The next generation of evidence-based personalized physical activity interventions to improve health outcomes after myocardial infarction

Background:

The benefits of supervised center-based exercise as part of cardiac rehabilitation (exCR) for patients after myocardial infarction (MI) are undisputible, however, participation remains low. Remote exCR (telerehabilitation) combine the accessibility of home-based exCR with the specialist monitoring and support of center-based exCR.

The associations between the full range of physical activity (PA) intensities, sedentary time and clinical outcomes has not yet been clarified after MI, as previous studies are limited by self-reported data. The use of wearable devices for the objective quantification of dose-response relationships between PA and clinical outcomes is strongly suggested.

Objectives:

1. We hypothesize that a novel telerehabilitation intervention (remote exCR) can extend the capability of center-based exCR to increase the proportion of patients with MI successfully completing an exercise program.

2. By using accelerometer-based measures we can objectively explore how the full spectrum of PA and sedentary time is associated with rehospitalizations, major adverse cardiovascular events, cardiometabolic health and health-related quality of life after MI. Work plan:

1. Multicenter registry-based cross-sectional cluster randomized crossover clinical trial (RRCT). A total of 1500 patients after MI will be included during 2021-2023. Patients at intervention clusters can choose between remote exCR and center-based exCR. Control clusters will be offered center-based exCR, only. Each patient exercise 2 times/week for 3 months. SWEDEHEART will be used to collect outcomes.

2. We estimate to include one fourth of eligible patients after MI (n=4500) during 2-years. Patients will wear the accelerometer for 7 days at follow-up visits (2 months and 1-year) after discharge. We will examine the dose-response relations of several exposure variables from the accelerometer measurements with the outcomes.

Significance:

Using a RRCT design within the SWEDEHEART platform, a large cohort of patients after MI can be included to a low cost. If remote exCR could extend the capability of center-based exCR to increase the proportion of patients with MI successfully completing exCR, this will contribute to health benefits to the individual patient, and providing a more equal access to health care.

Increased knowledge on the health benefits of the full spectrum of PA intensities can help health care providers to personalize evidence-based PA interventions.