Personal Activity Intelligence (PAI) e-health Program for Defence Force and Ex-Service Personnel and immediate family following heart rehabilitation.

Interventional Intervention Details- the PAI e-health Program: The program involves the provision of a wrist-worn monitor and 4 x 2-hour group sessions over a 6 week period (i.e. weeks 1, 2, 4 and 6) held at The University of Queensland, St Lucia, Brisbane, Queensland followed by a further 6 weeks of self-directed activity with fortnightly follow-up telephone calls (i.e. weeks 8, 10, and 12). Groups will be between 2-5 participants. This is aimed at educating them about Personal Activity Intelligence (PAI) and their physical activity goals. At the first session participants will be given a fitness wristband to keep. This measures heart rate when exercising to calculate PAI points. The device is called AMAZFIT GTS wristband. It uses an LED light to illuminate the capillaries around the participants wrist, tracking the velocity of the blood flow and thus, heart rate. Physical Activity Intelligence (PAI) is calculated by an algorithm in the device that uses the participant's heart rate, awarding them with a number of PAI depending on the intensity of the exercise with the goal of reaching 100 PAI per week. Each session will consist of activities that will include: • PAI-learning • PAI-playtime • Behaviour Change Counselling and Interpretive assistance PAI-learning- This is designed to learn how to use the PAI app on their smartphone, how to activate heart rate recording, how to connect with PAI-buddies and how to troubleshoot problems. PAI-playtime- During this activity an accredited exercise physiologist (AEP) will guide participants through different types of exercise (for short bouts of 5-10 minutes) at different intensities to see the different ways PAI can be obtained. This will demonstrate different ways to ‘earn’ PAI and include instruction on how to self- direct exercise. Blood pressure and rating of perceived exertion (RPE) will be monitored throughout this session. This activity will last approximately 1 hour. Behaviour Change Counselling and Interpretive Assistance- Semi-structured discussions and behaviour change techniques will be used to support and enable participants to improve physical activity and exercise adherence using the PAI app for self-monitoring. This activity also involves answering questions and addressing any issues that participants may have. Participants randomised to the program will be asked to work towards accumulating at least 100 PAI/week for 12 weeks. Program sessions will be under the directorship of CI Dr Burton (clinical health psychologist) and capped at 5 participants per group. During these visits, participants will be given the wrist-worn heart rate device (Amazfit GTS) and educated on the PAI app (freely available for iPhone/iPad and android devices) and metric. The following 3 group sessions will each follow this format: 1-hour will be used for behavioural counselling including ‘interpretative assistance’ to deepen understanding of the PAI concept and app (including the online PAI e-Health community), discussing experiences using the PAI App, behaviour change problem solving and support; and 1 hour for ‘PAI-playtime’. Between each weekly session, participants will explore and practice using the PAI app. Participants will be given a booklet describing PAI use and examples of exercise sessions that they experienced during the program. The 100 PAI/week can be achieved by a combination of different exercise types and intensities and the participants can, at any time, get information from the app regarding how many minutes at specified heart rates is needed to achieve the weekly goal of 100 PAI. Via the monitor, participants will receive automatic feedback on a daily basis, and data will be recorded onto a secured server. The PAI e-health group will also be able to invite “buddies” from this project into their “PAI community”. Buddies may see and motivate each other to obtain 100 PAI/week, exchange experiences, etc. At the end of the face to face sessions, participants shall be able to: a) use the PAI app: connect app to the heart rate monitor, sync data; b) join/leave/invite ‘buddies’ into the PAI e-Health community; c) know where to get PAI help if they experience any technical problems d) understand the PAI metric and weekly recommendations, and e) know how to mix and match exercises of varying modality and intensity to reach 100 PAI/week. In the following six weeks participants will self-direct their physical activity. Participants will receive a fortnightly check-in phone call from the research team to report adverse events and/or technical issues that have not already been reported. If researchers observe no PAI being recorded, participants will also receive a phone call to ascertain whether there are any technical issues. Contact frequency and nature or/reason for contact with project staff will be recorded and reported. A specifically designed educational booklet will be provided to participants to record experiences and to assist with the behavioural intervention. Adherence to the intervention will be monitored via session attendance checklists at the university, fortnightly phone calls during self directed home exercise phase as well as via weekly PAI data download. The intervention will be delivered by a research assistant with a minimum 2 years' experience in clinical exercise physiology and overseen by a physiotherapist.