An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial

Konstantinos Antypas, Silje C Wangberg, Konstantinos Antypas, Silje C Wangberg

Abstract

Background: An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual.

Objective: Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version.

Methods: The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program.

Results: Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression.

Conclusions: Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention.

Trial registration: ClinicalTrials.gov: NCT01223170; https://ichgcp.net/clinical-trials-registry/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).

Keywords: Internet; cardiovascular diseases; cellular phone; eHealth; exercise therapy; health behavior; persuasive communication; physical activity; rehabilitation; self-management; telemedicine.

Conflict of interest statement

Conflicts of Interest: The authors participated in the design of the interventions described in the manuscript.

Figures

Figure 1
Figure 1
Screenshot of the discussion forum.
Figure 2
Figure 2
Weekly overview of the planned activities in the activity calendar. The usernames in the screenshot are of test users and not of real cases.
Figure 3
Figure 3
Sample SMS text message translations. Motivational (top): Don’t give up! Both young and old benefit from physical activity. Therefore, it is never too late to start. Before planned activity (middle): Remember ball game, football/handball at 17:50. After planned activity (bottom): Did you do the activity ball game, football/handball? If so, you can confirm it by following the link.
Figure 4
Figure 4
Screenshot of profile page (My Page) with a graph representing the user’s level of achievement of their weekly physical activity goals. The usernames in the screenshot are of test users and not of real cases.
Figure 5
Figure 5
Flow diagram of the study.
Figure 6
Figure 6
Change in International Physical Activity Questionnaire (IPAQ) total physical activity median score for each group over time.
Figure 7
Figure 7
Adherence to the website.

References

    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2224–60. doi: 10.1016/S0140-6736(12)61766-8.
    1. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA, American Heart Association Exercise‚ Cardiac Rehabilitation‚Prevention Committee of the Council on Clinical Cardiology‚ Council on Nutrition‚ Physical ActivityMetabolism‚ Council on CardiovascularStroke Nursing‚Council on EpidemiologyPrevention Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013 Aug 20;128(8):873–934. doi: 10.1161/CIR.0b013e31829b5b44.
    1. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Funck-Brentano C, Filippatos G, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Altiner A, Bonora E, Durrington PN, Fagard R, Giampaoli S, Hemingway H, Hakansson J, Kjeldsen SE, Larsen ML, Mancia G, Manolis AJ, Orth-Gomer K, Pedersen T, Rayner M, Ryden L, Sammut M, Schneiderman N, Stalenhoef AF, Tokgözoglu L, Wiklund O, Zampelas A, European Society of Cardiology (ESC) European Association for Cardiovascular PreventionRehabilitation (EACPR) Council on Cardiovascular Nursing. European Association for Study of Diabetes (EASD) International Diabetes Federation Europe (IDF-Europe) European Stroke Initiative (EUSI) International Society of Behavioural Medicine (ISBM) European Society of Hypertension (ESH) European Society of General Practice/Family Medicine (ESGP/FM/WONCA) European Heart Network (EHN) European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts) Eur J Cardiovasc Prev Rehabil. 2007 Sep;14 Suppl 2:E1–40. doi: 10.1097/01.hjr.0000277984.31558.c4.
    1. Piepoli MF, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, Dendale P, Doherty P, Gaita D, Höfer S, McGee H, Mendes M, Niebauer J, Pogosova N, Garcia-Porrero E, Rauch B, Schmid JP, Giannuzzi P. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery. Eur J Prev Cardiol. 2012 Jun 20; doi: 10.1177/2047487312449597.
    1. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, Franklin B, Sanderson B, Southard D, American Heart Association Exercise‚ Cardiac Rehabilitation‚Prevention Committee‚ the Council on Clinical Cardiology. American Heart Association Council on Cardiovascular Nursing. American Heart Association Council on EpidemiologyPrevention. American Heart Association Council on Nutrition‚ Physical Activity‚Metabolism. American Association of CardiovascularPulmonary Rehabilitation Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007 May 22;115(20):2675–82. doi: 10.1161/CIRCULATIONAHA.106.180945.
    1. Franklin BA, Bonzheim K, Gordon S, Timmis GC. Rehabilitation of cardiac patients in the twenty-first century: changing paradigms and perceptions. J Sports Sci. 1998 Jan;16 Suppl:S57–70. doi: 10.1080/026404198366687.
    1. Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: a meta-analysis. J Med Internet Res. 2012;14(6):e161. doi: 10.2196/jmir.2171.
    1. Laplante C, Peng W. A systematic review of e-health interventions for physical activity: an analysis of study design, intervention characteristics, and outcomes. Telemed J E Health. 2011 Sep;17(7):509–23. doi: 10.1089/tmj.2011.0013.
    1. Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev. 2013 Sep 30;9:CD010395. doi: 10.1002/14651858.CD010395.pub2.
    1. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013 Mar;31(3):455–67; discussion 467. doi: 10.1097/HJH.0b013e32835ca8dd.
    1. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010;12(2):e23. doi: 10.2196/jmir.1286.
    1. Murray E, Burns J, See TS, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev. 2005;(4):CD004274. doi: 10.1002/14651858.CD004274.pub4.
    1. Jackson CL, Bolen S, Brancati FL, Batts-Turner ML, Gary TL. A systematic review of interactive computer-assisted technology in diabetes care. Interactive information technology in diabetes care. J Gen Intern Med. 2006 Feb;21(2):105–10. doi: 10.1111/j.1525-1497.2005.00310.x.
    1. Lau PW, Lau EY, Wong del P, Ransdell L. A systematic review of information and communication technology-based interventions for promoting physical activity behavior change in children and adolescents. J Med Internet Res. 2011;13(3):e48. doi: 10.2196/jmir.1533.
    1. McLean S, Nurmatov U, Liu JL, Pagliari C, Car J, Sheikh A. Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis. Br J Gen Pract. 2012 Nov;62(604):e739–49. doi: 10.3399/bjgp12X658269.
    1. Lustria ML, Noar SM, Cortese J, Van Stee SK, Glueckauf RL, Lee J. A meta-analysis of web-delivered tailored health behavior change interventions. J Health Commun. 2013;18(9):1039–69. doi: 10.1080/10810730.2013.768727.
    1. de Waure C, Lauret GJ, Ricciardi W, Ferket B, Teijink J, Spronk S, Myriam Hunink MG. Lifestyle interventions in patients with coronary heart disease: a systematic review. Am J Prev Med. 2013 Aug;45(2):207–16. doi: 10.1016/j.amepre.2013.03.020.
    1. Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med. 2009 Aug;38(1):18–27. doi: 10.1007/s12160-009-9133-4.
    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. 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. Revere D, Dunbar PJ. Review of computer-generated outpatient health behavior interventions: clinical encounters "in absentia". J Am Med Inform Assoc. 2001;8(1):62–79.
    1. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012;14(6):e152. doi: 10.2196/jmir.2104.
    1. Brug J, Steenhuis I, van Assema P, Glanz K, De Vries H. Computer-tailored nutrition education: differences between two interventions. Health Educ Res. 1999 Apr;14(2):249–56.
    1. Brug J, Campbell M, van Assema P. The application and impact of computer-generated personalized nutrition education: a review of the literature. Patient Educ Couns. 1999 Feb;36(2):145–56.
    1. Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Am J Public Health. 1994 May;84(5):783–7.
    1. Oenema A, Brug J, Lechner L. Web-based tailored nutrition education: results of a randomized controlled trial. Health Educ Res. 2001 Dec;16(6):647–60.
    1. de Nooijer J, Lechner L, de Vries H. Tailored versus general information on early detection of cancer: a comparison of the reactions of Dutch adults and the impact on attitudes and behaviors. Health Educ Res. 2002 Apr;17(2):239–52.
    1. Brubaker PH, Rejeski WJ, Smith MJ, Sevensky KH, Lamb KA, Sotile WM, Miller HS. A home-based maintenance exercise program after center-based cardiac rehabilitation: effects on blood lipids, body composition, and functional capacity. J Cardiopulm Rehabil. 2000;20(1):50–6.
    1. Lear SA, Ignaszewski A, Laquer EA, Pritchard PH, Frohlich JJ. Extensive lifestyle management intervention following cardiac rehabilitation: pilot study. Rehabil Nurs. 2001;26(6):227–32.
    1. Moholdt TT, Amundsen BH, Rustad LA, Wahba A, Løvø KT, Gullikstad LR, Bye A, Skogvoll E, Wisløff U, Slørdahl SA. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J. 2009 Dec;158(6):1031–7. doi: 10.1016/j.ahj.2009.10.003.
    1. Rognmo Ø, Moholdt T, Bakken H, Hole T, Mølstad P, Myhr NE, Grimsmo J, Wisløff U. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. 2012 Sep 18;126(12):1436–40. doi: 10.1161/CIRCULATIONAHA.112.123117.
    1. Aamot IL, Forbord SH, Gustad K, Løckra V, Stensen A, Berg AT, Dalen H, Karlsen T, Støylen A. Home-based versus hospital-based high-intensity interval training in cardiac rehabilitation: a randomized study. Eur J Prev Cardiol. 2013 Apr 23; doi: 10.1177/2047487313488299.
    1. Antypas K, Wangberg SC. E-Rehabilitation - an Internet and mobile phone based tailored intervention to enhance self-management of cardiovascular disease: study protocol for a randomized controlled trial. BMC Cardiovasc Disord. 2012;12:50. doi: 10.1186/1471-2261-12-50.
    1. Antypas K, Wangberg SC. Combining users' needs with health behavior models in designing an internet- and mobile-based intervention for physical activity in cardiac rehabilitation. JMIR Res Protoc. 2014 Mar;3(1):e4. doi: 10.2196/resprot.2725.
    1. Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Applied Psychology. 2008 Jan;57(1):1–29. doi: 10.1111/j.1464-0597.2007.00325.x.
    1. McKee G, Bannon J, Kerins M, FitzGerald G. Changes in diet, exercise and stress behaviours using the stages of change model in cardiac rehabilitation patients. Eur J Cardiovasc Nurs. 2007 Sep;6(3):233–40. doi: 10.1016/j.ejcnurse.2006.10.002.
    1. Wangberg SC. An Internet-based diabetes self-care intervention tailored to self-efficacy. Health Educ Res. 2008 Feb;23(1):170–9. doi: 10.1093/her/cym014.
    1. Bandura A. Self-Efficacy: the Exercise of Control. New York: WH Freeman; 1997.
    1. Latimer AE, Rivers SE, Rench TA, Katulak NA, Hicks A, Hodorowski JK, Higgins ET, Salovey P. A Field Experiment Testing the Utility of Regulatory Fit Messages for Promoting Physical Activity. J Exp Soc Psychol. 2008 May;44(3):826–832. doi: 10.1016/j.jesp.2007.07.013.
    1. Fuglestad PT, Rothman AJ, Jeffery RW. Getting there and hanging on: the effect of regulatory focus on performance in smoking and weight loss interventions. Health Psychol. 2008 May;27(3 Suppl):S260–70.
    1. Kurtze N, Rangul V, Hustvedt BE. Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study (HUNT) population of men. BMC Med Res Methodol. 2008;8:63. doi: 10.1186/1471-2288-8-63.
    1. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. 2006 Sep;9(6):755–62.
    1. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992 Mar;63(1):60–6.
    1. Williams GC, Deci EL. Self-Determination Theory: Questionnaires. 2006. [2006-04-04]. Perceived Competence Scales .
    1. Barrera M, Glasgow RE, McKay HG, Boles SM, Feil EG. Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management. Am J Community Psychol. 2002 Oct;30(5):637–54.
    1. Thombs BD, Magyar-Russell G, Bass EB, Stewart KJ, Tsilidis KK, Bush DE, Fauerbach JA, McCann UD, Ziegelstein RC. Performance characteristics of depression screening instruments in survivors of acute myocardial infarction: review of the evidence. Psychosomatics. 2007;48(3):185–94. doi: 10.1176/appi.psy.48.3.185.
    1. Dijkstra A. Working mechanisms of computer-tailored health education: evidence from smoking cessation. Health Educ Res. 2005 Oct;20(5):527–39. doi: 10.1093/her/cyh014.
    1. Kurtze N, Rangul V, Hustvedt BE. Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study (HUNT) population of men. BMC Med Res Methodol. 2008;8:63. doi: 10.1186/1471-2288-8-63.
    1. Killip S. What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. The Annals of Family Medicine. 2004 May 01;2(3):204–208. doi: 10.1370/afm.141.
    1. Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11. doi: 10.2196/jmir.7.1.e11.
    1. Wangberg SC, Bergmo TS, Johnsen JA. Adherence in Internet-based interventions. Patient Prefer Adherence. 2008;2:57–65.
    1. Vandelanotte C, Spathonis KM, Eakin EG, Owen N. Website-delivered physical activity interventions a review of the literature. Am J Prev Med. 2007 Jul;33(1):54–64. doi: 10.1016/j.amepre.2007.02.041.
    1. Oenema A, Brug J, Dijkstra A, de Weerdt I, de Vries H. Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial. Ann Behav Med. 2008 Apr;35(2):125–35. doi: 10.1007/s12160-008-9023-1.
    1. Bjarnason-Wehrens B, Grande G, Loewel H, Völler H, Mittag O. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes? Eur J Cardiovasc Prev Rehabil. 2007 Apr;14(2):163–71. doi: 10.1097/HJR.0b013e3280128bce.
    1. Neubeck L, Redfern J, Fernandez R, Briffa T, Bauman A, Freedman SB. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):281–9. doi: 10.1097/HJR.0b013e32832a4e7a.
    1. Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart. 2005 Jan;91(1):10–4. doi: 10.1136/hrt.2004.045559.
    1. Tomson T, Björnström C, Gilljam H, Helgason A. Are non-responders in a quitline evaluation more likely to be smokers? BMC Public Health. 2005 May 23;5:52. doi: 10.1186/1471-2458-5-52.
    1. Couper MP, Peytchev A, Strecher VJ, Rothert K, Anderson J. Following up nonrespondents to an online weight management intervention: randomized trial comparing mail versus telephone. J Med Internet Res. 2007;9(2):e16. doi: 10.2196/jmir.9.2.e16.
    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. King AC. Interventions to promote physical activity by older adults. J Gerontol A Biol Sci Med Sci. 2001 Oct;56 Spec No 2:36–46.
    1. Gelter H. Friluftsliv: The Scandinavian philosophy of outdoor life. Canadian Journal of Environmental Education. 2000;5(1):77–92.
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of Sports Medicine American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334–59. doi: 10.1249/MSS.0b013e318213fefb.
    1. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK, American Heart Association Council on Clinical Cardiology Subcommittee on Exercise‚ Rehabilitation‚Prevention. American Heart Association Council on Nutrition‚ Physical Activity‚Metabolism Subcommittee on Physical Activity Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) Circulation. 2003 Jun 24;107(24):3109–16. doi: 10.1161/01.CIR.0000075572.40158.77.
    1. Stephens J, Allen J. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs. 2013;28(4):320–9. doi: 10.1097/JCN.0b013e318250a3e7.
    1. Pack QR, Mansour M, Barboza JS, Hibner BA, Mahan MG, Ehrman JK, Vanzant MA, Schairer JR, Keteyian SJ. An early appointment to outpatient cardiac rehabilitation at hospital discharge improves attendance at orientation: a randomized, single-blind, controlled trial. Circulation. 2013 Jan 22;127(3):349–55. doi: 10.1161/CIRCULATIONAHA.112.121996.
    1. Boesch C, Myers J, Habersaat A, Ilarraza H, Kottman W, Dubach P. Maintenance of exercise capacity and physical activity patterns 2 years after cardiac rehabilitation. J Cardiopulm Rehabil. 2005;25(1):14–21; quiz 22.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

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