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

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dc.contributor.advisor Maddison, R en
dc.contributor.advisor Gant, N en
dc.contributor.author Rawstorn, Jonathan en
dc.date.accessioned 2016-09-05T00:47:51Z en
dc.date.issued 2016 en
dc.identifier.uri http://hdl.handle.net/2292/30212 en
dc.description.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. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264876012902091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Breaking accessibility barriers: development & evaluation of an mHealth platform for remotely delivered exercise-based cardiac rehabilitation en
dc.type Thesis en
thesis.degree.discipline Health Sciences en
thesis.degree.grantor The University of Auckland en
thesis.degree.level Doctoral en
thesis.degree.name PhD en
dc.rights.holder Copyright: The author en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.elements-id 540779 en
pubs.record-created-at-source-date 2016-09-05 en


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