Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial

Håvard Haglo, Eivind Wang, Ole Kristian Berg, Jan Hoff, Jan Helgerud, Håvard Haglo, Eivind Wang, Ole Kristian Berg, Jan Hoff, Jan Helgerud

Abstract

Background: Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding.

Objective: This study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL).

Methods: Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period.

Results: VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected.

Conclusions: High-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients' reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population.

Trial registration: ClinicalTrials.gov NCT04649528; https://ichgcp.net/clinical-trials-registry/NCT04649528.

Keywords: VO2max; cardiovascular health; endurance training; maximal oxygen uptake; mobile app; quality of life.

Conflict of interest statement

Conflicts of Interest: HH is employed by Myworkout, Medical Rehabilitation Clinic owned by Myworkout AS, the developer of the smartphone app Myworkout GO. J Helgerud and J Hoff are board members and shareholders of Myworkout AS. Due to the potential conflict of interest, EW and OKB monitored adherence to the design and statistical analysis in the study. There are no further disclosures or potential conflicts of interest to report.

©Håvard Haglo, Eivind Wang, Ole Kristian Berg, Jan Hoff, Jan Helgerud. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 21.10.2021.

Figures

Figure 1
Figure 1
Trial flow diagram. AG: app group; SG: supervised group.
Figure 2
Figure 2
Screenshot of app (Myworkout GO) feedback following a treadmill 4×4 high-intensity interval training session for a female subject.
Figure 3
Figure 3
Time course of heart rate (HR) response during a 4×4 high-intensity interval training session halfway through the intervention. Subjects and the supervising physiologist were blinded to HR during the session. Intensity was guided by rate of perceived exertion. The n value is 10. The black line represents the mean. The gray error band represents SD. The area between dotted lines represents intended intensity during intervals.
Figure 4
Figure 4
Changes in maximal oxygen uptake (VO2max) in mL per kg of body weight per minute after 10 weeks of high-intensity interval training. (A) Mean (SEM) change from pretraining to posttraining. (B) and (C) Individual values. AG: app group; SG: supervised group. *P<.001, within group difference from pretraining to postraining.
Figure 5
Figure 5
Health-related quality of life before and after high-intensity interval training. Values are presented as mean (SEM). Horizontal dotted lines represent normative data. AG: app group (n=14); SG: supervised group (n=21). *P<.05, **P<.01, ***P≤.001; significant within group difference from pretraining.

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