BackgroundCardiac rehabilitation (CR) is an essential part of contemporary coronary heart disease management. However, patients exiting a center-based CR program have difficulty retaining its benefits.ObjectiveWe aimed to evaluate the added benefit of a home-based CR program with telemonitoring guidance on physical fitness in patients with coronary artery disease (CAD) completing a phase II ambulatory CR program and to compare the effectiveness of this program in a prolonged center-based CR intervention by means of a randomized controlled trial.MethodsBetween February 2014 and August 2016, 90 CAD patients (unblinded, mean age 61.2 years, SD 7.6; 80/90, 89.0% males; mean height 1.73 m, SD 0.7; mean weight 82.9 kg, SD 13; mean body mass index 27.5 kg/m2, SD 3.4) who successfully completed a 3-month ambulatory CR program were randomly allocated to one of three groups: home-based (30), center-based (30), or control group (30) on a 1:1:1 basis. Home-based patients received a home-based exercise intervention with telemonitoring guidance consisting of weekly emails or phone calls; center-based patients continued the standard in-hospital CR, and control group patients received the usual care including the advice to remain physically active. All the patients underwent cardiopulmonary exercise testing for assessment of their peak oxygen uptake (VO2 P) at baseline and after a 12-week intervention period. Secondary outcomes included physical activity behavior, anthropometric characteristics, traditional cardiovascular risk factors, and quality of life.ResultsFollowing 12 weeks of intervention, the increase in VO2 P was larger in the center-based (P=.03) and home-based (P=.04) groups than in the control group. In addition, oxygen uptake at the first (P-interaction=.03) and second (P-interaction=.03) ventilatory thresholds increased significantly more in the home-based group than in the center-based group. No significant changes were observed in the secondary outcomes.ConclusionsAdding a home-based exercise program with telemonitoring guidance following completion of a phase II ambulatory CR program results in further improvement of physical fitness and is equally as effective as prolonging a center-based CR in patients with CAD.Trial RegistrationClinicalTrials.gov NCT02047942; https://clinicaltrials.gov/ct2/show/NCT02047942 (Archived by WebCite at http://www.webcitation.org/70CBkSURj)
Background Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. Objective The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. Methods Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. Results Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups ( Ptime > 0.05 for all), irrespective of the intervention ( Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity ( Ptime < 0.05). No interaction effect was found for physical activity. Conclusion Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. Trial registration ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942
BackgroundCardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR.MethodsA technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations.ResultsOf 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = −0.16; p = 0.005).ConclusionsCVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0329-9) contains supplementary material, which is available to authorized users.
The accuracy of wrist worn heart rate monitors based on photoplethysmography (PPG) is not fully clinically accepted. Therefore, we aimed to validate heart rate measurements of a commercially available PPG heart rate monitor, i.e. the Garmin Forerunner 225. Twelve healthy volunteers (six women; mean age: 28 years) performed a treadmill protocol consisting of: five minutes sitting, five minutes standing, 10 minutes walking at 4 km/h, 10 minutes walking at a gradient of 5% and intensity of 4-6 metabolic equivalents (METs), 10 minutes walking at a gradient of 8% and intensity of seven METs or more. Walking speeds were individually determined. Walking bouts were separated by a standardised five minute rest period. Heart rate was measured as the average of the last three minutes standing and of each walking bout. A three lead patch-based electrocardiogram (ECG; Zensor) was used as criterion method. Statistical analyses included Pearson's correlation (r), paired t-tests, root mean squared error (RMSE) and Bland?Altman plots. The mean values per three minutes of every condition did not differ significantly between the Garmin Forerunner 225 and the Zensor. RMSE was 3.01 beats per minute (bpm) or 2.89%. The Bland-Altman bias was 1.57 bpm. Limits of agreement (LoA) were wide, ranging from 32.53 to 29.40 bpm. However, Pearson's r ranged from 0.650 to 0.868 suggesting moderate to strong validity. Generally, mean heart rates, r values, RMSE and the Bland-Altman bias indicated good overall agreement in this sample of healthy adults, but wide LoA are making it difficult to trust individual measurements.
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