Hareld Kemps's research while affiliated with Eindhoven University of Technology and other places

Publications (110)

Article
Objective: To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity versus standard CR. Design: Cost-effectiveness analysis based on observations in a randomized controlled clinical trial. Setting: Three regional CR centres in the Netherlands. Participants: Cardiac pati...
Article
Objectives: Knowledge on information needs in cardiac rehabilitation (CR) patients is scarce. This study investigates determinants of information needs in patients with coronary artery disease (CAD). Design: Prospective observational study. Participants: A total of 259 patients participated. Setting: CR centre serving a general hospital in T...
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Background: Gamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research sett...
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Background Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise p...
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Introduction Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare provid...
Chapter
Cardiovascular diseases (CVDs) are currently the leading cause of death worldwide. Accumulated evidence indicates that a healthy diet contributes significantly to health promotion and an increase in quality of life for those living with CVDs. While dietary intake management plays an integral part in cardiac rehabilitation (CR), tracking dietary int...
Preprint
BACKGROUND Multiple questionnaires exist to assess digital literacy. However, participation and adherence to digital health interventions is linked with other factors such as digital skills and access. OBJECTIVE The aim of the development of the Digital Health Readiness-Q (DHR-Q) was to create a short, usable, and freely accessible questionnaire t...
Article
Background While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objec...
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Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and...
Preprint
BACKGROUND Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (a type of incentive in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous rese...
Article
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Purpose Various parameters of mechanical dyssynchrony have been proposed to improve patient selection criteria for cardiac resynchronization therapy, but sensitivity and specificity are lacking. However, echocardiographic parameters are consistently investigated at rest, whereas heart failure (HF) symptoms predominately manifest during submaximal e...
Article
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the oth...
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Background In this study, the relationship between AF-related quality of life (AFEQT) at baseline in AF-patients and the improvement on perceived symptoms and general state of health (EHRA, European Heart Rhythm Association score) at 12 months was assessed across predefined age categories. Methods Between November 2014 and October 2019 patients di...
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Introduction Current cardiac telerehabilitation (CTR) interventions are insufficiently tailored to the preferences and competences of individual patients, which raises the question whether their implementation will increase overall participation and adherence to cardiac rehabilitation. However, research on patient-specific factors that influence pa...
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Importance Cardiac telerehabilitation (CTR) has been found to be a safe and beneficial alternative to traditional center-based cardiac rehabilitation (CR) and might be associated with higher participation rates by reducing barriers to CR use. However, implementation of CTR interventions remains low, which may be owing to a lack of cost-effectivenes...
Article
Aims Accumulating evidence questions the clinical value of percutaneous coronary intervention (PCI) for patients with chronic coronary syndrome (CCS). We therefore compare the impact of exercise-based cardiac rehabilitation (CR) vs. PCI in patients with CCS on 18-month mortality and morbidity, and evaluate the effects of combining PCI with exercise...
Article
Background As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for pa...
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Aims: The kinocardiograph (KCG) is an unobtrusive device, consisting of a chest sensor, which records local thoracic vibrations produced in result of cardiac contraction and ejection of blood into the great vessels [seismocardiography (SCG)], and a lower back sensor, which records micromovements of the body in reaction to blood flowing through the...
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Background A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) invo...
Preprint
BACKGROUND Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common. OBJECTIVE In this study, we evaluated adherence to a...
Article
Background Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common. Objective In this study, we evaluated adherence to a...
Article
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Cardiac rehabilitation (CR) has evolved as an important part of the treatment of patients with cardiovascular disease. However, to date, its full potential is fairly underutilised. This review discusses new developments in CR aimed at improving participation rates and long-term effectiveness in the general cardiac population. It consecutively highl...
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A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehab...
Preprint
BACKGROUND As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. OBJECTIVE The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for pa...
Article
Introduction: eHealth interventions have the potential to improve the quality of healthcare and reduce costs. However, to implement eHealth interventions successfully instruments are needed to facilitate this process. This study aims to develop an eHealth implementation guideline for implementation of eHealth interventions in daily practice. Meth...
Preprint
BACKGROUND A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) invo...
Article
Full-text available
Commercially available health technologies such as smartphones and smartwatches, activity trackers and eHealth applications, commonly referred to as wearables, are increasingly available and used both in the leisure and healthcare sector for pulse and fitness/activity tracking. The aim of the Position Paper is to identify specific barriers and know...
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Background Healthy living is key in the prevention and rehabilitation of cardiovascular disease (CVD). Yet, supporting and maintaining a healthy lifestyle is exceptionally difficult and people differ in their needs regarding optimal support for healthy lifestyle interventions. Objective The goals of this study were threefold: to uncover stakeholde...
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This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Lik...
Article
Aims Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR pr...
Article
Background: Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually...
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Background: Despite proven clinical benefits, only a minority of patients complete outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI). The main purpose of this study was to evaluate to what extent and at which time patients drop out of CR, and to assess which patient-related characteristics can predict dropout. Methods...
Article
Importance: Hypertensive pregnancy disorders (HPDs) are associated with an increased risk of long-term cardiovascular disease. Speckle tracking echocardiography (STE) might be useful in the early detection of preclinical cardiac changes in women with HPDs. Objective: The aim of this study was to study whether STE is a suitable method to detect d...
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The ongoing coronavirus disease 2019 (COVID-19) crisis is having a large impact on acute and chronic cardiac care. Due to public health measures and the reorganisation of outpatient cardiac care, traditional centre-based cardiac rehabilitation is currently almost impossible. In addition, public health measures are having a potentially negative impa...
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The coronavirus disease 2019 (COVID-19) pandemic has led to preventive measures worldwide. With the decline of infection rates, less stringent restrictions for sports and exercise are being implemented. COVID-19 is associated with significant cardiovascular complications; however there are limited data on cardiovascular complications and long-term...
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The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality o...
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Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low, and targets for secondary prevention of cardiovascular disease are not met in the majority of patients, indicating that secondary prevention programmes such as CR leave room for impr...
Article
Background Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually...
Preprint
BACKGROUND Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often co-exist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually...
Article
Establishment of the maturational patterns of the fetal left and right ventricle strain and strain rate by two-dimensional speckle tracking echocardiography is a prerequisite for its routine clinical adaptation in pregnancy. The aim of this study is to review systematically current literature on the development of left and right ventricle strain an...
Article
Purpose The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of Chronic Heart Failure (CHF). The recovery of the oxygen pulse (OP) is a non‐invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central hemodynamic response to ex...
Article
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and ‘modern’ cardi...
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Background Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised...
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The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic...
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Aims In asymptomatic athletes, abnormal exercise test (ET) results have a poor positive predictive value. It is unknown whether abnormal ET results in the absence of obstructive coronary artery disease (CAD) are related to coronary microvascular dysfunction. It is also unknown whether they should be considered false-positive ET results or a consequ...
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Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. Methods: In this cross-sectional study, a piloted survey was a...
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Background Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods A survey was administered to CR programs globally. Cardiac associations and local...
Article
Background: CRT leads to improvement in exercise capacity, cardiac function and mortality in selected CHF patients. Exercise capacity improves even greater when combining CRT with moderate-intensity exercise training (ET). However, high-intensity interval training (HIT) as additional therapy to CRT has not yet been established. Given the complemen...
Article
Aims: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries. Methods: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facil...
Article
Background: A recent survey among Dutch cardiac rehabilitation centers demonstrated considerable between-center variations in the contents of exercise training programs. For patients entering cardiac rehabilitation, current guidelines recommend tailored exercise training programs based on patient characteristics and rehabilitation goals. Objectiv...
Article
Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, v...
Article
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Background Previous studies revealed a high rate of abnormal exercise test (ET) results in the absence of obstructive coronary artery disease (CAD) in asymptomatic athletes. The physiological background of this phenomenon is not well established. In particular, it is unclear whether sports-induced morphological cardiac adaptations are determinants...
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Metabolic syndrome (MetS) – a clustering of pathological conditions, including abdominal obesity, hypertension, dyslipidemia and hyperglycaemia – is closely associated with the development of type 2 diabetes mellitus (T2DM) and a high risk of cardiovascular disease. A combination of multigenetic predisposition and lifestyle choices accounts for the...
Article
Purpose: The clinical relevance of abnormal exercise testing (ET) results (at least 0.1 mV ST segment depression measured during exercise or recovery in three consecutive beats) in athletes without obstructive coronary artery disease (CAD) is not well understood. It is unknown whether this phenomenon reflects a physiological adaptation to sport or...
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Purpose: Assessment of limitations in the perfusion dynamics of skeletal muscle may provide insight in the pathophysiology of exercise intolerance in, e.g., heart failure patients. Power doppler ultrasound (PDUS) has been recognized as a sensitive tool for the detection of muscle blood flow. In this volunteer study (N = 30), a method is demonstrat...
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Cardiorespiratory fitness (CRF) provides important diagnostic and prognostic information. It is measured directly via laboratory maximal testing or indirectly via submaximal protocols making use of predictor parameters such as submaximal VO2, heart rate, workload, and perceived exertion. We have established an innovative methodology, which can prov...
Data
Supporting infomration data_squat.xlsx. (XLSX)
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Background: Although exercise-based cardiac rehabilitation improves exercise capacity of coronary artery disease patients, it is unclear which training characteristic determines this improvement. Total energy expenditure and its constituent training characteristics (training intensity, session frequency, session duration and programme length) vary...
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Objective: Near-infrared spectroscopy (NIRS) measurements of tissue oxygen saturation (StO2) are useful for the assessment of skeletal muscle perfusion and function during exercise, however, they are influenced by overlying skin and adipose tissue. This study explored the extent and nature of the influence of adipose tissue thickness (ATT) on StO2...
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Background Cardiac rehabilitation has beneficial effects on morbidity and mortality in patients with coronary artery disease, but is vastly underutilised and short-term improvements are often not sustained. Telerehabilitation has the potential to overcome these barriers, but its superiority has not been convincingly demonstrated yet. This may be du...
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Background The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. Methods We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in the Netherlands. Our participant...
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The extent and speed of transient skeletal muscle deoxygenation during exercise onset in chronic heart failure (CHF) patients is related to impairments of local O2 delivery and utilization. This study examined the physiological background of submaximal exercise performance in 19 moderately impaired CHF patients (Weber class A, B, and C) compared wi...
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Background Although test characteristics of exercise electrocardiography are well established in symptomatic patients, data on healthy athletes are scarce. This systematic review focuses on the diagnostic utility of exercise electrocardiography for the detection of coronary heart disease in athletes during pre-participation screening. Objectives Th...
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Background: High-intensity interval training (HIT) improves exercise capacity in patients with chronic heart failure (CHF). Moreover, HIT was associated with improved resting cardiac function. However, the extent to which these improvements actually contribute to training-induced changes in exercise capacity remains to be elucidated. Therefore, we...
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Oxygen uptake (V̇O2) kinetics are prolonged in patients with chronic heart failure (CHF). This may be caused by impaired oxygen delivery or skeletal muscle derangements. We investigated whether impaired cardiac output (Q) kinetics limit skeletal muscle oxygen delivery relative to the metabolic demands at submaximal exercise in CHF patients by evalu...
Article
Although aerobic exercise training has shown to be an effective treatment for chronic heart failure patients, there has been debate about the design of training programs and which training characteristics are the strongest determinants of improvement in exercise capacity. Therefore, we performed a meta-regression analysis to determine a ranking of...
Article
Despite their widespread use, audit and feedback (A&F) interventions show variable effectiveness on improving professional performance. Based on known facilitators of successful A&F interventions, we developed a web-based A&F intervention with indicator-based performance feedback, benchmark information, action planning and outreach visits. The goal...
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Background Guideline adherence with respect to exercise-based cardiac rehabilitation (CR) is hampered by a large variety of complex guidelines and position statements, and the fact that these documents are not specifically designed for healthcare professionals prescribing exercise-based CR programs. This study aimed to develop clinical algorithms t...
Conference Paper
Energy expenditure have been often estimated using computational models based on heart rate (HR) and appropriate personalization strategies to account for users cardio-respiratory characteristics. However, medications like beta blockers which are prescribed to treat several cardiac conditions have a direct influence on the cardiovascular system and...