Medium-term effectiveness of a comprehensive internet-based and patient-specific telerehabilitation program with text messaging support for cardiac patients: randomized controlled trial
Open accessAbstract
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.
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A 6-month telerehabilitation programme led to greater improvement in physical fitness and quality of life.
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- Authors
- Frederix, I., Hansen, D., Coninx, K., Vandervoort, P., Vandijck, D., Hens, N., Van Craenenbroeck, E., Van Driessche, N., & Dendale, P.
- Affiliations
- Jessa Hospital (BE)
- Hasselt University (BE)
- Ziekenhuis Oost-Limburg (BE)
- Ghent University (BE)
- University of Antwerp (BE)
- Corresponding author
- Frederix, Ines
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2015-07-23
- Volume
- 17
- Issue
- 7
- Pages
- e185
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4528085
- OpenAlex
- W1517168335
- Cited by
- 185
- References
- 28
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 17 · 2023: 19 · 2022: 22 · 2021: 26 · 2020: 18 · 2019: 20 · 2018: 13 · 2017: 18 · 2016: 7
- FWCI
- 9.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Document Server@UHasselt (UHasselt) (submittedVersion, cc-by)
- Funders
- Fonds Wetenschappelijk Onderzoek (1128915N)
- Vlaamse regering
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- telerehabilitation, cardiac rehabilitation, online intervention, text messaging, telecoaching, peak aerobic capacity, physical activity, health-related quality of life, dietary recommendations, smoking cessation, step count, outpatient rehabilitation, International Physical Activity Questionnaire
- MeSH terms
- Telerehabilitation, Adult, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Rehabilitation Centers, Exercise, Internet, Text Messaging
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