E-CHANGE: An
Electronic Intervention to Increase Exercise
Existing computer technology can potentially be used by health professionals to provide more efficient, yet personalized assistance necessary to help patients make the difficult lifestyle changes needed for long-term exercise. Evidence exists that patients can and will use computer technologies to obtain clinical services. Although computers have been used for home monitoring of patient symptoms, providing information and offering support, there has been limited use of computers by health professionals to engage patients in systematic health behavior change. The goals of this project were to conduct a pilot test of E-CHANGE, a computerized health behavior change program designed to assist cardiac patients to incorporate the lifestyle changes needed for long-term exercise. Titled, Electronically Change Habits by Applying New Goals and Experiences (E-CHANGE), this computer-based intervention consists of a sequence of nurse-led activities designed to increase cardiac patients’ expectancy-value, self-efficacy, problem-solving and relapse prevention skills regarding exercise maintenance.
A prototype of the E-CHANGE system was developed and consists of specially-designed behavior change programs that patients access by Internet in their homes. Individuals keep electronic diaries and receive electronically-produced graphs of their exercise behavior over time as they use a trial-and-learn approach to understand their behavior and problem-solve lifestyle issues. A nurse monitors the system daily for any questions from patients and initiates a weekly electronic contact with each patient to answer questions and offer general support and feedback.
A pilot test of the E-CHANGE program was conducted with a convenience sample of 25 subjects: 7 participants in a CRP comprised the E-CHANGE group who were matched with a comparison group of 18 CRP participants. Matching was based on gender, age, race, and co-morbidity. All subjects (18 men and 7 women, 4 African Americans; mean age = 66 years) met the inclusion and exclusion criteria of having had a cardiac event (myocardial infarction, CABG surgery, and/or angioplasty), participating in a CRP, >20 years of age, speak and read English, and free of clinical features that constitute the criteria for high risk for safe participation in cardiac exercise programs. Eighty-six percent of the subjects had prior experience with computers; 24% had no internet access or experience accessing the World Wide Web; only 10% of subjects stated they used the internet for health information. Exercise was measured in both groups for 6 months using portable heart rate wristwatch monitors and diaries.
Findings showed that subjects in the E-CHANGE group averaged over 6 hours more exercise in the first 2 months (exercise adoption) as compared to those in the usual care (UC) group. Similar group differences in the exercise frequency (number of exercise sessions) were found. Exercise intensity (time exercised in target heart rate zone {THZ}) also was higher in the E-CHANGE group. Additionally, the metabolic equivalents in energy expenditure (METS) due to moderate or higher intensity exercise by those in the E-CHANGE group were three times that of the UC group. Positive group differences of similar magnitude also were found in exercise maintenance (3-6 months following the CRP). The percentage of individuals still exercising at 6 months was also greater in the E-CHANGE group. Given the small sample size of this pilot study relative to the dispersion of exercise measures (large standard deviations), significance tests were not conducted. We conclude, however, that the E-CHANGE intervention is feasible and holds promise to be an effective way to increase exercise in cardiac patients.
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