1Universität Witten/Herdecke Fakultät für Gesundheit Witten, Deutschland
Guideline-based cardiac rehabilitation lessens coronary artery disease (CAD) effects with evidence-based approaches, yet patients struggle with maintaining healthy habits post-rehabilitation. While innovative eHealth solutions could help, eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ has been developed to enhance post-cardiac rehabilitation results through a personalized eHealth intervention that promotes healthy lifestyle changes, particularly regular physical activity.
Questions/Objective(s)
To evaluate the effectiveness of a personalized eHealth intervention (“RehaPlus+") in promoting lifestyle changes in patients with CAD after center-based rehabilitation. We hypothesized that RehaPlus+ is as effective (non-inferior) as standard care (IRENA) in terms of enhancing regular physical activity.
Methods
In a quasi-experimental design, patients with CAD (myocardial infarction, 59%; percutaneous coronary intervention, 39%; and/or arterial bypass grafting, 14%) were included in a 24-week eHealth program (RehaPlus+, n=84) or a 24-week conventional outpatient program (IRENA, n=85) after standardized in-patient rehabilitation. The RehaPlus+ group received customized motivational text messages three times weekly for six months and supportive phone calls from a health coach. The IRENA group participated in a six-month outpatient program comprising 24 sessions of 90-minute strength and endurance training. Primary outcome variables were regular physical activity and weekly activity of daily living six months post-completion of medical rehabilitation assessed by BSA questionnaire. Secondary factors examined through questionnaires included physical activity during work and floors climbed weekly (by BSA), psychological well-being (by WHO-5), cardiac self-efficacy (by CSE), health-related wellbeing (by SF-36), and work ability (by WAI).
Results
116 patients (RehaPlus+: n=53, IRENA: n=63) were analyzed (89 males and 27 females, 56.0 ± 7.3 years). The RehaPlus+ group exhibited a mean weekly physical activity duration of 175.4 ± 203.9 minutes at 6 months after inpatient rehabilitation, while the IRENA group recorded 119.0 ± 173.2 minutes per week (p=0.070). The RehaPlus+ group showed significantly higher levels of activity of daily living, with an average of 471.0 ± 565.0 minutes per week, compared to the IRENA group with 343.3 ± 469.0 minutes per week (p=0.045). Quality of life, cardiac self-efficacy, and well-being increased similarly in both groups, with no significant differences observed (p>0.05).
Discussion
The personalized eHealth program, RehaPlus+ exhibited comparable effects on supporting regular physical activity and activity of daily living among CAD patients compared to standard care (IRENA). These outcomes highlight the capacity of eHealth interventions to assist in maintaining healthy lifestyle habits beyond center-based rehabilitation.