Personalised prescription for cardiac rehab on a smartphone

University of Auckland researchers are currently recruiting patients with a recent diagnosis of coronary heart disease or who have had a cardiac event to take part in a remotely monitored, exercise-based cardiac rehabilitation study that will provide them with a personalised exercise prescription and behavioural support delivered by a smartphone.

The study will compare the REMOTE-CR program developed by Ralph Maddison and colleagues from the university’s National Institute for Health Innovation (NIHI) with gym-based cardiac rehab.

REMOTE-CR is delivered over 12 weeks and involves a personalised exercise prescription, real-time remote exercise monitoring and behavioural support to increase exercise adherence. It was developed for use by patients who find it difficult to attend supervised, on-site exercise programs.

The NIHI team is now recruiting patients for a randomised controlled trial consisting of 162 participants, half of whom will receive the 12-week program REMOTE-CR intervention and the other half an eight to 12-week standard supervised exercise-based program.

The primary outcome is post-treatment maximal oxygen uptake (V̇O2max), with secondary outcomes including cardiovascular risk factors, self-efficacy, and intentions and motivation to be active. It will also study the cost of each program to compare the two modes of delivery.

The intervention aims to have individuals participate in moderate to vigorous aerobic-based exercise for at least 30 minutes most days of the week.

The exercise prescription involves an individualised program of exercise based on personal preferences and current exercise capacity. Participants will be provided with a weekly prescription detailing exercise duration, frequency and intensity through an app designed for this study.

They will also be remotely monitored in real time by an exercise physiologist by connecting to a remote exercise monitoring system that can monitor their location, distance, speed, heart rate, respiratory rate, training load and single-lead ECG.

The system also allows the physiologist to provide real-time feedback and support through alerts, messages or calls on the smartphone and to respond to adverse events if necessary. They can also provide post-exercise feedback and modify the exercise prescription as required.

According to the study protocol, the REMOTE system can support simultaneous monitoring of multiple participants. Participants are loaned a BioHarness 3 physiological sensing device to wear during exercise. Data is sent from the device via Bluetooth to the smartphone.

“The smartphone app collects and transmits physiological data to a remotely located web server in real-time,” the authors write. “The web app displays these data in remote locations, and enables real-time provision of feedback to moderate participants’ exercise behaviour.”

It also includes a middleware platform for mobile service provisioning called Odin, also developed at the University of Auckland, which provides reliable communication, minimises data usage cost and maximises device battery life.

The trial also includes support to facilitate exercise adherence, including strategies sent to participants via the smartphone by the exercise physiologist to help increase confidence and motivation to exercise. The app also allows participants to review their exercise performance and assess progress toward personalised goals.

Dr Maddison said in a statement that REMOTE-CR can increase the availability of supervised exercise for cardiac patients in New Zealand and around the world, but the study needed to prove it works before it was made more widely available.

In addition to the 12-week exercise program, participants will need to attend three appointments over six months at the university or Tauranga clinics.

“They will get a personalised 12-week exercise program and comprehensive fitness assessments, including blood pressure, cholesterol, blood glucose and weight measurements at no cost,” Dr Maddison said. “Participants will help to shape the future of cardiac rehabilitation.”

Posted in New Zealand eHealth

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