title: Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial.
abstract: BACKGROUND
  Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed.
  
  
  OBJECTIVE
  The aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients.
  
  
  METHODS
  This multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO2 peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks.
  
  
  RESULTS
  Mean VO2 peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01).
  
  
  CONCLUSIONS
  This study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO2 peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care.
authors.affiliation: Mobile Health Institute, Faculty of Medicine & Life Sciences, Hasselt University, Diepenbeek, Belgium. ines.frederix@gmail.com.
authors.forename: Ines
authors.identifier: http://orcid.org/0000-0001-8636-5972
authors.initials: I
authors.lastname: Frederix
authors.forename: Dominique
authors.identifier: http://orcid.org/0000-0003-3074-2737
authors.initials: D
authors.lastname: Hansen
authors.forename: Karin
authors.identifier: http://orcid.org/0000-0001-6730-3426
authors.initials: K
authors.lastname: Coninx
authors.forename: Pieter
authors.identifier: http://orcid.org/0000-0003-3118-7560
authors.initials: P
authors.lastname: Vandervoort
authors.forename: Dominique
authors.identifier: http://orcid.org/0000-0002-6276-6445
authors.initials: D
authors.lastname: Vandijck
authors.forename: Niel
authors.identifier: http://orcid.org/0000-0003-2209-088X
authors.initials: N
authors.lastname: Hens
authors.forename: Emeline
authors.identifier: http://orcid.org/0000-0001-7686-2668
authors.initials: E
authors.lastname: Van Craenenbroeck
authors.forename: Niels
authors.identifier: http://orcid.org/0000-0002-6094-2548
authors.initials: N
authors.lastname: Van Driessche
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0003-0821-4559
authors.initials: P
authors.lastname: Dendale
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012047:Rehabilitation Centers; D011795:Surveys and Questionnaires; D000069350:Telerehabilitation / Q000379:methods*; D060145:Text Messaging
keywords: Internet; eHealth; effectiveness; telemedicine