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Table 2 Overview of the HeartMan intervention components

From: A Personal Decision Support System for Heart Failure Management (HeartMan): study protocol of the HeartMan randomized controlled trial

Intervention component Strategy Description of the intervention
Nutrition Education on:
- knowledge of healthy nutrition
- eating behavior
- Questionnaire to evaluate knowledge and healthy behavior
Baseline and end of the trial
- Personalized feedback and education is coupled to the questionnaire
- Possibility to consult questionnaire and education material via the application on a voluntary basis during the trial
Exercise Endurance exercise - Assessment of physical capacity: cyclo-ergometry (if available) and 6MWT
- Differentiation based on baseline physical capacity level (low level: cyclo-ergometry < 1 W/kg or 6MWT < 300 m vs. normal level: ≥1 W/kg or 6MWT ≥300 m)
- Individual exercise program via the application:
Frequency: 2–5 times per week
Intensity: HR rest + 40–70% HRR or RPE 10–14/20
Time: 10-40 min
Type: cycling, walking, steps
- Individual progress:
Increase in frequency or time after a predefined number of weeks (after patient’s approval)
Increase in intensity if following criteria are met:
• Adherence to exercise therapy > 60% of training sessions
• Not overshooting the target heart rate in 80% of the training sessions
• Patient’s subjective opinion of exercise intensity: ‘no discomfort’ in 80% of the training sessions
• After at least 8 weeks of exercise training
  Resistance exercise - Differentiation based on baseline physical capacity level
- Individual exercise program via the application:
Frequency: 2–3 times per week
Intensity: 60–70% 1Repetition maximum
Time: 1–2 sets per day
Type: dynamic upper and lower limb exercises, with no or light weights
- Individual progress:
Increase in frequency or time after a predefined number of weeks (after patient’s approval)
Increase in intensity (from no weights to light weights) after a predefined number of weeks (after patient’s approval)
Medication intake Weekly pill organizer - Passive pill dispenser, with personalized reminder function in HeartMan application:
Guidance to prepare medication once per week
Daily personalized notifications to remind the patient to take his medication at the right time
- Assessment of medication adherence by a weekly question whether the patient has taken the recommended medication or not
Appointments   - Personalized reminder function in HeartMan application 1 day before the appointment (only upon the patient’s request)
Mental support Cognitive behavioral therapy - Patient profiling: adaption of the communication according to the psychological profile (anxious, depressed or low motivation) in order to increase adherence to lifestyle interventions
  Mindfulness exercises - Mindfulness exercises are offered to the patient on a daily basis, adapted to the patient’s profile (anxious, depressed or motivated).
- Different types of exercises:
Listening
Focusing
Awareness
Games
Disease education (illness perception) Education on:
- Heart failure disease: causes, symptoms
- Pharmacological treatment:
indications, common side effects
- Sexual dysfunction and sexual activity
- Written education in a depository
- To consult on a voluntary basis
  1. 6MWT, six-minute walking test; HR, heart rate; HRR, heart rate reserve; RPE, rating of perceived exertion