JMIR Publications

ABSTRACT

Background:

Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, whereas adoption of a healthy post-rehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change-based eHealth maintenance programs for CAD patients are scarce. RehaPlus+ aims to improve post- rehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA).

Objective:

To evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care.

Methods:

169 patients with CAD after stent implantation or bypass surgery were divided unblinded into a case manager-assisted 24-week eHealth group (RehaPlus+, n=84) or conventional physician-assisted outpatient program (usual care, n=85) recruited after center-based phase II rehabilitation using a quasi-experimental approach. The study was designed as a non-inferiority trial. RehaPlus+ participants received customized motivational messages twice weekly for six months, while the usual care group engaged in a six-month outpatient program involving 24 sessions of 90-minute strength and endurance training. The primary outcomes, evaluated using the self-assessed BSA questionnaire, were regular PA (≥ 150 minutes per week) and weekly activities of daily living (ADL) six months post-rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (BSA), psychological well-being (WHO-5), cardiac self-efficacy (CSE), health-related quality of life (SF-36), and work ability (WAI) via questionnaire.

Results:

Data of 105 patients (RehaPlus+: 44, usual care: 61; 80 males, 25 females; mean age 56.0 ± 7.3 years) were available at 6-months follow-up. At 6 months after discharge from phase II CR, the RehaPlus+ group exhibited 182 ± 208 min/week of PA and the usual care group 119 ± 175 min/week (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 ± 538 min/week compared to the usual care group with 308 ± 412 min/week at 6 months follow-up with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined non-inferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P >.05).

Conclusions:

RehaPlus+ is not inferior to the usual care program since both groups improved PA and ADL to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles post-rehabilitation. Clinical Trial: ClinicalTrials.gov NCT06162793