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Title: Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial
Authors: FREDERIX, Ines 
HANSEN, Dominique 
CONINX, Karin 
VANDIJCK, Dominique 
HENS, Niel 
Van Craenenbrouck, Emeline
Van Driessche, Niels
Issue Date: 2015
Abstract: Background Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed. Objective The aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients. Methods This multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO2 peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks. Results Mean VO2 peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01). Conclusions This study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO2 peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care.
Notes: Corresponding Author: Ines Frederix, MD research doctorat Mobile Health Institute Faculty of Medicine & Life Sciences Hasselt University Building D Agoralaan Diepenbeek, 3590 Belgium Phone: 32 16583382 Fax:32 16583382 Email: ines.frederix [at]
Keywords: telemedicine; eHealth; effectiveness; Internet
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ISSN: 1438-8871
e-ISSN: ****-****
DOI: 10.2196/jmir.4799
ISI #: 000358686600003
Rights: Copyright © Ines Frederix, Dominique Hansen, Karin Coninx, Pieter Vandervoort, Dominique Vandijck, Niel Hens, Emeline Van Craenenbroeck, Niels Van Driessche, Paul Dendale. Originally published in the Journal of Medical Internet Research (, 23.07.2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Category: A1
Type: Journal Contribution
Validations: ecoom 2016
Appears in Collections:Research publications

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