JMIR Publications

ABSTRACT

Background:

Cardiac exercise rehabilitation is an important intervention for disease management of patients with coronary heart disease after percutaneous coronary intervention(PCI). Still, the participation and compliance of exercise rehabilitation remain suboptimal. Mobile health technology is a promising approach to promoting involvement in cardiac exercise rehabilitation. Remote rehabilitation can overcome the problems existing in traditional rehabilitation, such as the long distance of patients to rehabilitation centers, fixed appointment time, and high cost of treatment.

Objective:

To evaluate the effects of an exercise rehabilitation platform based on the Persuasive Systems Design model on physical activity, exercise endurance, self-perceived fatigue, exercise self-efficacy, and quality of life for patients after percutaneous coronary intervention.

Methods:

A single-blinded, parallel, randomized controlled trial design was used. The study was conducted in the Department of Cardiology of a tertiary hospital in Hangzhou, China. A total of 180 eligible patients with coronary heart disease were enrolled from June to December 2023. Participants were randomly assigned (1:1) to the intervention group or the control group, with 90 patients in each group. The control group received routine exercise rehabilitation nursing after PCI, and the intervention group participated in exercise rehabilitation nursing based on the Persuasive Systems Design (PSD) model. The intervention is a 24-week eHealth cardiac rehabilitation program. The primary outcome was physical activity level, which was measured by the International Physical Activity Questionnaire (Long volume). The secondary outcomes included exercise endurance, self-perceived fatigue, exercise self-efficacy, and quality of life assessed by the 6-Minute Walk Test, Borg fatigue rating scale, Exercise Self-efficacy Scale, and Short Form of 36 Health Survey Questionnaire, respectively. Data on the primary and secondary outcome measures were collected at baseline(T0), at 12 weeks of intervention (T1), and at 4 (T2), 8 (T3), and 12 (T4) weeks of follow-up. The generalised estimating equation (GEE) model was used to examine changes in the outcome variables between the two groups across the study endpoints.

Results:

Participants showed significant improvement in physical activity levels across the study, which was most significant at T4 (Β=48.799, P<.001). The interaction effect between intervention and time on physical activity, exercise endurance, self-perceived fatigue, exercise self-efficacy, and quality of life was significant. Compared with the control group, higher physical activity level was shown in the intervention group at T1 (Β=861.109, P<.001), T2 (Β=899.386, P<.001), T3 (Β=879.404, P<.001) and T4 (Β=937.288, P<.001). Participants in the intervention group indicated lower self-perceived fatigue (P<.001) at T2, T3, and T4, better exercise endurance (P<.001), exercise self-efficacy (P<.001) and quality of life (P<.001) at T1, T2, T3, and T4. No significant difference was found in self-perceived fatigue between groups at T1 (Β =0.062, P=.50).

Conclusions:

The findings of this study demonstrate the effectiveness of the intervention based on the PSD model in improving the physical activity level, exercise endurance, exercise self-efficacy, and quality of life, and reducing the self-perceived fatigue of patients. These findings also provide insights into the application of eHealth nursing interventions to enhance the rehabilitation of patients with coronary heart disease. Clinical Trial: ClinicalTrials.gov ChiCTR2300071666; https://clinicaltrials.gov/study/ ChiCTR2300071666