UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine; Graduate School of Biomedical Sciences

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Document Type



Cardiology | Cardiovascular Diseases | Rehabilitation and Therapy | Telemedicine


BACKGROUND: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction.

OBJECTIVE: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation.

METHODS: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life.

RESULTS: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100).

CONCLUSIONS: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.


cardiac rehabilitation, exercise, health watch, mHealth, telerehabilitation

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© Eric Y Ding, Nathaniel Erskine, Wim Stut, David D McManus, Amy Peterson, Ziyue Wang, Jorge Escobar Valle, Daniella Albuquerque, Alvaro Alonso, Naomi F Botkin, Quinn R Pack, David D McManus. Originally published in JMIR Human Factors (, 08.07.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Ding EY, Erskine N, Stut W, McManus DD, Peterson A, Wang Z, Escobar Valle J, Albuquerque D, Alonso A, Botkin NF, Pack QR, McManus DD. MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study. JMIR Hum Factors. 2021 Jul 8;8(3):e18130. doi: 10.2196/18130. PMID: 34255660; PMCID: PMC8299347. Link to article on publisher's site

Journal/Book/Conference Title

JMIR human factors

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.