Coronary heart disease (CHD) is one of the leading causes of death worldwide. It develops due to the progressive narrowing or complete blockage of the coronary arteries, significantly increasing the risk of heart attacks. Patients with type 2 diabetes (T2DM) are particularly at risk: elevated blood sugar levels damage the blood vessels and, in combination with high cholesterol levels, exacerbate processes that increasingly burden the cardiovascular system. Their medical care often requires complex management. A lack of physical activity and obesity are among the most significant modifiable risk factors for cardiovascular diseases, especially in the elderly. Therefore, medical guidelines recommend regular physical training for individuals with CHD and T2DM.
The clinical study "Lifestyle Intervention in Chronic Ischemic Heart Disease and Diabetes (LeIKD)", led by Prof. Dr. Martin Halle, Chair of Preventive Sports Medicine and Sports Cardiology, investigated the effectiveness of a telemedicine-supported lifestyle intervention in older patients with CHD and T2DM. To improve the care of this high-risk group, the study examined whether a home-based lifestyle intervention, supported by a sports app along with individualized written nutritional recommendations and health literacy information, could improve blood sugar levels and overall well-being in a total of 502 patients. The study was conducted at eleven national centers with the support of the Techniker Krankenkasse (TK). It has now been published in the international journal "Nature Medicine," which has an impact factor of 58.7.
Prof. Halle summarizes the significance of the study: "Diabetes is associated with elevated blood sugar levels, and sugar is extremely aggressive – it attacks the blood vessels in the body, similar to how it breaks down raspberries in muesli. This leads to changes in the arteries, cholesterol deposits, and ultimately progressive vascular damage. For patients with both diabetes and coronary heart disease, this is a ticking time bomb – the risk of heart attacks, heart failure, and other complications increases significantly, making close medical supervision and lifestyle adjustments essential."
The study aimed to significantly reduce elevated blood sugar levels compared to standard care through a six-month, individualized home training program with nutritional recommendations, regular feedback, and improved health literacy – and to maintain these effects even after the intensive care phase ended for another six months.
Participants were divided into two groups: The standard group received no active intervention but was given a one-time written standard recommendation on nutrition and physical activity based on current guidelines. The intervention group received access to the sports app with individualized endurance and strength training sessions and was regularly supervised by telephone during the six-month intensive phase. The written nutritional recommendations were based on the participants' dietary records. During the subsequent six-month observation phase, patients were expected to continue the interventions independently using the app, without additional phone calls or external motivation.
The results showed a significant improvement in long-term blood sugar levels during the intensive phase. However, after the intensive phase ended and personal supervision ceased, the values deteriorated again. This suggests that app usage alone is not sufficient to bring about long-term changes. "Our study shows that a lifestyle program for patients with CHD and diabetes seems to be effective only when combined with personal interactions," explains Prof. Halle. "A purely app-based approach without human support, on the other hand, may not lead to sustainable health improvements."
Another important aspect was patient adherence to app usage. Although many were willing to use digital offerings, the predominantly older participants (the average age at study entry was 68 years) showed some uncertainty in handling the technology. This could be a reason why the positive effects did not persist in the long term or were lower than expected in the first six months. Optimizing lifestyle intervention programs remains a major challenge. Conducting the study during the COVID-19 pandemic was also particularly demanding. Originally, the study aimed to recruit 1,500 patients; ultimately, 502 participants were enrolled. This makes it the largest study of its kind on this topic to date.
Prof. Halle concludes: "Our results highlight the need for a holistic approach. The current app hype must be put into perspective because simply providing a digital training plan does not necessarily lead to sustainable therapeutic success. Personal supervision remains an indispensable component of patient care."
To the homepage of the Chair of Preventive Sports Medicine and Sports Cardiology
To the study: "Lifestyle Intervention in Chronic Ischemic Heart Disease and Diabetes (LeIKD)"
Contact:
Prof. Dr. Martin Halle
Chair of Preventive Sports Medicine and Sports Cardiology
Georg-Brauchle-Ring 56
80992 Munich
Phone: 089 4140 6774 (Klinikum rechts der Isar)
Phone: 089 289 24441 (Uptown Campus)
E-Mail: Martin.Halle(at)mri.tum.de
Text: Bastian Daneyko
Fotos: Pixabay/Private