Brito da Silva H1, Nevzati A1
1Zurich University Hospital, Zurich, Switzerland
Background: Cardiovascular disease (CVD) is one of the leading death causes in today's society. In Switzerland alone, it represented 25.06% of the reported death cases in 2015. In cardiac rehabilitation, the multidisciplinary and individual assessment of risk factors is a key aspect.
With the growing popularity of smart phone technology, mobile applications (APPs) and wearable activity monitoring (WAM), new possibilities to assess and reduce risk factors are provided.
Purpose: In Order to implement mHealth in the cardiac rehabilitation of the Zurich University Hospital (USZ), the authors screened the state of evidence for mobile health (mHealth) in prevention of CVD and its effect on lifestyle modifications.
Methods: A common literary search was performed on PubMed. Included were RCTs published after 2010 that used mobile technology in order to attain lifestyle modifications. Reviews were considered relating to background information and sources.
Results: Six RCTs were analyzed. Three Studies had a short message service (SMS) intervention, two used WAM and two utilized APPs or smartphone accessible platforms.
Three Studies reported a significant weight loss using semi personalized SMS, WAMs with real time Feedback or a smartphone based platform. A significant increase of physical activity was detected in the studies using SMS and WAM. One Study using SMS reported a five time higher number in patients achieving goal blood pressure, compared to the control group. One Study found a significant increase of maximal workload and exercise duration in Patients performing 14 mobile device guided and Tele-ECG monitored home trainings following 10 interval trainings in an outpatient clinic.
Conclusion(s): To this point, a great number of studies have investigated the effects of short message services in different fields of clinical practice, as it has proven to be a cost effective, simply measurable way to reach a large population of patients. Motivational messages and real time feedback can promote behavior and lifestyle change, which is crucial in a long-term reduction of risk factors and secondary prevention. However, the current development of mobile technologies demand more research on usability, validity of APPs and WAMs in clinical use.
Implications: According to the consulted RCTs, evidence seems to be given for the enhancement of physical activity, weight loss, blood pressure and maximal exercise workload using mHealth. This calls for a clinical implementation of Apps and WAMs in long-term risk factor reduction. Nevertheless, before introducing patients to mHealth, a personalized risk factor assessment should be performed. Further, literature has shown that a mix between face-to-face care such as an outpatient rehabilitation setting combined with the use of mHealth has more effect than one intervention alone.
An application for the cardiac rehabilitation of the USZ could contain records of standard physical performance tests, laboratory, weight and blood pressure. It should objectively track the patient's physical activity and give real time cues based on behavior change theory. An electronic diet log could be an optional function.
A challenge could be the integration of app data in our electronic medical record system and vice versa.
Keywords: Cardiac rehabilitation, mHealth, secondary prevention
Funding acknowledgements: This work was not funded.
With the growing popularity of smart phone technology, mobile applications (APPs) and wearable activity monitoring (WAM), new possibilities to assess and reduce risk factors are provided.
Purpose: In Order to implement mHealth in the cardiac rehabilitation of the Zurich University Hospital (USZ), the authors screened the state of evidence for mobile health (mHealth) in prevention of CVD and its effect on lifestyle modifications.
Methods: A common literary search was performed on PubMed. Included were RCTs published after 2010 that used mobile technology in order to attain lifestyle modifications. Reviews were considered relating to background information and sources.
Results: Six RCTs were analyzed. Three Studies had a short message service (SMS) intervention, two used WAM and two utilized APPs or smartphone accessible platforms.
Three Studies reported a significant weight loss using semi personalized SMS, WAMs with real time Feedback or a smartphone based platform. A significant increase of physical activity was detected in the studies using SMS and WAM. One Study using SMS reported a five time higher number in patients achieving goal blood pressure, compared to the control group. One Study found a significant increase of maximal workload and exercise duration in Patients performing 14 mobile device guided and Tele-ECG monitored home trainings following 10 interval trainings in an outpatient clinic.
Conclusion(s): To this point, a great number of studies have investigated the effects of short message services in different fields of clinical practice, as it has proven to be a cost effective, simply measurable way to reach a large population of patients. Motivational messages and real time feedback can promote behavior and lifestyle change, which is crucial in a long-term reduction of risk factors and secondary prevention. However, the current development of mobile technologies demand more research on usability, validity of APPs and WAMs in clinical use.
Implications: According to the consulted RCTs, evidence seems to be given for the enhancement of physical activity, weight loss, blood pressure and maximal exercise workload using mHealth. This calls for a clinical implementation of Apps and WAMs in long-term risk factor reduction. Nevertheless, before introducing patients to mHealth, a personalized risk factor assessment should be performed. Further, literature has shown that a mix between face-to-face care such as an outpatient rehabilitation setting combined with the use of mHealth has more effect than one intervention alone.
An application for the cardiac rehabilitation of the USZ could contain records of standard physical performance tests, laboratory, weight and blood pressure. It should objectively track the patient's physical activity and give real time cues based on behavior change theory. An electronic diet log could be an optional function.
A challenge could be the integration of app data in our electronic medical record system and vice versa.
Keywords: Cardiac rehabilitation, mHealth, secondary prevention
Funding acknowledgements: This work was not funded.
Topic: Cardiorespiratory; Disability & rehabilitation; Robotics & technology
Ethics approval required: No
Institution: Swiss ethical law
Ethics committee: KEK Zurich
Reason not required: No ethical approval was needed for a review according to Swiss ethical law
All authors, affiliations and abstracts have been published as submitted.
