The prevalence of cardiovascular disease, a major cause of disease burden in Australia and other developed countries, is increasing due to a rapidly ageing population and environmental, biomedical and modifiable lifestyle factors.
Although cardiac rehabilitation (CR) programs have been shown to be beneficial and effective, rates of referral, uptake and utilisation of traditional hospital or community centre programs are poor.
Home-based CR programs have been shown to be as effective as centre-based programs, and recent advances in information and communication technologies (ICT) can be used to enhance the delivery of such programs.
The Care Assessment Platform (CAP) is an integrated home-based CR model incorporating ICT (including a mobile phone and the internet) and providing all the core components of traditional CR (education, physical activity, exercise training, behaviour modification strategies and psychological counselling).
The mobile phone given to patients has an integrated accelerometer and diary application for recording exercise and health information. A central database, with access to these data, allows mentors to assess patients’ progress, assist in setting goals, revise targets and give weekly personal feedback.
Mentors find the mobile-phone modalities practical and easy to use, and preliminary results show high usage rates and acceptance of ICT by participants.
The provision of ICT-supported home-based CR programs may enable more patients in both metropolitan and remote settings to benefit from CR.
- 1. Heart Foundation of Australia. Cardiovascular disease statistics. http://www.heartfoundation.org.au/Heart_Information/Statistics/Pages/default.aspx (accessed Oct 2009).
- 2. Beilin L, Huang RC. Childhood obesity, hypertension, the metabolic syndrome and adult cardiovascular disease. Clin Exp Pharmacol Physiol 2008; 35: 409-411.
- 3. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-952.
- 4. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001; (1): CD001800.
- 5. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682-692.
- 6. Walters DL, Aroney CN, Chew DP, et al. Variations in the application of cardiac care in Australia. Med J Aust 2008; 188: 218-223. <MJA full text>
- 7. Scott IA, Lindsay KA, Harden HE. Utilisation of outpatient cardiac rehabilitation in Queensland. Med J Aust 2003; 179: 341-345. <MJA full text>
- 8. Johnson NA, Inder KJ, Nagle AL, Wiggers JH. Secondary prevention among cardiac patients not referred to cardiac rehabilitation [letter]. Med J Aust 2009; 190: 161. <MJA full text>
- 9. Thomas RJ. Cardiac rehabilitation/secondary prevention programs: a raft for the rapids: why have we missed the boat? Circulation 2007; 116: 1644-1646.
- 10. Jolly K, Taylor R, Lip GY, et al. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess 2007; 11: 1-118.
- 11. Miller NH, Haskell WL, Berra K, DeBusk RF. Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulation 1984; 70: 645-649.
- 12. Castro CM, Kind AC. Telephone assisted counseling for physical activity. Exerc Sport Sci Rev 2002; 30: 64-68.
- 13. Neubeck L, Redfern J, Fernandez R, et al. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil 2009; 16: 281-289.
- 14. Taylor RS, Watt A, Dalal HM, et al. Home-based cardiac rehabilitation versus hospital-based rehabilitation: a cost effectiveness analysis. Int J Cardiol 2007; 119: 196-201.
- 15. Walters DL, Särelä A, Fairfull A, et al. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP). BMC Cardiovasc Disord 2010; 10: 5.
- 16. Dellifraine JL, Dansky KH. Home-based telehealth: a review and meta-analysis. J Telemed Telecare 2008; 14: 62-66.
- 17. Patrick K, Raab F, Adams MA, et al. A text message-based intervention for weight loss: randomized controlled trial. J Med Internet Res 2009; 11: e1.
- 18. Weaver A, Young AM, Rowntree J, et al. Application of mobile phone technology for managing chemotherapy-associated side-effects. Ann Oncol 2007; 18: 1887-1892.
- 19. Nguyen HQ, Gill DP, Wolpin S, et al. Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD. Int J Chron Obstruct Pulmon Dis 2009; 4: 301-313.
- 20. Scherr D, Kastner P, Kollmann A, et al. Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial. J Med Internet Res 2009; 3: e34.
- 21. Murray E, Burns J, See TS, et al. Interactive health communication applications for people with chronic disease (review). Cochrane Database Syst Rev 2009; (1): CD004274. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004274/frame.html (accessed Nov 2010).
- 22. Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2007; 115: 2675-2682.
- 23. Mattila E, Parkka J, Hermersdorf M, et al. Mobile diary for wellness management — results on usage and usability in two user studies. IEEE Trans Inf Technol Biomed 2008; 12: 501-512.
- 24. Särelä A, Korhonen I, Salminen J, et al. A home-based care model for outpatient cardiac rehabilitation based on mobile technologies. Proceedings of the 3rd International Conference on Pervasive Computing Technologies for Healthcare; 2009 Apr 1–3; London, UK: IEEE Press.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.