Supporting cardiac rehabilitation with eNutriCardio (v1.0)
Research type
Research Study
Full title
Piloting a web-based personalised nutrition app (eNutriCardio) with patients offered cardiac rehabilitation (v1.0)
IRAS ID
301799
Contact name
Faustina Hwang
Contact email
Sponsor organisation
University of Reading
Clinicaltrials.gov Identifier
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Following a heart attack or percutaneous coronary intervention (PCI) procedure (to ‘open up’ narrowed blood vessels in the heart), patients are encouraged to join a cardiac rehabilitation (CR) programme, which provides health and lifestyle advice to assist recovery and reduce risk of future cardiac events. Whilst NICE recommends that CR should “offer people an individual consultation to discuss diet”, access to registered dietitians is limited. Instead, CR patients typically receive general healthy eating guidance.
Since approximately 50% of patients decline CR, online tools may improve participation. The University of Reading have developed a web-based application (eNutriCardio) that uses a diet questionnaire to assess the quality (‘healthiness’) of a user’s diet. It provides the user with unique, personalised recommendations of foods to increase/reduce to improve diet quality, which aligns with UK public health dietary advice, and incorporates behaviour change techniques.
This pilot study will investigate whether supplementing the Royal Berkshire Hospital Trust’s (RBFT) CR offering with personalised nutrition advice from eNutriCardio (intervention) has a different impact on diet quality and cardiac risk factors (e.g. weight and blood cholesterol) than the CR offering alone (control) after 12 weeks. 50 post-heart attack or PCI patients will provide a dried blood spot sample and record their typical diet using eNutriCardio before being randomly allocated to the control or intervention group. Both groups will be invited to participate in the RBFT’s CR programme, but only intervention participants will receive nutrition advice from eNutriCardio. After 12 weeks, both groups will repeat the diet questionnaire and blood spot sample at home. A follow-up questionnaire will be completed after a further 8 weeks. Participants may also join an optional focus group to discuss their experiences of CR and eNutriCardio. This study is funded by the Health Innovation Partnership, a collaboration between the University of Reading and RBFT.Summary of results
The research team would like to thank everyone who took part in this study. You have helped us understand whether or not eNutriCardio could be helpful as part of cardiac rehabilitation, and what would make eNutriCardio better.ABSTRACT
Background: Lifestyle changes, including eating well, are an important part of cardiac rehabilitation. Previous studies have shown that when healthy eating advice is personalised to the individual, it is more effective than when everybody receives the same advice - these previous studies were conducted with people without health conditions.
Purpose of the study: To see if personalised nutrition advice from an app called eNutriCardio can help people with certain heart conditions to eat more healthily.
What was tested: Personalised nutrition advice from the eNutriCardio app alongside usual NHS care was compared to usual NHS care alone.
People taking part: 31 people completed the study. These were people who had been admitted to the Royal Berkshire Hospital in Reading for either a heart attack or a percutaneous coronary intervention procedure (to ‘open up’ narrowed blood vessels in the heart).
Results: This study found that people who had personalised nutrition advice from eNutriCardio alongside usual NHS care improved the healthiness of their diets more than those who had usual NHS care alone.SPONSOR
The study sponsor (who runs the study and manages the results) was the University of Reading. (contact: Abbe Davy, Head of Quality Assurance in Research, a.j.davy@reading.ac.uk; address: Whiteknights, Reading, RG6 6AS) The study was carried out as a collaboration between the University of Reading and the Royal Berkshire NHS Foundation Trust.FUNDER
This study was funded by the Health Innovation Partnership, a collaboration between the University of Reading and the Royal Berkshire NHS Foundation Trust.GENERAL INFORMATION ABOUT THIS STUDY
The study took place in and around Reading, UK.
This study started in November 2022 and ended in July 2024.
Lifestyle changes, including eating well, are an important part of cardiac rehabilitation. Lifestyle changes can reduce the chances of further cardiac complications in the future. Previous studies have shown that when healthy eating advice is personalised to the individual, it is more effective than when everybody receives the same advice – these previous studies were conducted with people without health conditions.
The main objective of this study was to find out if a personalised nutrition app developed by the researchers would help people with certain heart conditions to eat more healthily. The app is called eNutriCardio. Using the app, people first complete a detailed questionnaire about what they ate and drank during the last four weeks. The app then automatically scores the overall healthiness of their diet (called their “healthy eating score”) and presents healthy eating advice that has been tailored to the individual.
The study involved patients who were in the Royal Berkshire Hospital (Reading, UK) because they had had a heart attack (myocardial infarction) or because they were having a procedure to “open up” narrowed blood vessels in the heart (percutaneous coronary intervention). These patients had been invited to join a cardiac rehabilitation programme.
Study participants were put into two groups by chance (randomised). Both groups used the eNutriCardio app to complete the food and drink questionnaire at the start of the study. Then, one group was offered their usual NHS cardiac rehabilitation programme (without advice from eNutriCardio). The other group was offered their usual NHS cardiac rehabilitation programme plus they received personalised healthy eating advice from the eNutriCardio app. The researchers did not tell people which group they were in, but people would have been able to know depending on whether or not they could see any advice on eNutriCardio. Both groups used the eNutriCardio app to complete the food and drink questionnaire again after 12 weeks.
Participants had fingerprick blood tests at the start and end of the study. They were also asked to complete additional questionnaires at the start and end of the 12-week study period and during a follow-up at 20 weeks.
The main objective of the study was to find out if, over the 12 weeks of the study, there was any difference between the two groups in terms of how their healthy eating scores changed.
Researchers also spoke with small groups of participants who had both completed the study and taken part in the NHS cardiac rehabilitation programme, to discuss their experiences of both the NHS cardiac rehabilitation programme and of the eNutriCardio app.WHAT PATIENTS WERE INCLUDED IN THIS STUDY?
The main requirements to take part in the study were that people:
• had been admitted to the Royal Berkshire Hospital for a heart attack or a percutaneous coronary intervention procedure (to ‘open up’ narrowed blood vessels in the heart),
• were aged 18 years or older,
• lived in an “RG” postcode area,
• could read and understand English,
• could use the eNutriCardio app online during the study.
The main reasons for people not being eligible to take part included:
• had a diagnosed condition affecting memory,
• had any type of diabetes,
• were taking warfarin or weight loss medications,
• had a health condition that affected appetite or food intake,
• had other reasons why they could only eat or drink certain things (e.g. allergies, pregnancy), or could only eat at certain times of day,
• were receiving dietary advice from a healthcare professional,
• were following a specialised weight loss programme or planning to do so within the next 5 months, and/or
• were eating on less than 2 occasions daily.
61 people agreed to take part in the study and met all the study requirements.
41 people completed the food and drink questionnaire using the eNutriCardio app at the start of the study, and were randomly allocated to one of the two study groups. 31 people completed the second food and drink questionnaire at 12 weeks.
9 people spoke with researchers about their experiences of the NHS cardiac rehabilitation programme and of the eNutriCardio app.WHAT WAS THE APP BEING STUDIED?
The app is called eNutriCardio. It was developed by researchers from the University of Reading. The app gives people healthy eating advice that is tailored to what that person usually eats. It identifies which aspects of their diet could be improved and gives practical tips to help them make these changes.
To use the app in this study, a study participant logged into the eNutriCardio website. They could do this on a smartphone, tablet, laptop or computer. On the website, they completed a detailed questionnaire about what they ate and drank during the last four weeks. In this study, both groups completed this questionnaire on the app.
Only for the group receiving healthy eating advice from eNutriCardio, study participants received healthy eating advice as follows:
Based on the person’s responses to the food and drink questionnaire, the app scored the healthiness of the person’s diet (referred to as their “healthy eating score”). It created one overall healthy eating score for a person’s diet as a whole. It also created separate scores for 11 different parts of the diet that are important for our health (such as alcohol, salt, and vegetables). These scores were shown to the person and colour-coded red, amber, or green to show how close or far they were to meeting dietary recommendations for each of the 11 parts of the diet.
The app also used their healthy eating scores to recommend up to three parts of their diet they would benefit from improving (e.g., eating more vegetables, eating less salt and sugar). For each, it identified which foods and drinks they could have more (or less) of to be healthier. The app also gave practical tips for how to make changes to their diet, such as suggesting food swaps and portion sizes. All the advice given by the app was designed by experts in nutrition and dietetics.
Once people had read their advice, the app asked them to think about how ready they were to make changes. If they were ready to make changes or thinking about it, they were asked how they planned to make changes to their diet and to set personal healthy eating goals. For example, a person who had been advised they should eat more vegetables might set the following goal: “I will try to eat more vegetables by adding salad to my sandwiches”.
Alongside the advice given by the app, study participants also received coaching emails at weeks 2, 4 and 8 of the study. During weeks 2 and 8, people were emailed with a few short questions to get them to think about whether they had been able to meet the healthy eating goals they had set out. The were also asked to set new goals for the coming weeks. During week 4, they were emailed with a reminder of their advice and goals, their responses to their week 2 coaching email, and additional tips and links to online recipes related to their advice from eNutriCardio.WHAT WERE THE OVERALL RESULTS OF THE STUDY?
The main result we were studying was the change in healthy eating scores. Over 12 weeks, study participants who had personalised nutrition advice from eNutriCardio alongside usual NHS care improved their healthy eating scores more than those who had NHS usual care alone.
In terms of participant feedback about the eNutriCardio app, overall, study participants found the app easy to use. In the group that received personalised advice from eNutriCardio, all felt positively about the app’s potential to help improve their heart health, and all agreed that they were eating a healthier diet as a result of eNutriCardio’s advice. They also all agreed that the app should be offered to all NHS patients who are invited to join a cardiac rehabilitation programme.
Through speaking to study participants, researchers gained a better idea of what people found hard about eating healthier and what other support would be helpful. This information helps researchers understand how to make eNutriCardio better and more useful for patients in the future.
This summary shows only early insights from this one study. We are still analysing the data. Once we have completed the data analysis, we will post the results at https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fclinicaltrials.gov%252Fstudy%252FNCT05449769.%2FNBTI%2FK1u-AQ%2FAQ%2F4bd34da9-6c3e-4038-9efe-336891ff1aae%2F1%2FVFMWNA4nK4&data=05%7C02%7Cbromley.rec%40hra.nhs.uk%7Cfaab94d5c4f34d99466b08dddb4d253c%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638907846595221263%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=JVbU9Zd0Y%2BZGSpTTGKKNyzzN0HLn6WNMnXfGycEU1VU%3D&reserved=0
Other studies with eNutriCardio in the future may show different results.CONCLUSION
Findings from this study showed that personalised nutrition advice from eNutriCardio received alongside NHS usual care has potential to improve the healthiness of cardiac patients’ diets more than usual care alone. Overall, people who used the eNutriCardio app were positive about their experiences.ARE THERE PLANS FOR FURTHER STUDIES?
We are planning another larger study with the eNutriCardio app. The results from the current study will help us plan the next study. We are also conducting research to explore how the eNutri app could be used to support other patient groups.WHERE CAN I FIND MORE INFORMATION ABOUT THIS STUDY?
There is more information about this study on the clinicaltrials.gov website (NCT05449769) [https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclinicaltrials.gov%2Fstudy%2FNCT05449769&data=05%7C02%7Cbromley.rec%40hra.nhs.uk%7Cfaab94d5c4f34d99466b08dddb4d253c%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638907846595245817%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=QPkjyT6L0nOvFXNPrmaJrEJ9qZZbo4MuVfL3qxH76P4%3D&reserved=0].
More information about the eNutri project is also available at https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fresearch.reading.ac.uk%252Fenutri%252F.%2FNBTI%2FK1u-AQ%2FAQ%2F4bd34da9-6c3e-4038-9efe-336891ff1aae%2F2%2FzExCbq7iNh&data=05%7C02%7Cbromley.rec%40hra.nhs.uk%7Cfaab94d5c4f34d99466b08dddb4d253c%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638907846595262434%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=n9lxtn8cf4ooylj4jssRHL83BI5YLuiR%2FZZAzE%2BMzsc%3D&reserved=0
The researchers can be contacted by email at enutri@reading.ac.uk.REC name
London - Bromley Research Ethics Committee
REC reference
22/LO/0132
Date of REC Opinion
7 Apr 2022
REC opinion
Further Information Favourable Opinion