Breaking accessibility barriers: development & evaluation of an mHealth platform for remotely delivered exercise-based cardiac rehabilitation

Abstract

Background: Exercise-based cardiac rehabilitation (exCR) has multifactorial secondary prevention benefits for people with coronary heart disease (CHD). However, utilisation of traditionally supervised, centre-based programmes is limited by numerous barriers, including several factors that limit programme accessibility. Information and telecommunication technologies (i.e. telehealth), and mobile technologies in particular, could overcome access-related participation barriers and have demonstrated promising early health benefits, but exercise-specific interventions are limited.Aim: To develop and evaluate a mobile health (mHealth) exCR delivery model that combines clinical exercise specialists’ expertise with enhanced access.Methods: Four phases of research were undertaken: A systematic review and meta-analysis assessed current evidence in telehealth exCR, and identified opportunities to enhance programme delivery. A novel mHealth platform was designed to connect exCR participants with clinical exercise specialists from any location. Platform features enable evidence- and theory-based real-time remote exercise monitoring and coaching, behaviour change, and social support. A laboratory experiment evaluated platform feasibility and validity. A non-inferiority randomised controlled pilot trial (RCT) was designed and conducted to compare the effectiveness of remote and centre-based exCR programmes.Results: Existing telehealth exCR health benefits are similar to centre-based exCR; however, innovation is lacking and recent technological advances could enable more responsive, flexible, individualised and interactive interventions. A custom mHealth platform and complementary intervention content were developed to provide real-time remote exercise monitoring and coaching, theory-based behaviour change education, and social support. The platform demonstrated acceptable validity, and pilot RCT results show real-time remotely monitored exCR increased maximal aerobic exercise capacity, physical activity energy expenditure, and exercise self-confidence. Benefits were comparable to centre-based exCR, and intervention acceptability was highly rated.Conclusion: An mHealth platform can bring near universal accessibility to clinically supervised, evidence- and theory-based exCR, and health benefits compare favourably with gold standard centre-based programmes. Remotely monitored exCR could complement existing services by overcoming common access barriers, and may meet the needs of individuals who do not current access exCR.