patients with an alternative, or additional, method of recording engagement in their daily activities/occupations. The personalised intervention was perceived as enabling a more objective and detailed understanding of individual routines and energy expenditure, than the current activity, rest and sleep logs used in current services.

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

This pilot looked to explore whether KiActiv® Health could help those diagnosed with CFS/ME to improve the self-management of their condition by developing a greater understanding of how their day-to-day activities impact on their health and energy levels. In the context of CFS/ME, understanding how daily physical activities impact on energy balance, enables patients to maintain a level of movement within their energy availability, and is an important component of effective self-management.

Methodology

Between February and September 2020, referrals were made to KiActiv® from an NHS Fatigue Management Service.

In addition to collecting objective physical activity data and qualitative data from 2-hours of Mentor calls, patients completed validated pre- and post- intervention questionnaires, including the Chronic Fatigue Acceptance Questionnaire (CFAQ-8), and the Visual Analogue Scale (VAS) extracted from the EuroQol five-dimension questionnaire (EQ-5D). Two single-item worded questions graded on a 4-point Likert scale relating to awareness and confidence were also asked.

Key Findings

  • Demographic: 46 patients contacted KiActiv®, and 43 patients (8 males, 35 females) were enrolled on the programme. Average age = 38 years, average BMI = 26 kg/m2.
  • Completion: 41 patients (95%) 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. 76% of patients continued to engage with their KiActiv® technology beyond the initial 12-week programme.
  • PROMS: Statistically significant improvements were seen in CFAQ-8, EQ5D, awareness and confidence.
    • 64% of patients felt better able to pursue life activities regardless of their fatigue
    • 60% of patients gained greater awareness of how different activities could impact on their energy expenditure
    • 60% of patients were more accepting of their fatigue, culminating in a statistically significant improvement in overall health
      • This was despite a wide array of negative impacts such as the Covid-19 pandemic and illness, as well as other negative impacts specific to a CFS/ME cohort
    • 54% of participants improved their confidence in their ability to manage and pace their daily activities to optimise energy levels
    • 71% of patients believed that KiActiv® Health met or exceeded their expectations

  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise. This translated into increased understanding regarding how various everyday activities contribute to daily energy expenditure, and their subsequent impact on energy levels
    • Enhanced knowledge regarding how to effectively pace daily activities to better manage energy levels, which translated into an improved ability to self-manage
    • The ability to keep a consistent log of objectively measured physical activity, replacing the need for physical diaries or logs, which are often time and energy consuming
    • By improving their ability to efficiently manage their energy levels, some participants were able to undertake physical activities which they had previously stopped (i.e., going out for a walk with their partner, when they had previously felt too fatigued as a result of ‘overdoing it’ earlier in the day, or on previous days)

Of the 2 patients who did not complete the full 12-week programme, 1 did not have the required technology to start the programme, and the other withdrew citing the desire to focus solely on their current care.

Conclusion

The results from this pilot indicate that the use of KiActiv® Health can have a positive impact amongst patients diagnosed with CFS/ME. Once recruited to KiActiv® Health, patients were highly adherent and unlikely to drop out of the programme. For these patients, engagement in the mentoring sessions, wearing of the physical activity monitor, and syncing of the device, suggested that CFS/ME patients valued the innovation. CFS/ME patients particularly liked how the technology allowed them to objectively assess their physical activity energy expenditure, which in turn enabled them to make better informed decisions to improve energy management.

The disruption caused by the COVID-19 pandemic to usual CFS/ME 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. This pilot was offered to CFS/ME patients only but the results suggest that it could be equally successful amongst those diagnosed with other fatigue-inducing conditions, such as long COVID. 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 rehabilitation services.

Filed Under

NHS Glos. CCG: Pulmonary Conditions

3 February 2022

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

Executive Summary

Background

Regular physical activity improves breathing and can reduce other symptoms of pulmonary conditions, such as Chronic Obstructive Pulmonary Disease (COPD) and Asthma, as well as benefiting mental and physical wellbeing and quality of life (QoL). Many people actually find that the benefits of being active exceed those of inhaled drugs (British Lung Foundation, 2019). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with a pulmonary condition, in order to better self-manage their condition and reduce the likelihood of exacerbations which could lead to hospital admission.

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 various pulmonary conditions 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: 139 patients started KiActiv® Health (84 females, 55 males), average age = 66 years, average body mass index (BMI) = 29.0kg/m2.
  • Completion: 87 patients (62.6%) (49 females, 38 males) have completed the 12-week programme. 23 patients (16.5%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 89% 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.
    • 84.4% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health
    • 81.3% of respondents felt confident that they could manage their physical activity for their overall health now and in the future
    • 81.3% of patients felt that KiActiv® Health had benefitted them in some way
    • 90.6% of patients stated that they would recommend KiActiv® Health to a family member or friend
    • Patient reported benefits included:
      • Improved pulmonary symptoms
      • Benefits to other aspects of lifestyle such as improved sleep, reduced anxiety, healthier eating habits, and feeling more energised during the day
      • An increased awareness of all movement, not just exercise
      • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities
      • 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 physical and mental health, as well as overall QoL
      • Increased confidence when engaging with technology
  • 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 13-hours 16-minutes over 66 complete days, which is equivalent to 12-minutes per day of the intervention.
    • 100% of patients improved their physical activity in 1+ dimensions
    • 100% of patients improved their physical activity in 3+ dimensions
    • 78% 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 66 complete days were:
      • Non-Sedentary Time: +31hrs 33mins (+18%)
      • Moderate Activity: +13hrs 16mins (+583%)
      • Moderate Bouts: +8hrs 14mins (+1,163%)
      • Calorie Burn: +6,460kcals (+3%)

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).

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 respiratory diagnosis. 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 care will also reduce carbon emissions, supporting the vision for a healthier planet.

29th November 2021

Filed Under

NHS Glos. CCG: Hypertension

3 February 2022

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

Filed Under

NHS Glos. CCG & West England AHSN: Diabetes Digital Coach (DDC) Challenge

3 February 2022

View Executive Summary

Filed Under

NHS Glos. CCG: Community Diabetes Service

22 December 2021

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 pharmaceutical medications (Nathan et al., 2009), and should continue throughout the management phase of the condition (Duclos et al., 2015; Andrews et al., 2011). The Community Diabetes Service is made up of a team of specialist nurses, dietitians and diabetes educators/facilitators supporting people with type 2 diabetes to better manage their condition. KiActiv® Health has been made available for the Community Diabetes Service to refer people to as a valuable tool to support individuals in local communities to self-manage their type 2 diabetes and create sustainable habits to benefit their health and wellbeing.

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 through community care pathways to enable patients diagnosed with type 2 diabetes to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via their local Community Diabetes Service. 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: 13 patients started KiActiv® Health (9 females, 4 males), average age = 57 years, average body mass index (BMI) = 36.7kg/m2.
  • Completion: 7 patients (54%) (5 females, 2 males) have completed the 12-week programme. 5 patients (39%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 92% 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.
    • 100% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health
    • 100% of respondents felt confident that they could manage their physical activity for their overall health now and in the future
    • 100% of patients felt that KiActiv® Health had benefitted them in some way
    • 100% 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:
    • 100% of patients improved their physical activity in 1+ dimensions
    • 100% of patients improved their physical activity in 3+ dimensions
    • 100% 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 70 complete days were:
      • Non-Sedentary Time: +43hrs 27mins (+20%)
      • Moderate Activity: +17hrs 12mins (+33%)
      • Moderate Bouts: +14hrs 51mins (+332%)
      • Calorie Burn: +7,556kcals (+4%)

As a result of the physical activity improvements, 100% of the group achieved physical activity levels shown to reduce HbA1c by 0.89%, improvements that are comparable with diet and drug interventions (Umpierre et al., 2011).

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). Patients were able to improve physical activity levels by an amount which has been shown to reduce HbA1c by 0.89%, meaning that the positive impacts felt by participants in this cohort are comparable to those on diet and drug interventions (Umpierre et al., 2011).

KiActiv® Health increased self-management skills and participants received person-centered care along with tailored individual advice on optimising their daily physical activity to improve self-management of their type 2 diabetes and reduce the impact of any comorbidities or related complications. 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. 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.

2nd December 2021

Filed Under

Liverpool University Hospitals NHS: Phase 4 Cardiac Rehabilitation Pilot

24 October 2022

1Dr Tom Rayner, 1Dr Priyanka Meenamkuzhy-Hariharan, 2Miss Kirstie Tew, 1,3Professor Michael Fisher

1Liverpool University Hospitals NHS Foundation Trust, Prescot St, Liverpool, L7 8XP, UK; 2KiActiv®; 3University of Liverpool, Liverpool, UK

Executive Summary

Background

Cardiac rehabilitation (CR) is effective in reducing premature death and improves physical and psychosocial health and quality of life (QoL) (BACPR, 2012; NICE, 2013). Much, although not all, of this benefit is thought to be due to physical activity (PA). However, participation is sub-optimal, with only 35-50% of eligible individuals taking up CR (NACR, 2019). 

We aimed to test the hypothesis that a technology-enabled service incorporating accurate physical activity data from a wearable, personalised online feedback and remote mentor support, in addition to CR, leads to increases in PA.

Methodology

Patients referred for CR between September 2020 and April 2021 eligible for inclusion were commenced on the KiActiv® Health 12-week CR programme (n=17) in addition to a pandemic-limited conventional CR service. Baseline characteristics were assessed. Area under the curve (AUC) and incremental AUC calculations determined average total PA and additional PA achieved over multiple domains. QoL and mental health questionnaires completed before and after CR were compared using paired t-tests

Results

Eighty-two percent of patients completed the programme (n=14). The mean age for the cohort was 58 and 82% were male. Clients wore the PA monitor and visited the online platform on 95% and 31% of days during the programme, respectively. Improvements in PA were seen in one or more, three or more and four or more domains for 92.9%, 78.6% and 64.3% of participants, respectively. There were increases in non-sedentary time, moderate activity, calorie burn and moderate bouts in patients on the programme (Figure 1).

All patients reported an improvement in at least one domain of QoL, with statistically significant improvements in physical fitness and overall health (p<0.05). Symptom scores for questionnaire-reported depression and anxiety decreased, though not statistically significantly.

Discussion

Engagement with the KiActiv® Health CR programme was excellent, and was associated with improvements in PA, self-reported mental health and QoL. Randomised data is required to compare this intervention to usual practice and provide evidence of causation.

After peer review, we were asked to present the results of our pilot study at the BACPR conference in 2022.

Click here to see the poster

Filed Under

The Royal Liverpool and Broadgreen University Hospitals NHS: Cardiac Rehabilitation

10 February 2022

Dr Barnaby Hirons, Professor Michael Fisher, Kirstie Tew, MSc.

Executive Summary

Background

Physical Activity is a key component of Cardiac Rehabilitation (CR). However, provision is limited to weekly or bi-weekly structured exercise training and general advice on physical activity in a free-living environment. Our unique innovation provides a way to optimise free-living physical activity, as recommended by the British Association of Cardiac Rehabilitation and Prevention (BACPR), in a bespoke and precise fashion.

We undertook a pilot study with the Royal Liverpool and Broadgreen University Hospitals NHS Trust in order to establish the efficacy and feasibility of using on-body monitoring and contextualised feedback with CR patients.

Methodology

  • Patients wore the validated wearable monitor for 5-full days in the first and final weeks of their Phase 3 outpatient-based CR programmes.
  • Data was passed through Ki’s proprietary algorithms and reported back to patients in the context of their recovery.
  • Patients received bespoke feedback on their own ideal intensity range and their free-living activities which were beneficial to them.
  • Activities performed above their ideal recovery intensity were highlighted to show where they were working too hard.
  • Following the completion of the pilot, focus groups were conducted and patients reported their desire to understand how to be active, and what the ideal intensity was, for them to benefit.

Key Findings

  • Continuous monitoring of free-living physical activity was shown to be feasible and highly acceptable to CR patients.
  • Patients increased their physical activity at the ideal intensity and duration.
  • Contextualised feedback was associated with a 27% increase in the proportion of physical activity at the ideal intensity.

We were asked to present the results of our study at the BACPR conference in 2014, with our poster chosen for its “outstanding quality.”

Click here to see the poster

Filed Under

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