Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial

Abstract

Background Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective This study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions High-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients’ reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528

The Effectiveness of Self-Guided Digital Interventions to Improve Physical Activity and Exercise Outcomes for People With Chronic Conditions: A Systematic Review and Meta-Analysis

“…Overall, no studies were assessed as having a low risk of bias. The majority were assessed as having some risk of bias (39)(40)(41)(42)(43)(44)(45)(46)(47)(48), with the remaining five judged to be at high risk of bias in at least one domain (49)(50)(51)(52)(53). As shown in the weighted summary plot (Figure 2), this could be attributed to having potential bias in the selection of reported results.…”

“…Publications in this research area have been increasing recently with half published in the last 2 years (40,(44)(45)(46)(51)(52)(53)(54). Studies were conducted in Germany (41,44), the Netherlands (39,45), the United Kingdom (49,54), Korea (42,52), Australia (40), Brazil (48), Canada (53), China (47), Hong Kong (46), New Zealand (43), Norway (50), and the United States (51).…”

“…Almost half the studies were testing a website specific to the study (39, 41-43, 46, 54, 55) while three used existing platforms (40,52,53). Applications specifically designed for the study were used in seven studies and involved a smartphone or computer (44,(47)(48)(49)(50)(51)(52). Communication with participants was carried out via automated email (39,46,49,(53)(54)(55), automated SMS text messaging (41)(42)(43) or the study app features (47,48,(50)(51)(52).…”

“…Applications specifically designed for the study were used in seven studies and involved a smartphone or computer (44,(47)(48)(49)(50)(51)(52). Communication with participants was carried out via automated email (39,46,49,(53)(54)(55), automated SMS text messaging (41)(42)(43) or the study app features (47,48,(50)(51)(52). Biosensors were used in five studies (39,43,49,51,52).…”

“…Self-regulatory theory, cognitive behavioral theory, social cognitive theory, exposure-based behavior principles, implementation-intention-based principles, health belief model and operant behavior principles were also each used once (39-41, 43, 46, 47, 54, 55). No underpinning theory was reported for six of the self-guided interventions (44,(48)(49)(50)(51)(52).…”