School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China.
Front Public Health. 2022 Jul 14;10:865712. doi: 10.3389/fpubh.2022.865712. eCollection 2022.
Zero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD).
A parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group.
One hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group ( = 70) or control group ( = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), = 0.04, Cohen's = 0.34] than the control group.
This pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes.
The research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.
零次运动（ZTEx）是一种简单的增强力量和耐力的体力活动（PA），不需要额外的设备，可以潜在地增加 PA 和健身。这项试点试验研究了智能手机 ZTEx 干预在促进冠心病（CHD）患者 PA 和健身方面的可行性和潜在效果。
在中国三家心脏病诊所对稳定型冠心病（CHD）患者进行了一项平行组评估员盲法随机对照试验。实验组接受了 15 分钟的简短个人面对面会议和 12 周的 ZTEx 即时通讯，其中包括 28 张图片电子信息和智能手机 ZTEx 应用程序（ZTExApp）。对照组接受了相同时长的个人会议和相同数量及格式的电子信息，但内容是健康饮食和呼吸练习。根据以下方面评估可行性：失访率、使用率、回复率和对干预的看法。结果评估包括主要结局（PA）、健身、运动自我效能和意图、感知幸福和健康以及生活质量。采用线性混合模型，意向治疗分析调整了性别、年龄和基线值。对实验组进行了半结构化访谈，以收集反馈意见。
139 名患者（平均年龄 59.8 ± 6.6；71.2%为男性）被随机分配到实验组（n=70）或对照组（n=69），分别有 80%（56/70）和 82%（57/69）的患者完成了 12 周的随访评估。失访率为 18.7%。实验组报告 ZTEx 易于将 PA 融入日常生活，并对图片电子信息表示赞赏，其中 95%的患者向我们反馈了意见，但只有 19.6%（13/70）的参与者将他们的 PA 信息输入到 ZTExApp 的电子日记中。实验组的步行时间明显增加[平均差异（95%置信区间）：155.3（10.1，300.4），P=0.04，Cohen's = 0.34]，高于对照组。
这项试点研究表明，使用简短的 ZTEx 面对面会议和图片电子信息使冠心病患者能够将 PA 融入日常生活。未来需要进行更长时间随访和更便于用户使用的 ZTExApp 界面的确定性试验，以确定智能手机 ZTEx 干预在增强 PA 和相关结局方面的有效性。
该研究方案于 2016 年 7 月 22 日在香港大学临床试验注册处（HKUCTR）注册（研究标识符：HKUCTR-2165），并于 2018 年 3 月 14 日在国家卫生研究院（标识符号：NCT03464331）进行了回顾性注册。
