title: An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial.
abstract: BACKGROUND
  An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual.
  
  
  OBJECTIVE
  Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version.
  
  
  METHODS
  The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program.
  
  
  RESULTS
  Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression.
  
  
  CONCLUSIONS
  Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).
authors.affiliation: konstantinos.antypas@telemed.no.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Antypas
authors.forename: Silje C
authors.initials: SC
authors.lastname: Wangberg
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000523:psychology; D040421:Cell Phone; D003863:Depression; D015444:Exercise; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D060145:Text Messaging; D013813:Therapy, Computer-Assisted / Q000379:methods
keywords: Internet; cardiovascular diseases; cellular phone; eHealth; exercise therapy; health behavior; persuasive communication; physical activity; rehabilitation; self-management; telemedicine