A multicenter, blinded, randomized, 12-month study with parallel groups to compare the clinical and cost-effectiveness of a new hybrid exercise intervention with usual care: the PRIORITY-project (FWO-TBM |T004420N)

The current research proposal aims to implement a hybrid exercise intervention in 450 patients across the three stages of heart failure (HF) (i.e., stage A, B, and C) that are representative (in terms of stage, age, gender, and socioeconomic background) of the Flemish population, and to validate its clinical effectiveness through a one-year randomized controlled multicenter study.

We are conducting a large randomized controlled multicenter exercise study in which the number of patients is compared with a clinically relevant improvement in maximum oxygen uptake after personalized hybrid exercise therapy (i.e., a combination of supervised and home training sessions) or usual care in patients with HF stage A/B/C.

We also hypothesize that personalized exercise therapy delivered according to our hybrid exercise intervention will encourage a greater proportion of patients to adopt and maintain an active lifestyle in the long term. Finally, PRIORITY will use a machine learning approach to develop models that can identify patients who are more likely to 1) adhere to exercise therapy and 2) respond favorably to the PRIORITY exercise intervention, enabling a more personalized intervention strategy and exercise program to maximize its therapeutic effectiveness.

COPD and lung cancer are diseases with high mortality rates.

COPD accounts for 5% of all deaths worldwide, and lung cancer is the leading cause of cancer-related deaths. Both diseases are characterized by extrapulmonary effects. Muscle weakness, decreased exercise tolerance, physical inactivity, and a decline in quality of life are observed in patients with COPD and lung cancer. The aim of this research, in collaboration with ZOL Genk, is to gain more insight into these outcomes.

In the first study, we will compare stable COPD patients with patients experiencing an acute exacerbation (AE). Patients with an AE will also be prospectively followed during and one month after hospitalization. The objectives are: (1) to investigate the prognostic value of assessing physical functioning during AE in terms of hospitalization and mortality, and (2) to examine the impact of AE on physical functioning and symptoms.
In the second study, we will include patients with a primary diagnosis of non-small cell lung cancer (NSCLC) who will undergo treatment. Testing will take place before, during, and after treatment.

The research objectives are: (1) to examine physical functioning before the start of treatment in lung cancer patients compared to healthy controls, (2) to investigate changes in physical functioning and symptoms during the course of treatment in lung cancer patients, and (3) to assess the relationship between physical condition after lung cancer treatment and comorbidities, hospitalizations, and mortality.

Evaluations in both studies will include tests to measure physical functioning (functional exercise capacity, muscle strength, balance, physical activity) and questionnaires to assess symptoms.

Patients treated for lung cancer sometimes experience decreased physical fitness and reduced daily physical activity.

Physical training (for physical fitness) and movement coaching (for physical activity) are scientifically supported strategies to address these issues in various forms of cancer and chronic conditions (e.g., patients with chronic lung disease). It is important to 1) adapt these existing strategies to the specific needs of lung cancer patients; 2) demonstrate that they are feasible and effective for this patient group; and 3) assess to what extent they can positively influence quality of life and symptoms.

In this study, in collaboration with Ghent University and Jessa Hospital Hasselt, we will randomly assign 126 patients with NSCLC who underwent lung surgery 3 to 9 months ago into three groups: one group will receive movement coaching (focused on the home situation), one group will participate in supervised exercise training in the hospital three times a week, and one group will receive standard medical follow-up (similar to the other two groups).

The study will investigate the extent to which these interventions positively impact physical fitness, physical activity, quality of life, and experienced symptoms, both in the short term (after 12 weeks of intervention) and in the long term (12 weeks after the intervention ends). The input of experiential experts (patients) is crucial in this study, both for fine-tuning the movement coaching intervention in a prior pilot study and for assessing feasibility afterward.

Direct Access to Physiotherapy for Acute Lower Back Pain in Belgium (The Direct-Physio Trial)

Lower back pain (LBP) is the leading cause of disability worldwide. Increasing absenteeism from work and high medical costs make the optimization of care pathways necessary. Early or direct access to physiotherapy has already led to better clinical outcomes, reduced healthcare usage, and lower costs, and has also been implemented in other European countries (e.g., the Netherlands, the United Kingdom).

Despite these positive outcomes, direct access to physiotherapy has never been studied in Belgium. Therefore, the aim of this study is to investigate the added value of direct access to physiotherapy in terms of pain, disability, and cost-effectiveness for acute LBP compared to the usual care pathway with referral from a general practitioner. In this study, 600 adults with acute LBP, lasting more than 24 hours and less than 6 weeks, will be recruited and randomly assigned to either the usual care pathway with referral from the general practitioner or the experimental pathway with direct access to physiotherapy. Primary outcomes are pain intensity, location, and disability.

Secondarily, a cost-effectiveness analysis will be conducted to outline the costs associated with acute LBP and its treatment for both the patient and society. Secondary outcomes include beliefs and cognitions related to LBP, quality of life, disability, number of flare-ups, and overall therapy effect. All outcomes will be assessed at baseline, at the end of the intervention, and at 3 months, 1 year, and 2 years after inclusion.

The results of this study will be used to optimize the care pathway for acute LBP in Belgium. The study has been approved by the Medical Ethics Committee of UHasselt (ID number CME2021/066). This research is conducted in collaboration with AXXON, KU Leuven, UAntwerpen, and UCLouvain, and is funded by RIZIV-INAMI.

This research focuses on preventive, nature-based, and technology-supported screening and interventions related to stress (at work) and the promotion of mental well-being.

Project Examples:

Renewing in Nature for Impending Burnout: Multidisciplinary Nature-Based Prevention Program

With this project, we aim to intervene preventively in the development of burnout by detecting and addressing early stress-related complaints.

Specifically, we want to examine the impact of evidence-based multidisciplinary interventions and renewing in nature on stress-related complaints, and we will investigate the preventive influence of these interventions on the development of burnout.