Discussion
SECONDARY, SAID, CARDIOVASCULAR DISEASE
To the best of our knowledge, this study is the first to report on the challenges of implementing an ICT-based PA monitoring system in a hospital setting for patients undergoing cardiac rehabilitation. The findings of this study can be summarized as follows: (1) the educational intervention using the ICT-based PA monitoring system increased step counts at the time of hospital discharge more than the accelerometer alone, (2) the same trend was observed for step counts taken at moderate or greater intensity, and (3) the use of the PA monitoring system significantly improved the 6MWDs and SPPB. These findings suggest that an in-hospital educational intervention using an ICT-based PA monitoring system can increase activity during the inpatient phase and contribute to adequate performance recovery.The greatest strength of this study is that it demonstrates the usefulness of combining accelerometers with appropriate feedback using a visual tool. When education using the ICT-based PA monitoring system was used in conjunction with the accelerometer, a difference of more than 1000 steps was observed consistently compared with the use of the accelerometer alone. The only report with a similar validation to ours is an analysis of the effectiveness of visual feedback on PA delivered via ICT devices in 93 patients admitted to a pulmonary ward [This study also found a significant difference in 6MWD. The 6MWD reflects exercise tolerance and is a prognostic factor for patients with cardiovascular disease. The minimum clinically important difference in 6MWD is said to be 50 m [One possible reason for the effectiveness of this intervention may be that the ICT-based feedback system provided easy and clear access to quantitative data records. Self-monitoring is effective [We set a goal of 5000 steps for this study, but the average number of steps taken by the intervention group was only approximately 4000. In our experience, it is challenging to achieve improvements by only talking to patients in rehabilitation, and it has been reported that lending accelerometers to patients alone does not increase activity [Although this study constitutes innovative intervention research on hospitalized patients using ICT, some limitations should be considered. First, this was a single-center pilot study, and it did not have a large enough sample size. Based on the effect size results obtained by this study, to verify the effectiveness of the treatment, a proper design based on a calculated sufficient sample size is required. Second, the period between the loan of the accelerometers and discharge from the hospital was short, and it may not have been sufficient to verify the effect of the intervention. Third, the validation was conducted in an acute care hospital, and the threshold for determining good adherence may have been low due to the short length of stay. Finally, the secondary outcome of this study, 6MWD, was measured only once. Usually, 2 measurements are recommended because of the high variability associated with this test. Therefore, caution should be exercised when interpreting the results.