Adherence to Accelerometer Use in Older Adults Undergoing mHealth Cardiac Rehabilitation: Secondary Analysis of a Randomized Clinical Trial
Bibliographic record
Abstract
BACKGROUND: Wearable accelerometers, which continuously record physical activity metrics, are commonly used in mobile health-enabled cardiac rehabilitation (mHealth-CR). The association between adherence to accelerometer use during mHealth-CR and improvement in clinical outcomes, such as functional capacity, is understudied. The emergence of artificial intelligence (AI) technology provides novel opportunities to investigate accelerometry use patterns in relation to mHealth-CR outcomes. OBJECTIVE: In this study, we sought to use an AI clustering framework to identify distinct behavioral phenotypes of adherence to accelerometer use. We then aimed to quantify the association of these adherence phenotypes with functional capacity improvements in older adults undergoing mHealth-CR. METHODS: We analyzed data from the RESILIENT (Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease) trial, the largest randomized clinical study to date comparing mHealth-CR versus usual care in older adults (aged ≥65 years). Intervention arm participants were instructed to wear a Fitbit accelerometer for the 3-month study duration. Adherence to accelerometer use was quantified as overall adherence (percentage of days worn) via k-means clustering AI-derived measures and compared with changes in 6-minute walk distance (6-MWD), adjusted for demographic and clinical covariates. RESULTS: Among 271 participants with a mean age of 71 years (SD 8), of whom 198 (73%) were male, accelerometers were worn for an average of 76 days (95% confidence limits 73,78) over 3 months. Adjusted analyses showed a weak association between days of wear and improvement in 6-MWD, with every 30 additional days associated with an 11-meter improvement (P=.08). Our k-means clustering framework identified adherence phenotypes at two resolutions: low resolution (k=2 clusters) and high resolution (k=8 clusters). The consistently high adherence cluster trended toward a 24.6-meter improvement in 6-MWD compared to the low and declining adherence clusters (n=39; 95% CI 0.7-49.9; P=.06). The 8-cluster phenotyping revealed a richer set of adherence patterns, with the consistently high adherence cluster in this analysis having a 38.5-meter (95% CI 2.2-74.7; P=.04) improvement in 6-MWD than the low adherence cluster, as well as greater average daily steps over the 3-month intervention (mean 7518, SD 3415 vs mean 4800, SD 2920 steps; P=.008). CONCLUSIONS: A time-series AI clustering framework identified a range of behavioral phenotypes representing different degrees of adherence to accelerometer use. Regression analysis identified a weak association between the higher adherence phenotype and functional capacity improvement in older adults undergoing mHealth-CR. Our AI-derived accelerometry adherence phenotypes may offer a new approach to tailor mHealth-CR regimens to individual patients, potentially leading to better outcomes in this high-risk population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/study/NCT03978130. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32163.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".