Evaluating the interactive web-based program, activate your heart, for cardiac rehabilitation patients: a pilot study

Christopher Brough, Sally Boyce, Linzy Houchen-Wolloff, Louise Sewell, Sally Singh, Christopher Brough, Sally Boyce, Linzy Houchen-Wolloff, Louise Sewell, Sally Singh

Abstract

Background: Conventional cardiac rehabilitation (CR) programs are traditionally based on time-constrained, structured, group-based programs, usually set in hospitals or leisure centers. Uptake for CR remains poor, despite the ongoing evidence demonstrating its benefits. Additional alternative forms of CR are needed. An Internet-based approach may offer an alternative mode of delivering CR that may improve overall uptake. Activate Your Heart (AYH) is a Web-based CR program that has been designed to support individuals with coronary heart disease (CHD).

Objective: The aim of this pilot study was to observe the outcome for participants following the AYH program.

Methods: We conducted a prospective observational trial, recruiting low-risk patients with CHD. Measures of exercise, exercise capacity, using the Incremental Shuttle Walk Test (ISWT), dietary habits, and psychosocial well-being were conducted by a CR specialist at baseline and at 8 weeks following the Web-based intervention.

Results: We recruited 41 participants; 33 completed the program. We documented significant improvements in the ISWT distance (mean change 49.69 meters, SD 68.8, P<.001), and Quality of Life (QOL) (mean change 0.28, SD 0.4, P<.001). Dietary habits improved with an increased proportion of patients consuming at least 5 portions of fruit and vegetables per day, (22 [71%] to 29 [94%] P=.01) and an increased proportion of patients consuming at least 2 portions of oily fish per week (14 [45%] to 21 [68%], P=.01). We did not detect changes in anxiety and depression scores or exercise behavior.

Conclusions: We observed important improvements in exercise capacity, QOL, and dietary habits in a group of participants following a Web-based CR program. The program may offer an alternative approach to CR. A mobile version has been developed and we need to conduct further trials to establish its value compared to supervised CR.

Keywords: Activate Your Heart; Internet; Web-based; cardiac rehabilitation; coronary heart disease.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Activate Your Heart homepage.
Figure 2
Figure 2
Reading material section.
Figure 3
Figure 3
Part of the dashboard showing what tasks need to be completed in stage 2.
Figure 4
Figure 4
Mobile version of the Activate Your Heart dashboard.
Figure 5
Figure 5
Adding exercise using a smartphone.

References

    1. World Health Organization World health organization fact sheet: Top 10 causes of death. [2013-09-18]. .
    1. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010;340:b5631.
    1. World Health Organization Needs and action priorities in cardiac rehabilitation and secondary prevention in patients with CHD. 1993. [2014-01-30]. .
    1. Jolly K, Lip GY, Taylor RS, Raftery J, Mant J, Lane D, Greenfield S, Stevens A. The Birmingham Rehabilitation Uptake Maximisation study (BRUM): a randomised controlled trial comparing home-based with centre-based cardiac rehabilitation. Heart. 2009 Jan;95(1):36–42. doi: 10.1136/hrt.2007.127209.
    1. Grace SL, McDonald J, Fishman D, Caruso V. Patient preferences for home-based versus hospital-based cardiac rehabilitation. J Cardiopulm Rehabil. 2005;25(1):24–9.
    1. Thompson DR, Clark AM. Cardiac rehabilitation: into the future. Heart. 2009 Dec;95(23):1897–900. doi: 10.1136/hrt.2009.173732.
    1. Clark AM, King-Shier KM, Spaling MA, Duncan AS, Stone JA, Jaglal SB, Thompson DR, Angus JE. Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis. Clin Rehabil. 2013 Oct;27(10):948–59. doi: 10.1177/0269215513481046.
    1. De Vos C, Li X, Van Vlaenderen I, Saka O, Dendale P, Eyssen M, Paulus D. Participating or not in a cardiac rehabilitation programme: factors influencing a patient's decision. Eur J Prev Cardiol. 2013 Apr;20(2):341–8. doi: 10.1177/2047487312437057.
    1. Varnfield M, Karunanithi MK, Särelä A, Garcia E, Fairfull A, Oldenburg BF, Walters DL. Uptake of a technology-assisted home-care cardiac rehabilitation program. Med J Aust. 2011 Feb 21;194(4):S15–9.
    1. Sharp J, Freeman C. Patterns and predictors of uptake and adherence to cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2009;29(4):241–7. doi: 10.1097/HCR.0b013e3181adcf0f.
    1. Blair J, Corrigall H, Angus NJ, Thompson DR, Leslie S. Home versus hospital-based cardiac rehabilitation: a systematic review. Rural Remote Health. 2011;11(2):1532.
    1. Jolly K, Taylor R, Lip Gy, Greenfield S, Raftery J, Mant J, Lane D, Jones M, Lee Kw, Stevens A. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess. 2007 Sep;11(35):1–118.
    1. Oerkild B, Frederiksen M, Hansen JF, Prescott E. Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial. BMJ Open. 2012;2(6):-. doi: 10.1136/bmjopen-2012-001820.
    1. Dutton WH, Blank G. Oxford Internet Survey 2013 Report. [2014-01-31]. .
    1. Office of National Statistics Internet Access Quarterly Update. [2014-10-10]. .
    1. Bylund CL, Gueguen JA, Sabee CM, Imes RS, Li Y, Sanford AA. Provider-patient dialogue about Internet health information: an exploration of strategies to improve the provider-patient relationship. Patient Educ Couns. 2007 Jun;66(3):346–52. doi: 10.1016/j.pec.2007.01.009.
    1. Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: findings from a national probability sample. J Med Internet Res. 2009;11(1):e4. doi: 10.2196/jmir.1035.
    1. Kraal JJ, Peek N, van den Akker-Van Marle ME, Kemps HM. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study. BMC Cardiovasc Disord. 2013;13:82. doi: 10.1186/1471-2261-13-82.
    1. Kuhl EA, Sears SF, Conti JB. Internet-based behavioral change and psychosocial care for patients with cardiovascular disease: a review of cardiac disease-specific applications. Heart Lung. 2006;35(6):374–82. doi: 10.1016/j.hrtlng.2006.02.004.
    1. Schulz DN, Kremers SP, van Osch LA, Schneider F, van Adrichem MJ, de Vries H. Testing a Dutch web-based tailored lifestyle programme among adults: a study protocol. BMC Public Health. 2011;11:108. doi: 10.1186/1471-2458-11-108.
    1. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2004 Nov 10;6(4):e40. doi: 10.2196/jmir.6.4.e40.
    1. Griffiths KM, Farrer L, Christensen H. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust. 2010 Jun 7;192(11 Suppl):S4–11.
    1. Neville LM, O'Hara B, Milat A. Computer-tailored physical activity behavior change interventions targeting adults: a systematic review. Int J Behav Nutr Phys Act. 2009;6:30. doi: 10.1186/1479-5868-6-30.
    1. Song M, Choe MA, Kim KS, Yi MS, Lee I, Kim J, Lee M, Cho YM, Shim YS. An evaluation of Web-based education as an alternative to group lectures for diabetes self-management. Nurs Health Sci. 2009 Sep;11(3):277–84. doi: 10.1111/j.1442-2018.2009.00458.x.
    1. Vernooij JW, Kaasjager HA, van der Graaf Y, Wierdsma J, Grandjean HM, Hovens MM, de Wit GA, Visseren FL, SMARTStudy Group Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial. BMJ. 2012;344:e3750.
    1. Reid RD, Morrin LI, Beaton LJ, Papadakis S, Kocourek J, McDonnell L, Slovinec D'Angelo ME, Tulloch H, Suskin N, Unsworth K, Blanchard C, Pipe AL. Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. Eur J Prev Cardiol. 2012 Dec;19(6):1357–64. doi: 10.1177/1741826711422988.
    1. Southard BH, Southard DR, Nuckolls J. Clinical trial of an Internet-based case management system for secondary prevention of heart disease. J Cardiopulm Rehabil. 2003;23(5):341–8.
    1. Zutz A, Ignaszewski A, Bates J, Lear SA. Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study. Telemed J E Health. 2007 Jun;13(3):323–30. doi: 10.1089/tmj.2006.0051.
    1. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992 Dec;47(12):1019–24.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–70.
    1. Hillers TK, Guyatt GH, Oldridge N, Crowe J, Willan A, Griffith L, Feeny D. Quality of life after myocardial infarction. J Clin Epidemiol. 1994 Nov;47(11):1287–96.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77.
    1. Höfer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: a summary. Health Qual Life Outcomes. 2004;2:3. doi: 10.1186/1477-7525-2-3.
    1. Jolly K, Taylor RS, Lip GY, Singh S, BRUM Steering Committee Reproducibility and safety of the incremental shuttle walking test for cardiac rehabilitation. Int J Cardiol. 2008 Mar 28;125(1):144–5. doi: 10.1016/j.ijcard.2007.01.037.
    1. Arnold HJ, Sewell L, Singh S. A comparison of once-versus twice-weekly supervised phase III cardiac rehabilitation. Br J Cardiol. 2007;14:45–8.
    1. Harrison SL, Greening NJ, Houchen-Wolloff L, Bankart J, Morgan MD, Steiner MC, Singh SJ. Age-specific normal values for the incremental shuttle walk test in a healthy British population. J Cardiopulm Rehabil Prev. 2013;33(5):309–13. doi: 10.1097/HCR.0b013e3182a0297e.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, N.J: L. Erlbaum Associates; 1988.
    1. Lewin RJ, Furze G, Robinson J, Griffith K, Wiseman S, Pye M, Boyle R. A randomised controlled trial of a self-management plan for patients with newly diagnosed angina. Br J Gen Pract. 2002 Mar;52(476):194–6, 199.
    1. NACR The National Audit of Cardiac Rehabilitation: Annual Statistical Report. 2013. [2014-01-28]. .
    1. Pollard M, Sutherland C. Cardiac rehabilitation: Are we putting our hearts into it? Br J Cardiol. 2009;16(5):247–249.
    1. Murray E. Web-based interventions for behavior change and self-management: potential, pitfalls, and progress. Med 2.0. 2012 Aug 14;1(2):e3. doi: 10.2196/med20.1741.
    1. Vandelanotte C, Dwyer T, Van Itallie A, Hanley C, Mummery WK. The development of an internet-based outpatient cardiac rehabilitation intervention: a Delphi study. BMC Cardiovasc Disord. 2010;10:27. doi: 10.1186/1471-2261-10-27.
    1. Goessens BM, Visseren FL, de Nooijer J, van den Borne HW, Algra A, Wierdsma J, van der Graaf Y, SMART Study Group A pilot-study to identify the feasibility of an Internet-based coaching programme for changing the vascular risk profile of high-risk patients. Patient Educ Couns. 2008 Oct;73(1):67–72. doi: 10.1016/j.pec.2008.06.004.
    1. Sassen B, Kok G, Mesters I, Crutzen R, Cremers A, Vanhees L. A web-based intervention for health professionals and patients to decrease cardiovascular risk attributable to physical inactivity: development process. JMIR Res Protoc. 2012;1(2):e21. doi: 10.2196/resprot.1804.
    1. Weinstein PK. A review of weight loss programs delivered via the Internet. J Cardiovasc Nurs. 2006;21(4):251–8; quiz 259.
    1. Schneider F, de Vries H, Candel M, van de Kar A, van Osch L. Periodic email prompts to re-use an internet-delivered computer-tailored lifestyle program: influence of prompt content and timing. J Med Internet Res. 2013;15(1):e23. doi: 10.2196/jmir.2151.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever