How to keep coronary artery disease patients active after the acute rehabilitation phase? The value of an internet-based telerehabilitation programme.

Abstract

Background: Most cardiac patients return to their sedentary lifestyle after the acute rehabilitation phase. The aim of this study was to evaluate whether the addition of a motion sensor with automated feedback by e-mail or SMS to the conventional rehabilitation programme could result in an increase in daily activity among coronary artery disease patients. Methods: 20 coronary artery disease patients were included in this randomised, controlled trial after admission for PCI or CABG (target population of the study n=80). All patients were included during phase II of the cardiac rehabilitation programme. Patients with a defibrilator, important arrythmias or severe heart failure (NYHA class III and IV) were excluded from the trial. The patients in the intervention group(n=14) were asked to wear the motion sensor continuously during the day for 6 weeks. Each week they uploaded their step data on the web and received new step goals for the next week. The feedback programme was designed to gradually increase the patients' activity level. In the control group(n=6), the patients wore the motion sensor two times for one week for measurement purposes only(week 1 and 6). These sensors were taped, thereby making it impossible for the patients from the control group to monitor their daily activities. All patients performed a maximal cardiopulmonary exercise test at week 1 and 6 to determine their peak oxygen uptake(VO2-peak). The primary hypothesis of the trial was that the addition of a telerehabilitation programme to the conventional cardiac rehabilitation programme results in a sustained, increased amount of daily activity outside the rehabilitation centre. The secondary hypothesis was that this also would translate into a greater increase in VO2 peak. The Wilcoxon and Mann-Whitney test were used to test these hypotheses. Results: for the intervention patients, the Wilcoxon test showed a significant increase in daily activity between week 1 and week 6 (P=0,0009) and a significant increase in VO2peak (P=0,0098). In the control group, the respective P values were 0,219 and 0,375. The Mann-Whitney test comparing the increase in walking steps from week 1 to week 6 between the intervention and control group did also show a trend toward larger increase in the intervention group(P=0,054). Conclusions: The addition of an internet-based telerehabilitation programme to conventional cardiac rehabilitation resulted in a significant increase in daily activity level and VO2 peak after 6 weeks, as compared to conventional rehabilitation alone. This observation was promising because it has proven difficult to encourage cardiac patients to stay active or to increase their daily physical activity level. An internet-based telerehabilitation intervention that uses motion sensors might be a valuable instrument to overcome this difficulty.