Heart patients who participate in cardiac rehabilitation programs tend to revert to unhealthy lifestyles once the formal gym-based regimen ends, but apps and coaching can help, Duke says.

Mobile apps coupled with digital healthcare coaching help keep heart attack patients healthier and working out more, says a new study from Duke University Health System.

Heart patients who participate in cardiac rehabilitation programs typically do well during enrollment but tend to revert to unhealthy lifestyles once the formal gym-based regimen ends, Duke says.

Finding a way to sustain patients’ lifestyle improvements after supervised cardiac rehab has ended was the focus of a small pilot study by Duke Health researchers. They devised a follow-up program that uses wearable fitness trackers and virtual sessions with a health coach.

The mobile group not only sustained their fitness levels, but actually continued to increase peak fitness.

The 12-week mobile health program not only kept cardiac rehab patients from losing ground, it appeared to help them maintain and even gain fitness, Duke says. The researchers published their initial findings in the American Heart Journal and are now looking to scale up the study with a larger group of patients.

“The benefits of a cardiac rehab program are well-established, but the gains tend to be temporary,” says Dr. William Kraus, who led the project as part of the Duke Molecular Physiology Institute. “Good habits are hard to maintain for a lot of people once they are on their own and no longer have someone overseeing their progress.”

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The researchers enrolled 25 heart disease patients after they completed a typical cardiac rehabilitation program, which included 36 medically guided exercise sessions in a gym setting, diet counseling and other programs that encourage healthy lifestyle choices.

Following rehab, 16 of the patients were randomly selected to participate in the mobile health program, consisting of a wearable activity tracker, a personalized prescription to walk a certain number of steps a day, and up to 12 weeks of personalized virtual sessions with a health coach.

A comparison group of nine patients were discharged from cardiac rehab with usual care, which did not include any specific lifestyle recommendations other than advice to continue with good diet and exercise choices.

After 12 weeks, the researchers measured fitness levels and physical activity levels of participants in both groups. As expected, the usual care group’s peak fitness fell by 8.5%. But the mobile group not only sustained their fitness levels, but actually continued to increase peak fitness, although not at a statistically significant rate given the small size of the study, Duke says.

While the minutes per week of physical activity of people in the usual care group tailed off across all levels of activity, those in the mobile health group shifted their activity level to a higher intensity from moderate-low to moderate-high intensity.

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“While both groups were exercising above the government guidelines of 150 minutes per week of moderate intensity at the end of cardiac rehab, only the mobile group members were meeting this guideline 12 weeks after cardiac rehab,” Duscha says.

“The mobile health group only decreased their moderate level exercise by 16 minutes per week, while the usual care group fell off by 113 minutes per week,” he says. “This has important public health implications, because maintenance of physical activity and physical fitness are inversely associated with cardiovascular events, such as heart attack and stroke.”

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