Background Telerehabilitation approaches have been successful in supporting coronary artery disease (CAD) patients to rehabilitate at home after hospital-based rehabilitation. However, on completing a telerehabilitation program, the effects are not sustained beyond the intervention period because of the lack of lifestyle adaptations. Furthermore, decline in patients’ motivation lead to recurrence of disease and increased rehospitalization rates. We developed HeartHab, using persuasive design principles and personalization, to enable sustenance of rehabilitation effects beyond the intervention period. HeartHab promotes patients’ understanding, motivates them to reach personalized rehabilitation goals, and helps to maintain positive lifestyle adaptations during telerehabilitation. Objective This study aimed to investigate the impact of the HeartHab app on patients’ overall motivation, increasing physical activities, reaching exercise targets, quality of life, and modifiable risk factors in patients with CAD during telerehabilitation. The study also investigated carryover effects to determine the maintenance of effects after the conclusion of the intervention. Methods A total of 32 CAD patients were randomized on a 1:1 ratio to telerehabilitation or usual care. We conducted a 4-month crossover study with a crossover point at 2 months using a mixed-methods approach for evaluation. We collected qualitative data on users’ motivation, user experience, and quality of life using questionnaires, semistructured interviews and context-based sentiment analysis. Quantitative data on health parameters, exercise capacity, and risk factors were gathered from blood tests and ergo-spirometry tests. Data procured during the app usage phase were compared against baseline values to assess the impact of the app on parameters such as motivation, physical activity, quality of life, and risk factors. Carryover effects were used to gather insights on the maintenance of effects. Results The qualitative data showed that 75% (21/28) of patients found the HeartHab app motivating and felt encouraged to achieve their rehabilitation targets. 84% (21/25) of patients either reached or exceeded their prescribed physical activity targets. We found positive significant effects on glycated hemoglobin ( P =.01; d =1.03; 95% CI 0.24-1.82) with a mean decrease of 1.5 mg/dL and high-density lipoprotein (HDL) cholesterol ( P =.04; d =0.78; 95% CI 0.02-1.55) with a mean increase of 0.61 mg/dL after patients used the HeartHab app. We observed significant carryover effects on weight, HDL cholesterol, and maximal oxygen consumption (VO 2 max), indicating the maintenance of effects. Conclusions Persuasive design techniques integrated in HeartHab and tailoring of exercise targets were effective in mo...

In mobile tele-rehabilitation applications for Coronary Artery Disease (CAD) patients, behavior change plays a central role in influencing better therapy adherence and prevention of disease recurrence. However, creating sustainable behavior change that holds a beneficial impact over a prolonged period of time remains an important challenge. In this paper we discuss various models and frameworks related to persuasion and behavior change, and investigate how to incorporate these with a multidisciplinary usercentered design approach for creating a mobile tele-rehabilitation application. By implementing different concepts that contribute to behavior change and applying a set of distinct persuasive design patterns, we were able to translate the high-level goals of behavior theory into a mobile application that explicitly incorporates behavior change techniques and also offers a good overall user experience. We evaluated our system, HeartHab, in a lab setting and show that our approach leads to a high user acceptance and willingness to use the system in daily activities. CCS Concepts

In remote rehabilitation of cardiac patients, patients need a better understanding of various factors influencing their disease condition to become active participants in their care. Nonetheless, current e-learning approaches in healthcare lack personalization and a deeper understanding of individual patient needs. Most e-learning platforms in healthcare are merely an accumulation of content created by caregivers where patients have no means to seek tailored information to suit specific personal needs. This forms a barrier in patient understanding, debilitating them from becoming active stakeholders in their rehabilitation progress. We identify pitfalls in current approaches and gaps in information needs of patients and caregivers' perspectives from literature. We organized two workshops-(i) with various professional caregivers involved in coaching cardiac patients, and (ii) with cardiac patients and their informal caregivers-to bridge caregivers' perspectives with patients' needs. Further, we prototyped and evaluated two tools to support shared decision making of information needs based on outcomes synthesized from the two workshops. In this paper, we discuss results of the workshops and prototype evaluations. Finally, we discuss how this shared decision making approach supports patient understanding and improves their adherence to rehabilitation goals.

Conventional center-based cardiac rehabilitation adherence is poor, adversely affecting long-term efficacy. Innovative strategies such as telerehabilitation are perceived as promising alternatives to improve care delivery. This paper presents the results of prior and ongoing work on the design and development of MobileHeart, a telemedical smartphone-based application to be used in secondary prevention for ischemic heart disease patients. Its constituent components are discussed separately, the minimal necessary cardiovascular monitoring requirements are elaborated in more detail. The results are offered starting from a clinical perspective to stress its relevance in the establishment of scientifically/medically sound programs.