Telerehabilatation; Effect on exercise tolerance levels in patients after participation in app-guided cardiac rehabilitation program compared to traditional care

Abstract

Background: Cardiac rehabilitation (CR) after Acute Coronary Syndrome (ACS) intends to help patients learn to live with their heart condition, prevent future problems, and improve exercise tolerance. Previous research has shown that many patients refuse to participate, drop out prematurely, or relapse into old behaviours. A customized program with digital support potentially improves CR-participation, sustain lifestyle changes, and move care to the home-environment. Aim: This study aimed to determine the effect of the CR-program via telemonitoring (TCR) using an app developed by the Jeroen Bosch Hospital (JBZ), compared with a traditional centre-based cardiac rehabilitation program (CB-CR), on lifestyle changes in patients after ACS measured by physical fitness tests and quality of life, emotional and social functioning by health-related questionnaires. Methods: In this prospective longitudinal quasi-experimental study, two groups were compared; TCR (1: intervention group) and CB-CR (2: control group). The primary outcome was change in mean peak load measured by an ergometry performed before and after CR. The secondary outcomes were changes in the percentage of the peak load (responsiveness), and scores of the questionnaires KVL-H, GAD-7, PHQ-9, ESSI, and Five Shots, before and after CR. Also, differences in baseline characteristics between the groups were assessed. Results: In total 55 participants were included (TCR: n=42; CB-CR: n=13), with no drop-outs. No significant difference in absolute change of peak load (p=0,316) or responsiveness (p=0,158) was found. It was not possible to determine the differences in the scores of the questionnaires because insufficient questionnaires were completed. No differences were found in the baseline characteristics. Conclusion: TCR is non-superior to CB-CR on lifestyle changes in physical fitness in the short term measured by ergometry in patients after ACS. Recommendations: Caution should be taken when interpreting these preliminary results, as the desirable sample size had not yet been reached. To investigate the sustainability and long-term effect of TCR, this study should continue and re-run the measurements after one year with an analysis of the incidence of new cardiac events. Qualitative research on patients' experiences would be useful to make TCR more responsive to patients' needs, improve self-management and provide better person-centred care.