Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 17, 2024
Date Accepted: Jul 22, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A behavioral change-based eHealth program for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance: the RehaPlus+ concept
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 standard care.
Methods:
169 patients with CAD after stent implantation or bypass surgery were divided into a 24-week eHealth group (RehaPlus+, n=84) or a conventional outpatient program group (IRENA, n=85) after center-based phase II rehabilitation using a quasi-experimental approach. RehaPlus+ participants received customized motivational messages twice weekly for six months, while the IRENA group engaged in a six-month outpatient program involving 24 sessions of 90-minute strength and endurance training. The primary outcomes, evaluated using the BSA questionnaire, were regular PA (≥ 150 minutes per week) and weekly activities of daily living (AoDL) 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, IRENA: 61; 80 males, 25 females; mean age 56.0 ± 7.3 years) were available at 6-months follow-up. RehaPlus+ improved PA (181.85 ± 207.84 mins/week) to a greater extent than IRENA (119.20 ± 174.89 mins/week) with no interaction group effect (p=.120). RehaPlus+ showed greater AoDL than IRENA with no interaction group effect (442.79 ± 537.93 vs. 308.27 ± 411.52 mins/week, p=.836). There were no differences between the groups for all secondary outcomes (p > .05).
Conclusions:
RehaPlus+ is not inferior to the IRENA program. RehaPlus+ enhances PA and AoDL in patients following cardiac rehabilitation. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles post-rehabilitation. Clinical Trial: ClinicalTrials.gov NCT06162793
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