{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T07:29:21Z","timestamp":1771054161361,"version":"3.50.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004955","name":"Austrian Research Promotion Agency","doi-asserted-by":"publisher","award":["865531"],"award-info":[{"award-number":["865531"]}],"id":[{"id":"10.13039\/501100004955","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cardiovascular diseases are the leading cause of death worldwide and are partly caused by modifiable risk factors. Cardiac rehabilitation addresses several of these modifiable risk factors, such as physical inactivity and reduced exercise capacity. However, despite its proven short-term merits, long-term adherence to healthy lifestyle changes is disappointing. With regards to exercise training, it has been shown that rehabilitation supplemented by a) home-based exercise training and b) supportive digital tools can improve adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In our multi-center study (ClincalTrials.gov Identifier: NCT04458727), we analyzed the effect of supportive digital tools like digital diaries and\/or wearables such as smart watches, activity trackers, etc. on exercise capacity during cardiac rehabilitation. Patients after completion of phase III out-patient cardiac rehabilitation, which included a 3 to 6-months lasting home-training phase, were recruited in five cardiac rehabilitation centers in Austria. Retrospective rehabilitation data were analyzed, and additional data were generated via patient questionnaires.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>107 patients who did not use supportive tools and 50 patients using supportive tools were recruited. Already prior to phase III rehabilitation, patients with supportive tools showed higher exercise capacity (<jats:italic>P<\/jats:italic><jats:sub>max<\/jats:sub>\u2009=\u2009186\u2009\u00b1\u200953 W) as compared to patients without supportive tools (142\u2009\u00b1\u200941\u2005W, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Both groups improved their <jats:italic>P<\/jats:italic><jats:sub>max<\/jats:sub>, significantly during phase III rehabilitation, and despite higher baseline <jats:italic>P<\/jats:italic><jats:sub>max<\/jats:sub> of patients with supportive tools their <jats:italic>P<\/jats:italic><jats:sub>max<\/jats:sub> improved significantly more (<jats:italic>\u0394P<\/jats:italic><jats:sub>max<\/jats:sub>\u2009=\u200919\u2009\u00b1\u200918\u2005W) than patients without supportive tools (<jats:italic>\u0394P<\/jats:italic><jats:sub>max<\/jats:sub>\u2009=\u20099\u2009\u00b1\u200917\u2005W, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.005). However, after adjusting for baseline differences, the difference in <jats:italic>\u0394P<\/jats:italic><jats:sub>max<\/jats:sub> did no longer reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Therefore, our data did not support the hypothesis that the additional use of digital tools like digital diaries and\/or wearables during home training leads to further improvement in P<jats:sub>max<\/jats:sub> during and after phase III cardiac rehabilitation. Further studies with larger sample size, follow-up examinations and a randomized, controlled design are required to assess merits of digital interventions during cardiac rehabilitation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2023.1150444","type":"journal-article","created":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T03:20:12Z","timestamp":1689391212000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of digital tools in outpatient cardiac rehabilitation including home training\u2014results of the EPICURE study"],"prefix":"10.3389","volume":"5","author":[{"given":"Dieter","family":"Hayn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahdi","family":"Sareban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"H\u00f6fer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Wiesm\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"M\u00fcrzl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Porodko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Puelacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa-Marie","family":"Moser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Philippi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heimo","family":"Traninger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Niebauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s10654-014-9983-3","article-title":"The global impact of non-communicable diseases on households and impoverishment: a systematic review","volume":"30","author":"Jaspers","year":"2015","journal-title":"Eur J Epidemiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1161\/CIR.0b013e31820a55f5","article-title":"Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association","volume":"123","author":"Heidenreich","year":"2011","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"CD001800","DOI":"10.1002\/14651858.CD001800.pub3","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"1","author":"Anderson","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s13561-017-0173-3","article-title":"The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature","volume":"7","author":"Edwards","year":"2017","journal-title":"Health Econ Rev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s00508-014-0527-3","article-title":"Long-term effects of outpatient cardiac rehabilitation in Austria: a nationwide registry","volume":"126","author":"Niebauer","year":"2014","journal-title":"Wien Klin Wochenschr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1016\/j.jacc.2017.08.017","article-title":"Physical activity and mortality in patients with stable coronary heart disease","volume":"70","author":"Stewart","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1016\/S0140-6736(17)31634-3","article-title":"The effect of physical activity on mortality and cardiovascular disease in 130\u2008000 people from 17 high-income, middle-income, and low-income countries: the PURE study","volume":"390","author":"Lear","year":"2017","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur Heart J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1161\/CIRCULATIONAHA.110.010710","article-title":"Dose response between physical activity and risk of coronary heart disease: a meta-analysis","volume":"124","author":"Sattelmair","year":"2011","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1007\/s00508-020-01767-x","article-title":"A little is better than none: the biggest gain of physical activity in patients with ischemic heart disease","volume":"132","author":"Huber","year":"2020","journal-title":"Wien Klin Wochenschr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1177\/2047487312446137","article-title":"Outpatient cardiac rehabilitation: the Austrian model","volume":"20","author":"Niebauer","year":"2013","journal-title":"Eur J Prev Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S0002-9149(02)03159-4","article-title":"Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profiles after a cardiac rehabilitation program in obese patients with coronary heart disease","volume":"91","author":"Yu","year":"2003","journal-title":"Am J Cardiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.ahj.2005.12.023","article-title":"The extensive lifestyle management intervention (ELMI) after cardiac rehabilitation: a 4-year randomized controlled trial","volume":"152","author":"Lear","year":"2006","journal-title":"Am Heart J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e18773","DOI":"10.2196\/18773","article-title":"Digital health interventions for cardiac rehabilitation: systematic literature review","volume":"23","author":"Wongvibulsin","year":"2021","journal-title":"J Med Internet Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.12998\/wjcc.v8.i10.1818","article-title":"Remotely monitored telerehabilitation for cardiac patients: a review of the current situation","volume":"8","author":"Batalik","year":"2020","journal-title":"World J Clin Cases"},{"key":"B17","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/HCR.0000000000000592","article-title":"Do wearable activity trackers increase physical activity among cardiac rehabilitation participants? A SYSTEMATIC REVIEW AND META-ANALYSIS","volume":"41","author":"Ashur","year":"2021","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e21061","DOI":"10.2196\/21061","article-title":"Digital technology interventions for risk factor modification in patients with cardiovascular disease: systematic review and meta-analysis","volume":"9","author":"Akinosun","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13102-019-0126-8","article-title":"Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis","volume":"11","author":"Hannan","year":"2019","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"B20","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.hrtlng.2022.04.016","article-title":"Safety of home-based cardiac rehabilitation: a systematic review","volume":"55","author":"Stefanakis","year":"2022","journal-title":"Heart Lung"},{"key":"B21","doi-asserted-by":"publisher","first-page":"248","DOI":"10.23736\/S1973-9087.23.07773-0","article-title":"The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review","volume":"59","author":"Batalik","year":"2023","journal-title":"Eur J Phys Rehabil Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0186261","DOI":"10.1371\/journal.pone.0186261","article-title":"Digitally enhanced recovery: investigating the use of digital self-tracking for monitoring leisure time physical activity of cardiovascular disease (CVD) patients undergoing cardiac rehabilitation","volume":"12","author":"Vogel","year":"2017","journal-title":"PLoS One"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1016\/0002-9149(91)90870-q","article-title":"Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction","volume":"67","author":"Oldridge","year":"","journal-title":"Am J Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/2047487314560100","article-title":"High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation","volume":"23","author":"Tschentscher","year":"2016","journal-title":"Eur J Prev Cardiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1016\/j.amjmed.2017.02.036","article-title":"Cardiorespiratory fitness change and mortality risk among black and white patients: henry ford exercise testing (FIT) project","volume":"130","author":"Ehrman","year":"2017","journal-title":"Am J Med"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2023.1150444\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T03:20:13Z","timestamp":1689391213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2023.1150444\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,14]]},"references-count":25,"alternative-id":["10.3389\/fdgth.2023.1150444"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2023.1150444","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,14]]},"article-number":"1150444"}}