# Virtual Care Strategies to Improve Participation in Cardiac Rehabilitation among Veterans

> **NIH VA I01** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2022 · —

## Abstract

Background: Cardiac rehabilitation (CR) is a comprehensive secondary prevention program involving
exercise training, behavioral activation, and psychosocial support following cardiac events such as myocardial
infarction, coronary revascularization, valve replacement. Randomized clinical trials (RCT) have demonstrated
lower mortality and greater physical, mental, and social functioning in patients who participate in CR vs. usual
care. However, the long-term mortality benefit of CR is directly proportional to the number of sessions
completed, and less than half of Veterans who enroll in CR complete the recommended number of sessions.
Significance: Home-based CR (HBCR) is an alternative to traditional CR programs that has comparable
efficacy in improving morbidity/mortality and increases access to critical services. Improving participation in
home-based CR has been identified as a major priority by the National Director of Cardiology. We propose to
test a novel and easily scalable intervention to increase HBCR adherence and improve functional capacity/
physical activity in Veterans at risk for secondary cardiac events. This project addresses a major quality gap
and aligns closely with VHA Modernization priorities of: a) virtual care/telehealth utilization; b) digital
transformation; and c) MISSION Act implementation by offering high quality, easy to access care.
Innovation and Impact: There is major potential to improve Veteran engagement in CR by combining digital
coaching (d-Coaching) with existing VA-supported technologies. Our theory-based intervention targets a
critical component of successful CR engagement that is not available through traditional programs: virtual
social support through a social network. In addition, we propose to improve self-efficacy and self-regulation
through interactive digital multi-media education, personalized feedback, and motivation so that Veterans can
complete the prescribed HBCR program and maintain physical activity long-term. The innovative features
include: 1) the use of the VA-approved MOVN mobile app to deliver the d-Coaching intervention and provide
peer social networks; 2) interactive tailored messages via Annie text messaging to reinforce Veteran-centered
goals, learning, and support; and 3) optional participation in a Fitbit private group leaderboard.
Specific Aims: Aim 1: Determine the effect of the d-Coaching intervention on the number of completed HBCR
sessions over 3 months. Aim 2: Determine the effect of the d-Coaching intervention on: a) functional capacity
(6-minute walk test), b) physical activity (daily step counts, sedentary time), c) psychosocial outcomes
(depressive symptoms, quality of life), and d) clinical outcomes (HbA1C, lipids) and rehospitalization/
mortality. Aim 3: Determine the effect of the d-Coaching intervention on social cognitive factors of self-efficacy,
self-regulation, and perceived social support. Aim 3a: Evaluate the extent to which self-efficacy, self-regulation,
and perc...

## Key facts

- **NIH application ID:** 10424351
- **Project number:** 1I01HX003472-01A1
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** Linda Grace Park
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10424351

## Citation

> US National Institutes of Health, RePORTER application 10424351, Virtual Care Strategies to Improve Participation in Cardiac Rehabilitation among Veterans (1I01HX003472-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10424351. Licensed CC0.

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