Health Coaching to Maintain or Improve Physical Activity and Physical Function Post-Structured Cardiac Rehabilitation Programming Among Older Adults: A Pilot Study

Cardiovascular disease is the leading cause of death for men and women in the United States.1,2 Cardiac rehabilitation (CR) is crucial for individuals recovering from a heart attack, valve replacement, or heart failure, among other heart problems that require surgery or medical care.2 However, post-CR physical activity (PA) often declines, with only 15% of individuals remaining physically active 6 months following CR.3,4 This decline is more pronounced among older adults due to safety concerns and age-related health conditions.5,6 Targeting the transition period post-CR with a behavior change intervention may promote long-term PA maintenance among this older adult population. Thus, the Target-CR pilot study aimed to assess the feasibility of health coaching (HC) versus education to maintain or improve PA and physical function post-CR among older adults. METHODS STUDY DESIGN The Target-CR study (NCT05773287) enrolled participants who had completed traditional insurance-covered CR and was approved by the Duke University Institutional Review Board (Pro00112929). Participants were recruited between September 2023 and March 2024. All participants provided written informed consent. PARTICIPANTS Potential participants (N = 146) were pre-screened for eligibility using electronic health records for age and diagnosis. Of these, 52 were contacted, 15 met the inclusion criteria, and 13 enrolled. Inclusion criteria included: (1) willingness to provide informed consent; (2) ability to read and speak English; (3) ≥60 years old; (4) diagnosed with coronary heart disease; (5) of adequate clinical stability to allow study participation; and (6) own a smartphone/tablet. Exclusion criteria included: (1) planned relocation; (2) scheduled medical procedures; (3) decompensated heart failure; (4) heart failure—class IV; (5) severe pulmonary hypertension; (6) end-stage renal disease; (7) cardiac transplantation; (8) impairment from stroke, injury, or other medical condition; (9) dementia; (10) any other illnesses that, in the opinion of the local clinician, would negatively impact or mitigate participation; (11) hospitalization for any psychiatric condition within 1 year or Mental Health Screening Questionnaire score >4, if not currently in treatment; and (12) inpatient substance abuse rehabilitation program participation within 1 year. INTERVENTION Participants were randomized into two groups for 3 months: (1) HC or (2) education. Both groups received a Garmin Vivosmart 5 device and a step goal ranging from 5000 to 8000 steps per day based on their baseline step count.7,8 The education group received one 30-minute education session, while the HC group received 6 HC sessions lasting 30 to 60 minutes (Supplemental Digital Content 1, available at: https://links.lww.com/JCRP/A671). MEASUREMENTS Anthropometrics, self-reported PA, and physical function were assessed by trained staff members at baseline and 3 months. Steps per day were continuously monitored using the Garmin device. Satisfaction with the intervention was evaluated at 3 months. STATISTICAL ANALYSES Data were analyzed using JMP Pro v.17.0 (SAS Institute). A P value of