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July 3, 2026Journal of Cardiopulmonary Rehabilitation and Prevention

Persistently low engagement in mobile health cardiac rehab is linked to frailty and non-White race.

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Why the study?

Mobile health cardiac rehabilitation may improve access to care among older adults with ischemic heart disease, but engagement remains poorly understood.

What are the digital engagement phenotypes and associated factors among older adults with ischemic heart disease participating in mobile health cardiac rehabilitation?

Population

298 older adults with ischemic heart disease in the intervention arm of the RESILIENT trial

Comparison

Three digital engagement phenotypes (persistently low vs intermediate declining vs persistently high)

Design

Latent class analysis of randomized trial intervention participants

Key result

Mobile health cardiac rehabilitation engagement yielded 3 phenotypes, with persistently low engagement independently associated with non-White race (48% vs 12% vs 15%, P<0.001) and frailty.

Authors

CGClaire GravesASANTOINETTE SCHOENTHALERGSGreg Sweeney

Discussion

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Overview

May warrant attention to engagement barriers in frail non-White patients; leaves open optimal strategies to boost mHealth CR uptake.

Key Points

  • To assess engagement patterns in mobile health cardiac rehabilitation among older adults with ischemic heart disease.
  • Analyzed weekly engagement data from 298 intervention participants in the RESILIENT trial.
  • Engagement scored from exercise entry, communication with therapists, video viewing, and blood pressure measurements.
  • Latent class analysis identified digital engagement phenotypes.
  • Identified 3 engagement phenotypes: persistently low, intermediate declining, and persistently high.
  • Low engagement was linked to non-White race (48% compared to others) and frailty (28% vs 10% and 7%).
  • Improvement in 6-minute walk test varied: 20.8 m (low), 29.7 m (intermediate), and 54.5 m (high; P = .003).

Study Design

Type

RCT (n=298)

Structured PICO

What are the digital engagement phenotypes and associated factors among older adults with ischemic heart disease participating in mobile health cardiac rehabilitation?

P
Population
298 older adults with ischemic heart disease (median age 71.0 years, 28% women) participating in the intervention arm of a mobile health cardiac rehabilitation trial.
I
Intervention
Mobile health cardiac rehabilitation (weekly engagement scored 0 to 11 based on exercise entry, communication with exercise therapist, video viewing, and blood pressure measurement)
O
Outcome
Digital engagement phenotypes identified by latent class analysispatient reported

Engagement with mobile health cardiac rehabilitation varies significantly among older adults, with non-White and frail patients showing persistently lower engagement and correspondingly less functional improvement.

Cite This Study

Graves et al. (2026) conducted an RCT in Ischemic heart disease (n=298). Mobile health cardiac rehabilitation was evaluated on Digital engagement phenotypes. Mobile health cardiac rehabilitation engagement yielded 3 phenotypes, with persistently low engagement independently associated with non-White race (48% vs 12% vs 15%, P<0.001) and frailty.

synapsesocial.com/papers/6a4752f85c29257aa257965dhttps://doi.org/10.1097/hcr.0000000000001047
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Rehabilitation at Home Using Mobile Health for Older Adults Hospitalized for Ischemic Heart Disease2025 · 25 citations
  2. 2Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial2021 · 13 citations
  3. 3Patterns of Adherence to Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease2024 · 3 citations
  4. 4Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial (Preprint)2021
  5. 5Abstract P467: Patterns of Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: Preliminary Analysis of the RESILIENT Trial2024