The Added Value of Remote Technology in Cardiac Rehabilitation on Physical Function, Anthropometrics, and Quality of Life: Cluster Randomized Controlled Trial

Abstract

Background Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies’ high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation. Objective We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation. Methods Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test. Results Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P<.001) and increment in self-assessed QoL were greater (environmental factors: 0.5; P=.02) in the remote technology intervention group than the reference group. Both groups achieved statistically significant improvements in the 6-minute walk test in both time frames (P=.01-.03). Additionally, the remote technology intervention group achieved statistically significant changes in the environmental domain at 0-6 months (P=.03) and waist circumference at both time frames (P=.01), and reference group achieve statistically significant changes in waist circumference at 0-6 months (P=.02). Conclusions Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required. Trial Registration ISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

“…18–39 The studies varied in research designs, including 11 randomized controlled trials, 18–20,23,26,27,30–33,35 five pilot studies, 21,24,25,28,36 two observational studies, 29,34 one case study, 22 one qualitative study, 37 one mixed-method study, 38 and one cross-sectional study. 39 The studies had been conducted in different locations: 11 of them in Europe, 18–20,22,28,31,33–36,39 six in Asia, 23,24,29,30,32,37 three in Australia, 25–27 and two in North America. …”

“…Patients participating in the group-based cardiac telerehabilitation were required to have their own, relevant technological equipment with Internet access (computer, telephone, and mobile connection). 18–39 A variety of other devices and applications were also used in the included studies (Supplemental Material Table 3). Out of the 22 studies, a chat feature was primarily utilized as a means of delivering the intervention in 15 studies, 21,22,24–27,29–32,34,35,37–39 telemonitoring, 18,20,24,28–30,32–37,39 and a virtual platform 21–25,28,30–32,34,35,37…”

“…18–39 A variety of other devices and applications were also used in the included studies (Supplemental Material Table 3). Out of the 22 studies, a chat feature was primarily utilized as a means of delivering the intervention in 15 studies, 21,22,24–27,29–32,34,35,37–39 telemonitoring, 18,20,24,28–30,32–37,39 and a virtual platform 21–25,28,30–32,34,35,37–39 were used in 14 studies, other mobile connections in 12 studies…”

“…The studies varied in research designs, including 11 randomized controlled trials, [18][19][20]23,26,27,[30][31][32][33]35 five pilot studies, 21,24,25,28,36 two observational studies, 29,34 one case study, 22 one qualitative study, 37 one mixed-method study, 38 and one cross-sectional study. 39 The studies had been conducted in different locations: 11 of them in Europe, [18][19][20]22,28,31,[33][34][35][36]39 six in Asia, 23,24,29,30,32,37 three in Australia, [25][26][27] and two in North America. 21,38 The target population of 21 of the studies was coronary artery disease patients with heart failure and in one study coronary artery disease patients and the patients' partners.…”

“…18,21,[23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] In the most recently published studies, motivational messages and feedback had been included and were produced by technology by coding these to the used electronic platform. 32,35,37 Only six of the studies clearly described group interactions and social support interactions. 22,24,26,30,35,38 The duration of the cardiac telerehabilitation interventions ranged from 6 weeks 32 to 12 weeks.…”