Remote Exercise Monitoring Trial for Exercise-based Cardiac Rehabilitation

Consistent with recommendations for supervised home-based exercise, the technology-assisted, home-based, remote monitored exercise cardiac rehabilitation (TexCR) intervention will be delivered over 12 weeks. It will comprise a personalised exercise prescription, telephone support, and behavioural strategies to increase exercise adherence (goal setting, exercise scheduling, overcoming barriers), delivered via smartphone. Participants will be remotely monitored in real-time during bouts of exercise by an exercise physiologist. The intervention aims to have individuals participate in moderate to vigorous aerobic-based exercise for at least 30 minutes (preferably more) most daysof the week, in line with current recommendations and American College of Sports Medicine (ACSM) guidelines. Specific details are provided below. Exercise prescription: An individualised exercise prescription, based on personal preferences and current exercise capacity, is a core component of the intervention. Following ACSM guidelines for exercise in cardiac patients participants will be provided with a weekly prescription detailing exercise duration, frequency and intensity, via a smartphone application (app). The prescribed exercise intensity will be sufficient to induce a “training effect”, yet below a metabolic load that evokes abnormal clinical signs or symptoms. The preferred mode of exercise will be walking, although participants will be able to choose other modes (e.g. stationary cycling, rowing) if preferred. During pre-defined time (e.g., 07:00-09:00) windows participants will connect to a remote exercise monitoring system where a remotely-located exercise physiologist will monitor their location, distance, speed, heart rate, respiratory rate, training load and single lead ECG in real-time; provide real-time feedback and support via participants’ smartphones (including alerts, text messages or telephone calls); respond to adverse events if necessary; provide post-exercise feedback; and modify participants’ exercise prescription if needed. Participants can be monitored in any environment with an active broadband connection (mobile, Wi-Fi, Bluetooth) and the system supports simultaneous monitoring of multiple participants. Support and strategies to facilitate exercise adherence: Behaviour change strategies will be delivered to participants via messages sent through the smartphone. The programme will be grounded in self-efficacy theory, which is the most examined psychological variable within the cardiac setting. Strategies will focus on increasing confidence and motivation to exercise, overcoming barriers to being physically active, scheduling exercise into daily life, goal setting, and enhancing social support and networks to be active. The smartphone app will also allow participants to review their exercise performance and assess progress toward personalised goals. TexCR System: The system comprises a physiological sensing device, smartphone and web apps, and a middleware platform. The BioHarness 3 (Zephyr Technologies, USA) physiological sensing device enables measurement of a comprehensive range of physiological parameters required for monitoring exercise performance. Bluetooth connectivity permits transmission of data to smartphones. We have developed and pre-tested smartphone (Android) and web apps, incorporating the Odin middleware platform. The smartphone app collects and transmits physiological data to a remotely located web server in real-time. The web app displays these data in remote locations, and enables real-time provision of feedback to moderate participants’ exercise behaviour. The Odin middleware platform, developed by Computer Science at the University of Auckland, is an off-the-shelf solution that provides reliable communication, minimises data usage cost and maximises device battery life.