Fabian Borst, Monika Reuss-Borst, Johannes Boschmann, Peter Schwarz
Abstract
Due to the positive effects of rehabilitation declining over time, the aim of this study was to investigate the long-term physical activity level (PAL) following inpatient rehabilitation in relation to the use of a smartphone-based after-care program. 202 patients (mean Body Mass Index (BMI): 30,8 kg/m2; 61% female) with chronic diseases (e.g., diabetes mellitus, obesity, chronic low back pain, depression) were recruited between 08/2020 and 08/2021 in this single-arm observational study. All patients underwent a 3-week inpatient rehabilitation program. PAL (in total activity minutes/week) was measured with a validated (online) questionnaire (Freiburger Questionnaire on PA) after 3, 6, 9, and 12 months. App usage (online time, completion of a course) was recorded automatically and used to evaluate the app user behavior (adherence).
Introduction
Physical inactivity is one of the most important modifiable risk factors for a variety of chronic diseases, such as rheumatic disorders (osteoarthritis, chronic low back pain), the metabolic syndrome (obesity, diabetes mellitus, gout, arterial hypertension), cardiovascular diseases, some frequent cancers (postmenopausal breast cancer, colon cancer), and also psychiatric diseases, in particular depression [1]. Accordingly, the World Health Organization (WHO) considers a sedentary lifestyle to be one of the four most important risk factors for mortality [2].
Materials and method
This study was designed as a single-arm observational study under real life conditions following the completion of an inpatient rehabilitation program. Eligible patients suffering from chronic diseases (diabetes mellitus, obesity, chronic low back pain, depression) were recruited at the Hescuro-Rehabilitation Center Bad Bocklet (Germany) from August 2020 until August 2021. After an inpatient treatment for 3–5 weeks, patients fulfilling the eligibility criteria were invited to an informational session introducing the voluntary study along with the smartphone application “Videa bewegt”.
Results
Of the 264 patients fulfilling the inclusion criteria, 202 (77%) took part in the study. Most of the participants were female (61%) and in the age range of 50–59 (44%). The mean BMI was 30.8 kg/m2. 97/202 (48%) of the patients had a BMI >30 kg/m2 (obesity class 1), with 49/202 (24%) having a BMI >35 kg/m2 (obesity class 2). The leading clinical diagnosis 97/202 (48%) of patients was a psychosomatic disorder (mostly depression), followed by patients with orthopedic diseases (mostly chronic low back pain). 78/202 (39%) received a monthly income between 2,000 and 5,000 €, reflecting a middle class income in Germany [33].
Discussion
Thus far, few studies have addressed the applicability and effectiveness of digital interventions on PAL in a post-rehabilitation setting, since inpatient rehabilitation measures that are provided on a legal basis are available only in selected European countries (Austria, Germany, Switzerland). Our study sample reflects a representative German rehabilitation population characterized by the prevailing (pre-retirement) age group of 50–59 years, with most participants having a non-academic educational level and mostly prevalent chronic health problems associated with an increased risk of early retirement.
Conclusions
To our knowledge, this is the first study that investigated PAL over a period of 12 months in rehabilitation patients using a mobile health application for 3 months post-rehabilitation. Firstly, our study confirms the effectiveness of an inpatient rehabilitation program in this high-burden (mostly obese) patient group. App users as well as non-users successfully increased their PAL after the inpatient rehabilitation.
Citation: Borst F, Reuss-Borst M, Boschmann J, Schwarz P (2023) Can mobile-health applications contribute to long-term increase in physical activity after medical rehabilitation?–A pilot-study. PLOS Digit Health 2(10): e0000359. https://doi.org/10.1371/journal.pdig.0000359
Editor: Laura M. König, Universität Wien: Universitat Wien, AUSTRIA
Received: January 4, 2023; Accepted: August 25, 2023; Published: October 16, 2023
Copyright: © 2023 Borst et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data has been added as supporting information.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000359#sec017
