Key Points:
- Though physical inactivity leads to poor cardiovascular outcomes, especially for those with cardiovascular disease, few studies have been performed to validate the utility of effective lifestyle interventions in this patient population
- The MyoMobile Study was a single-center randomized controlled trial to assess the effect of a personalized mobile health intervention compared to usual care on physical activity level in patients with heart failure with preserved ejection fraction (HFpEF)
- The trial compared three patient groups – usual care, patients receiving a pedometer to measure daily step count (tracking arm), and patients receiving an individualized, app-based physical activity coaching based on pedometer-based assessment of daily step count (coaching arm) – to assess change in daily step count as well as other secondary outcomes
- The coaching arm demonstrated a significant increase in daily step count compared to not only usual care, but also the tracking arm, which may demonstrate the benefits of personalized coaching for lifestyle modification therapy
Heart failure (HF) is a major cause of cardiovascular mortality and is a leading cause of hospitalization. HF prevalence is increasing, in part attributed to an aging population with resultant high prevalence of predisposing risk factors (e.g. hypertension, diabetes, obesity), improved survival, and better treatment of predisposing factors (e.g. myocardial infarction). In the community, HFpEF is a more common phenotype of HF. In addition, most beneficial medical therapy is limited to heart failure with reduced ejection fraction (HFrEF), but similar therapy for HFpEF is more limited.
Physical inactivity and sedentary lifestyle lead to worsened cardiovascular outcomes, including obesity, and ultimately morbidity and mortality. Increase in physical activity, in contrast, is associated with improved outcomes. Guidelines state at least 30 minutes of moderate-intensity activity for at least 5 days per week (or at least 150 minutes per week). However, exercise recommendations are not adequately implemented in daily clinical practice. Unfortunately, patients enrolled in supervised exercise training programs have also been reported to demonstrate low adherence. In contrast, accelerometers provide an objective, continuous assessment of physical activity during patients’ lives over a longer period. Furthermore, there is limited validated evidence for effective lifestyle treatment in HFpEF patients.
The MyoMobile study was a single-center, three-arm randomized controlled trial designed to assess the effect of a 12-week, app-based coaching program for physical exercise in HFpEF patients ( NCT04940312). Study participants received 12 weeks of either app-based physical activity tracking plus coaching (the coaching arm), app-based tracking without coaching (the tracking arm), or usual care. Physical exercise, including daily step count, was assessed by accelerometry and a pedometer to measure the daily step count with use of the “MyoMobile” app. Primary outcome was change in daily step count after 12 weeks in the coaching arm compared to standard care, whereas secondary endpoints included comparisons with the other study arm and changes in subclinical markers of function. The main results were presented at AHA Scientific Sessions 2024.
A total of 185 participants were included. The trial demonstrated a significant increase in step count within the coaching arm compared to usual care of about 1324 steps daily (95% CI: 497, 2,151, p=0.002). Notably, the trial also secondarily demonstrated a significant increase in daily step count of 1048 steps daily among the coaching arm compared to the tracking arm (95% CI 168; 1,929, p=0.021). There was no difference in step count observed between the tracking arm and usual care (change in step count: 182, 95% CI -617; 980, p=0.66), and there were no significant changes seen for other secondary outcomes.
Ultimately, the MyoMobile study demonstrated significant increase in physical activity among HFpEF patients using app-based physical activity with coaching compared to current standard of care. Furthermore, the study also demonstrates an improvement with coaching specifically, given the significant increase in daily step count among those with coaching and tracking compared to tracking alone, and the lack of significant increase in step count between the tracking arm and usual care. Given the importance of physical activity in treatment of HFpEF patients, these results have ramifications for the utility of personalized coaching, in addition to mobile health technology, in lifestyle modification therapy.