Effects of an eHealth Cardiac Exercise Rehabilitation Platform for Patients After Percutaneous Coronary Intervention Based on the Persuasive Systems Design Model: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Cardiac exercise rehabilitation is an important intervention for disease management of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Still, the participation and compliance with exercise rehabilitation remain suboptimal. Mobile health technology is a promising approach to promoting involvement in cardiac exercise rehabilitation. Remote rehabilitation can overcome the problems existing in traditional rehabilitation. OBJECTIVE This study aimed to evaluate the effects of an eHealth cardiac rehabilitation (CR) platform based on the persuasive systems design model in addition to standard CR after PCI on physical activity (PA), exercise endurance, self-perceived fatigue, exercise self-efficacy (ESE), and quality of life for patients after PCI. METHODS A single-blinded, parallel, randomized controlled trial design was used. The study was conducted in the Department of Cardiology of a tertiary hospital in Hangzhou, China. A total of 180 eligible patients with CHD were enrolled from June to December 2023. Participants were randomly assigned (1:1) to the intervention group or the control group, with 90 patients in each group. The study is a 24-week eHealth CR program. The primary outcome was PA level; the secondary outcomes included exercise endurance, self-perceived fatigue, ESE, and quality of life. Data on the primary and secondary outcome measures were collected at baseline (T0), at 12 weeks of intervention (T1), and at 4 (T2), 8 (T3), and 12 (T4) weeks of follow-up. The generalized estimating equation model was used to examine changes in the outcome variables between the 2 groups across the study end points. RESULTS Generalized estimating equation analyses revealed significant group-by-time interactions for all outcome measures (all <i>P</i><.001). At T4, compared with the control group, the intervention group demonstrated statistically significant improvements in the following outcomes: PA: median 1723.00 versus 805.50 Metabolic Equivalent Task minutes per week (β coefficient=937.29, 95% CI 867.61-1006.97); 6-minute walk distance: median 436.00 versus 405.00 m (β coefficient=31.00); self-perceived fatigue: median 9.00 versus 10.00 (β coefficient=–1.00, indicating reduced fatigue); ESE: 61.11 versus 27.78 (β coefficient=33.33); Short Form of 36 Health Survey Questionnaire score: 91.19 versus 84.13 (β coefficient=7.06; all <i>P</i><.001). Notably, there was no significant difference in self-perceived fatigue between the 2 groups at T1 (<i>P</i>=.50). CONCLUSIONS The findings of this study demonstrate the effectiveness of the eHealth CR based on the persuasive systems design model in addition to standard CR after PCI in improving the PA level, exercise endurance, ESE, quality of life, and self-perceived fatigue of patients. These findings also provide insights into the application of an eHealth cardiac exercise rehabilitation interventions to enhance the rehabilitation of patients with CHD. CLINICALTRIAL China Clinical Trials Registry (ChiCTR) ChiCTR2300071666; https://www.chictr.org.cn/showprojEN.html?proj=197908