By Carly M. Goldstein, PhD | October 20, 2020

Our patients in cardiac and pulmonary rehabilitation are becoming increasingly tech literate, and device ownership (e.g., smartphone, internet-connected tablet) is approaching saturation. Patients across demographic groups are recognizing the value of incorporating technology into their healthcare experience. Technology can afford a reduction in time spent traveling to medical appointments, greater access to medical professionals (through secure messaging), and a centralized portal for personal health information (the value of which should not be underestimated for patients with multiple appointments and providers).

However, a very important question remains: Just how much tech are cardiac and pulmonary rehabilitation patients willing to use?

I recently conducted a research study with 30 adults participating in cardiac rehabilitation. The majority (90 percent) of patients were currently in Phase II rehabilitation, as opposed to our hospital’s maintenance program. Every participant identified as falling into one or more of the following groups: female; a racial or ethnic minority; or disabled or underserved. Nearly all participants owned a cell phone and nearly all the cell phone owners had smartphones. Patients reported being most interested in using technology when it was easy to use (by their standards, not someone else’s) and when it would provide them with support, services or access that they either could not get elsewhere or that were time- or cost-prohibitive to receive individually in person.

This mirrors what we see in other areas of the literature and what many cardiac and pulmonary rehabilitation professionals report encountering in practice. Perhaps most importantly, patients require easy troubleshooting and technical support. If a technology fails, they do not want to talk to a robot to fix it. They want easy and immediate access to a real human being who can help. This will be crucial for developers to keep in mind when creating technology (e.g., online health education programs, patient-facing portals) that will be utilized by our patients. It will also be essential information for healthcare systems that purchase or lease technology-based programs to disseminate to their patients. Without providing our patients with adequate support, our patients will fail and we will fail our patients.

I work with patients to help them reduce excess weight in service of reducing cardiovascular risk factors. A lot of my discussions center around diet and exercise. Patients continue to have many questions about off-the-shelf activity monitors and smartphone application-based calorie counters. These technologies have largely made a massively positive public health impact, especially when you consider health inequity’s impact on access to safe, heart-healthy weight reduction services. Patients are especially confused about the sleep data that some commercial-grade wearables produce. They tend to show dozens of awakenings nightly, which makes patients believe something is terribly wrong. These patients do not understand the difference between commercial-grade and research-grade measurement. Additionally, devices will tailor physical activity goals to the limited activity people get, resulting in patients underestimating the physical activity they need and not striving for our physical activity guidelines.

Moreover, when calorie counters incorporate physical activity into daily calorie goals (e.g., allowing a patient to eat more because they exercised a lot that day), patients may not benefit as evidenced by a recent study by Thomas and colleagues.

In general, I recommend advising patients to not eat what they burn, particularly because people (and trackers) unintentionally overestimate physical activity and underestimate portions. Patients need more guidance than they realize in tailoring these widely accessible technologies to fit their personal needs. Provided we can meet them where they are, hear their concerns and build tech that works for them, I think our patients will benefit tremendously from the proliferation of technology in healthcare, including in cardiac and pulmonary rehabilitation.