New technologies help people with heart disease
People taking part in cardiac rehabilitation exercise programmes are likely to maintain healthy behaviours for longer
with text message and web-based support, according to recent research from the University of Auckland.
Several trials led by Associate Professor Ralph Maddison from the University’s School of Population Health, have shown
that the additional support gave people the confidence and motivation to be more physically active, improved their
quality of life, and was likely cost-effective as an on-going programme.
“Cardiac rehabilitation is a secondary prevention programme that offers education and support to assist patients with
coronary heart disease to make lifestyle changes,” says Dr Maddison.
“Despite the benefits of cardiac rehabilitation, attendance at centre-based sessions remains low”, he says. “Remotely
delivered interventions may offer patients another way to engage successfully in cardiac rehabilitation.
“They improve access for people needing cardiac support by giving people help to self-manage their rehabilitation.”
The mobile technology (mHealth) has the potential to reach more patients by delivering cardiac rehabilitation directly
to mobile phones, providing options for those unable to attend centre-based rehabilitation programmes.
The first trial (HEART) evaluated if a mHealth exercise-based cardiac rehabilitation programme could improve people’s
physical activity levels and their exercise capacity (or fitness) - over and above usual cardiac rehabilitation services
offered in New Zealand adults diagnosed with heart disease.
“The primary outcome of this trial was people’s exercise capacity or physical fitness measured by oxygen uptake during a
treadmill walking test,” says Dr Maddison. “Secondary outcomes included physical activity levels, confidence and
motivation to be active, health related quality of life and cost-effectiveness.”
In the trial, half of the participants had a programme of text messaging and access to a website where they could set
exercise goals and review their text messages. The text messages provided information about exercise prescription as
well as giving people behaviour change strategies on how to engage in regular physical activity.
They were also given a pedometer and could record the number of steps each day when they logged onto the website. This
website had links to information about other community-based programmes, as well as links to short videos of role models
who talked about their exercise programme and the challenges they had overcome.
“Results showed that both groups increased their exercise capacity a small amount with no significant difference between
the two groups,” says Dr Maddison. “However there were significant increases in leisure time activity and walking for
those on the intervention programme.”
The intervention had a positive effect on confidence and motivation to exercise, as well as the physical domain of the
Health Related Quality measure. As an on-going programme, HEART was considered likely cost-effective for increasing
leisure time activity and walking.
The study of exercise behaviour was published recently in the European Journal of Preventative Cardiology.
Building on the HEART trial, Dr Maddison and Mrs Pfaeffli-Dale have developed and evaluated a mHealth comprehensive
cardiac rehabilitation programme for improving people’s adherence to healthy lifestyle behaviours – such as being
physically active, having a good fruit and vegetable intake, not smoking, and low alcohol consumption in New Zealand
adults diagnosed with heart disease.
The Text4 Heart trial has recruited 120 participants with heart disease. Like HEART, the programme consists of text
messaging and internet support aimed at encouraging positive changes for exercise, diet, smoking and alcohol
consumption.
“The primary outcome of this trial is the proportion of participants adhering to healthy behaviours after six months -
measured using a composite health behaviour score,” says Dr Maddison. “Secondary outcomes include assessments of overall
cardiovascular disease risk, body composition, illness perceptions, self-efficacy, hospital anxiety/depression and
medication adherence.”
Results from this trial are due in a few weeks.
Another trial just started called REMOTE (and funded by the Auckland Medical Research Foundation) does not involve text
messaging, but instead allows people to exercise at home or in their community while being monitored remotely and in
real time.
Participants in the intervention receive a package of technology including a chest sensor band that records heart rate,
ECG, breathing rate and uses GPS for recording movement and acceleration.
The device talks to a mobile phone App, sending back information via a middleware platform, so that the researchers can
view the data from anywhere in New Zealand in real time. This web based app can monitor up to 12 people at a time.
“Participants do this three times a week with them logging on at a set time and doing their exercise prescription under
the watch of a remote exercise scientist, who lets them know how much to do each day,” says Dr Maddison.
The exercise scientist sets their exercise prescription and monitors them during their exercise session. Using the
technology, the exercise scientist reviews their progress and provides feedback and support to exercise on a regular
basis. Participants can also set goals and review their own progress.
“We are comparing the results of this 12-week programme to a standard supervised exercise-based cardiac rehabilitation
programme, and we want to see if it is as good as but no worse than current care.”
“Collectively, this research aims to provide people with heart disease another option, particularly for those who cannot
access traditional cardiac rehabilitation because of work or family commitments or they live at a distance from a
hospital-based programme,” says Dr Maddison. “They can help to overcome the physical and financial barriers to typical
cardiac rehabilitation.”
ENDS