BACKGROUND: Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity. AIM: To determine the effects of 12-week TACR on health outcomes of patients with CHD. DESIGN: Two-arm randomized controlled trial. SETTING: Cardiovascular department of a regional hospital. POPULATION: Coronary heart disease patients with central obesity. METHODS: The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). RESULTS: Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: β=2713.48, P=0.03; T2:β=2450.70, P=0.08), weekly sitting minutes (T1: β=-665.17, P=0.002; T2: β=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (β=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: β=24.9, P<0.001; T2: β=15.50, P<0.001), smoking cessation (T2: β=-2.28, P<0.04), self-efficacy (T2: β=0.63, P=0.02), body mass index (T1:β =-0.97, P=0.03; T2: β=-0.73, P=0.04) and waist circumferences (T1: β =-1.97, P=0.003; T2: β =-3.14, P=0.002) were identified. CONCLUSIONS: Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients. CLINICAL REHABILITATION IMPACT: Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.

Department of Cardiology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China

Department of Physiotherapy and Rehabilitation Faculty of Medicine Masaryk University Brno Czech Republic

Department of Rehabilitation University Hospital Brno Brno Czech Republic

Elaine Hubbard Center for Nursing Research on Aging School of Nursing University of Rochester Medical Center Rochester NY USA

School of Nursing The Hong Kong Polytechnic University Hong Kong China

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Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. American Heart Association Council on Lifestyle and Cardiometabolic Health ; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021;143:e984–1010. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33882682&dopt=Abstract 10.1161/CIR.0000000000000973 PubMed DOI PMC

Ades PA, Savage PD. The Treatment of Obesity in Cardiac Rehabilitation: A REVIEW AND PRACTICAL RECOMMENDATIONS. J Cardiopulm Rehabil Prev 2021;41:295–301. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34461619&dopt=Abstract 10.1097/HCR.0000000000000637 PubMed DOI PMC

Piché ME, Poirier P, Lemieux I, Després JP. Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: an Update. Prog Cardiovasc Dis 2018;61:103–13. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=29964067&dopt=Abstract 10.1016/j.pcad.2018.06.004 PubMed DOI

Mu L, Liu JM, Zhou GH, Wu CQ, Chen BW, Lu Y, et al. Obesity Prevalence and Risks Among Chinese Adults Findings From the China PEACE Million Persons Project, 2014-2018. Circ-Cardiovasc Qual. 2021;14. PubMed PMC

World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 2000. PubMed

Taylor RS, Dalal HM, McDonagh ST. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol 2022;19:180–94. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34531576&dopt=Abstract 10.1038/s41569-021-00611-7 PubMed DOI PMC

Hamm LF, Sanderson BK, Ades PA, Berra K, Kaminsky LA, Roitman JL, et al. Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2011;31:2–10. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=21217254&dopt=Abstract 10.1097/HCR.0b013e318203999d PubMed DOI

American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. Sixth edition. Champaign, IL: Human Kinetics; 2020.

Ritchey MD, Maresh S, McNeely J, Shaffer T, Jackson SL, Keteyian SJ, et al. Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative. Circ Cardiovasc Qual Outcomes 2020;13:e005902. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31931615&dopt=Abstract 10.1161/CIRCOUTCOMES.119.005902 PubMed DOI PMC

Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW. J Cardiopulm Rehabil Prev 2021;41:407–12. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34727559&dopt=Abstract 10.1097/HCR.0000000000000656 PubMed DOI PMC

Campbell T, Rash JA, Vallis M. Appreciating the Importance of Unmet Needs Associated With Obesity in Cardiac Rehabilitation: A Call for Critical Improvement in Program Availability. Can J Cardiol 2019;35:684–7. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31151697&dopt=Abstract 10.1016/j.cjca.2019.04.005 PubMed DOI

Batalik L, Filakova K, Sladeckova M, Dosbaba F, Su J, Pepera G. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med 2023;59:248–58. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=36692413&dopt=Abstract 10.23736/S1973-9087.23.07773-0 PubMed DOI PMC

Su JJ, Yu DS, Paguio JT. Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta-analysis. J Adv Nurs 2020;76:754–72. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31769527&dopt=Abstract 10.1111/jan.14272 PubMed DOI

Su JJ, Liu JY, Cheung DS, Wang S, Christensen M, Kor PP, et al. Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2023;22:562–74. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=36695341&dopt=Abstract 10.1093/eurjcn/zvac116 PubMed DOI

Platz K, Kools S, Howie-Esquivel J. Benefits, Facilitators, and Barriers of Alternative Models of Cardiac Rehabilitation: A QUALITATIVE SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2023;43:83–92. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=36346781&dopt=Abstract 10.1097/HCR.0000000000000738 PubMed DOI

Devi R, Powell J, Singh S. A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial. J Med Internet Res 2014;16:e186. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=25217464&dopt=Abstract 10.2196/jmir.3340 PubMed DOI PMC

Blioumpa C, Karanasiou E, Antoniou V, Batalik L, Kalatzis K, Lanaras L, et al. Efficacy of supervised home-based, real time, videoconferencing telerehabilitation in patients with type 2 diabetes: a single-blind randomized controlled trial. Eur J Phys Rehabil Med 2023;59:628–39. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=37350165&dopt=Abstract 10.23736/S1973-9087.23.07855-3 PubMed DOI PMC

Su JJ, Yu DS. Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: A randomised controlled trial. Int J Nurs Stud 2021;122:104040. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34333211&dopt=Abstract 10.1016/j.ijnurstu.2021.104040 PubMed DOI

Zutz A, Ignaszewski A, Bates J, Lear SA. Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study. Telemed J E Health 2007;13:323–30. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17603835&dopt=Abstract 10.1089/tmj.2006.0051 PubMed DOI

Batalik L, Dosbaba F, Hartman M, Konecny V, Batalikova K, Spinar J. Long-term exercise effects after cardiac telerehabilitation in patients with coronary artery disease: 1-year follow-up results of the randomized study. Eur J Phys Rehabil Med 2021;57:807–14. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33619944&dopt=Abstract 10.23736/S1973-9087.21.06653-3 PubMed DOI

Varnfield M, Karunanithi M, Lee CK, Honeyman E, Arnold D, Ding H, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart 2014;100:1770–9. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=24973083&dopt=Abstract 10.1136/heartjnl-2014-305783 PubMed DOI

American Association of Cardiovascular and Pulmonary Rehabilitation. AACVPR Cardiac Rehabilitation Resource Manual: promoting health and preventing disease. Champaign, IL: Human Kinetics; 2013.

Widmer RJ, Allison TG, Lennon R, Lopez-Jimenez F, Lerman LO, Lerman A. Digital health intervention during cardiac rehabilitation: A randomized controlled trial. Am Heart J 2017;188:65–72. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=28577682&dopt=Abstract 10.1016/j.ahj.2017.02.016 PubMed DOI

American Diabetes Association . 9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018;41(Suppl 1):S86–104. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=29222380&dopt=Abstract 10.2337/dc18-S009 PubMed DOI

American Psychological Association. Publication search for “Emotional health”; 2023 [Internet]. Available from: https://www.apa.org/pubs/search?query=&fq=ClassificationFilt:%22Emotional%20Health%22&sort=ContentDateSort [cited 2023, Nov 15].

Hu DY, Tong QG. Hypertension and Hyperlipidemia. Diet and Exercise. Beijing: China Light Industry Press; 2017.

Chinese National Center for Cardiovascular Diseases. Report on cardiovascular disease in China 2018. Beijing: Encyclopedia of China Publishing House; 2019.

Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004;31:143–64. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15090118&dopt=Abstract 10.1177/1090198104263660 PubMed DOI

Thomas RJ, Sapir O, Gomes PF, Iftikhar U, Smith JR, Squires RW. Advances, Challenges, and Progress in Cardiac Rehabilitation in Chronic CVD Management. Curr Atheroscler Rep 2023;25:247–56. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=37040008&dopt=Abstract 10.1007/s11883-023-01100-7 PubMed DOI

American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription, Eleventh edition. Lippincott Williams & Wilkins; 2020.

Office of Disease Prevention and Health Promotion. Health Literacy Online; 2016 [Internet]. Available from: https://health.gov/healthliteracyonline/ [cited 2023, November 15].

Su JJ, Yu DS. Effectiveness of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: a randomized controlled trial protocol. BMC Cardiovasc Disord 2019;19:274. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31783800&dopt=Abstract 10.1186/s12872-019-1262-5 PubMed DOI PMC

El-Amrawy F, Nounou MI. Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial? Healthc Inform Res 2015;21:315–20. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=26618039&dopt=Abstract https://doi.org/10.4258/hir.2015.21.4.315 PubMed DOI PMC

Macfarlane D, Chan A, Cerin E. Examining the validity and reliability of the Chinese version of the International Physical Activity Questionnaire, long form (IPAQ-LC). Public Health Nutr 2011;14:443–50. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=20939939&dopt=Abstract 10.1017/S1368980010002806 PubMed DOI

Walker SN, Sechrist KR, Pender NJ. The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nurs Res 1987;36:76–81. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3644262&dopt=Abstract 10.1097/00006199-198703000-00002 PubMed DOI

Cao WJ, Chen CS, Hua Y, Li YM, Xu YY, Hua QZ. Factor analysis of a health-promoting lifestyle profile (HPLP): application to older adults in Mainland China. Arch Gerontol Geriatr 2012;55:632–8. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=22854282&dopt=Abstract 10.1016/j.archger.2012.07.003 PubMed DOI

Global Adult Tobacco Survey Collaborative Group. Tobacco questions for surverys: A subset of key questions from the global adult tobacco survey (GATS). Second edition. Center for Disease Control and Prevention; 2011.

Sullivan MD, LaCroix AZ, Russo J, Katon WJ. Self-efficacy and self-reported functional status in coronary heart disease: a six-month prospective study. Psychosom Med 1998;60:473–8. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9710293&dopt=Abstract 10.1097/00006842-199807000-00014 PubMed DOI

Zhang X, Zhan Y, Liu J, Chai S, Xu L, Lei M, et al. Chinese translation and psychometric testing of the cardiac self-efficacy scale in patients with coronary heart disease in mainland China. Health Qual Life Outcomes 2018;16:43. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=29530024&dopt=Abstract 10.1186/s12955-018-0872-4 PubMed DOI PMC

Höfer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: a summary. Health Qual Life Outcomes 2004;2:3. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14713315&dopt=Abstract 10.1186/1477-7525-2-3 PubMed DOI PMC

Thompson DR, Oldridge NB, Yu DS, Yu CM. Translation and validation of two Chinese health-related quality of life instruments in patients with coronary heart disease. Hong Kong Med J 2009;15(Suppl 2):8–11. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=19258626&dopt=Abstract PubMed

Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol 2003;42:111–31. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12828802&dopt=Abstract 10.1348/014466503321903544 PubMed DOI

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335–43. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7726811&dopt=Abstract 10.1016/0005-7967(94)00075-U PubMed DOI

Chan RC, Xu T, Huang J, Wang Y, Zhao Q, Shum DH, et al. Extending the utility of the Depression Anxiety Stress scale by examining its psychometric properties in Chinese settings. Psychiatry Res 2012;200:879–83. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=22921506&dopt=Abstract 10.1016/j.psychres.2012.06.041 PubMed DOI

Rawstorn JC, Gant N, Direito A, Beckmann C, Maddison R. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Heart 2016;102:1183–92. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=26936337&dopt=Abstract 10.1136/heartjnl-2015-308966 PubMed DOI

Dempsey PC, Strain T, Khaw KT, Wareham NJ, Brage S, Wijndaele K. Prospective Associations of Accelerometer-Measured Physical Activity and Sedentary Time With Incident Cardiovascular Disease, Cancer, and All-Cause Mortality. Circulation 2020;141:1113–5. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32223676&dopt=Abstract 10.1161/CIRCULATIONAHA.119.043030 PubMed DOI

Hamer M, Stamatakis E. Physical activity and mortality in men and women with diagnosed cardiovascular disease. Eur J Cardiovasc Prev Rehabil 2009;16:156–60. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=19276984&dopt=Abstract 10.1097/HJR.0b013e32831f1b77 PubMed DOI

Su JJ, Paguio J, Baratedi WM, Abu-Odah H, Batalik L. Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: qualitative process evaluation of a randomized controlled trial. Heart Lung 2023;57:214–21. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=36265371&dopt=Abstract 10.1016/j.hrtlng.2022.10.005 PubMed DOI

Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res 2012;14:e152. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=23151820&dopt=Abstract 10.2196/jmir.2104 PubMed DOI PMC

Baumel A, Muench FJ. Effort-Optimized Intervention Model: Framework for Building and Analyzing Digital Interventions That Require Minimal Effort for Health-Related Gains. J Med Internet Res 2021;23:e24905. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33709943&dopt=Abstract 10.2196/24905 PubMed DOI PMC

Sotirakos S, Fouda B, Mohamed Razif NA, Cribben N, Mulhall C, O’Byrne A, et al. Harnessing artificial intelligence in cardiac rehabilitation, a systematic review. Future Cardiol 2022;18:154–64. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33860679&dopt=Abstract https://doi.org/10.2217/fca-2021-0010 PubMed DOI

Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS. J Cardiopulm Rehabil Prev 2021;41:207–13. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34158454&dopt=Abstract 10.1097/HCR.0000000000000629 PubMed DOI PMC

Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease: A pilot randomized controlled trial

Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs