JMIR Publications

ABSTRACT

Background:

Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events that is associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality as well as maintaining functional capacity. Leveraging mobile health strategies to increase adherence to PA is a promising approach. Based on the Social Cognitive Theory, we sought to determine whether mobile health strategies (MOVN mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months.

Objective:

The objectives of this pilot randomized controlled trial were to: 1) evaluate group differences in PA and functional capacity; and 2) determine group differences in depression and self-efficacy to maintain exercise after CR.

Methods:

During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the MOVN mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Fitbit Charge 2® to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months.

Results:

We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 66.8 ± 8.6 and 22% were female; retention rate was 85%. Our results from 51 patients who completed follow up showed the intervention group had a statistically significant higher mean daily steps count compared to the control (8,860 vs. 6,633) (P = .02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise.

Conclusions:

Our technology-based intervention using a mobile app, push-through messages, and Fitbit® proposes a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. This intervention addresses a major public health initiative to promote PA in patients with CVD with the potential to improve critical PA, clinical, and psychosocial outcomes. Clinical Trial: ClinicalTrials.gov NCT03446313