Cardiac patients show high interest in technology enabled cardiovascular rehabilitation
Technology use
The internet use observed here is high. Only Peels et al. [12] reported in 2010 similar numbers in a healthy Dutch cohort with ages between 55 and 65 years, however, in their age group of over 65 years, this percentage decreased to 68 %. Other studies, performed in the same time period, have shown that, 67 and 77 % of men and women aged 50–64 years were using the internet in the United States of America, and also 43 % of Slovenians older than 65 years [13–15]. Age is considered a major determining factor when it comes to technology use. However, our as well as other results show that the internet can be a useful tool to support cardiac patients of all ages and that age currently is certainly not to be seen as an immovable barrier for web-based interventions [12, 16].
Concerning mobile phone use, with 97 % mobile phone and 64 % smartphone ownership, our study is in line with the findings from Dale et al. [11] who also studied CR patients. Similarly, in the older population in general, mobile phones and smartphones are used by the vast majority of men and women [13, 14, 17]. Despite the widespread use of smartphones in our population, current interest in a smartphone App for CR support was lower compared to interest in internet based CR support. However, interest was significantly higher in the younger population compared to the older population which keeps the opportunities for future SMS and App use open. Our findings are in line with Pouchieu et al. [18] who investigated a French, mostly female (76 %) population with a mean age of 51.2 years, demonstrating low interest in Apps, but also observed that younger persons showing higher interest. Further qualitative research is necessary to complement our findings and guide a CR intervention with regards to choices on mobile phone and/or internet use.
The low rates (22 %) of game-experience seen in our study population are comparable to the results of Scanlon et al. [17], who reported that only 3 % of their investigated cohort used a game console. This option for delivering CR is thus certainly subject for further research.
Heart rate monitors were used by one third of the studied cardiac population, despite the fact that almost all of them exercise in a supervised setting. Moreover, 68 % of the patients that did not use a heart rate monitor reported that they find heart rate monitoring important for home based exercise. This might mean that patients who exercise at home will be more likely to use a heart rate monitor. Since many years, heart rate zones based on maximal symptom limited exercise testing constitute the golden standard for defining the exercise training intensity for patients with heart disease [19–25]. Therefore, it can be assumed that the respondents on this TUQ are aware of how to use heart rate zones when exercising on their own, however evaluation of heart rate monitor use amongst patients not engaged in supervised CR is necessary to complement our findings. Given the reported interest in heart rate monitoring during home exercise, the importance of heart rate based training, along with the large availability of heart rate monitors on the market, this is a feature a technology enabled CR platform should implement.
Physical activity monitoring is a very modern lifestyle trend and new Apps and devices are continuously being introduced. Nevertheless this type of monitoring is only scarcely adopted by the patients in our study. So far, no randomized controlled study was able to establish the effectiveness of physical activity monitoring for increasing physical fitness and decreasing mortality of patients with cardiac disease. Moreover, many questions with regard to validity and reliability of these devices remain. In that light, physical activity monitors do not seem useful for monitoring of CR but rather have their potential for increasing the motivation to live a healthy and active life.