UNSTRUCTURED
Background: Exercise benefits in heart failure (HF) have been well established. However, adherence to the recommended exercise guidelines in patients with HF has been difficult to achieve. Access to the internet using mobile health (mHealth) provides opportunities to test the delivery of exercise programs to the patient’s homes and improve much-desired adherence.
Objective: The objectives of the study were to: i) describe sample sizes, sample demographics, clinical characteristics of participants and recruitment sites; ii) summarize types of mHealth technology used to improve exercise adherence in patients with HF; iii) describe baseline training protocols and exercise programs (exercise modality, intensity, duration, frequency) prescribed to participants; iv) highlight how the term “adherence” was utilized and how it was measured across mHealth studies and adherence achieved; v) highlight theoretical platforms used in designing the interventions and primary and secondary Outcomes in these trials; and vi) highlight the effect of age, gender, race, New York Heart Association functional classification, and heart failure etiology (systolic vs diastolic) on exercise adherence.
Methods: This review included studies that: 1) utilized an intervention that included mHealth or telehealth technology, 2) included primary or secondary reports of exercise adherence in patients with HF, 3) were a primary or secondary study published between 2015 - 2022, 4) were written in English, and 5) utilized an experimental or quasi-experimental design.
Results: A total of 8 studies met inclusion criteria with 4 randomized controlled designs and 4 quasi-experimental designs. The sample sizes range from 12 to 81 with study durations lasting 4 weeks to 26 weeks. 4 studies delivered intervention used videoconferencing while 4 studies used other software applications. Tablets, computers, desktops, and televisions were used for video streaming. Exercise programs varied across studies and were primarily researcher-developed. Adherence was measured to the prescribed exercise program using self-report, self-report with validation using activity monitors, and keeping attendance counts. The effect of age, gender, race, HF etiology, NYHA functional classification and HF etiology on exercise adherence were not reported.
Conclusions: There is some preliminary evidence suggesting the feasibility of using mHealth technology for building exercise adherence in patients with HF. However, fully powered studies are lacking. Also lacking is the report on the sustainability of the achieved adherence over time. Further research is needed to explore the full potential of mHealth for improving exercise adherence in patients with HF.