Feasibility of an exercise-based cardiac telerehabilitation program for patients with ischemic heart disease: a pilot study
Authors: Santaularia N , Vazquez-Oliva G , Arnau A , Sanchez D , Ruiz-Zaldivar J , Sistach L , Orte S , Mari D , Guerrero P , Corzan P , Fito N , Creus M J , Salo E , Ribalta A , Cuberas G 
Published: June 2024

Abstract

Background
Telerehabilitation can improve access to cardiac rehabilitation programs, thereby reducing barriers to in-person attendance.

Purpose
To assess the feasibility of an exercise-based cardiac telerehabilitation program through a mobile application for patients and an associated web-based telemonitoring platform for health professionals in patients diagnosed with ischemic heart disease.

Methods
We conducted a pilot study. Patients received a short training to make correct use of the mobile app. The app was then installed on their mobile phone and they received a heart band and an activity watch. The outpatient program was started in the hospital, for 2 weeks and consisted of 3 hours/week of supervised physical exercise to learn how to use the platform and ensure the correct learning of the exercise routine. Afterwards, the patient performed a minimum of 3 sessions/week of physical exercise under telemonitoring until the 10 weeks were completed. During the first 2 weeks of unsupervised telemonitoring, one individual video call/week was scheduled to ensure correct use of the app. In addition, a synchronous online group physical exercise session was held in the fifth week. Through the platform, exercise-related parameters (heart rate, Börg scale and kilometres) were monitored to respond to possible incidents and to allow the clinician to adapt the physical exercise regimen according to the evolution. Simultaneously, the patient received reminders about the exercise regimen, medication, information on individualised cardiovascular risk factors and motivational messages during the 10 weeks of phase II. The team of clinical research professionals managed the alerts received through the web-based telemonitoring platform. After completion of the phase II, the usability and feasibility of the app and the web-based telemonitoring platform were analysed using the Mobile Application Rating Scale (MARS) and the user version (uMARS) that provides a reliable method to assess the quality of mobile health (mHealth) apps.

Results
Fourteen patients [71% men; 50 years (SD 10)] were analysed. According to overall total score, the feedback was good for users (uMARS mean 4.0 [SD 0.35]) and for professionals (MARS mean 3.8 [SD 0.36]). The information and aesthetics content of the app were particularly appreciated for patients, with a mean score of 4.4 (SD 0.67) and 4.2 (SD 0.61) respectively. The functionality (3.9 [SD 0.79]) and the engagement (3.8 [SD 1.2]) of the app were also appreciated. Related to professionals, the engagement and the functionality content were particularly appreciated, with a mean score of 3.9 (SD 1.38) and 3.9 (SD 0.42) respectively. The information (3.7 [SD 1.25]) and the aesthetics (3.6 [SD 0.51]) were also well accepted.

Conclusions
The quality of our app was considered to be good for patients diagnosed with ischemic heart disease following the exercise-based cardiac telerehabilitation program and for the health professionals.