Relationship Between Clinical, Psychological, Physiological, and Technical Parameters and the Use of Digital Tools During Cardiac Rehabilitation Including Home Training (Preprint)

Abstract

BACKGROUND Home and telehealth-based interventions are increasingly used in cardiac rehabilitation (CR), a multidisciplinary model of health care. Digital tools such as wearables or digital training diaries are expected to support patients to adhere to recommended lifestyle changes, including physical exercise programmes. As previously published, the EPICURE study analysed the effects of digital tools, i.e., a digital training diary, adherence monitoring, and wearables, on exercise capacity during out-patient CR phase III (OUT-III) which includes an approximately 12-week home training phase. The study encompassed 149 Austrian patients, of which 50 utilized digital tools. OBJECTIVE The present paper takes a deeper look into the EPICURE data to better understand a) the relation between the use of digital tools and various psychological, clinical, and physiological parameters, and b) the relation between these parameters and the improvement of exercise capacity during cardiac rehabilitation. METHODS For this work, we analysed questionnaires concerning the patients’ CR and data acquired by digital tools during CR. On all these parameters we performed two analyses: 1) Comparison of the two groups with and without digital tools and 2) correlation with the change in the maximum workload as achieved during the exercise stress test. If data pre and post OUT-III were available, the change in the respective parameter during OUT-III was determined and group analysis and correlation were applied on a) data pre OUT-III, b) data post OUT-III, and c) the change during OUT-III. RESULTS We found significant improvements in quality of life in both groups, with no discernible differences between patients with or without digital tools. Patients with digital tools perceived significantly higher competence during CR, and they anticipated higher cardiac risks if non-adherent to physical activity. Although, the overall subjectively reported adherence was not significantly different in the two groups, specific items differed: Patients with digital tools were significantly less likely not to do their exercises when they were tired and to forget their exercises. Concerning reasons for (non-) adherence, patients with digital tools reported significantly more often to do their exercises because they enjoyed them, whereas they were significantly less likely a) to stop exercising when pain was worse and b) to continue doing their exercises when pain improved. Finally, patients who reported a high level of concrete planning achieved significantly higher improvements in exercise capacity. CONCLUSIONS We conclude that digital tools can support adhere to exercise training recommendations during facility- as well as home-based out-patient CR. This comprehensive analysis provides valuable insights into the multifaceted impact of digital tools on outpatient cardiac rehabilitation including home training, shedding light on factors influencing patient outcomes and adherence in the evolving landscape of digital health interventions. CLINICALTRIAL ClincalTrials.gov Identifier: NCT04458727