Quality Improvement of Smartwatch-Based Exercise Monitoring in Hemophiliacs During the COVID-19 Pandemic in a Resource-Limited Nationwide Setting (Better Hemo-Life)


  •  Nawachai Lertvivatpong    
  •  Apichat Photi-a    
  •  Montol Suwannurak    
  •  Chanchai Traivaree    

Abstract

Background: Hemophilia is a rare X-linked bleeding disorder that commonly presents with hemarthrosis. Although the joints bleed easily, exercise is encouraged to support joint function. Unfortunately, some patients avoid exercise due to perceived barriers and a lack of motivation.

Objective: This quality improvement study was conducted over 6 months to promote exercise among hemophiliacs through education, coaching, and monitoring. The primary outcome was improvement in physical fitness, including parameters: maximum oxygen uptake (VO2 max), 6-minute walk test (6MWT), and wall squat (WS). The secondary outcomes were improvements in perceptions and quality of life (QoL).

Study design: A prospective observational study was conducted among hemophiliacs nationwide from April to October 2021, during the pandemic peak in Thailand.

Methods: 35 participants were included, with hemophilia A and B comprising 32 and 3, respectively. The severity of hemophilia was moderate (31.4%) and severe (68.6%). Smart watches were distributed for monitoring and assessment. The primary outcome was measured 3 times and analyzed using repeated-measures ANOVA. The secondary outcomes were collected from an electronic questionnaire pre- and post-monitoring and analyzed using the Wilcoxon signed-rank test.

Results: A total of 34 male participants were enrolled. The mean age was 25.8±9.3 (12-44). VO2 max means were 60.9±10.3, 46.5±6.5, and 46.5±6.3 ml/kg/min, which declined significantly after 3 months, but did not differ significantly between the 3rd and 6th months. Means of 6MWT were 407.9±164.4, 470.8±136.50, 507.5±115.63 meters and increased statistically significantly (p<0.001). The means of WS were 62.6±57.7, 93.2±67.3, 113.9±69.6 seconds, and increased statistically significantly (p<0.001). Exercise perception scores increased statistically significant (3[0-3] vs. 6[6-6], p<0.001) and exercise anxiety scores decreased statistically significant (7[6-8] vs. 4[2-6], p<0.001). QoL scores increased statistically significant (7[5-8] vs 9[7-9], p<0.001).

Conclusions: Exercise monitored via smartwatch showed improvements in 6MWT, reflecting aerobic exercise, and WS, reflecting muscle strengthening. Meanwhile, VO2 max did not show concurrently, which might be from various factors. Furthermore, participants showed a significant increase in perception and QoL scores after completing the study.



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