Personalized Remotely Guided Preventive Exercise Therapy for a Healthy Heart - the PRIORITY project (PRIORITY)

PRIORITY aims to generate the scientific evidence for the use of
remotely guided exercise therapy as an accessible, clinical and costeffective
treatment to prevent the deleterious effects of sedentary
aging on the heart and forestall progression towards heart failure (HF).
In Belgium, an epidemic of HF exists, with 200 000 HF patients and 40
new cases every day. Mortality approaches 50% within 5 yrs of
diagnosis. The best treatment of HF is prevention. Exercise is one of the
most efficacious ways to improve health outcome of HF patients stage
A-C. Yet, despite a Class I recommendation for exercise, only one third
of HF patients stage A-C receives an adequate dose of physical activity.
As such, a huge treatment gap exists. Our pilot study in 20 patients
showed that a hybrid exercise intervention which combines supervised
exercise with remotely guided home-based exercise increases uptake
and compliance to properly dosed exercise. A wide-spread utilization
strategy is now needed to ensure maximal translation of the results to
the benefit of Flemish patients and the health ecosystem. PRIORITY will
validate the clinical and cost-effectiveness of our hybrid exercise
intervention by means of a multi-center single blind randomized
controlled trial in 450 HF patients (i.e 150 stage A, 150 stage B, 150
stage C). Patients will be randomized (1:1) to usual care or hybrid
exercise intervention. Outcomes will be assessed at baseline, 4 months,
one and two-years. Primary outcome is the proportion of patients with
a clinically relevant improvement in peak oxygen uptake, the most
important predictor of premature death in HF patients stage A-C.
Further, big data of physical activity collected during the trial will be
used to develop models using machine-learning algorithms which can
predict physical activity uptake, compliance and changes in peak oxygen
uptake and CV health to facilitate the creation of more personalized
interventions and better tailored exercise prescription.