Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: A Qualitative Study

Background: Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences of highly active patients (i.e., recreational athletes or, simply, athletes) with established coronary artery disease (CAD) in CR. Consequently, existing CTR interventions do not address the specific needs of the athletic sub-population. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup.

Objective: This study aims to inform the design of technologies that facilitate CTR for athletes. We intend to identify athletes’ values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values.

Methods: We employed Value-Sensitive Design (VSD), a human-centric design approach, to elicit design requirements for CTR that can serve athletes with established coronary artery disease (CAD). To identify athletes’ values, we conducted 25 value-oriented, semi-structured interviews with 15 athletic patients and 10 healthcare professionals (HCPs) involved in CR programs. In a second phase, we conducted six card-sorting focus group sessions with 13 patients and 7 HCPs to identify desired CTR features. Lastly, we derive high-level CTR technology requirements connected to the athlete's needs and values.

Results: We define 12 athlete values divided into three categories: body-centric, care-centric and data and technology-centric. We cluster findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and pair them with corresponding values.

Conclusions: Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment.