Physical activity lifestyle formation through digital support following phase II rehabilitation: clinical outcomes of the ACTIVE-CaRe Pilot study

Exercise-based cardiac rehabilitation (CR) is a cornerstone in the treatment of patients with cardiovascular diseases or cardiovascular risk factors. While CR programs demonstrate strong effectiveness and result in increased levels of physical activity, many patients still relapse into physical inactivity post-rehabilitation. Digital activity planning and tracking technologies may enhance long-term adherence and sustainability of CR by providing ongoing support.

The ACTIVE-CaRe Pilot study aimed to pilot the feasibility of integrating a digital activity planning tool (aktivplan) into a standard rehabilitation program to support patients’ regular physical activity following phase II rehabilitation and to collect first clinical outcomes.

We conducted the pilot study as a multicenter, two-arm, parallel-group, non-blinded randomized controlled trial (RCT). One inpatient and one outpatient Austrian rehabilitation center invited 86 patients admitted for CR or other rehabilitation indications with increased cardiovascular risk (physical inactivity plus additional cardiovascular risk factors) to take part in the study. Thirty-four patients gave written consent to participate and were randomized based on study site, sex and exercise capacity (Pmax) to the intervention group (IG: n=16; aktivplan — a digital tool providing a personalized prospective physical activity plan) or standard care (control group, CG: n=18; no digital support). Prior to discharge, the intervention group received the aktivplan app and a personalized physical activity plan. Data were collected at baseline (start of phase II rehabilitation, T0), discharge from phase II rehabilitation (T1) and 10-week follow-up (T2) including ergometry to assess exercise capacity (maximal power output at the end of ergometry - Pmax). Exercise capacity data at discharge was only collected if ergometry was part of routine clinical care. Moderate and vigorous physical activity (MVPA) was measured by accelerometry (ActiGraph GT9X Link) during three weeks prior to the follow-up. We present a descriptive complete case analysis, as the number of study participants was not powered for inferential statistical analysis.

Exercise capacity of patients who underwent ergometry at each time point T0-T3 are presented in figure 1. Study participants of the IG (n=6) showed continuous increase in exercise capacity from start to discharge: 13.1 ± 8.0 % and discharge to follow-up: 1.2 ± 8.8 %; and the CG (n=10) from start to discharge: 5.1 ± 8.1 % and discharge to follow-up: 7.5 ± 9.6 %. The IG (n=11) had a MVPA per day of 216 ± 71 min.day-1 and the CG (n=16) of 188 ± 91 min.day-1.

The ACTIVE-CaRe pilot study showed that integrating a digital planning tool into a standard rehabilitation program is feasible. The variability and longitudinal trend of increased physical activity and exercise capacity provide a helpful basis for planning a subsequent effectiveness study.