Giggins Oonagh M, Doyle Julie, Smith Suzanne, Vavasour Grainne, Moran Orla, Gavin Shane, Sojan Nisanth, Boyle Gordon
NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland.
JMIR Cardio. 2023 Feb 10;7:e40283. doi: 10.2196/40283.
Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR.
We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre-Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program.
In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed.
In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F=.026; P=.87) nor effect for time (F=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study.
This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31855.
基于运动的心脏康复（CR）被推荐用于冠心病（CHD）。然而，全球范围内均有报道称CR运动项目的参与率和依从性较差。远程开展CR运动课程可能会消除一些与传统医院或中心式CR相关的障碍。
我们开发了一个定制平台，即东部走廊医学工程中心-心脏康复（ECME-CR），以支持远程开展CR运动。这项试点试验旨在测试ECME-CR平台，并将远程CR运动项目与传统的中心式项目进行比较，以检验其有效性和可行性。
总共招募了21名冠心病患者，并将其分配到干预组或对照组。两组均执行相同的为期8周的运动项目。干预组的参与者在干预期间参加基于网络的运动课程并使用ECME-CR平台，而对照组的参与者参加面对面授课。在基线和为期8周的干预期结束后对结果进行评估。主要结局指标是运动能力，采用6分钟步行试验（6MWT）进行评估。次要结局包括握力测量、自我报告的生活质量、心率、血压和身体成分。进行了一系列组间与组内混合方差分析，以检验组间和组内研究结果的平均差异。还分析了参与者对运动项目的依从性。
干预组有8名参与者（男性：n = 5；年龄：平均69.7岁，标准差7.2岁；身高：平均163.9厘米，标准差5.4厘米；体重：平均81.6千克，标准差14.1千克），对照组有9名参与者（男性：n = 9；年龄：平均69.8岁，标准差8.2岁；身高：平均173.8厘米，标准差5.2厘米；体重：平均94.4千克，标准差18.0千克）完成了运动项目。尽管干预组（从平均490.1米，标准差80.2米到平均504.5米，标准差93.7米）和对照组（从平均510.2米，标准差48.3米到平均520.6米，标准差49.4米）从基线到随访的6MWT距离均有改善，但未观察到显著的交互效应（F = 0.026；P = 0.87），也未观察到时间效应（F = 2.51；P = 0.14）。其他任何次要终点均未出现显著效应（所有P>0.0275）。干预组（14.25/16，89.1%）和对照组（14.33/16，89.6%）对运动项目的依从性都很高。研究期间两组均未报告不良事件或安全问题。
这项试点试验未显示出远程授课项目或中心式项目有显著积极效果的证据。6MWT可能对识别这一稳定冠心病患者群体的变化不够敏感。这项试验确实提供了证据，表明在数字自我监测支持下的远程CR运动是可行的，对于不太可能参加传统中心式项目的个体可以考虑采用。
国际注册报告识别码（IRRID）：RR2-10.2196/31855。
