EXERHEART

Inchemic heart disease remains as leading cause of mortality worldwide, accounting for about 9 million deaths in 2021 (WHO, 2024). Non-Communicable cardiometabolic diseases, such as diabetes, have increased globally and have climbend among the leading causes of mortality. About 537 million adults globally are diagnosed with diabetes and about 374 millions are at increased risk of developing diabetes. It’s one of the fastest growing diseases in the 21st century, increasing about 316% in 15 years (International Diabetes Federation, 2021). Cardiovascular diseases are the leading cause of mortlality in persons with diabetes, and related costs of the disease are as high as 33 billion euros (American Diabetes Association, 2018). Furthermore, metabolic diseases often coexist, which often results in increased risk, increased need for healthcare and increased costs (American Diabetes Association, 2021a).

Physical activity and exercise have been endorsed as a treatment or adjunct therapy for, at least, 26 health conditions, including some cardiometabolic diseases (Pedersen and Saltin, 2015; Shah et al., 2021). Daily physical activity is a crucial part of the 24-hour activity cycle, with an indelible impact on health (Rosenberger et al. 2019) that has been considered to fall under the scope of self-management, as they are dependent on the role and will of each person in their life (American Diabetes Association, 2021b). It. Simple physical activity behaviors such as walking one mile per day, or more (≥1.6km/ day), may provide a two-fold reduction in adjusted risk of all-cause mortality and a five-fold reduction in adjusted risk of non-coronary CVD death in older adults with diabetes (Smith et al., 2007). Self-management is a key dimension of patient empowerment, listed as an established good practice by the European project EMPATHiE. New research in needed to increase the adoption of physical activity behaviors and participation.

Regarding exercise, there are established guidelines for a wide array of non-communicable cardiometabolic conditions including diabetes, obesity and coronary artery disease (Liguori, 2021). Despite the importance of the intervention of an exercise professional for exercise prescription, the increased technology available for routinely assess physiologic parameters that can contribute to enhance a tailored or precision exercise prescription, which may maximize the benefits for each person (Ruiz et al., 2023). Continued research is needed to increase and strengthen knowledge to support and maximize tailored or precision exercise prescription and its effects. Nevertheless, evidence is lacking to determine the best approaches to ensure greater efficacy, effectiveness and efficiency of precision exercise for specific populations, tailored to each person.

Technology-based and technology-enhanced interventions, including mobile applications and wearable technology, for cardiometabolic diseases, such as diabetes, seems useful to promote health literacy and healthy behaviors, such as physical activity, empowering users for health-enhancing selfcare, improve health outcomes and reduce metabolic risk and complications (Cui et al., 2016; Fleming et al., 2020). Nevertheless, evidence is lacking to determine the best approaches to ensure greater efficacy, effectiveness and efficiency of available technology.

The assessment of efficiency and economic evaluation of physical activity and exercise interventions are often overlooked but are cornerstone to support policy and public support. Although economic evaluation of such interventions is still unripe, promising results encourage further efforts in the study and development of tech-enhanced interventions (Rinaldi et al., 2020). Additional research is warranted to support new public health policies which can provide the best benefits for the population and ensure sustainability of implemented practices.

Keywords: Cardiometobilic Health; Physical Exercise; Cardiovascular Risk Reduction

General Objective:Assess the efficacy, efectiveness and efficiency of randomized controlled multicenter blended physical activity and precision exercise programs, within a 24h Activity framework, for the promotion of cardiometabolic, included in ExerHeart.

Specific Objectives:

• To gather and analyze existing data regarding tech-supported expanded physical activity and precision exercise programs for specific non-communicable clinical conditions, for improving cardiometabolic health.
• To build evidence-based multicenter interventions for specific non-communicable clinical conditions, for improving cardiometabolic health.
• To assess how can common accessible tech (e.g. smartphones) and existing mainstream free apps, easy to use by non-tech persons, be useful to expand and strengthen exercise guidelines compliant programs, within a 24h physical activity framework, for improving cardiometabolic health.
• To assess the efficacy of different personalized exercise prescription approaches for specific clinical target groups, for improving cardiometabolic health.
• To assess the effectiveness of different tech-enhanced exercise programs for specific clinical target groups, for improving cardiometabolic health.
• To assess the efficiency and overall economic analysis of different tech-enhanced exercise programs for specific clinical target groups, for improving cardiometabolic health.

References

1. (WHO, 2024). WHO’s Global Health Estimates. Geneve, WHO. (Accessed on September 20th). https://www.who.int/data/global-health-estimates
2. International Diabetes Federation (2021). IDF Diabetes Atlas. 10th Edn. Available at: www.diabetesatlas.org (Accessed September 20, 2024).
3. American Diabetes Association (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care 41, 917–928. https://doi.org/10.2337/dci18-0007
4. American Diabetes Association (2021a). Cardiovascular disease and risk management: Standards of medical care in diabetes - 2021. Diabetes Care 44, S125–S150. https://doi.org/10.2337/dc21-S010
5. Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine—Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25, 1–72. https://doi.org/10.1111/sms.12581
6. Rosenberger, M. E., Fulton, J. E., Buman, M. P., Troiano, R. P., Grandner, M. A., Buchner, D. M., & Haskell, W. L. (2019). The 24-Hour Activity Cycle: A New Paradigm for Physical Activity. Medicine & Science in Sports & Exercise, 51(3), 454–464. https://doi.org/10.1249/MSS.0000000000001811
7. American Diabetes Association (2021b). Facilitating behavior change and wellbeing to improve health outcomes: Standards of medical care in diabetes−2021. Diabetes Care 44, S53–S72. https://doi.org/10.2337/dc21-S005
8. THE EMPATHIE PROJECT: EMPOWERING PATIENTS IN THE MANAGEMENT OF CHRONIC DISEASES, (https://ehff.eu/the-empathie-project-empowering-patients-in-the-management-of-chronic-diseases/).
9. Liguori, Gary, & Medicine, A. C. of S. (2021). ACSM’s Guidelines for Exercise Testing and Prescription(Eleventh, Paperback edition). Wolters Kluwer Health. ISBN/ISSN: 9781975150181.
10. Ruiz, J. R., Sevilla‐Lorente, R., & Amaro‐Gahete, F. J. (2023). Time for precision exercise prescription: The same timing may not fit all. The Journal of Physiology, JP285958. https://doi.org/10.1113/JP285958
11. Cui, M., Wu, X., Mao, J., Wang, X., and Nie, M. (2016). T2DM self-management via smartphone applications: A systematic review and meta-analysis. PLoS One 11, 1–15. https://doi.org/10.1371/journal.pone.0166718
12. Fleming, G. A., Petrie, J. R., Bergenstal, R. M., Holl, R. W., Peters, A. L., and Heinemann, L. (2020). Diabetes digital app technology: benefits, challenges, and recommendations. A consensus report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetologia 63, 229–241. https://doi.org/10.1007/s00125-019-05034-14
13. Rinaldi, G., Hijazi, A., and Haghparast-Bidgoli, H. (2020). Cost and costeffectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review. Diabetes Res. Clin. Pract. 162:108084. https://doi.org/10.1016/j.diabres.2020.10808

Related projects:

• VAPrevention (home page), Funded by means of national funds by FCT – Fundação para a Ciência e a Tecnologia, I.P (Ref.ª 2022.02969.PTDC; https://doi.org/10.54499/2022.02969.PTDC);
• Train4Health (home page) Funded by European Union, under the ERASMUS plus program (Ref.ª 2019-1-PT01-KA203-061389);
• VASelfCare (home page), Funded by means of national funds by FCT – Fundação para a Ciência e a Tecnologia, I.P (Ref.ª Project LISBON-01-0145-FEDER-024250, 02/SAICT/2016).

MSc/PhD students:

• 8 MSs Students are envisaged for the monitoring of the Physical Activity and Exercise community programs and for collecting and treating data.
• 2 PhD Students are envisaged for overviewing the implementation of the Programs, organizing and treating and all the data collected, combined.

Sponsors

• ULS Médio Tejo
• ULS Lezíria
• Liga dos Amigos do Hospital de Santarém
• Câmara Municipal de Rio Maior
• Câmara Municipal de Santarém
• Serviço Nacional da Saúde (SNS)/ National Health Services of Portugal
• Direção Nacional de Saúde / National Health Directorate
• Associação Portuguesa de Cardiologia
• Associação Portuguesa de Hipertensão
• Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore Emanuele Marzetti: https://scholar.google.it/citations?hl=it&user=_l6AEXYAAAAJ