“The use of ICT tools for self-control is essential”

“The use of ICT tools for self-control is essential”

Assistance Hospital of Angiology and CV and director of the Operating Room of the CHUPporto and the CMIN. Researcher at UMIB. Visiting Associate Professor at ICBAS

Published on June 22, 2022

Peripheral arterial disease (PAD) is a progressively disabling disease that impairs patients’ overall quality of life. It has high costs for the national health system, but mainly for patients and families. Exercise is the first-line treatment associated with controlling risk factors, proving effective in increasing the distance traveled without pain.

Exercise programs, in the form of walking, should be performed for a minimum of 30 to 45 minutes per session, 3 to 4 times a week, for no less than 12 weeks.

However, personalized programs in a hospital context, currently in force, are unattractive and limiting, due to the lack of availability of spaces and human resources dedicated to face-to-face rehabilitation therapy, the costs associated with this rehabilitation therapy, l ‘increase in costs for the patient due to the need to travel and incompatibility of working hours.

These factors are compounded by the difficulties and impositions of distancing caused by the covid-19 pandemic situation, with a strong impact on the functional recovery of these patients. The prescription of personalized and supervised physical exercise in the patient’s area of ​​residence has no cost and is not limited in time, thus overcoming the limitations of supervised programs in a hospital context.

Improving functional capacity and quality of life by minimizing symptoms and decreasing vascular morbidity and mortality are the main focuses in the treatment of PCT.


Ivone Silva

Trials have shown the persistent benefits of supervised exercise therapy (SET) in patients with intermittent claudication (IC) compared to a simple visit advice, but it remains an underused tool. SET programs have not been very successful as they are not available in most European countries, as only 30% of vascular surgeons have direct access to them, there are insufficient facilities and patient compliance is low. The limitation of patients in adherence to exercise is due, in many cases, to socioeconomic constraints, mainly due to lack of transportation and time.

To overcome these problems, structured home exercise therapy (HBET), with an observation component (for example, log diaries) and specific personalized walking tips, can provide an effective alternative when SET programs are not available. available.

The rate of adherence to exercise is low mainly due to lack of motivation, reasons and difficulties associated with health status, patient choice and lack of results (Harzand et al., 2020; Harwood et al., 2016). However, J. Golledge et al, in 2019, published a meta-analysis suggesting that HBET programs supplemented with motivational intervention significantly improved walking performance and physical activity in patients with PAD.

This has been shown to improve the more structured and controlled the HBET programs. Therefore, it is urgent to develop strategies to improve adherence rates to exercise programs in this population and to promote behavior change (Kim et al., 2021).

M-mHealth technologies provide valuable tools for producing structured and supervised HBET programs. Information and communication technology (ICT) tools have already been applied to patient tracking during HBET programs, such as Geographic Information System (GIS) tools (e.g. Google Maps). which are cheap and easy to use household tools, with a wide range. of availability.

McDermott et al, using Google Maps, concluded that it can provide sufficient accuracy to control PAD exercises at home by providing a goal-based method that objectively measures patients ’adherence to an exercise plan.

The use of ICT tools for self-control is critical to long-term behavior change. We believe that HBET programs for patients with PAD, supported by mHealth tools to improve follow-up and adherence to behavior change, can be effective in the long term.

Studies investigating the use of mHealth in patients with PAD, especially in mobile applications, are very limited. Even more limited are the available mobile applications developed specifically for DAP, which promote and control exercise sessions, in an HBET framework.

To date, only two applications have been developed for this purpose (CReTe, Spain, 2014 and JBZetje, Netherlands, 2021).

Both collect data from exercise sessions, such as distance traveled, number of stops, reasons for stops, time and walking speed, and allow patients to access their history of walks and progression, but neither has the ability to customize routes according to patient preferences. and ability to walk.

The WalkingPad program aims to contribute a set of resources (app, platform, virtual assistant) of a cross-cutting and multidisciplinary nature through which healthcare professionals can promote patient co-responsibility in the management of the disease in a responsible and sustainable way. .

The WalkingPad program prescription can be part of the prescription menu currently available in the clinical system (Sclinico), not only in hospitals within the field of outpatient consultations, but also in healthcare and together with the surrounding community, challenging people to take an active part in managing their illness.

The WalkingPad program interface / resources are sustainable over time as they can be included in participants’ lives, in the form of health behavior; because it is a tool that can be used by anyone with low or high levels of digital literacy, it does not require high levels of knowledge or advanced technology, because it has no associated costs and for the benefits and added value in disease management. by the patient (follow-up by the app and motivational component by the AV) as well as by the healthcare professional (obtaining adherence data over time directly on the platform to be consulted).

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