Conclusions
ToDo-CR behavior
RECRUITMENT
It does not appear that the Vire app and ToDo-CR program targeting sedentary behavior is an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation participants. Although those using the Vire app and the ToDo-CR program had more hospital admissions, these admissions were less costly. Further research is warranted to improve engagement and implementation with age appearing to be less of an impacting factor and prior experience with apps correlating more with engagement. This type of intervention may work as a better resource for those not already attending cardiac rehabilitation, who are at greater risk of hospitalizations, to influence sedentary behavior and potentially reduce costs associated with cardiac-related hospital admissions.The authors gratefully acknowledge the participants who took the time to participate in this study. They also gratefully acknowledge Bridget Bourke and Jayden Black for their assistance with follow-up assessments; the support of Genevieve Fletcher, Heather Chadwick, and Allyce Holmes for assisting with recruitment; and the cardiac rehabilitation teams of the Canberra Hospital, Calvary Public Hospital, and National Capital Private Hospital. This work was supported by the Medical Research Future Fund (grant 1184607), and the lead author was further supported by a Digital Health Cooperative Research Centre Doctor of Philosophy top-up scholarship. These funding bodies were not involved in the design, analysis, interpretation, or writing of the manuscript.Authors' Contributions: All authors contributed to the study design. KP drafted the manuscript and completed all the analyses. All authors contributed to the interpretation of the results and subsequent drafts and have read and approved the final manuscript.Conflicts of Interest: The Vire app and ToDo-CR was created by a private company, Onmi. Onmi provided no funding for this study. SvB is a manager and designer for Onmi and the Vire app and the developer of the ToDo-CR behavior change program. All other authors declare no other conflicts of interest.Supplementary tables for the ToDo-CR randomized controlled trial.CONSORT-eHEALTH checklist (V 1.6.1).