Personalized Activity Intervention in Rehabilitation After Cardiac Operations (the PACO Trial)
Personalized Activity Intervention in Rehabilitation After Cardiac Operations (the PACO Trial)
The PACO trial is a randomized clinical trial conducted in Heart Centers of Kuopio and Turku
 university hospitals. The coronary artery disease, aortic valve stenosis and mitral valve
 insufficiency patients preparing for elective coronary artery bypass grafting (CABG), aortic
 valve replacement (AVR) or mitral valve repair (MVR) will be randomized to either
 intervention or control group. The specific operation groups (CABG, AVR and MVR) will be
 analyzed separately. The 7-day baseline measurements of sedentary behaviour (SB), physical
 activity (PA) and sleep will be conducted to the patients by using the RM42 accelerometer
 during the pre-operative month.

 After the cardiac procedure is completed and the patient is moved to post-operative ward, the
 control group patients will begin the standard post-operative rehabilitation program of the
 participating hospitals (activity guidance given by a physiotherapist). Patients in the
 intervention groups will follow the identical program but after discharge they will also
 receive personalized activity guidance through the combination of ExSed smart phone
 application, Suunto MoveSense accelerometer and cloud system during the first 90 days of
 post-operative rehabilitation. Weekly evolving daily goals to replace SB with PA (daily goals
 for steps, moderate PA, light PA and standing, and sitting time limit) will be designed for
 each patient of the intervention groups. A new daily step goal will be delivered from the
 cloud system to the patient's smart phone in the beginning of each week of the intervention.
 The daily step goal of the first intervention week is based on patient's walking distance
 assessed by a physiotherapist in post-operative ward. The following goals will be
 automatically evolved in the basis of patient's personal average step count of the previous
 week. The MoveSense accelerometer will measure accumulated levels of SB, PA and sleep, and
 transmit the data to user's ExSed application with Bluetooth. With information about
 accumulated levels of SB and PA, the application is able to guide the patient to accomplish
 the predefined activity goal. The guidance and motivation will be offered with pop-up
 notifications and histograms (columns are fulfilled according to patient's accumulated daily
 activity). The researches retain a remote access to the activity data of patients in the
 cloud system. The ExSed application will be connected to the cloud system with internet
 connection.

 In addition, the patients of the intervention groups will receive short video files (lasting
 from 1 to 3 minutes) containing exercise guidance from a physiotherapist specialized to
 cardiac operation patients. These videos are available on the ExSed application during the
 intervention. The physiotherapist will also contact each patient (by mobile phone) with
 structured contact form from 1 to 4 times in a month to make sure that the intervention is
 proceeding as designed.
Inclusion Criteria:

 -  An eligible patient with coronary artery disease, aortic valve stenosis or mitral
 valve insufficiency scheduled for elective coronary artery bypass grafting, aortic
 valve replacement or mitral valve repair operation.

 -  He / she does not have any severe disease or functional limitation limiting PA (other
 than CVD).

 -  He / she is willing to wear a hip- and wrist-worn accelerometer.

 -  He / she is willing and capable to use a smart phone application.

 Exclusion Criteria:

 -  He / she ends up in prolonged intensive care after cardiac operation.

 -  He / she has a memory disorder (i.e. Alzheimer's disease).