Table 1
Baseline demographics and clinical characteristics of the study population
| Clinical feature | Group 1 (Urban, n = 89) | Group 2 (Rural, n = 94) | p-value |
|---|---|---|---|
| Average age (years) | 65.4 ± 4.3 | 63.7 ± 5.1 | >0.05 |
| Male, n (%) | 47 (52.8) | 51 (54.3) | >0.05 |
| Female, n (%) | 42 (47.2) | 43 (45.7) | >0.05 |
| Stable angina CCS FC II, n (%) | 11 (12.4) | 8 (8.5) | >0.05 |
| Stable angina CCS FC III, n (%) | 78 (87.6) | 86 (91.5) | >0.05 |
| Duration of IHD (years) | 4.2 ± 0.33 | 3.6 ± 0.26 | >0.05 |
| Arterial hypertension, n (%) | 75 (84.3) | 76 (80.8) | >0.05 |
| Systolic BP (mmHg) | 148.9 ± 11.2 | 156.9 ± 16.0. | <0.05 |
| Diastolic BP (mmHg) | 96.2 ± 13.5 | 94.5 ± 10.1 | >0.05 |
| BMI (kg/m2) | 30.8 ± 4.52 | 29.7 ± 3.91 | >0.05 |
| Waist circumference (cm) | 111.8 ± 13.6 | 118.7 ± 18.4 | <0.05 |
| Active smoking, n (%) | 21 (23.6) | 29 (30.8) | >0.05 |
Table 2
Physical activity program based on FCs of coronary artery disease
| Type of physical activity | FC-I | FC-II | FC-III |
|---|---|---|---|
| General developmental exercises (min) | 35–45 | 25–35 | 20–30 |
| Dosed walking exercise (min) | 30 | 20–30 | 20 |
| Breathing exercises | +++ | +++ | +++ |
| Slow walking exercises (km) | 2.5–3.0 | 2.0–2.5 | 1.5–2.0 |
Figure 1
Flowchart of the HealthRunApp working scheme and clinical monitoring loop.
Table 3
Baseline daily activity budgets (hours per day).
| Daily activity index | Urban men (n = 47) | Urban women (n = 42) | Rural men (n = 51) | Rural women (n = 43) |
|---|---|---|---|---|
| Sleep (nocturnal and daytime) | 11.4 ± 1.8 | 10.2 ± 2.1 | 10.4 ± 1.8 | 11.6 ± 1.8 |
| Watching television | 5.3 ± 0.8 | 4.8 ± 0.9 | 4.2 ± 0.8 | 5.7 ± 0.7 |
| Light physical activity (walking, light exercise) | 2.2 ± 0.5 | 2.5 ± 0.6 | 3.4 ± 0.5 | 1.5 ± 0.4 |
Table 4
Baseline subjective physical activity levels (ODA-23+ Questionnaire).
| Subjective activity level | Urban men (n = 47) | Urban women (n = 42) | Rural men (n = 51) | Rural women (n = 43) |
|---|---|---|---|---|
| High | 7 (14.9%) | 4 (9.5%) | 9 (17.6%) | 5 (11.6%) |
| Medium | 21 (44.7%) | 19 (45.3%) | 24 (47.1%) | 19 (44.1%) |
| Low | 15 (31.9%) | 14 (33.3%) | 13 (25.5%) | 16 (37.3%) |
| Very low | 4 (8.5%) | 5 (11.9%) | 5 (9.8%) | 3 (7.0%) |
Table 5
Baseline objective exercise tolerance levels based on cycle ergometry
| Objective exercise tolerance | Urban men (n = 47) | Urban women (n = 42) | Rural men (n = 51) | Rural women (n = 43) |
|---|---|---|---|---|
| Moderate (450-600 kg-m/min) | 11 (23.4%) | 5 (11.9%) | 15 (29.4%) | 5 (11.6%) |
| Low (300 kg-m/min) | 25 (53.2%) | 21 (50.0%) | 29 (56.9%) | 19 (44.2%) |
| Very low (150 kg-m/min) | 11 (23.4%) | 16 (38.1%) | 7 (13.7%) | 19 (44.2%) |
| High (≥750 kg-m/min) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Table 6
Subjective versus objective physical activity disparity matrix
| Demographic cohort | Subjective medium/high rate (%) | Objective medium/high rate (%) | Patients overestimating capacity (%) |
|---|---|---|---|
| Urban men (n = 47) | 59.6 | 23.4 | 36.2 |
| Urban women (n = 42) | 54.8 | 11.9 | 42.9 |
| Rural men (n = 51) | 64.7 | 29.4 | 35.3 |
| Rural women (n = 43) | 55.7 | 11.6 | 44.1 |
Table 7
Pre-and post-intervention changes in TWV (kg-m)
| Patient group | Baseline TWV (kg-m) | 6-Month TWV (kg-m) | Relative increase | p-value |
|---|---|---|---|---|
| Urban men (n = 47) | 1841.3 ± 153.5 | 3452.4 ± 285.7 | 1.87x | <0.01 |
| Urban women (n = 42) | 1647.8 ± 173.6 | 2706.4 ± 241.1 | 1.64x | <0.05 |
| Rural men (n = 51) | 1916.8 ± 214.2 | 3374.0 ± 285.6 | 1.76x | <0.05 |
| Rural women (n = 43) | 1506.7 ± 174.1 | 2965.4 ± 209.8 | 1.97x | <0.01 |
Table 8
Cycle ergometry and hemodynamic parameters initially and at 6 months
| Parameter | Urban cohort (n = 89) | Rural cohort (n = 94) | ||
|---|---|---|---|---|
| Baseline | 6 months | Baseline | 6 months | |
| Ergometry duration (min) | 4.16 ± 0.08 | 7.21 ± 0.14*** | 5.04 ± 0.09 | 7.43 ± 0.19*** |
| Resting heart rate (bpm) | 76.2 ± 5.8 | 63.5 ± 4.3 | 68.7 ± 7.1 | 63.4 ± 4.7 |
| Peak heart rate (bpm) | 129.5 ± 9.1 | 102.4 ± 8.3* | 133.7 ± 10.2 | 98.6 ± 7.9* |
| Resting SBP (mmHg) | 128.2 ± 10.2 | 119.2 ± 10.2 | 136.7 ± 11.0 | 123.8 ± 10.9 |
| Peak SBP (mmHg) | 159.7 ± 14.2 | 139.4 ± 11.3 | 165.8 ± 13.4 | 141.3 ± 11.7 |
| Resting DBP (mmHg) | 96.2 ± 8.5 | 85.8 ± 6.1 | 94.5 ± 8.1 | 84.5 ± 7.3 |
| Peak DBP (mmHg) | 105.7 ± 9.6 | 97.9 ± 7.4 | 107.6 ± 9.1 | 97.7 ± 8.6 |
| ST-segment shift (mm) | 1.6 ± 0.07 | 1.1 ± 0.03*** | 1.9 ± 0.09 | 1.3 ± 0.04*** |
| Supraventricular extrasystoles (beats/24 hr) | 24.5 ± 2.1 | 8.4 ± 0.28*** | 54.8 ± 3.4 | 18.1 ± 2.7*** |
| Ventricular extrasystoles (beats/24 hr) | 10.8 ± 1.1 | 0.5 ± 0.06*** | 35.7 ± 2.7 | 1.7 ± 0.07*** |
Figure 2
Impact of personalised exercise on prognostic apolipoprotein levels and Apo-B/Apo-A-I ratios after 6 months. Apo-A-I, Apolipoprotein A-I; Apo-B, Apolipoprotein B.
Figure 3
Clinical care algorithm and monitoring protocol of the HealthRunApp system. Apo-A-I, Apolipoprotein A-I; Apo-B, Apolipoprotein B; FC, functional class.
| No | Question | Alternative answer options | Points |
|---|---|---|---|
| 1 | If you are currently working, what is the level of physical activity required by your job? | 1. My work is primarily sedentary. 2. My work involves extensive walking, but I do not lift heavy objects. 3. My work requires extensive walking and lifting heavy weights. | 1.4 4.1 5.8 |
| 2 | Do you regularly experience psycho-emotional stress either at work or at home? | 1. Yes. 2. No. | 3.0 1.7 |
| 3 | How physically active are you during your leisure time or throughout a typical day? | 1. I generally do not perform activities requiring physical effort. 2. I walk in the fresh air and perform chores requiring little physical effort. 3. I maintain a very active lifestyle, engage in physical exercise, and do not limit my physical exertion. | 0 9 3.5 5.7 |
| 4 | How many times per week do you spend your leisure time actively as described above? | State the exact number of times: ____________ | — |
| 5 | How many minutes do you walk in a typical day? | 1. Less than 15 min. 2. 15–30 min. 3. 30–60 min. 4. More than 1 hr per day. | 1.1 2.3 4.1 5.5 |
| 6 | What is your typical walking pace/speed? | 1. Fast. 2. Average. 3. Slow and leisurely. | 5.7 3.8 1.3 |
| 7 | What is the maximum distance you can walk continuously without needing to stop? | 1. More than 1 km (indicate distance: ____ km). 2. Exactly 1 km. 3. 500–900 m. 4. 200–400 m. 5. Less than 200 m. | 4.7 3.3 1.8 0.8 0.0 |
| 8 | What is the primary clinical or physical reason that forces you to stop walking? | 1. Retrosternal pain (chest pain behind the breastbone). 2. Discomfort in the region of the heart. 3. Shortness of breath (dyspnea). 4. Heart palpitations or cardiac arrhythmias. 5. Dizziness. 6. Pain or weakness in the lower extremities. 7. General fatigue (without specific pain/symptoms). | 0.7 0.7 1.2 1.2 1.7 1.7 3.8 |
| 9 | What is the absolute maximum distance you walk during an entire day? | 1. Less than 1 km. 2. 1 km or more. | 2.0 3.5 |
| 10 | State the exact maximum daily walking distance in kilometers: | State value: _______ km | 3.5 × km |
| 11 | How frequently do you utilize elevators instead of climbing stairs? | 1. I always climb stairs and avoid elevators. 2. I always climb stairs, but not higher than the third floor. 3. There is no elevator in my house/work, so I must climb stairs (2+ floors) daily. 4. I rarely use the elevator because I live/work on the first or second floor. 5. Occasionally, if climbing only 1 or 2 floors, I walk. 6. I prefer to utilize the elevator in almost all situations. | 5.8 4.7 4.9 2.6 2.5 1.2 |
| 12 | How often do you perform physical activities that lead to slight dyspnea or sweating? | 1. Daily. 2. 2–3 times per week. 3. Once per week. 4. 2–3 times per month. 5. Once per month or less. 6. I do not perform such physical activities. | 5.3 4.5 3.4 2.3 1.6 0.2 |
| 13 | How do you currently rate your overall physical condition and training capacity? | 1. Very good. 2. Good. 3. Average. 4. Worse than average. 5. Poor. | 5.6 4.9 3.7 1.7 0.7 |
| 14 | Has your physical activity level changed over the past six months? | 1. Significantly decreased. 2. Slightly decreased. 3. Remained exactly the same. 4. Increased. | 0.8 2.3 3.5 5.2 |
| 15 | Are you currently participating in structured physical exercise or training? | 1. Yes (including recently started). 2. No. | 5.3 0.8 |
| 16 | Where have you primarily performed your physical exercise or training recently? | 1. In an organized rehabilitation group at a medical facility. 2. Individually at home. | 5.4 4.2 |
| 17 | What types of activities do your home training sessions include? (Select all that apply) | 1. Gymnastic exercises. 2. Structured walking. 3. Running/Jogging. 4. Outdoor cycling. 5. Stationary cycling or mechanical trainers. 6. Dumbbell exercises. 7. Swimming. 8. Skiing. 9. Active sports games (football, tennis, etc.). | 3.1 4.2 5.1 5.3 5.3 5.4 5.4 5.5 5.5 |
| 18 | How many times per week do you perform structured exercise? | 1. Less than once per week. 2. 1–2 times per week. 3. 3–4 times per week. 4. 5 times or more per week. | 2.0 3.8 2.0 6.1 |
| 19 | What is the average duration of each exercise session in minutes? | 1. Less than 20 min. 2. 20–30 min. 3. More than 30 min. | 3.2 4.7 5.9 |
| 20 | If you do not exercise, what is your primary reason? (Select one main reason) | 1. I believe exercise is harmful to my current state of health. 2. I believe exercise does not provide any benefit. 3. I already lead an active lifestyle and do not need extra exercise. 4. I do not consider it necessary. 5. I cannot motivate/force myself to start exercising. 6. I would only exercise if it were organized in a medical facility. 7. My current state of health prevents me from exercising. 8. Structured exercise is medically forbidden/contraindicated. | 0.4 0.7 4.0 1.3 1.6 2.5 0.8 1.5 |
| 21 | What is your current frequency of sexual activity? | 1. More than once per week. 2. 2–4 times per month. 3. Once per month or less. 4. Very rarely or none. | 5.3 4.1 2.1 0.5 |
| 22 | How much time do you spend inside a car daily as either a driver or a passenger? | 1. 3 hr or more per day. 2. 2–3 hr per day. 3. 1–2 hr per day. 4. Less than 1 hr per day, or not every day. | 1.6 2.3 3.0 3.8 |
| 23 | What household chores do you regularly perform? (e.g., shopping, cooking, cleaning, etc.) | 1. I perform household chores for more than 1 hr every day. 2. I do chores under 1 hr daily, but spend 1+ hr on weekends. 3. I do chores daily or almost daily, but for under 1 hr per day. 4. I do not do much housework, but must perform heavy chores. 5. I perform housework only occasionally. 6. I do not perform any household chores. | 5.2 4.5 3.8 3.7 2.0 0.8 |
| No | Does your health now limit you in these activities? If so, how much? | Scoring options | ||
|---|---|---|---|---|
| Yes, limited a lot | Yes, limited a little | No, not limited at all | ||
| A. | Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. | 1 | 2 | 3 |
| B. | Moderate activities, such as moving a table, vacuuming, dusting, or gathering berries. | 1 | 2 | 3 |
| C. | Lifting or carrying groceries. | 1 | 2 | 3 |
| D. | Climbing several flights of stairs. | 1 | 2 | 3 |
| E. | Climbing one flight of stairs. | 1 | 2 | 3 |
| F. | Bending, kneeling, or stooping. | 1 | 2 | 3 |
| G. | Walking more than 1 km. | 1 | 2 | 3 |
| H. | Walking several blocks. | 1 | 2 | 3 |
| I. | Walking one block. | 1 | 2 | 3 |
| J. | Bathing or dressing yourself. | 1 | 2 | 3 |
| No | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? | Scoring options | |
|---|---|---|---|
| Yes | No | ||
| A. | Cut down on the amount of time you spent on work or other activities. | 1 | 2 |
| B. | Accomplished less than you would like. | 1 | 2 |
| C. | Were limited in the kind of work or other activities. | 1 | 2 |
| D. | Had difficulty performing the work or other activities (e.g., it took extra effort). | 1 | 2 |
| No | During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? | Scoring options | |
|---|---|---|---|
| Yes | No | ||
| A. | Cut down on the amount of time you spent on work or other activities. | 1 | 2 |
| B. | Accomplished less than you would like. | 1 | 2 |
| C. | Did not do work or other activities as carefully as usual. | 1 | 2 |
| No | These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling | Scoring options | |||||
|---|---|---|---|---|---|---|---|
| All of the time | Most of the time | A good bit of the time | Some of the time | A little bit of the time | None of the time | ||
| A. | Did you feel full of life/pep? | 1 | 2 | 3 | 4 | 5 | 6 |
| B. | Have you been a very nervous person? | 1 | 2 | 3 | 4 | 5 | 6 |
| C. | Have you felt so down in the dumps that nothing could cheer you up? | 1 | 2 | 3 | 4 | 5 | 6 |
| D. | Have you felt calm and peaceful? | 1 | 2 | 3 | 4 | 5 | 6 |
| E. | Did you have a lot of energy? | 1 | 2 | 3 | 4 | 5 | 6 |
| F. | Have you felt downhearted and blue? | 1 | 2 | 3 | 4 | 5 | 6 |
| G. | Did you feel worn out? | 1 | 2 | 3 | 4 | 5 | 6 |
| H. | Have you been a happy person? | 1 | 2 | 3 | 4 | 5 | 6 |
| I. | Did you feel tired? | 1 | 2 | 3 | 4 | 5 | 6 |
| No | How TRUE or FALSE is each of the following statements for you? | Scoring options | ||||
|---|---|---|---|---|---|---|
| Definitely true | Mostly true | Don’t know | Mostly false | Definitely false | ||
| A. | I seem to get sick a little easier than other people. | 1 | 2 | 3 | 4 | 5 |
| B. | I am as healthy as anybody I know. | 1 | 2 | 3 | 4 | 5 |
| C. | I expect my health to get worse. | 1 | 2 | 3 | 4 | 5 |
| D. | My health is excellent. | 1 | 2 | 3 | 4 | 5 |