JMIR Publications

ABSTRACT

Background:

Cardiac rehabilitation (CR) remains underutilized due to low referral rates, limited availability, and logistical constraints despite improving outcomes in patients following transcatheter aortic valve replacement (TAVR). “Rehabbing with Peloton”, a novel CR support model, aims to address this through use of digital exercise platforms to offer convenient, safe activity for patients post-TAVR. With unique limitations post-TAVR and the extensive content offered on Peloton, a systematic review and curation of exercise modules is needed to set the foundation for CR support models that can improve activity promotion and outcomes.

Objective:

To review and curate a list of exercise modules available through the Peloton application to support an activity promotion intervention appropriate for use with patients in the weeks following a TAVR procedure.

Methods:

Peloton modules were filtered by inclusion criteria including category (outdoor walking, strength, yoga, and low impact cardio), duration, and difficulty (beginner for all, intermediate for low-impact cardio). Additional filters included “low impact" and “warm-up” for low impact cardio, and “chair yoga" and “shavasana” for yoga. Videos were reviewed by trained personnel and excluded if they exceeded 20 minutes, required additional equipment, or included movements deemed risky by experts for patients post-TAVR (e.g., balancing, Valsalva-inducing, or producing significant afterload). 20% of videos were randomly selected for double review.

Results:

Of over 8,000 Peloton videos screened—outdoor walking (n=639), strength (n=3,000+), yoga (n=4,000+), and low-impact cardio (n=457)— review yielded 231 videos meeting the inclusion and exclusion criteria: outdoor walking (n=116), strength (n=52), yoga (n=23), and low impact cardio (n=40).

Conclusions:

This project establishes a novel systematic, patient-centered review process to identify safe and appropriate digital exercise content for post-TAVR patients within extensive commercial fitness content. The framework models a key step for future CR support models, including “Rehabbing with Peloton”, that integrate virtual platforms to address challenges in access to CR and enhance accessibility for patients, potentially leading to improvements in clinical outcomes, patient engagement, and scalability. Through consideration of the limitations and needs in post-transcatheter aortic valve replacement patients, this project provides a novel outline of expert review and selection of widely available digital exercise content that programs like “Rehabbing with Peloton” and others can use in building modules to safely and effectively support cardiac rehabilitation. This crucial step allows this project and others to integrate virtual exercise platforms like Peloton to address significant challenges in access to cardiac rehabilitation, such as low availability and logistical constraints, and enhance accessibility for patients, which can potentially improve clinical outcomes, patient activity and engagement, and scalability. Clinical Trial: ClinicalTrials ID # NCT07008911