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  • 1.
    Ben Gal, Tuvia
    et al.
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University.
    Perkiö Kato, Naoko
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
    Yaari, Vicky
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University.
    Avraham, Ben
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale2019In: Heart, Lung and Circulation, ISSN 1443-9506, E-ISSN 1444-2892, article id S1443-9506(19)31523-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.

    AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.

    METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.

    RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.

    CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

  • 2.
    Chiala, Oronzo
    et al.
    Univ Roma Tor Vergata, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ortali, Giorgio Alberto
    Casa Cura Villa della Querce Nemi, Italy.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    RELATIONSHIPS AMONG MEASURES OF PHYSICAL FITNESS IN ADULT PATIENTS WITH HEART FAILURE2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 8, p. 607-615Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the relationships among 3 measures of physical fitness (exercise capacity, muscle function and functional capacity) in patients with heart failure, and to determine whether these measures are influenced by impairment of movement. Methods: Secondary analysis of baseline data from the Italian subsample (n= 96) of patients with heart failure enrolled in a randomized controlled trial, the HF-Wii study. Exercise capacity was measured with the 6-min walk test, muscle function was measured with the unilateral isotonic heel-lift, bilateral isometric shoulder abduction and unilateral isotonic shoulder flexion, and functional capacity was measured with the Duke Activity Status Index. Principal component analysis was used to detect covariance of the data. Results: Exercise capacity correlated with all of the tests related to muscle function (r=0.691-0.423, pamp;lt; 0.001) and functional capacity (r = 0.531). Moreover, functional capacity correlated with muscle function (r=0.482-0.393). Principal component analysis revealed the bidimensional structure of these 3 measures, thus accounting for 58% of the total variance in the variables measured. Conclusion: Despite the correlations among exercise capacity, muscle function and functional capacity, these measures loaded on 2 different factors. The use of a wider range of tests will help clinicians to perform a more tailored assessment of physical fitness, especially in those patients with heart failure who have impairment of movement.

  • 3.
    Chiala, Oronzo
    et al.
    Univ Roma Tor Vergata, Italy.
    Vellone, Ercole
    Univ Roma Tor Vergata, Italy.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ortali, Giorgio Alberto
    Cardiopulm Rehabil Casa Cura Villa Querce Nemi, Italy.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Univ Calif Irvine, CA USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic Univ, Australia.
    Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure2018In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 47, no 5, p. 465-470Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity. Objectives: The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients. Methods: This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment. Results: The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT. Conclusions: The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. (C) 2018 Elsevier Inc. All rights reserved.

  • 4.
    Dell'Acqua, Pierangelo
    et al.
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, The Institute of Technology.
    Klompstra, Leonie Verheijden
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Samini, Ali
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, The Institute of Technology.
    An Assistive Tool for Monitoring Physical Activities in Older Adults2013Conference paper (Refereed)
    Abstract [en]

    Active living in older adults reduces disabilities and increases quality of life. Adherence to physical activity is low in older adults, therefore new possibilities to motivate to exercise must be explored. One of this new possibilities is to use exergaming. In this paper, we present an assistive tool for monitoring daily, physical activities in older adults with access to exergaming in their home environments. The proposed system employs the Kinect device and allows one to analyse the body movements. From a pilot study, we proved that the system can detect movements through exergaming. In the future we plan to implement the developed monitoring tool as well as exergaming in nursing homes.

  • 5.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Medical Centre, Israel; Tel Aviv University, Israel.
    Boyne, Josiane
    Maastricht University, Netherlands.
    Vellone, Ercole
    University of Roma Tor Vergata, Italy.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dickstein, Kenneth
    University of Bergen, Norway.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Hoes, Arno
    University of Medical Centre Utrecht, Netherlands.
    Piepoli, Massimo F.
    AUSL Piacenza, Italy; Fdn Toscana G Monasterio, Italy.
    Chiala, Oronzo
    University of Roma Tor Vergata, Italy.
    Martensson, Jan
    Jonköping University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, no 7, p. 743-748Article in journal (Refereed)
    Abstract [en]

    Aims

    Exercise is known to be beneficial for patients with heart failure (HF), and these patients should therefore be routinely advised to exercise and to be or to become physically active. Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes, the level of daily physical activity in most patients with HF is low. Exergaming may be a promising new approach to increase the physical activity of patients with HF at home. The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity, to decrease healthcare resource use, and to improve self-care and health-related quality of life.

    Methods and results

    A multicentre randomized controlled study with two treatment groups will include 600 patients with HF. In each centre, patients will be randomized to either motivational support only (control) or structured access to a Wii game computer (Wii). Patients in the control group will receive advice on physical activity and will be contacted by four telephone calls. Patients in the Wii group also will receive advice on physical activity along with a Wii game computer, with instructions and training. The primary endpoint will be exercise capacity at 3months as measured by the 6min walk test. Secondary endpoints include exercise capacity at 6 and 12 months, level of daily physical activity, muscle function, health-related quality of life, and hospitalization or death during the 12 months follow-up.

    Conclusion

    The HF-Wii study is a randomized study that will evaluate the effect of exergaming in patients with HF. The findings can be useful to healthcare professionals and improve our understanding of the potential role of exergaming in the treatment and management of patients with HF.

    Trial registration

    NCT01785121

  • 6.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    The rise of activity monitoring2019In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, no 4, p. 380-381Article in journal (Other academic)
    Abstract [en]

    n/a

  • 7.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Actiever worden met een spelcomputer2011In: Ledenmagazine, de Hart & Vaatgroep, Vol. 28, no 3, p. 15-15Article in journal (Other (popular science, discussion, etc.))
  • 8.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic University, Australia.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ski, Chantal F.
    University of Melbourne, Australia.
    Thompson, David R.
    University of Melbourne, Australia.
    Preference-based care and research2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 1Article in journal (Other academic)
    Abstract [en]

    n/a

  • 9.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Physical activity in patients with heart failure: motivations, self-efficacy and the potential of exergaming2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity.

    The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity.

    Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home.

    Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity.

    More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming.

    The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming.

    Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy.

    Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.

  • 10.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ekdahl, Anne W.
    Lund Univ, Sweden.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Milberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Eckerblad, Jeanette
    Karolinska Inst, Sweden.
    Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 187Article in journal (Refereed)
    Abstract [en]

    BackgroundThe prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home.MethodsThis is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression.ResultsIn total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period.ConclusionIn order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL.Trial registrationClinicaltrials.gov identifier: NCT01446757, the trial was registered prospectively with the date of trial registration October 5(th), 2011.

  • 11.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    An in-depth, longitudinal examination of the daily physical activity of a patient with heart failure using a Nintendo Wii at home: a case report2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 6, p. 599-602Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore the influence of the Nintendo Wii on the daily physical activity of a patient with chronic heart failure at home.

    METHODS: A 74-year-old Swedish patient with heart failure had access to a Nintendo Wii at home for 12 weeks. Exercise motivation, exercise self-efficacy and exercise capacity were assessed before and after the intervention. Data on perceived physical effort, global well-being and expended energy were collected every day during the intervention.

    RESULTS: During the 12 weeks of access to the Nintendo Wii, daily physical activity increased by 200% on weekdays and 57% on weekends, compared with baseline. The patient’s exercise motivation and exercise self-efficacy increased during the study, whereas perceived physical effort and global well-being did not change. The patient had no difficulties in using the system and did not suffer any major harm.

    DISCUSSION: The results of this case study suggest that providing patients with heart failure access to a Nintendo Wii is a promising and safe intervention. The energy expended by the patient per day increased, as did exercise capacity. Playing the Nintendo Wii did not increase the perceived physical effort, but increased motivation to exercise and decreased barriers to exercising.

  • 12.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study2014In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 14, no 119Article in journal (Refereed)
    Abstract [en]

    Background

    Regular daily physical activity is recognised as important in heart failure (HF) patients, but adherence to physical activity is low (<50%). To improve adherence to exercise in HF patients, alternative approaches to motivate and increase self-efficacy to exercise are needed. Therefore, we have studied a new phenomenon: exergames (games to improve physical exercise). The aims of the study were to assess the influence of the exergame platform Nintendo Wii on exercise capacity and daily physical activity in heart failure patients, to study factors related to exercise capacity and daily physical activity, and to assess patients’ adherence to exergaming.

    Methods

    A 12-week pilot study with a pretest-posttest design was conducted. The intervention consisted of an instruction on how to use the Wii and 12 weeks’ access to Wii at home. The main variables tested were exercise capacity (measured with a six-minute walking test), daily physical activity (measured with an activity monitor), and time exergaming (daily self-report with a diary). Bivariate correlations were used to assess associations between symptom experience, self-efficacy, motivation, anxiety, and depression.

    Results

    In total, 32 heart failure patients were included. More than half of the patients (53%) significantly increased their exercise capacity after 12 weeks. No significant difference was found in daily physical activity between baseline and 12 weeks. Lower NYHA class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The daily mean time spent exergaming was 28 minutes, and having grandchildren and being male were related to more time spent exergaming.

    Conclusion

    Exergaming has the potential to increase exercise capacity in elderly, chronically ill cardiac patients. Although the daily physical activity did not change over time, exergaming was feasible for heart failure patients and might be a rehabilitation option for patients with heart failure

  • 13.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 1603-1610Article in journal (Refereed)
    Abstract [en]

    Background: Adherence to recommendations for physical activity is low in both male and female patients with heart failure (HF). Men are more physically active than women. In order to successfully promote physical activity, it is therefore essential to explore how much and why HF patients are physically active and if this is related to sex. The aim of this study was therefore to evaluate physical activity in HF patients, to describe the factors related to physical activity, and to examine potential barriers and motivations to physical activity with special focus on sex differences. Methods: The study had a cross-sectional survey design. HF patients living at home received a questionnaire during May-July 2014, with questions on physical activity (from the Short Form-International Physical Activity Questionnaire), and potential barriers and motivations to physical activity. Results: A total of 154 HF patients, 27% women, with a mean age of 70 +/- 10 were included. In total, 23% of the patients reported a high level of physical activity, 46% a moderate level, and 34% a low level. Higher education, self-efficacy, and motivation were significantly associated with a higher amount of physical activity. Symptoms or severity of the disease were not related to physical activity. All the potential barriers to exercise were reported to be of importance. Psychological motivations were most frequently rated as being the most important motivation (41%) to be physically active. Physical motivations (33%) and social motivations were rated as the least important ones (22%). Women had significantly higher total motivation to be physically active. These differences were found in social, physical, and psychological motivations. Discussion: One-third of the HF patients had a low level of physical activity in their daily life. Severity of the disease or symptoms were not related, whereas level of education, exercise self-efficacy, and motivation were important factors to take into account when advising a HF patient about physical activity. Women reported higher motivation to be physically active than men, but there was no difference in the reported level of physical activity.

  • 14.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Using virtual reality to increase exercise capacity of heart failure patients2013Conference paper (Other academic)
    Abstract [en]

    Purpose Exercise is an important self-care behaviour and is related to decreased mortality in heart failure (HF). There are several barriers for HF patients to start exercising in conventional ways (rehabilitation center, fitness club).Virtual reality might be a solution to increase exercise at home. The Wii, a video game console made by Nintendo, uses virtual reality to increases the possibilities to exercise. The aim of this study was to assess change in exercise capacity in HF patients using the Wii game console at home for 12 weeks and examine factors related to this change.

    Methods The Wii was installed in the home of 32 HF patients (age 64 ± 14 years, 10 female, 68% NYHA II) for a period of 12 weeks. At baseline and at 12 weeks the patients performed the 6-minute walking test (6MWT) to assess physical capacity and completed a questionnaire concerning exercise self-efficacy and exercise motivation. Patients also completed a diary about the amount of minutes playing on the Wii, HF symptoms and perceived exertion.

    Results At baseline patients walked on the 6MWT a mean distance of 500 (±93) meters and at 12 weeks this had increased to 521 (±101) meters. More than half of the patients (n=17) had a clinically significant improvement of 30 meters or more and 9 patients (28%) decreased the amount of meters walked. One patient (3%) increased in the amount of meters but less than 30 meters. Patients who increased the amount of meters during 6MWT had a significant lower NYHA class. No associations were found between change in meter walked and the amount of minutes played on the Wii, the perceived exertion, or HF symptoms

    Conclusion Virtual reality in the rehabilitation of HF patients is a new innovative method to increase activity. More than half of the patients in this pilot study achieved a clinically relevant increase in exercise capacity due to access to the Wii at home for 12 weeks. Patients with a lower functional class at baseline seemed to benefit the most using the Wii.

  • 15.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Muhic, Almira
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Cabanes, R
    Gastelurrutia, B
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Cabanes, R
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Rodrigues, R
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Gonzales, B
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Lupon, J
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Bayes-Genis, A
    Germans Trias i Pujol University Hospital, Unitat d’Insuficiència Cardíaca, Badalona, Spain.
    Physical activity in daily life in heart failure patients living in two European countries, Volume 17, Issue Supplement S12015Conference paper (Other academic)
    Abstract [en]

    Aims: 

    Exercise is recognized as important in patients with heart failure (HF). It is unclear if there are differences in physical activity between European Countries, therefore the aims of this study were to

    -Assess physical activity levels in HF patients,

    -Describe the different types of physical activity of HF patients 

    -Explore differences between patients from Spain and Sweden 

    Method: The short International Physical Activity Questionnaire (sIPAQ) was used to assess the level of physical activity during the previous week. The sIPAQ contains seven items to identify the frequency and duration of light, moderate, and vigorous PA, as well as inactivity during the past week. Data was collected during April-July 2014 in Swedish and Spanish HF patients. Differences were analysed using Pearson’s chi-square or Mann-Whitney U test.

    Results: 

    Population:

    • 548 Spanish and 154 Swedish HF patients
    • 29% female, mean age 69±12 years, 75% NYHA class II/19% NYHA III
    • No differences were found in gender, age NYHA class between the two countries 

    Patients in Sweden compared to Spanish patients:

    • Had a higher mean physical activity level
    • Did more vigorous activities, like lifting, digging, aerobics, or fast bicycling
    • Did more moderate activities like carrying light loads, bicycling at a regular pace, or doubles tennis.
    • Did less walking (walking at work and at home, walking to travel from place to place, and any other walking that might be done solely for recreation, sport, exercise, or leisure) 

    Conclusions: 

    Despite that most of the patients were in NYHA class II and not symptomatic even at moderate to high level of activity, one third of them had a low physical activity level in their daily life.

    We found differences in the kind of physical activities between Spain and Sweden, which could be due to cultural and regional differences. Specific differences and consequences need to be further explored.

  • 16.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Van der Wal, Martje H. L.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Groningen, Netherlands.
    Letter: Response to letter to the editor: Seasonal variation in physical activity in patients with heart failure in HEART and LUNG, vol 49, issue 6, pp 576-5762019In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 49, no 6, p. 576-576Article in journal (Other academic)
    Abstract [en]

    n/a

  • 17.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    van der Wal, Martje H. L.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Groningen, Netherlands.
    Seasonal variation in physical activity in patients with heart failure2019In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 48, no 5, p. 381-385Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Physical activity is important for all heart failure (HF) patients to improve quality of life and physical function. Since adherence to physical activity is low and could differ between seasons, it is essential to explore factors related to change that may depend on seasonal changes. The purpose of this study was to describe the seasonal differences in physical activity and assess factors that influence these differences in a country with markedly different winter-to-summer weather conditions (in temperature, hours of daylight and snow fall). Methods: The study had a cross-sectional survey design. Outpatients with HF completed a questionnaire on physical activity, motivation and self-efficacy to exercise and I-IF symptom severity in the summer and the winter in a northern hemisphere country. We used analysis of variance to evaluate seasonal differences in physical activity, motivation, self-efficacy and HF symptom severity. Results: Eighty-seven patients with HF (29% women, mean age 70 +/- 9 years) were included and 35% performed less physical activity (METs) in the winter, compared to the summer. Increased symptom severity during the winter was associated with lower activity levels. Conclusion: One-third of the patients performed less physical activity during the winter compared to the summer, and this was associated with symptom severity. Decreased physical activity was not related with motivation and self-efficacy. This study emphasises the need for personalised physical activity programmes that also assess symptom severity and change in symptom severity depending between seasons. (C) 2019 The Authors. Published by Elsevier Inc.

  • 18.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Turollo, Andrea
    Fondazione Ospedale San Camillo, I.R.C.C.S., Venice.
    Using a virtual reality application to improve physical activity in heart failure patients2012Conference paper (Other academic)
    Abstract [en]

    Introduction: A virtual reality application might be a promising tool to increase exercise in the homes of patients with Heart failure (HF). However, the feasibility to use an exergame for elderly heart failure patients, from patient and provider perspective is currently not known. The aim is to assess the feasibility to increase daily activity in HF patients using the Wii game console.

    Method: A descriptive study design will be used. Nintendo Wii sport will be used by 40 patients with HF. Intervention: Nintendo Wii sport will be installed in the home of 10 heart failure patients for a period of 3 months. A personalized exercise plan will be made with the patient for 10 weeks by a physiotherapist or nurse. An instructor will help the patient to install and set up the program, to make a training plan and to help the patient to use the system.

    Data collection: At baseline, at 3 and 6 months data will be collected on self care behavior, heart failure knowledge, exercise self-efficacy, exercise motivation and depression and anxiety. During the use of the Wii computer patients fill in a diary which contains questions about heart failure symptom monitoring, global well-being, perceived exertion and daily activity. At 3 and 6 months a qualitative interview will be conducted to assess the feasibility of using the Wii computer. Patients will also use activity monitors (SenseWear and Direct Life) to assess the total daily activity. Actual use, problems and questions to the instructor will also be assessed.

    Results: The first patients are recruited for the study and data are planned to be available during the conference

    Conclusion: This study will provide insight on the feasibly to apply virtual reality application in HF patients to increase their physical activity in their home.

  • 19.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of a digital pen and paper tool to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence2011Conference paper (Other academic)
  • 20.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of the digital pen to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence - a pilot study2011Conference paper (Other academic)
  • 21.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    What are patients with heart failure willing to pay for an exergame intervention?2019Conference paper (Refereed)
    Abstract [en]

    Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.

    Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.

    Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.

    Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.

    Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.

    The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.

    Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.

  • 22.
    Vellone, Ercole
    et al.
    Univ Roma Tor Vergata, Italy.
    Chiala, Oronzo
    Univ Roma Tor Vergata, Italy.
    Boyne, Josiane
    Maastricht Univ, Netherlands.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Evangelista, Lorraine S.
    Univ Calif Irvine, CA USA.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Cognitive impairment in patients with heart failure: an international study2020In: ESC Heart Failure, E-ISSN 2055-5822Article in journal (Refereed)
    Abstract [en]

    Aims Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients. Methods and results A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients older age, lower education, and lower 6MWT scores (R-2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores. Conclusions CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

  • 23.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Arts and Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Moons, Philip
    Katholieke Universiteit, Leuven, Belgium .
    Norekvål, Tone M
    Haukeland University Hospital, Norway .
    Smith, Karen
    Ninewells Hospital, UK .
    Martensson, Jan
    Jönköping University, Sweden .
    Thompson, David R
    Australian Catholic University, Melbourne, Australia .
    De Geest, Sabina
    Katholieke Universiteit, Leuven, Belgium .
    Lenzen, Mattie
    Erasmus MC, Rotterdam, The Netherlands .
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Anaemia and iron deficiency in cardiac patients: what do nurses and allied professionals know?2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11 Suppl 1, p. S90-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency.

    METHOD: A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology.

    RESULTS: Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal.

    CONCLUSION: Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

  • 24.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science.
    Mårtensson, Jan
    Jonköping University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. University of Calif Irvine, CA USA.
    Exergaming Through the Eyes of Patients with Heart Failure: A Qualitative Content Analysis Study2017In: Games for Health Journal, ISSN 2161-783X, E-ISSN 2161-7856, Vol. 6, no 3, p. 152-158Article in journal (Refereed)
    Abstract [en]

    Objective: Exergaming appears to be a promising tool to increase exercise capacity in patients with chronic heart failure (HF). Therefore, it is important to obtain more in-depth knowledge about preferences, attitudes, use, and abilities in regard to exergaming. The aim of this study was to describe the experiences of patients with HF when using an exergame platform at home. Materials and Methods: A qualitative descriptive study using content analysis was conducted on interviews with 14 patients with HF (6 women, ages ranging between 56 and 81 years). The patients were recruited from three centers in Sweden included in a randomized controlled study. These patients had access to an exergame platform at home and were advised to exergame for 30 minutes per day. Results: The analysis resulted in three categories describing patients experience of exergaming: (1) making exergaming work, (2) added value of exergaming, and (3) low appeal of exergaming. Conclusion: This is the first study that explores how patients with HF experience using an exergame platform at home. The study provided important information on what aspects to discuss when initiating an exergame platform at home and following patients who may want to use an exergame platform at home. The results also revealed that this technology may be suitable for some patients, while others prefer other kinds of physical activity.

  • 25.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Exergaming in older adults: A scoping review and implementation potential for patients with heart failure2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 5, p. 388-398Article, review/survey (Refereed)
    Abstract [en]

    Background:

    Physical activity can improve exercise capacity, quality of life and reduce mortality and hospitalization in patients with heart failure (HF). Adherence to exercise recommendations in patients with HF is low. The use of exercise games (exergames) might be a way to encourage patients with HF to exercise especially those who may be reluctant to more traditional forms of exercise. No studies have been conducted on patients with HF and exergames.

    Aim:

    This scoping review focuses on the feasibility and influence of exergames on physical activity in older adults, aiming to target certain characteristics that are important for patients with HF to become more physically active.

    Methods:

    A literature search was undertaken in August 2012 in the databases PsychInfo, PUBMED, Scopus, Web of Science and CINAHL. Included studies evaluated the influence of exergaming on physical activity in older adults. Articles were excluded if they focused on rehabilitation of specific limbs, improving specific tasks or describing no intervention. Fifty articles were found, 11 were included in the analysis.

    Results:

    Exergaming was described as safe and feasible, and resulted in more energy expenditure compared to rest. Participants experienced improved balance and reported improved cognitive function after exergaming. Participants enjoyed playing the exergames, their depressive symptoms decreased, and they reported improved quality of life and empowerment. Exergames made them feel more connected with their family members, especially their grandchildren.

    Conclusion:

    Although this research field is small and under development, exergaming might be promising in order to enhance physical activity in patients with HF. However, further testing is needed.

  • 26.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Univ Calif Irvine, CA 92717 USA.
    Self-efficacy Mediates the Relationship Between Motivation and Physical Activity Patients With Heart Failure2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Motivation is necessary in patients with heart failure (HF) who are attempting to become more physically active but may not be sufficient to initiate physical activity. Self-efficacy might explain the relationship between motivation and physical activity. Objective: The aim of this study was to examine the role of exercise self-efficacy in the relationship between exercise motivation and physical activity in patients with HF. Methods: A total of 100 stable patients with HF (88% in New York Heart Association class IVIII; mean age, 67 +/- 13 years; 62% men) were studied. Self-efficacy was measured with the Exercise Self-Efficacy Scale; motivation, with the Exercise Motivation Index; and physical activity, with a self-report questionnaire. Logistic regression analyses were made to examine the mediation effect of exercise self-efficacy on the relationship between exercise motivation and physical activity. Result: Forty-two percent of the 100 patients reported engaging in less than 60 minutes per week of physical activity. Motivation predicted physical activity (b = 0.58, P amp;lt; .05), but after controlling for self-efficacy, the relationship between motivation and physical activity was no longer significant (b = 0.76, P = .06), indicating full mediation. Conclusion: Motivation to be physically active is important but not sufficient. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of self-efficacy.

  • 27.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson Östbring, Malin
    Institutionen för medicin och optometri, Fakulteten för hälso- och livsvetenskap, Linnéuniversitetet, Kalmar, Sverige .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Fridlund, Bengt
    Forskarskolan Hälsa och Välfärd, Jönköpings universitet, Jönköping, Sverige.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hjelmfors, Lisa
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ingadottir, Brynja
    Faculty of Nursing, University of Iceland, Reykjavik, Iceland..
    Liljeroos, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lundgren, Johan
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Mårtensson, Jan
    Forskarskolan Hälsa och Välfärd, Avdelningen för omvårdnad, Jönköpings universitet, Jönköping, Sverige.
    Mourad, Ghassan
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.2019In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 37, no 10, p. 493-497Article in journal (Refereed)
  • 28.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Are virtual reality applications feasible to increase physical activity in heart failure patients? A systematic review2011Conference paper (Refereed)
  • 29.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Design of a study using a virtual reality application to improve physical activity in heart failure patients2011Conference paper (Refereed)
  • 30.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Turolla, Andrea
    Fondazione Ospedale San Camillo – I.R.C.C.S., Venice, Italy.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Using a game computer to stimulate activity at home in heart failure patients - The study design2011Conference paper (Refereed)
  • 31.
    Wagenaar, Kim P.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Rutten, Frans H.
    University of Medical Centre Utrecht, Netherlands.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bhana, Yusuf
    TranslateMedia, England.
    Sieverink, Floor
    University of Twente, Netherlands.
    Ruschitzka, Frank
    University Hospital Zurich, Switzerland.
    Seferovic, Petar M.
    University of Belgrade, Serbia.
    Lainscak, Mitja
    Gen Hospital Celje, Slovenia.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Polichirurg Hospital AUSL Piace, Italy.
    Broekhuizen, Berna D. L.
    University of Medical Centre Utrecht, Netherlands.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    Dickstein, Kenneth
    University of Bergen, Norway.
    heartfailurematters.org, an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 11, p. 1447-1454Article in journal (Refereed)
    Abstract [en]

    Aims In 2007, the Heart Failure Association of the European Society of Cardiology (ESC) launched the information website heartfailurematters.org (HFM site) with the aim of creating a practical tool through which to provide advice and guidelines for living with heart failure to patients, their carers, health care professionals and the general public worldwide. The website is managed by the ESC at the European Heart House and is currently available in nine languages. The aim of this study is to describe the background, objectives, use, lessons learned and future directions of the HFM site. Methods and results Data on the number of visitor sessions on the site as measured by Google Analytics were used to explore use of the HFM site from 2010 to 2015. Worldwide, the annual number of sessions increased from 416 345 in 2010 to 1 636 368 in 2015. Most users (72-75%) found the site by using a search engine. Desktops and, more recently, smartphones were used to visit the website, accounting for 50% and 38%, respectively, of visits to the site in 2015. Conclusions Although its use has increased, the HFM site has not yet reached its full potential: fewer than 2 million users have visited the website, whereas the number of people living with heart failure worldwide is estimated to be 23 million. Uptake and use could be further improved by a continuous process of qualitative assessment of users preferences, and the provision of professional helpdesk facilities, comprehensive information technology, and promotional support.

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