Act Health

IntroductionRegular physical activity at a moderate-to-vigorous intensity is associated with a lower risk of recurrent cardiovascular events and mortality in individuals with coronary heart disease (CHD). Walking is a common form of physical activity; however, there is no evidence-based recommendation for the optimal step cadence (steps per minute) to achieve these intensity levels among individuals with coronary heart disease. Thus, this study aimed to establish the agreement between manually counted step cadence and step cadence assessed by waist- and wrist-worn accelerometers during treadmill walking among individuals with CHD. Next, the study aimed to establish the association between manually counted and accelerometer-assessed step cadence with cardiorespiratory intensity, followed by the development and validation of cadence thresholds for moderate- and vigorous-intensity levels.MethodsParticipants (n = 87) performed a graded treadmill test. Step cadence was counted manually and by a waist- and wrist-worn accelerometer (Actigraph GT3x). Step cadence and oxygen consumption were measured during the final minute of walking at four speeds (3–6 km·h−1). Agreement between manual and accelerometer cadence was established using Bland–Altman analyses. Step cadence thresholds for relative (%VO₂ peak) and absolute (METs) intensity were derived using generalized estimating equations in a training cohort (70%) and validated in a validation cohort (30%).ResultsAccelerometers underestimated the aggregated cadence compared with manual assessments, with a mean difference of −16 and −31 steps/min for waist- and wrist-worn accelerometers, respectively, with a higher level of agreement at higher speeds. Manually assessed cadence thresholds for moderate intensity were 99 (relative) and 92 (absolute) steps/min compared with 61 and 45 steps/min from waist-worn accelerometers. For vigorous intensity, manual and accelerometer thresholds were similar: 116 vs. 112 (relative) and 126 vs. 135 (absolute) steps/min. Both methods effectively identified valid thresholds for moderate and vigorous cardiorespiratory intensity.ConclusionStep cadence is a valid indicator of intensity in CHD populations, with manual and accelerometer methods showing comparable accuracy, despite accelerometer underestimation at lower speeds.Clinical Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000605695 (02062023).

BackgroundAt‐home rehabilitation programs for people with dementia require essential components that are both person‐centred and goal‐directed. While several interventions have been evaluated in Australia, they often require significant resources and time to deliver. This research investigates end‐user priorities for developing a cost‐effective and accessible home‐based dementia rehabilitation program, for people unable to participate in group settings in the Australian Capital Territory.MethodA co‐design working group was established to ensure the views of all stakeholders contributed to the intervention design, which has funding allocated for six home visits per participant. An occupational therapist and physiotherapist will design and monitor the intervention which will be delivered by an allied health assistant. Four two‐hour co‐design workshops were held over a period of six months. Sixteen experts were recruited, comprising three dyads, and ten healthcare professionals with a minimum of three years cumulative experience working with people with dementia. Workshops were recorded and transcribed, and iterative thematic analysis was applied.ResultFour overarching themes and seven subthemes were identified. Themes: 1) Awareness, acceptance and access; 2) Person‐centred care: Understanding unique needs, preferences, and goals, with two subthemes: a) Respect and dignity, b) Flexibility and adaptability; 3) Empowerment through community engagement & continuous support, with three subthemes: a) Building confidence & self‐efficacy. b) A gateway to engaging with other services c) Preventing information overload & overwhelm; and 4) Multidisciplinary coordinated care, with two subthemes: a) creating a raft and b) ensuring robust handover processes.ConclusionEngaging relevant stakeholders in the co‐design process helped to identify key components deemed feasible and valuable for an at‐home intervention for people with dementia. Findings demonstrate confidence from participants that the program would be feasible and valuable to people with dementia living at home. Assessing the feasibility and effectiveness of the at‐home rehabilitation program is necessary to determine whether it should be implemented in the public health system in the Australian Capital Territory.

<b>Tarang Sharma and colleagues</b> argue for increased collaboration across public and private sectors—internationally and with patients—in drug assessment and managed entry agreements to support equitable and sustainable access to costly medicines