eHealth-based Cardiac Rehabilitation in Post-myocardial Infarction Patients

The Effectiveness of eHealth-based Cardiac Rehabilitation in Post-myocardial Infarction Patients：a Randomized Controlled Trial.

The goal of this randomized controlled trial is to compare the effect of eHealth-based cardiac rehabilitation with the effect of usual care on exercise capacity and qualify of life in patients after myocardial infarction.

Cardiac rehabilitation can improve exercise capacity, life of quality, readmission rate and mortality rate for patients after myocardial infarction. International guidelines list cardiac rehabilitation after myocardial infarction as class IA recommendation. However, low participation rate of cardiac rehabilitation due to barriers such as lacking of time, transport or affordability issues is an unsolved problem worldwide. eHealth, consisting of telemedicine, mobile health and personalized care using wearable devices has the potential to remove the barriers and become an effective model to deliver cardiac rehabilitation. Thus, we design a randomized controlled trial to compare the effect of a case manager-led eHealth-based cardiac rehabilitation program with usual care on the compliance, physical activity, quality of life, and cardiorespiratory fitness in patients after myocardial infarction.

Participants receive a 12-wk case manager-led eHealth-based cardiac rehabilitation program with follow-up at 12 week, 6 months and 12 months.

The 12-wk case manager-led eHCR program includes: Individualized exercise prescription according to the results of cardiopulmonary exercise test. At least one session of in-person physical therapy to familiarize participants with the process of exercise training before the initiation of telerehabilitation. Telerehabilitation: a 30-minute moderate aerobic exercise training with remote monitoring and instruction using video conferencing. (Frequency: twice per week in the first 4 weeks, once per week in the 5th-8th week, once every 2 weeks in the 9th-12th week) Additional self-exercise to achieve the target volume of 150-minute moderate aerobic exercise and 2 sessions of resistance training per week. Patient education for secondary prevention delivered regularly via a communication app on the smartphone. Weekly follow-up call from a case manager via phone call or communication app.

Peak oxygen uptake will be assessed using cardiopulmonary exercise test before intervention, at 12 weeks (post-intervention), and at 12 months.

Ventilatory anaerobic threshold will be assessed using cardiopulmonary exercise test before intervention, at 12 weeks (post-intervention), and at 12 months.

The investigators will assess the change in Patient Health Questionnaire (PHQ-9). The PHQ-9 score ranges from 0-27. Higher scores indicate worsen symptoms.

The investigators will assess the change in Generalized Anxiety Disorder scale (GAD-7). The GAD-7 score ranges 0-21. Higher scores indicate worsen symptoms.

The investigators will assess the change in physical activity using Long form International Physical Activity Questionnaire(IPAQ) Taiwan version.

The grip strength will be measured using a grip goniometer with the participants seated and the elbow flexed at 90 degrees.

The isometric knee extension strength will be measured using a dynamometer with participants seated and knee flexed at 90 degrees.

Inclusion criteria: ≥ 20 years of age. Within 6 months after the onset of acute myocardial infarction. At lowest to moderate risk according to the guideline from American Association of Cardiovascular and Pulmonary Rehabilitation. Unable or refused to attend center-based cardiac rehabilitation. Exclusion criteria: Unable to walk independently or use a stationary bike. Unable to follow verbal command. Not having a smartphone which can get on the internet. Having contraindications for exercise according to American College of Sports Medicine's Guidelines for Exercise Testing and Prescription. Unable to provide informed consent.