Effects of a 12-week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial

doi:10.1016/j.ahj.2018.02.001

American Heart Journal

Volume 199, May 2018, Pages 105-114

https://doi.org/10.1016/j.ahj.2018.02.001 Get rights and content

Abstract

Background

Site-based cardiac rehabilitation (CR) provides supervised exercise, education and motivation for patients. Graduates of CR have improved exercise tolerance. However, when participation in CR ceases, adherence to regular physical activity often declines, consequently leading to worsening risk factors and clinical events. Therefore, the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR.

Methods and Results

A 12-week mHealth program was implemented using physical activity trackers and health coaching. Twenty-five patients were randomized into mHealth or usual care after completing CR. The combination of a 4.7 ± 13.8% increase in the mHealth and a 8.5 ± 11.5% decrease in the usual care group resulted in a difference between groups (P ≤ .05) for absolute peak VO₂. Usual care decreased the amount of moderate-low physical activity minutes per week (117 ± 78 vs 50 ± 53; P < .05) as well as moderate-high (111 ± 87 vs 65 ± 64; P < .05). mHealth increased moderate-high physical activity (138 ± 113 vs 159 ± 156; NS). The divergent changes between mHealth and usual care in moderate-high physical activity minutes/week resulted in a difference between groups (21 ± 103 vs – 46 ± 36; P < .05).

Conclusions

A 12-week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO₂ and physical activity achieved by site-based CR.

Section snippets

Patient population

Five hundred and three patients over 15 months were screened for eligibility (Figure 1). Subjects were screened at time of CR referral and again (if adherent to CR) at approximately CR session #28. Major inclusion criteria included age ≥18 years old, completing 36 on-site CR sessions, clinical stability allowing safe home exercise and a CPX test, ownership of a smartphone and not currently using a physical activity tracker. A majority of patients who did not meet inclusion criteria were

Patient population

The length of time between hospital discharge or office clinic diagnosis and starting CR was 26.9 ± 21.1 days. The average number of insurance-based CR sessions was 35.7 ± 1.0. One patient completed a self-pay CR program. The average time spent in CR was 121.7 ± 28.5 days. Table I shows the baseline patient characteristics of the groups. Groups were equivalent for all characteristics except ACE inhibitor use (31.3% mHealth vs 88.9% usual care, P < .05). Patients completed the Morisky Medical Adherence

Discussion

This pilot study randomized patients after completing CR into either a mHealth intervention or usual care. The purpose was to determine the effects on peak VO₂ and physical activity patterns after a 12-week mHealth program using smartphones, physical activity trackers and health coaching. In this initial study, we demonstrated efficacy for the use of a mHealth intervention to sustain both the fitness levels (peak VO₂) and amount of physical activity gained while regularly attending a CR

Acknowledgements

We would like to thank the Duke Cardiac Rehabilitation staff for their invaluable assistance in identifying potential participants for this study. We would also like to thanks the study participants.

Funding source

This research was supported in part by Vida Health, Inc. The remainder was supported by internal Duke University research funds (Glaxo Research Fund) available to one of the authors (WEK).

Disclosures

Morgan Brady and Connie Chen are employees of Vida Health, Inc.

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: Jerome L. Fleg, MD served as guest editor for this article.

: Clinical Trial Registration: clinicaltrials.gov (registration number NCT02431546).

: Duscha, BD; mHealth and Cardiac Rehabilitation.

: Journal Subject Codes: Cardiovascular Disease, Exercise, Rehabilitation.

View full text

Clinical InvestigationEffects of a 12-week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial

Abstract

Background

Methods and Results

Conclusions

Section snippets

Patient population

Patient population

Discussion

Acknowledgements

Funding source

Disclosures

J Am Coll Cardiol

Am Heart J

J Acad Nutr Diet

Heart Lung Circ

Prog Cardiovasc Dis

Am Heart J

J Am Coll Cardiol

J Card Fail

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Chest

J Clin Epidemiol

Am Heart J

J Am Coll Cardiol

Patient Educ Couns

Prog Cardiovasc Dis

Heart Disease and Stroke Statistics-2016 Update: A Report from the American Heart Association

Circulation

Compressed Mortality File 1999-2009. CDC WONDER Online Database, compiled for Compressed Mortality File 1999–2009 Series 20, No. 20, 2012. Underlying cause-of-death 1999–2009

Deaths: leading causes for 2009

Natl Vital Stat Rep

Exercise-based cardiac rehabilitation for coronary heart disease

Cochrane Database Syst Rev

Adherence to prescribed exercise and diet regimens two months post-cardiac rehabilitation

Can J Cardiovasc Nurs

Maintenance of health behavior change in preventive cardiology. Internalization and self-regulation of new behaviors

Behav Modif

Compliance with cardiovascular disease prevention strategies: a review of the research

Ann Behav Med

Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease

Heart

The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals

Circulation

Diet and exercise adherence and practices among medically underserved patients with chronic disease: variation across four ethnic groups

Health Educ Behav

Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians

J Natl Med Assoc

Clinical Investigation
Effects of a 12-week mHealth program on peak VO₂ and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial