The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study

Abstract

Background Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective We evaluated the impact on CR participation rates associated with the addition of the option of mobile app–based CR (Cardihab) for patients declining conventional CR. Methods A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results CR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake.

Implementing a Sedentary Behavior Change Smartphone App in Cardiac Rehabilitation

“…27 Future interventions may instead benefit from tailoring apps that participants are already using. Furthermore, acknowledging personal preference may assist with real-world implementation irrespective of CR participants' digital literacy, 6 especially as more apps and wearable activity trackers infiltrate the market.…”

“…Still, the complexity of implementing such interventions is broad with some concerns for uptake and retention by participants and healthcare providers. [5][6][7] Enablers to using mHealth interventions in CR and other cardiovascular disease populations include level of personalization, 5,[7][8][9][10] professional and technical support, 5,[7][8][9]11 behavior change techniques (eg, goal setting), 5,[7][8][9][10][11] tracking elements related to cardiac conditions (eg, heart rate), 7,8,[10][11][12] digital literacy (eg, ability to download, use, problem solve), 7,8 psychological characteristics (eg, motivation, self-efficacy), 5,8 social connectedness, 5 and personal preference. 5 Barriers center around technology issues (eg, draining phone battery).…”

“…5 Barriers center around technology issues (eg, draining phone battery). 6,8 The influence of participants' previous experience with using technology (eg, apps and wearable activity trackers) is not well established; however, the perceived ease of use may be a contributing factor for uptake and engagement. 13 Having greater app user engagement is associated with better outcomes for risk factor reduction and management 14 ; unfortunately, this is not always achieved.…”

Digital interventions in the management of advanced liver disease: Prescription and monitoring of healthy living in homes

“…Telerehabilitation includes exercises for which intensity and duration can be monitored with technology (“telemonitoring”) with a focus on improving exercise‐related outcomes 15 . In the cardiovascular literature, numerous studies exist on the use of telerehabilitation in frail patients with a variety of tools, including smartphone apps, smartwatches, and wearable sensors 16–20 . Recent literature review by Cruz and colleagues 21 failed to identify any studies investigating the role of digital interventions in nutritional management in CLD as compared with studies in chronic kidney disease ( n = 6), cancer ( n = 6), and cardiovascular disease ( n = 3).…”

“…15 In the cardiovascular literature, numerous studies exist on the use of telerehabilitation in frail patients with a variety of tools, including smartphone apps, smartwatches, and wearable sensors. [16][17][18][19][20] Recent literature review by Cruz and colleagues 21 failed to identify any studies investigating the role of digital interventions in nutritional management in CLD as compared with studies in chronic kidney disease (n = 6), cancer (n = 6), and cardiovascular disease (n = 3). One of the potential challenges in the CLD population may be acceptance and adequate access to technology (Figure 1).…”