Her brother's heart surgery at 4 years old sparked an early interest in cardiology for Linda Park , PhD, NP.
But it was the disappointment years later as a cardiac nurse practitioner watching patients forego or dismiss cardiac rehabilitation after surgery that prompted her to consider alternative motivations.
"It hurt my soul that many patients didn't have the tools to manage their symptoms and disease progression on their own," Park said. "They made amazing recoveries from physical activity if they chose to attend cardiac rehab but regressed once they stopped exercising and went back to a sedentary lifestyle. It was important to find a way to keep them motivated at home."
Maintaining physical activity after cardiac surgery is important, especially for older adults. Gentle weights, aerobic exercise, and stretches helps patients to gradually increase their strength and confidence while being closely monitored for safety by rehab medical staff. This improves their balance, gait, strength, and endurance, resulting in fewer falls and increased mobility. Without rehab, patients increase their risk of secondary heart issues, more rapid loss of physical function, and depression.
Patients recovering from heart surgery or other cardiac procedures like stent placements are usually referred to cardiac rehabilitation, typically a 12-week program of supervised exercise training, education on behavior modification, and counseling.
However, according to the Centers for Disease Control and Prevention (CDC) only 24% of discharged heart patients sign up for rehab and of those just 26% complete the 12 weeks, mostly due to scheduling challenges from work and family commitments or a long commute distance for rehab.
Pedometers, apps, texts work to encourage
Park, in her search for new ways to motivate patients, wondered whether digital tools such as smart watches, cell phones, and implantable sensors might offer a solution.
The popularity of wearable and remote monitoring devices like smartwatches, fitness trackers, and blood pressure monitors, which allow for real-time tracking of a patient's vital signs, have made remote health monitoring possible. Park pondered if they could effectively be used to monitor cardiac patients following rehab or those who decline to attend. But would they work?
To find out, Park launched a National Institutes of Health-funded study in 2021, to measure the effectiveness of digital tools, like pedometers, fitness apps, and smartphone text reminders to motivate and educate to participants to make healthy choices about food and exercise.
"Our study confirmed that digital intervention using a wearable device and mobile phone app increased physical activity with daily step counts following cardiac rehab."
Linda Park, PhD, NP
Sixty male and female cardiac patients with an average age of 68 years were randomly divided into two groups and provided pedometers and encouraged to participate in cardiac rehabilitation. The first was a control group receiving a pedometer and periodic educational text messages to increase their step count. The second group received additional interventions such as access to a mobile fitness app and weekly texted messages to motivate and educate for two months following cardiac rehab.
Fifty-one of the 60 patients completed the 12-week cardiac rehab, and the group with access to the mobile app and motivational messages recorded 8,860 daily steps compared to 6,633 average daily steps of the control group, or about 25% more.
"Our study confirmed that digital intervention using a wearable device and mobile phone app increased physical activity with daily step counts following cardiac rehab," Park said.
She is continuing to drill deeper into how best to motivate cardiac patients to follow through on physical activity after getting a diagnosis of heart disease. Her subsequent multi-center NIH-funded study compares patients from urban and rural areas to track the impact of digital coaching and tools on their physical activity after completing cardiac rehab. She has also used digital tools for activities like online group yoga to reduce social isolation and increase these patients' ability to function in their day-to-day activities.
"I think the digital health opportunities we have right now can do so much good," Park said. "Transmitting data from glucometers and blood pressure monitors directly from the patient to their electronic health record is not yet possible for all health providers, but it is the gold standard we're working toward. This is a very exciting time for digital health."
