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Internet-based training of coronary artery patients: the Heart Cycle Trial

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Abstract

Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System). This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity, arrhythmias and adherence to training prescriptions, wirelessly via the internet, to a medical team that provided feedback and adjusted training prescriptions. Exercise capacity was evaluated prior to and 6 months after intervention. 118 patients (58 �� 10 years, 105 men) with CAD referred for CR were randomized (IG: n = 55, CG: n = 63). However, 15 patients (27 %) in the IG and 18 (29 %) in the CG withdrew participation and technical problems prevented a further 21 patients (38 %) in the IG from participating. No training-related complications occurred. For those who completed the study, peak VO2 improved more (p = 0.005) in the IG (1.76 ± 4.1 ml/min/kg) compared to CG (−0.4 ± 2.7 ml/min/kg). A newly designed system for home-based CR appears feasible, safe and improves exercise capacity compared to national CR. Technical problems reflected the complexity of applying remote monitoring solutions at an international level.

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Abbreviations

BF:

Breathing frequency

BP:

Blood pressure

CAD:

Coronary artery disease

CG:

Control group

CPX:

Cardiac exercise testing

CR:

Cardiac rehabilitation

CTC:

Central Training Committee

dO2/HR:

Aerobic workrate

EF:

Ejection fraction

GEx:

Guided exercise

HF:

Heart failure

HR:

Heart rate

HRR:

Heart rate reserve

IG:

Intervention group

MI:

Myocardial infarction

O2/HR:

Oxygen pulse

PC:

Personal computer

QoL:

Quality of life

VO2 peak:

Peak oxygen uptake

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Acknowledgments

The data collection would not have been possible without the help of Mrs. Nadine Kruckow, Clinical Trial Center Aachen, Mr. Salvador Domínguez del Río, Clinical Research Associate, Medtronic, and furthermore Mr. Jean-Marc Koller (Centre Suisse d’Electronique et de Microtechnique SA) and Mr. Harald Reiter (Philips technology) for the technical assistance and support.

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    Authors and Affiliations

    1. Clinic for Cardiac and Pulmonary Rehabilitation, Rosenquelle, Kurbrunnenstraße 5, 52077, Aachen, Germany

      Erik Skobel

    2. Department of Cardiology, Angiology, Pneumology and Intensive Care, Medicine, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany

      Erik Skobel, Andreas Napp, Sigrid Glöggler & Nikolaus Marx

    3. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands

      Christian Knackstedt

    4. ITACA Institute, Polytechnic University of Valencia, Valencia, Spain

      Alvaro Martinez-Romero

    5. Life Supporting Technologies, Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politécnica de Madrid, Madrid, Spain

      Dario Salvi & Cecilia Vera-Munoz

    6. Centre Suisse d’Electronique et de Microtechnique SA, 2002, Neuchâtel, Switzerland

      Jean Luprano

    7. Servicio de Cardiología, Hospital Clínico Universitario San Carlos de Madrid, Madrid, Spain

      Ramon Bover

    8. Clinical Trial Center Aachen, Aachen, Germany

      Sigrid Glöggler

    9. Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany

      Birna Bjarnason-Wehrens

    10. Hull-York Medical School, University of Hull, Hull, UK

      Alan Rigby & John Cleland

    11. Department of Cardiology, Spire Hull and East Riding Hospital, Hull, UK

      Alan Rigby & John Cleland

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    1. Erik Skobel
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    Corresponding author

    Correspondence to Erik Skobel.

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    Conflict of interest

    Erik Skobel and Christian Knackstedt have received consultant honoraria from Philips, coordinator of the Project HeartCycle.

    Funding

    This work leading to these results has been supported by the European Community’s 7th FP project Heart Cycle (Grant agreement no. FP7-216695), coordinated by Philips.

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    Erik Skobel and Christian Knackstedt contributed equally.

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    Skobel, E., Knackstedt, C., Martinez-Romero, A. et al. Internet-based training of coronary artery patients: the Heart Cycle Trial. Heart Vessels 32, 408–418 (2017). https://doi.org/10.1007/s00380-016-0897-8

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