title: Internet-based training of coronary artery patients: the Heart Cycle Trial.
abstract: Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System). This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity, arrhythmias and adherence to training prescriptions, wirelessly via the internet, to a medical team that provided feedback and adjusted training prescriptions. Exercise capacity was evaluated prior to and 6 months after intervention. 118 patients (58 ± 10 years, 105 men) with CAD referred for CR were randomized (IG: n = 55, CG: n = 63). However, 15 patients (27 %) in the IG and 18 (29 %) in the CG withdrew participation and technical problems prevented a further 21 patients (38 %) in the IG from participating. No training-related complications occurred. For those who completed the study, peak VO2improved more (p = 0.005) in the IG (1.76 ± 4.1 ml/min/kg) compared to CG (-0.4 ± 2.7 ml/min/kg). A newly designed system for home-based CR appears feasible, safe and improves exercise capacity compared to national CR. Technical problems reflected the complexity of applying remote monitoring solutions at an international level.
authors.affiliation: Clinic for Cardiac and Pulmonary Rehabilitation, Rosenquelle, Kurbrunnenstraße 5, 52077, Aachen, Germany. erik.skobel@rosenquelle.de.|Department of Cardiology, Angiology, Pneumology and Intensive Care, Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. erik.skobel@rosenquelle.de.
authors.forename: Erik
authors.initials: E
authors.lastname: Skobel
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: Knackstedt
authors.affiliation: ITACA Institute, Polytechnic University of Valencia, Valencia, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Martinez-Romero
authors.affiliation: Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Madrid, Spain.
authors.forename: Dario
authors.initials: D
authors.lastname: Salvi
authors.affiliation: Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Madrid, Spain.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Vera-Munoz
authors.affiliation: Department of Cardiology, Angiology, Pneumology and Intensive Care, Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Napp
authors.affiliation: Centre Suisse d'Electronique et de Microtechnique SA, 2002, Neuchâtel, Switzerland.
authors.forename: Jean
authors.initials: J
authors.lastname: Luprano
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario San Carlos de Madrid, Madrid, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Bover
authors.affiliation: Department of Cardiology, Angiology, Pneumology and Intensive Care, Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.|Clinical Trial Center Aachen, Aachen, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Glöggler
authors.affiliation: Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany.
authors.forename: Birna
authors.initials: B
authors.lastname: Bjarnason-Wehrens
authors.affiliation: Department of Cardiology, Angiology, Pneumology and Intensive Care, Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.affiliation: Hull-York Medical School, University of Hull, Hull, UK.|Department of Cardiology, Spire Hull and East Riding Hospital, Hull, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Rigby
authors.affiliation: Hull-York Medical School, University of Hull, Hull, UK.|Department of Cardiology, Spire Hull and East Riding Hospital, Hull, UK.
authors.forename: John
authors.initials: J
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods*; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005858:Germany; D006339:Heart Rate; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D010101:Oxygen Consumption; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D000068997:Smartphone / Q000706:statistics & numerical data*; D013030:Spain; D006113:United Kingdom
keywords: Cardiac rehabilitation; Exercise training; Monitoring