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Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation.

Frith, Gabbi; Carver, Kathryn; Curry, Sarah; Darby, Alan; Sydes, Anna; Symonds, Stephen; Wilson, Katrina; McGregor, Gordon; Auton, Kevin; Nichols, Simon


Gabbi Frith

Kathryn Carver

Sarah Curry

Alan Darby

Anna Sydes

Stephen Symonds

Katrina Wilson

Gordon McGregor

Kevin Auton


Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me. Patients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me. Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals. Participation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face.


FRITH, G., CARVER, K., CURRY, S., DARBY, A., SYDES, A., SYMONDS, S., WILSON, K., MCGREGOR, G., AUTON, K. and NICHOLS, S. 2021. Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation. BMC health services research [online], 21, article number 1363. Available from:

Journal Article Type Article
Acceptance Date Nov 24, 2021
Online Publication Date Dec 24, 2021
Publication Date Dec 31, 2021
Deposit Date Nov 27, 2023
Publicly Available Date Nov 27, 2023
Journal BMC health services research
Electronic ISSN 1472-6963
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 21
Article Number 1363
Keywords Cardiac rehabilitation; Tele-health; eHealth; COVID-19
Public URL
Additional Information The supplementary materials published alongside this article are included at the end of the file.