JMIR Publications

ABSTRACT

Background:

Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of cardiac rehabilitation program. However, many patients with cardiovascular diseases are failing to meet cardiac rehabilitation guidelines that recommend moderate-to-vigorous intensity physical activity.

Objective:

The major objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants and provide evidence-based support for health care professionals and researchers. The secondary objective was to examine the effectiveness on improving cardiovascular-related outcomes, namely cardiorespiratory fitness, waist circumference and systolic blood pressure.

Methods:

A comprehensive search strategy was developed for four electronic databases (PubMed, Web of Science, Embase and The Cochrane Library), through December 16, 2021. Experimental studies reporting on eHealth interventions designed to increase moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants were included. Multiple, not-blind reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and using the Effective Practice and Organization of Care Cochrane Review Group for non-randomized controlled trials. A random-effect model was used to provide summary measures of effect (standardized mean difference and 95% confidence interval). All statistical analyses were performed using Stata 17.

Results:

We screened 2,560 records; 22 studies (n = 2,194) were included in the review of which 16 were in meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous intensity physical activity (standardized mean differences = 0.16, 95% confidence interval: 0.05 to 0.27, P = 0.004) and vigorous intensity physical activity (standardized mean differences = 0.2, 95% confidence interval: 0.00 to 0.39, P = 0.048), but did not improve moderate intensity physical activity (standardized mean differences = 0.19, 95% confidence interval: -0.12 to 0.51, P = 0.233). No changes were observed in cardiovascular-related outcomes. Post hoc subgroup analysis identified that wearable-based, web-based and communication-based eHealth intervention delivery methods were effective.

Conclusions:

eHealth interventions are effective at increasing minutes per week of moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants. Moreover, the effectiveness of the major eHealth intervention delivery methods was no difference, providing evidence that in the future, the health care professionals and researchers can personalize convenient and affordable interventions tailored to patient characteristics and needs. To eliminates the inconvenience of visiting center-based cardiac rehabilitation during the COVID-19 pandemic and to better provide support for home-based maintenance cardiac rehabilitation. Clinical Trial: The PROSPERO registration number is CRD42021278029 and registration date is September 17, 2021.