Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized controlled trial
- PMID: 40214639
- DOI: 10.1093/eurjpc/zwaf147
Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized controlled trial
Abstract
Aims: Women are under-represented in cardiac rehabilitation (CR), especially in lower-income settings. This study tested Technology-bAsed Cardiac rehabilitation Therapy (TaCT) on functional capacity, risk factors, quality of life (QoL; MacNew), heart-health behaviours (e.g. Global Physical Activity Questionnaire), cardiac symptoms (e.g. angina), and morbidity (e.g. hospitalization and procedure) in women.
Methods and results: Single-centre, single-blind, two parallel arms (1:1 SNOSE) randomized superiority trial, undertaken in an Indian outpatient cardiology department, where women with stable cardiac disease and smartphone access were recruited. TaCT was compared with standard care (CR rare), with assessments conducted before the intervention, and 6 months later. The 6-month comprehensive intervention was delivered via several technologies. Exercise prescriptions were based on an Incremental Shuttle Walk Test (ISWT; primary outcome). Analyses were based on intention-to-treat. Fifty women were randomized to intervention, and 50 to control (n = 89; 89.0% retained). There were few tobacco users. Results for the following outcomes favoured intervention: functional capacity [ISWT effect size = 0.3 (95% confidence interval = 1.0 to -0.2), P = 0.002; Duke Activity Status Index P < 0.001; Sit-to-Stand P = 0.003], QoL (global and all subscale P's < 0.001), and heart-health behaviours (exercise P < 0.001; medication adherence P = 0.02), and anxiety (P = 0.002). There were no significant differences in blood pressure, waist circumference, or cardiac symptoms. Three participants in the intervention group experienced morbidity and 1 suffered mortality and 9 in controls experienced morbidity only.
Conclusion: The TaCT program significantly improved functional capacity, QoL, heart-health behaviours and anxiety in women with cardiovascular disease in a middle-income country, demonstrating the potential of technology-based CR tailored for women in these settings.
Registration: CTRI/2021/07/035197 URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=51810&EncHid=79231.15408&modid=1&compid=19.
Keywords: Cardiac rehabilitation; Cardiovascular diseases; Developing countries; Exercise; Good health and well-being; Technology; Women.
Plain language summary
A Technology-bAsed Cardiac rehabilitation program (TaCT) for women in middle-income countries was developed for the first time, including a website with education materials, an app with personalized recommendations for care and management, text reminders, yoga/relaxation videos, and bi-weekly calls with a nurse; 50 women were randomly allocated (like the flip of a coin) to TaCT and 50 women to routine follow-up with their heart specialist, then followed for 6 months to test it.Women in the TaCT program had significantly better exercise capacity/function, quality of life, heart-health behaviours (exercise and taking pills), and lower anxiety than women who had only routine care; There were no differences in blood pressure, waist size, or heart symptoms between the groups.Only 3 women had morbidity in the TaCT group, but 9 women in the group that did not receive TaCT experienced morbidity (e.g. emergency department visit, hospitalization, and heart procedure).
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
Conflict of interest statement
Conflict of interest: The authors declare that they have no competing interests.
Comment in
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Delivering healthy living medicine: all shapes and sizes are needed and welcome.Eur J Prev Cardiol. 2025 Apr 11:zwaf223. doi: 10.1093/eurjpc/zwaf223. Online ahead of print. Eur J Prev Cardiol. 2025. PMID: 40272074 No abstract available.