Self-experimentation for long-lasting physical activity promotion in cardiac rehabilitation

Technology that makes people move!

To launch new projects that use the possibilities of technology in order to make people move, TU Delft Sports Engineering Institute and TU Delft Health Initiative have joint forces in a Combined health and sports idea accelerator.

Sport and physical activity stimulate a healthy lifestyle in every life stage. It stimulates physical and mental development with children, prevents adults from developing lifestyle related diseases, connects people of all ages and supports elderly to stay active longer. But sport also connects and supports an inclusive society where everyone can live active lives, unhindered by age, condition, gender or background. One of the major challenges of this time is to stimulate people to engage in physical activity in order to achieve physical and mental health. Technology can play a key role in the engagement of people to move more.

One of the projects that received funding is Self-experimentation for long-lasting physical activity promotion in cardiac rehabilitation. Read all about it below.
Want to know about the other project that received funding? Read about it here.

Self-experimentation for long-lasting physical activity promotion in cardiac rehabilitation

A heart-attack may very well be the ultimate wake-up call when it comes to changing your lifestyle and behaviour. Even so, four years on most cardiac patients have relapsed to a very low fitness and physical activity level. Explorative self-experimentation, developed by Jos Kraal and colleagues, makes changing physical activity behaviour for cardiac patients more personal.

‘On the one hand, you have 101 theories describing behaviour and how to change it,’ says Jos Kraal. ‘On the other hand, cardiac rehabilitation as a behavioural intervention often is a one size fits all solution.’ As a tenure track professor at Industrial Design Engineering at the TU Delft, Kraal is a member of the 4TU consortium Pride and Prejudice which aims to develop and evaluate lifestyle interventions for the prevention of chronic diseases. ‘A physical therapist or rehabilitation specialist may suggest hiking or cycling, but there is little room to take personal preferences and interests of a patient into account.’

Currently, there is little room for a rehabilitation specialist to take personal preferences and interests of a patient into account

Exploring what fits

Together with several researchers from TU Delft and the Pride and Prejudice consortium, Jos Kraal developed the Explorative Self-Experimentation (ESE) approach. It provides individuals with a toolbox supporting them to self-experiment with various behaviour change interventions and, most importantly, to reflect on their experiences – did I enjoy this intervention, do I feel better? A pilot study with office workers showed that it wasn’t so much the intervention itself (did I take 10.000 steps today) but rather an underlying goal that encouraged improved health behaviour (I like talking with people whilst taking a walk). 

Cardiac rehabilitation

Inspired by these outcomes, Kraal now wants to take ESE to the next level. ‘We want to study what modifications are required to apply it to an important healthcare topic: cardiac rehabilitation,’ he says. ‘Not only do these patients differ from office workers, but the strategy will also have to fit in with current medical care for these patients.’ And, whereas the pilot study was based on a booklet providing guidance, they will now also explore the added value of technology. Think of a digital platform or a smartphone app. ‘Compared to plain text, it will open up many more avenues for inspirational support. Physical attributes will continue to play a role, such as inspirational goal cards you can put next to your mirror – “When is your next bicycle ride with your grandson”.

By reflecting on their experiences, patients will come to a behaviour change plan that sticks

More and more funding

‘Seed money from the Delft Health Initiative and TU Delft Sports Engineering Institute call has been a true accelerator,’ Kraal says. ‘Pride and prejudice joined in, and we have already hired a junior researcher to continue this research. We are currently writing proposals for Medical Delta and Convergence and, of course, we are eyeing the national funding programs as well.’ Having been involved in cardiac rehabilitation ever since his PhD, Kraal has been able to assemble a very strong coalition for this project, including researchers from the Capri cardiac rehabilitation centre and from the Erasmus MC department of rehabilitation medicine. 

Compared to plain text, technology will open many more avenues for inspirational support

Silver bullet

The final part of the project will be to evaluate the effectiveness of the ESE intervention. This will be a challenge, not only because of the required medical-ethical approval, but also because it requires several years of follow-up. That doesn’t discourage Kraal at all. Having obtained a master’s degree both Movement Sciences and in Healthcare Policy, Innovation and Management, he knows the ropes of healthcare. And he already busies himself with a much wider application of ESE for lifestyle interventions: smoking, nutrition, and stress management. Kraal: ‘Prevention is the silver bullet in reducing chronic conditions.’