Real-Time Physical Activity Feedback Maintains Activity During Hospitalization: An Implementation–Effectiveness Evaluation of a Ward-Based Feedback Screen in Routine Cardiology Care Using RE-AIM and Interrupted Time Series Analysis (Preprint)

BACKGROUND Hospital admission is associated with increased sedentary behavior and low levels of physical activity. Hospitals have developed several strategies and interventions to address this unwanted inactivity and increase patient movement during admission. Self-monitoring of physical activity is a promising approach to support activity during hospital stays. OBJECTIVE This study investigated whether providing patients real time-physical activity feedback, compared to receiving no real time physical activity feedback, supported patients in maintaining activity levels in the cardiology ward. METHODS A Hybrid Type 2 interrupted time series design was applied. In Phase 1 (24 weeks), patients wore accelerometers (PAM AM400) with data visible only to healthcare professionals. In Phase 2 (24 weeks), self-monitoring was introduced using a ward-based screen that provided patients real-time feedback on daily physical activity. Implementation outcomes were evaluated within the RE-AIM framework, with “Maintenance,” defined as daily physical activity trends over time, serving as the primary outcome. The other RE-AIM dimensions (Reach, Effectiveness, Adoption, and Implementation) were assessed as secondary outcomes. RESULTS A total of 159 patients were included (75 in Phase 1, 84 in Phase 2). Daily physical activity levels were expressed as active minutes per day. No significant immediate change in daily activity occurred at the start of Phase 2 versus the end of Phase 1 (β = –0.127, p = 0.811). In Phase 1, physical activity declined statistically significantly over time (β = –0.002, p < 0.001; ~6% decrease per month). In Phase 2, following introduction of the self-monitoring intervention, this decline was no longer observed, and activity levels were maintained. A significant phase interaction (β = 0.002, p = 0.027) confirmed stabilization of physical activity levels in Phase 2. Secondary RE-AIM outcomes did not differ between phases. CONCLUSIONS The decline observed when only healthcare professionals accessed the data was no longer present once patients could monitor their own physical activity. Although seasonal influences cannot be excluded, these findings suggest that patient self-monitoring may support the maintenance of physical activity during hospital stays. Sustainability is complex, and determining the effect of patient self-monitoring alone remains challenging. Larger studies are needed to confirm these results. CLINICALTRIAL Trial registration was not required.