The effect of a game-based mobile app 'MyHeartMate' to promote lifestyle change in coronary disease patients: a randomized controlled trial

Robyn Gallagher; Clara K Chow; Helen Parker; Lis Neubeck; David S Celermajer; Julie Redfern; Geoffrey Tofler; Thomas Buckley; Tracy Schumacher; Karice Hyun; Farzaneh Boroumand; Gemma Figtree

doi:10.1093/ehjdh/ztac069

The effect of a game-based mobile app 'MyHeartMate' to promote lifestyle change in coronary disease patients: a randomized controlled trial

Eur Heart J Digit Health. 2022 Nov 24;4(1):33-42. doi: 10.1093/ehjdh/ztac069. eCollection 2023 Jan.

Authors

Robyn Gallagher^{1

2}, Clara K Chow^{3

4}, Helen Parker^{2

5}, Lis Neubeck⁶, David S Celermajer^{7

8

9}, Julie Redfern⁵, Geoffrey Tofler^{10

11}, Thomas Buckley^{1

12}, Tracy Schumacher¹³, Karice Hyun⁵, Farzaneh Boroumand^{1

5

14}, Gemma Figtree^{10

11

12}

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Building D17 Johns Hopkins Drive, Sydney, New South Wales 2006, Australia.
² Charles Perkins Centre, University of Sydney, Building D17 Johns Hopkins Drive, Sydney, New South Wales 2006, Australia.
³ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, 176 Hawkesbury Road, Westmead, New South Wales 2006, Australia.
⁴ Department of Cardiology, Westmead Hospital, 176 Hawkesbury Road, Westmead, New South Wales 2145, Australia.
⁵ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, New South Wales 2006, Australia.
⁶ The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Close, Sighthill, EH11 4QD, UK.
⁷ Faculty of Medicine and Health, Central Clinical School, University of Sydney, John Hopkins Drive, Camperdown, New South Wales 2006, Australia.
⁸ Department of Cardiology, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, New South Wales 2050, Australia.
⁹ Clinical Research Group, The Heart Research Institute, 7 Eliza Street, Newtown, New South Wales 2042, Australia.
¹⁰ Department of Cardiology, Royal North Shore Hospital, Reserve Road St, Leonards, New South Wales 2065, Australia.
¹¹ Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Reserve Road St, Leonards, New South Wales 2006, Australia.
¹² Cardiovascular Discovery Group, Kolling Institute of Medical Research, Reserve Road St, Leonards, New South Wales 2065, Australia.
¹³ Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Road, Callaghan, New South Wales 2308, Australia.
¹⁴ School of Mathematical and Physical Sciences, Macquarie University, Herring Road, North Ryde, New South Wales 2109, Australia.

Abstract

Aims: Secondary prevention reduces coronary heart disease (CHD) progression. Traditional prevention programs including cardiac rehabilitation are under-accessed, which smartphone apps may overcome. To evaluate the effect of a game-based mobile app intervention (MyHeartMate) to improve cardiovascular risk factors and lifestyle behaviours.

Methods and results: Single-blind randomized trial of CHD patients in Sydney, 2017-2021. Intervention group were provided the MyHeartMate app for 6 months. Co-designed features included an avatar of the patient's heart and tokens earned by risk factor work (tracking, challenges, and quizzes). The control group received usual care. Primary outcome was self-reported physical activity [metabolic equivalents (METs), Global Physical Activity Questionnaire] and secondary outcomes included lipid levels, blood pressure (BP), body mass index, and smoking. Pre-specified sample size was achieved (n = 390), age 61.2 ± 11.5 years; 82.5% men and 9.2% current smokers. At 6 months, adjusted for baseline levels, the intervention group achieved more physical activity than control (median difference 329 MET mins/wk), which was not statistically significant (95% CI -37.4, 696; P = 0.064). No differences occurred between groups on secondary outcomes except for lower triglyceride levels in the intervention [mean difference -0.3 (95% CI -0.5, -0.1 mmoL/L, P = 0.004)]. Acceptability was high: 94.8% of intervention participants engaged by tracking exercise or BP and completing missions; 26.8% continued to engage for ≥30 days. Participants (n = 14) reported the app supported tracking behaviours and risk factors, reinforcing and improving self-care confidence, and decreasing anxiety.

Conclusion: A game-based app proved highly acceptable for patients with CHD but did not improve risk factors or lifestyle behaviours other than triglyceride levels.

Keywords: Coronary heart disease; Digital health; Gamification; Mobile health; Randomized controlled trial; Risk factors; Secondary prevention.