Background Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Objective This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID) DERR1-10.2196/32163

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UNSTRUCTURED ABSTRACT Background: Participation in ambulatory cardiac rehabilitation (CR) remains low, especially among older adults. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Methods/Design: The RESILIENT trial (NCT03978130) is a multicenter randomized clinical trial that is enrolling patients age ≥65 with ischemic heart disease in a 3:1 ratio to either intervention (mHealth-CR) or control (usual care), with a target sample size of 400 participants. mHealth-CR consists of a commercially available mHealth software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcomes is change in functional mobility (6 minute walk distance) which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand characteristics that determine different patterns of utilization (e.g. persistent high engagement, declining engagement). Discussion: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains, as well as characteristics that determine sustained utilization of mHealth-CR. These findings will help in designing future precision medicine approaches to mHealth implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic which has shifted much of healthcare to the virtual setting.