title: Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform.
abstract: BACKGROUND
  Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on.
  
  
  OBJECTIVE
  We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location.
  
  
  METHODS
  An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support.
  
  
  RESULTS
  The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients' exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription.
  
  
  CONCLUSIONS
  The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. j.rawstorn@auckland.ac.nz.
authors.forename: Jonathan C
authors.identifier: http://orcid.org/0000-0002-9755-7993
authors.initials: JC
authors.lastname: Rawstorn
authors.forename: Nicholas
authors.identifier: http://orcid.org/0000-0001-9740-0163
authors.initials: N
authors.lastname: Gant
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0002-0847-1005
authors.initials: A
authors.lastname: Meads
authors.forename: Ian
authors.identifier: http://orcid.org/0000-0002-4931-8605
authors.initials: I
authors.lastname: Warren
authors.forename: Ralph
authors.identifier: http://orcid.org/0000-0001-8564-5518
authors.initials: R
authors.lastname: Maddison
keywords: behavioral medicine; myocardial ischemia; remote sensing technology; telemedicine; telerehabilitation; wireless technology