BACKGROUND: Guidelines on modifiable risk factors regarding cardiological patients are poorly implemented in clinical practice perhaps due to low health literacy. Several digital tools for improving lifestyle and behavioural intervention were developed. Our primary aim is to evaluate the effectiveness of a digital exercise prescription tool on the adherence to physical activity recommendations among patients with cardiovascular diseases. METHODS: A randomized controlled trial will be realized in cooperation with Cardiovascular Health Centres in Eastern Slovakia. Patients recruited through their cardiologists, will be randomised at 1:1 ratio to the three-months' experimental condition or control condition. The experimental group will receive standard lifestyle consultation leading to individually optimized prescription of physical activity. The control group will receive standard, usual-cardio-care lifestyle counselling, also in the domain of physical activity. The digital system will be used for optimized exercise prescription. The primary outcome is a change in the patient's adherence to exercise recommendations. Data will be collected in both groups prior to consultation and after 3 months. DISCUSSION: This study protocol presents background and design of a randomized control trial to investigate the effectiveness of a digital system-provide exercise prescription tool on the adherence to physical activity recommendations. An optimized exercise prescription that better reflects patient's diagnosis, comorbidities and medication can have a significant impact on secondary prevention of cardiovascular disease. This trial can provide important evidence about the effectiveness of digital exercise guidance in everyday practice of cardiovascular healthcare. TRIAL REGISTRATION: The study was registered on 1st November, 2017 and is available online at ClinicalTrials.gov (ID: NCT03329053 ).

1st Department of Internal Medicine Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Department of Community and Occupational Medicine University Medical Center Groningen University of Groningen Hanzeplein 1 9700 Groningen RB Netherlands

Department of Health Psychology Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Graduate School Kosice Institute for Society and Health Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Institute of Physical Education and Sport P J Safarik University Ondavska 21 040 11 Kosice Slovakia

Olomouc University Society and Health Institute Palacky University Olomouc Krizkovskeho 8 771 47 Olomouc Czech Republic

Zobrazit více v PubMed

Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, Burns R, Rayner M, Townsend N. European cardiovascular disease statistics 2017. Brussels: European Heart Network; 2017.

European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines. EACPR. Corrà U, Piepoli MF, Carré F, Heuschmann P, Hoffmann U, Verschuren M, Halcox J, Document Reviewers. Giannuzzi P, Saner H, Wood D, Piepoli MF, Corrà U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, Mcgee H, Mendes M, Niebauer J, Zwisler AD, Schmid JP. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the cardiac rehabilitation section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. 2010;31(16):1967–1974. doi: 10.1093/eurheartj/ehq236. PubMed DOI

Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the lancet commission on hypertension. Lancet. 2016;388(10060):2665–2712. doi: 10.1016/S0140-6736(16)31134-5. PubMed DOI

Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques-Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur Heart J Acute Cardiovasc Care. 2017;6(4):299–310. doi: 10.1177/2048872616689773. PubMed DOI

Vigorito C, Abreu A, Ambrosetti M, Belardinelli R, Corrà U, Cupples M, Davos CH, Hoefer S, Iliou MC, Schmid JP, Voeller H, Doherty P. Frailty and cardiac rehabilitation: a call to action from the EAPC cardiac rehabilitation section. Eur J Prev Cardiol. 2017;24(6):577–590. doi: 10.1177/2047487316682579. PubMed DOI

WHO . Global action plan for the prevention and control of NCDs 2013–2020. Geneva: WHO; 2013.

Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA. Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res. 2016;39(2):88–94. doi: 10.1038/hr.2015.111. PubMed DOI

Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. doi: 10.1161/JAHA.112.004473. PubMed DOI PMC

Hulkkonen J, Aatola H, Pälve K, Lehtimäki T, Hutri-Kähönen N, Viikari JS, Raitakari OT, Kähönen M. Determinants of exercise peak arterial blood pressure, circulatory power, and exercise cardiac power in a population based sample of Finnish male and female aged 30 to 47 years: the cardiovascular risk in young Finns study. BMC Cardiovasc Disord. 2014;14:35. doi: 10.1186/1471-2261-14-35. PubMed DOI PMC

García-Ortiz L, Recio-Rodríguez JI, Puig-Ribera A, Lema-Bartolomé J, Ibáñez-Jalón E, González-Viejo N, Guenaga-Saenz N, Agudo-Conde C, Patino-Alonso MC, Gomez-Marcos MA, EVIDENT Group Blood pressure circadian pattern and physical exercise assessment by accelerometer and 7-day physical activity recall scale. Am J Hypertens. 2014;27(5):665–673. doi: 10.1093/ajh/hpt159. PubMed DOI

Kelley GA, Sharpe Kelley K. Aerobic exercise and resting blood pressure in older adults: a meta-analytic review of randomized controlled trials. J Gerontol A Biol Sci Med Sci. 2001;56(5):M298–M303. doi: 10.1093/gerona/56.5.M298. PubMed DOI

Mota MR, de Oliveira RJ, Dutra MT, Pardono E, Terra DF, Lima RM, Simões HG, da Silva FM. Acute and chronic effects of resistive exercise on blood pressure in hypertensive elderly women. J Strength Cond Res. 2013;27(12):3475–3480. doi: 10.1519/JSC.0b013e31828f2766. PubMed DOI

Brito Ade F, de Oliveira CV, Brasileiro-Santos Mdo S, Santos Ada C. Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly. Clin Interv Aging. 2014;9:2151–2158. PubMed PMC

Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60(3):653–658. doi: 10.1161/HYPERTENSIONAHA.112.197780. PubMed DOI

Guimarães GV, Cruz LG, Tavares AC, Dorea EL, Fernandes-Silva MM, Bocchi EA. Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study. Blood Press Monit. 2013;18(6):342–345. doi: 10.1097/MBP.0000000000000000. PubMed DOI

Ashor AW, Lara J, Siervo M, Celis-Morales C, Oggioni C, Jakovljevic DG, Mathers JC. Exercise modalities and endothelial function: a systematic review and dose-response meta-analysis of randomized controlled trials. Sports Med. 2015;45(2):279–296. doi: 10.1007/s40279-014-0272-9. PubMed DOI

Farah C, Nascimento A, Bolea G, Meyer G, Gayrard S, Lacampagne A, Cazorla O, Reboul C. Key role of endothelium in the eNOS-dependent cardioprotection with exercise training. J Mol Cell Cardiol. 2017;102:26–30. doi: 10.1016/j.yjmcc.2016.11.008. PubMed DOI

Guo Y, Ledesma RA, Peng R, Liu Q, Xu D. The beneficial effects of cardiac rehabilitation on the function and levels of endothelial progenitor cells. Heart Lung Circ. 2017;26(1):10–17. doi: 10.1016/j.hlc.2016.06.1210. PubMed DOI

Walsh JH, Yong G, Cheetham C, Watts GF, O'Driscoll GJ, Taylor RR, Green DJ. Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects. Eur Heart J. 2003;24(18):1681–1689. doi: 10.1016/S0195-668X(03)00384-1. PubMed DOI

Pearson MJ, Smart NA. Effect of exercise training on endothelial function in heart failure patients: a systematic review meta-analysis. Int J Cardiol. 2017;231:234–243. doi: 10.1016/j.ijcard.2016.12.145. PubMed DOI

DeSouza CA, Shapiro LF, Clevenger CM, Dinenno FA, Monahan KD, Tanaka H, Seals DR. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation. 2000;102(12):1351–1357. doi: 10.1161/01.CIR.102.12.1351. PubMed DOI

de Moraes AC, Fernández-Alvira JM, Carvalho HB, Meirhaeghe A, Dallongeville J, Kafatos A, Marcos A, Molnar D, Manios Y, Ruiz JR, Labayen I, Widhalm K, Breidenassel C, Gonzalez-Gróss M, Moreno LA. Physical activity modifies the associations between genetic variants and blood pressure in European adolescents. J Pediatr. 2014;165(5):1046–9.e1-2. doi: 10.1016/j.jpeds.2014.07.007. PubMed DOI

Umpierre D, Ribeiro PA, Schaan BD, Ribeiro JP. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56(2):242–251. doi: 10.1007/s00125-012-2774-z. PubMed DOI

Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med. 2014;44(2):211–221. doi: 10.1007/s40279-013-0110-5. PubMed DOI PMC

Sarzynski MA, Burton J, Rankinen T, Blair SN, Church TS, Després JP, Hagberg JM, Landers-Ramos R, Leon AS, Mikus CR, Rao DC, Seip RL, Skinner JS, Slentz CA, Thompson PD, Wilund KR, Kraus WE, Bouchard C. The effects of exercise on the lipoprotein subclass profile: a meta-analysis of 10 interventions. Atherosclerosis. 2015;243(2):364–372. doi: 10.1016/j.atherosclerosis.2015.10.018. PubMed DOI PMC

Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355–1361. doi: 10.1056/NEJM200011093431902. PubMed DOI

Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. American Heart Association Council on Clinical Cardiology. American College of Sports Medicine Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on nutrition, physical activity, and metabolism and the council on clinical cardiology. Circulation. 2007;115(17):2358–2368. doi: 10.1161/CIRCULATIONAHA.107.181485. PubMed DOI

Fagard RH, Björnstad HH, Børjesson M, Carré F, Deligiannis A, Vanhees L, European Society of Cardiology ESC study Group of Sports Cardiology recommendations for participation in leisure-time physical activities and competitive sports for patients with hypertension. Eur J Cardiovasc Prev Rehabil. 2005;12(4):326–331. doi: 10.1097/01.hjr.0000174827.79645.f5. PubMed DOI

ESC Study Group of Sports Cardiology. Börjesson M, Assanelli D, Carré F, Dugmore D, Panhuyzen-Goedkoop NM, Seiler C, Senden J, Solberg EE. ESC study Group of Sports Cardiology: recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease. Eur J Cardiovasc Prev Rehabil. 2006;13(2):137–149. doi: 10.1097/01.hjr.0000199494.46708.5a. PubMed DOI

Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffmann A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. Eur J Cardiovasc Prev Rehabil. 2006;13(3):293–299. PubMed

Pelliccia A, Corrado D, Bjørnstad HH, Panhuyzen-Goedkoop N, Urhausen A, Carre F, Anastasakis A, Vanhees L, Arbustini E, Priori S. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil. 2006;13(6):876–885. doi: 10.1097/01.hjr.0000238393.96975.32. PubMed DOI

Heidbüchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A, Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil. 2006;13(4):475–484. doi: 10.1097/01.hjr.0000216543.54066.72. PubMed DOI

Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A, Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil. 2006;13(5):676–686. doi: 10.1097/01.hjr.0000239465.26132.29. PubMed DOI

Vanhees L, De Sutter J, GeladaS N, Doyle F, Prescott E, Cornelissen V, Kouidi E, Dugmore D, Vanuzzo D, Börjesson M, Doherty P, EACPR Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (part I) Eur J Prev Cardiol. 2012;19(4):670–686. doi: 10.1177/2047487312437059. PubMed DOI

Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Z, Cornelissen V, Adamopoulos S, Prescott E, Börjesson M, Bjarnason-Wehrens B, Björnstad HH, Cohen-Solal A, Conraads V, Corrado D, De Sutter J, Doherty P, Doyle F, Dugmore D, Ellingsen Ø, Fagard R, Giada F, Gielen S, Hager A, Halle M, Heidbüchel H, Jegier A, Mazic S, McGee H, Mellwig KP, Mendes M, Mezzani A, Pattyn N, Pelliccia A, Piepoli M, Rauch B, Schmidt-Trucksäss A, Takken T, van Buuren F, Vanuzzo D. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19(5):1005–1033. doi: 10.1177/1741826711430926. PubMed DOI

Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M, Writing Group, EACPR Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (part III) Eur J Prev Cardiol. 2012;19(6):1333–1356. doi: 10.1177/2047487312437063. PubMed DOI

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Authors/Task Force Members 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & rehabilitation (EACPR) Eur Heart J. 2016;37(29):2315–2381. doi: 10.1093/eurheartj/ehw106. PubMed DOI PMC

Liakos CI, Grassos CA, Babalis DK, European Society of Hypertension; European Society of Cardiology 2013 ESH/ESC guidelines for the management of arterial hypertension: what has changed in daily clinical practice? High Blood Press Cardiovasc Prev. 2015;22(1):43–53. doi: 10.1007/s40292-014-0071-2. PubMed DOI

Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, Gyberg V, Amouyel P, Bruthans J, Castro Conde A, Cífková R, Deckers JW, De Sutter J, Dilic M, Dolzhenko M, Erglis A, Fras Z, Gaita D, Gotcheva N, Goudevenos J, Heuschmann P, Laucevicius A, Lehto S, Lovic D, Miličić D, Moore D, Nicolaides E, Oganov R, Pajak A, Pogosova N, Reiner Z, Stagmo M, Störk S, Tokgözoğlu L, Vulic D, EUROASPIRE Investigators EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016;23(6):636–648. doi: 10.1177/2047487315569401. PubMed DOI

Berben L, Dobbels F, Engberg S, Hill MN, De Geest S. An ecological perspective on medication adherence. West J Nurs Res. 2012;34(5):635–653. doi: 10.1177/0193945911434518. PubMed DOI

Cramm JM, Nieboer AP. The importance of productive patient-professional interaction for the well-being of chronically ill patients. Qual Life Res. 2015;24(4):897–903. doi: 10.1007/s11136-014-0813-6. PubMed DOI PMC

Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834. doi: 10.1097/MLR.0b013e31819a5acc. PubMed DOI PMC

McKenna VB, Sixsmith J, Barry MM. The relevance of context in understanding health literacy skills: findings from a qualitative study. Health Expect. 2017;20(5):1049–1060. doi: 10.1111/hex.12547. PubMed DOI PMC

van Schaik TM, Jørstad HT, Twickler TB, Peters RJG, Tijssen JPG, Essink-Bot ML, Fransen MP. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Neth Heart J. 2017;25(7–8):446–454. doi: 10.1007/s12471-017-0963-6. PubMed DOI PMC

Institute of Medicine (US) Committee on Health Literacy. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington: National Academies Press (US); 2004. PubMed

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. doi: 10.7326/0003-4819-155-2-201107190-00005. PubMed DOI

Geboers B, de Winter AF, Luten KA, Jansen CJ, Reijneveld SA. The association of health literacy with physical activity and nutritional behavior in older adults, and its social cognitive mediators. J Health Commun. 2014;19(Suppl 2):61–76. doi: 10.1080/10810730.2014.934933. PubMed DOI

Koh HK, Brach C, Harris LM, Parchman ML. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care. Health Aff (Millwood) 2013;32(2):357–367. doi: 10.1377/hlthaff.2012.1205. PubMed DOI PMC

Zullig LL, McCant F, Melnyk SD, Danus S, Bosworth HB. A health literacy pilot intervention to improve medication adherence using Meducation® technology. Patient Educ Couns. 2014;95(2):288–291. doi: 10.1016/j.pec.2014.02.004. PubMed DOI

Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, McKibben RA, Michos ED, Ndumele CE, Ratchford EV, Coresh J, Blaha MJ. mActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015;4(11) 10.1161/JAHA.115.002239. PubMed PMC

Franklin NC, Lavie CJ, Arena RA. Personal health technology: a new era in cardiovascular disease prevention. Postgrad Med. 2015;127(2):150–158. doi: 10.1080/00325481.2015.1015396. PubMed DOI PMC

Hansen D, Dendale P, Coninx K, Vanhees L, Piepoli MF, Niebauer J, Cornelissen V, Pedretti R, Geurts E, Ruiz GR, Corrà U, Schmid JP, Greco E, Davos CH, Edelmann F, Abreu A, Rauch B, Ambrosetti M, Braga SS, Barna O, Beckers P, Bussotti M, Fagard R, Faggiano P, Garcia-Porrero E, Kouidi E, Lamotte M, Neunhäuserer D, Reibis R, Spruit MA, Stettler C, Takken T, Tonoli C, Vigorito C, Völler H, Doherty P. The European Association of Preventive Cardiology Exercise Prescription in everyday practice and rehabilitative training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol. 2017;24(10):1017–1031. doi: 10.1177/2047487317702042. PubMed DOI

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583. PubMed DOI PMC

Authors/Task Force Members. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Additional Contributor: Simone Binno (Italy) Document Reviewers. De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GY, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention & rehabilitation (EACPR) Eur J Prev Cardiol. 2016;23(11):NP1–NP96. doi: 10.1177/2047487316653709. PubMed DOI

Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB. PubMed DOI

Arredondo EM, Mendelson T, Holub C, Espinoza N, Marshall S. Cultural adaptation of physical activity self-report instruments. J Phys Act Health. 2012;9(Suppl 1):S37–S43. doi: 10.1123/jpah.9.s1.s37. PubMed DOI PMC

Sperber AD, Devellis RF, Boehlecke B. Cross-cultural translation: methodology and validation. J Cross-Cult Psychol. 1994;25(4):501–524. doi: 10.1177/0022022194254006. DOI

Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ) BMC Public Health. 2013;13:658. doi: 10.1186/1471-2458-13-658. PubMed DOI PMC

Kolarcik P, Cepova E, Madarasova Geckova A, Elsworth GR, Batterham RW, Osborne RH. Structural properties and psychometric improvements of the health literacy questionnaire in a Slovak population. Int J Public Health. 2017;62(5):591–604. doi: 10.1007/s00038-017-0945-x. PubMed DOI

Cicero AF, D'Addato S, Santi F, Ferroni A, Borghi C. Brisighella heart study. Leisure-time physical activity and cardiovascular disease mortality: the Brisighella heart study. J Cardiovasc Med (Hagerstown) 2012;13(9):559–564. doi: 10.2459/JCM.0b013e3283516798. PubMed DOI

Savela S, Koistinen P, Tilvis RS, Strandberg AY, Pitkälä KH, Salomaa VV, Miettinen TA, Strandberg TE. Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men. Eur J Epidemiol. 2010;25(9):619–625. doi: 10.1007/s10654-010-9483-z. PubMed DOI

Zobrazit více v PubMed

ClinicalTrials.gov
NCT03329053