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05 May 2023: Meta-Analysis

Benefits of Using Smartphones and Other Digital Methods in Achieving Better Cardiac Rehabilitation Goals: A Systematic Review and Meta-Analysis

Miruna Popovici 1ABCEF , Sorin Ursoniu 23ACD* , Horea Feier 14ADF , Mihaela Mocan 5ACDG , Otilia Mihaela G. Tomulescu 1BCF , Nilima Rajpal Kundnani 14CE , Mihaela Valcovici 14DEG , Simona Ruxanda Dragan 14ACDEF

DOI: 10.12659/MSM.939132

Med Sci Monit 2023; 29:e939132

Table 1 Demographic characteristics and baseline parameters description of included studies (n=11).

Author (Year)CountryStudy DesignDuration (Weeks)/Frequency (per week)Intervention (IG)Control (CG)Number of participants (n): (% of patients completing the study)DiagnosisAge (mean±SD)
Avila et al (2018) []23 BelgiumThree-arm RCT12 weeks/IG: 150 minutes/weekCG: NR, not reported, counseling to remain physically active=90 (95.5%) 60 (96.6%)HBCR program: 30 (93.3%)CBCR program: 30 (100%)CG: 30 (86.6%)Angiographically documented CAD/post-MI58.6±13 61.9±7.3 61.7±7.7
Batalik et al (2020) []24 Czech RepublicTwo-arm RCT12 weeks/IG: 80 minutes/ 3 times/weekCG: 80 minutes/ 3 times/week=56 (91.0%) 28 (92.8%) 28(89.2%)CHD (angina pectoris, MI in the last 6 months, LVEF >45%), heart revascularization (percutaneous angioplasty and aortocoronary bypass)56.5±6.9 57.7±7.6
Dorje et al (2019) []25 ChinaTwo-arm RCT24 weeks/IG: 2 months intensive program, followed by 4 months step-down stageCG: NR, not reported=312 (86.8%) 156(87.1%) 156 (86.5%)CHD (MI; stable/unstable angina), post-PCI59.1±9.4 61.9±8.7
Fang et al (2019) []26 ChinaTwo-arm RCT6 weeks/IG: 3 times/weekCG: NR, not reported=80 (83.7%) 40 (82.5%) 40 (85.0%)Post-PCI60.24±9.35 61.41±10.16
Frederix et al (2015) []27 BelgiumTwo-arm RCT24 weeks/IG: 2 times/weekCG: 45–60 minutes/session; 2 sessions/week=140 (90.0%) 70 (88.5%) 70 (91.4%)CHD (post-PCI or CABG), CHF with preserved or reduced ejection fraction61±9 61±8
Hawkes et al (2012) []28 AustraliaTwo-arm RCT24 weeks/IG: 30 minutes/session; 10 sessions/6 monthsCG: NR, not reported=430 (78.3%) 215 (75.3%) 215 (81.3%)CAD (post-MI, post-coronary artery intervention)59.9±11.1 61.3±11.3
Kraal et al (2014) []29 The NetherlandsTwo-arm RCT12 weeks/IG: 45–60 minutes/session; at least 2 sessions/weekCG: NR, not reported=50 (100%) 25 (100%) 25(100%)CHD (post-MI, unstable angina, revascularization procedure)60.6±7.5 56.1±8.7
Lunde et al (2020) []30 NorwayTwo-arm RCT48 weeks/IG: at least 30 minutes/session/weekCG: NR, not reported=113 (90.2%) 57 (84.2%) 56 (96.4%)CAD (post-PCI), valve surgery59.5±9.1 58.4±8.2
Snoek et al (2020) []31 The NetherlandsTwo-arm RCT48 weeks/IG: at least 30 minutes/ 5 days/weekCG: NR, not reported=179 (88.8%) 89(88.7%) 90 (88.8%)CHD (ACS, post-PCI/CABG), valve surgery72.4±5.4 73.6±5.5
Song et al (2020) []32 ChinaTwo-arm RCT24 weeks/IG: 30minutes exercises and 5–10 minutes warm-up/3–5 times/weekCG: NR, not reported=106 (90.5%) 53 (90.5%) 53 (90.5%)CHD54.17±8.76 54.83±9.13
Varnfield et al (2020) []33 AustraliaTwo-arm RCT24 weeks/IG: 30 minutes/most days of the weekCG: 2 times/week=120 (60%) 60(76,6%) 60(43,3%)Post-MI54.9±9.6 56.2±10.1
Avila et al (2018) []23 individualized aerobic exercise program, using heart rate monitor (Garmin Forerunner 210, Wichita USA). Data uploaded on Garmin platform. Feedback sent via email or phone once/week exercise program (endurance training, cycling, treadmill walking/running, arm ergometry or rowing, dynamic calisthenics) followed by relaxation supervised by a physiotherapist. Heart rate control monitoringUsual care- following standard procedures.(VO peak, VT1, VT2, Peak RER, Peak HR, Borg scale) (Steps/day, sedentary time; active energy expenditure; physical activity duration; moderate physical activity duration; vigorous physical activity duration)
Batalik et al (2020) []24 Exercise training, wrist HR monitor (M430). Data uploaded by each patient to Polar Flow web app, controlled by research assistant. Once a week, every patient received feedback via telephone from physiotherapistExercise training. Wrist HR. Direct supervision of physiotherapist. All HR data controlled by physiotherapist before uploading on Polar Flow(VO peak);Health- related quality of life (SF-36)
Dorje et al (2019) []25 SMART-CR/SP smartphone -based system delivering rehabilitation programs (educational modules and cartoons) via WeChat platform. Daily BP and HR, lifestyle changes and cardiological consultations uploaded. Database checked weekly by a registrarStandard care (follow-up visit to cardiologist and community doctors, health education, medical management)(6MWT)SBP, resting HR, lipid profile
Fang et al (2019) []26 HBCTR program included self-education on CHD. Physical activity monitored using remote system (belt strap with sensor, mobile app, servers, web portal)Standard protocol (self-education regarding CHD and biweekly follow-up by assigned clinicians)(6MWT) (SF-36), (CDS score) (SBP, DBP) (FTND score)
Frederix et al (2015) []27 Telerehabilitation program using a motion sensor, in addition to conventional program. The program included lifestyle change telecoaching and physical activity telemonitoringConventional program (endurance training, dietary and psychological consultation)(VO peak, HR max, OUES, VT1, VT2) (Steps count) (HeartQoL)
Hawkes et al (2012) []28 Individualized sessions of exercises delivered by telephone. Follow-up data collected by phone interview. ProActive Heart program assessed patient satisfactionRehabilitation program using written materials(SF-36) (BMI, dietary intake, smoking status)
Kraal et al (2014) []29 Exercises monitored by wearable heart rate recorder (Garmin Forerunner 70) uploaded to web app (Garmin Connect). Once/week feedback delivered via telephonePhysical exercises supervised by specialized therapists(VO peak, HR max) (MacNew questionnaire)
Lunde et al (2020) []30 Technology-based follow-up program, using a web app for establishing tasks, verifying fulfillment of tasks, providing feedback by supervising physicianUsual care (walking and cycling program)(VO peak)
Snoek et al (2020) []31 Smartphone based program with HR belt monitor. Periodical motivational interview delivered by telephone. Data transferred to secure web app, with access for both patient and nurse/specialistStandard care without any cardiac rehabilitation procedures(VO peak) (SF-36, GAD-7, PHQ-9)
Song et al (2020) []32 Exercise program monitored HR belts (Suunto). Data registered by smartphone app. Text or WeChat communication between patient and doctorsStandard care programSBP/DBP, lipid profile, glycemic profile, ASAT/ALAT. (VO peak, HR peak)
Varnfield et al (2020) []33 CAP-CR mobile-based program to deliver materials and to monitor patients. Smartphones (Nokia N96) with preinstalled monitoring apps given to pts. Data uploaded to web platform with access for both patients and specialistsTCR program with individualized exercises for each patient supervised by specialized personnel(6MWT)
RCT – randomized controlled trial; IG – intervention group; CG – control group; HBCR – home-based cardiac rehabilitation; CBCR – center-based cardiac rehabilitation; CAD – coronary artery disease; post-MI – post-myocardial infarction; VO peak – peak oxygen uptake; VT1 – first ventilatory threshold; VT2 – second ventilatory threshold; peak RER – peak respiratory exchange ratios; peak HR – peak heart rate; CHD – coronary heart disease; MI – myocardial infarction; LVEF – left ventricular ejection fraction; HR – heart rate; App – application; SF-36 – Short-Form 36 Health Survey Questionnaire; post-PCI – post-percutaneous coronary intervention; BP – blood pressure; 6MWT – 6-minute walk test; SBP – systolic blood pressure; HBCTR – home-based cardiac traditional rehabilitation; CDS – cardiac depression scale; DBP – diastolic blood pressure; FTND – Fagerstrom Test for nicotine dependence; CABG – coronary artery bypass graft; OUES – oxygen uptake efficiency slope; BMI – body mass index; HeartQoL – Heart Quality of Life; HbA – glycated hemoglobin; ACS – acute coronary syndrome; GAD-7 – General Anxiety Disorder Questionnaire; PHQ-9 – Patient Health Questionnaire; ASAT – aspartate aminotransferase; ALAT – alanine aminotransferase; CAP-CR – Care Assessment Platform Cardiac Rehabilitation; WC – waist circumference; NR – not reported.

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750