PMID- 37184917
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230601
IS  - 2561-1011 (Electronic)
IS  - 2561-1011 (Linking)
VI  - 7
DP  - 2023 May 15
TI  - The Association Between Mobile App Use and Change in Functional Capacity Among 
      Cardiac Rehabilitation Participants: Cohort Study.
PG  - e44433
LID - 10.2196/44433 [doi]
LID - e44433
AB  - BACKGROUND: Cardiac rehabilitation (CR) is underused in the United States and 
      globally, with participation disparities across gender, socioeconomic status, 
      race, and ethnicities. The pandemic led to greater adoption of telehealth CR and 
      mobile app use. OBJECTIVE: Our primary objective was to estimate the association 
      between CR mobile app use and change in functional capacity from enrollment to 
      completion in patients participating in a CR program that offered in-person, 
      hybrid, and telehealth CR. Our secondary objectives were to study the association 
      between mobile app use and changes in blood pressure (BP) or program completion. 
      METHODS: We conducted a retrospective cohort study of participants enrolled in CR 
      at an urban CR program in the United States. Participants were English speaking, 
      at least 18 years of age, participated in the program between May 22, 2020, and 
      May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by 
      number of exercise logs, vitals logs, and education material views. The primary 
      outcome was change in functional capacity, measured by change in 6-minute walk 
      distance (6MWD) from enrollment to completion. The secondary outcome was change 
      in BP from enrollment to completion. We estimated associations using 
      multivariable linear or logistic regression models adjusted for age, sex, race, 
      ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for 
      CR referral. RESULTS: A total of 107 participants (mean age 62.9, SD 13.02 years; 
      90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the 
      mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) 
      meter increase in 6MWD between enrollment and completion (P<.001). From 
      enrollment to completion, participants with an elevated BP at baseline (>/=130/80 
      mmHg) experienced a significant decrease in BP (systolic BP -11.5 mmHg; P=.002 
      and diastolic BP -7.7 mmHg; P=.003). We found no significant association between 
      total app interactions and change in 6MWD (coefficient -0.03, 95% CI -0.1 to 
      0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI -0.03 to 0.03; 
      P=.87 and diastolic coefficient -0.005, 95% CI -0.03 to 0.02; P=.65). There was 
      no significant association between total exercise logs and change in 6MWD 
      (coefficient 0.1, 95% CI -0.3 to 0.4; P=.57) or total BP logs and change in BP 
      (systolic coefficient -0.02, 95% CI -0.1 to 0.06; P=.63 and diastolic coefficient 
      -0.02, 95% CI -0.09 to 0.04; P=.50). There was no significant association between 
      total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 
      0.99-1.01; P=.44). CONCLUSIONS: CR mobile app use as part of an in-person, 
      hybrid, or telehealth CR program was not associated with greater improvement in 
      functional capacity or BP or with program completion.
CI  - (c)Janah May Oclaman, Michelle L Murray, Donald J Grandis, Alexis L Beatty. 
      Originally published in JMIR Cardio (https://cardio.jmir.org), 15.05.2023.
FAU - Oclaman, Janah May
AU  - Oclaman JM
AUID- ORCID: 0009-0006-6312-9516
AD  - School of Medicine, University of California, San Francisco, San Francisco, CA, 
      United States.
FAU - Murray, Michelle L
AU  - Murray ML
AUID- ORCID: 0009-0004-0668-4148
AD  - Division of Cardiology, Department of Medicine, University of California, San 
      Francisco, San Francisco, CA, United States.
FAU - Grandis, Donald J
AU  - Grandis DJ
AUID- ORCID: 0009-0005-0853-7931
AD  - Division of Cardiology, Department of Medicine, University of California, San 
      Francisco, San Francisco, CA, United States.
FAU - Beatty, Alexis L
AU  - Beatty AL
AUID- ORCID: 0000-0001-8405-7386
AD  - Division of Cardiology, Department of Medicine, University of California, San 
      Francisco, San Francisco, CA, United States.
AD  - Department of Epidemiology and Biostatistics, University of California, San 
      Francisco, San Francisco, CA, United States.
LA  - eng
PT  - Journal Article
DEP - 20230515
PL  - Canada
TA  - JMIR Cardio
JT  - JMIR cardio
JID - 101718325
PMC - PMC10227697
OTO - NOTNLM
OT  - EHR
OT  - adolescence
OT  - blood pressure
OT  - cardiac rehabilitation
OT  - e-health
OT  - electronic health record
OT  - functional capacity
OT  - mHealth
OT  - mobile application
OT  - telehealth assessment
OT  - telemedicine
OT  - youth
COIS- Conflicts of Interest: ALB was formerly employed by (2018-2019) and held stock in 
      (2019-2021) Apple Inc and was formerly on the board of the American Association 
      of Cardiovascular and Pulmonary Rehabilitation (2020-2021). ALB has received 
      research support from the National Heart, Lung, and Blood Institute (NHLBI) and 
      the National Institute of Mental Health (NIMH), unrelated to this manuscript 
      topic.
EDAT- 2023/05/15 13:05
MHDA- 2023/05/15 13:06
PMCR- 2023/05/15
CRDT- 2023/05/15 11:54
PHST- 2022/11/18 00:00 [received]
PHST- 2023/04/07 00:00 [accepted]
PHST- 2023/03/09 00:00 [revised]
PHST- 2023/05/15 13:06 [medline]
PHST- 2023/05/15 13:05 [pubmed]
PHST- 2023/05/15 11:54 [entrez]
PHST- 2023/05/15 00:00 [pmc-release]
AID - v7i1e44433 [pii]
AID - 10.2196/44433 [doi]
PST - epublish
SO  - JMIR Cardio. 2023 May 15;7:e44433. doi: 10.2196/44433.