CAMP: Cardiac Rehabilitation, Adjustment Disorder, Medication Adherence and Physical Activity

Cardiovascular diseases are the leading cause of death and hospitalization both worldwide and in Switzerland. The direct and indirect socio-economic consequences are of great relevance. According to the World Health Organization (WHO), 13% of deaths worldwide in 2012 were caused by coronary heart disease (WHO, 2016). Physical inactivity was identified as a major risk factor for the development of coronary heart disease. For many patients, however, changes in health behavior are difficult and successful, sustained changes in behavior after an acute cardiac event are demonstrably profound.

In Switzerland, about 7000 patients per year undergo inpatient cardiovascular rehabilitation (e.g. after a heart attack). These persons are distributed among twelve inpatient rehabilitation centers which, according to the “Swiss Working Group for Cardiovascular Prevention, Rehabilitation and Sports Cardiology” (, guarantee comprehensive secondary prevention for patients based on scientifically proven findings. In addition to the primary goal of reintegrating patients into everyday life, the rehabilitation programmes focus primarily on nutritional counseling, stress management, smoking cessation, implementation of adequate secondary prophylaxis with medication and a physical activity programme in line with lifestyle changes. The ongoing evaluation of the programmes checks and guarantees effectiveness.

It is, however, largely unknown, what happens in the days after discharge, when patients return to their everyday lives. How well are patients able to implement the recommendations regarding physical activity and medication in everyday life? What cognitive, social and situational factors are associated with a successful change in behavior? Which risk factors can predict the failure of behavioral change? There are neither international nor Swiss studies on this subject. In addition, research to date has mostly focused on differences between groups (interindividual comparisons). These findings do not always correspond to the development within an individual (intraindividual). In order to be able to make a statement regarding the development of relevant factors within the person after rehabilitation, measurements are needed in everyday life with the help of a so-called intensive longitudinal design.

There is also a high prevalence of psychopathology in patients with coronary heart disease. This also includes adaptation disorders, which until recently were neglected in research due to an ambiguous definition. ICD-11 will include a more specific definition. Another goal of this project is to investigate the prevalence of adaptation disorder in patients with coronary artery disease, as well as the development of symptoms and interactions with factors of behavioral change at the intra- and interindividual level.

Our study aims to answer these important questions and to derive practical implications for sustainable changes in health behavior after cardiovascular rehabilitation. The MobileCoach platform will be used to collect relevant data in this project.


Bierbauer, W., Bermudez, T., Bernardo, A., Fleisch-Silvestri, R., Hermann, M., Schmid, J.‑P., Kowatsch, T., & Scholz, U. (2022) Implementation of a Novel Medication Regimen Following Cardiac Rehabilitation: an Application of the Health Action Process Approach. International Journal of Behavioral Medicine. Advance online publication.

Related Work

Kowatsch, T., Volland, D., Shih, I., Rüegger, D., Künzler, F., Barata, F., Filler, A., Büchter, D., Brogle, B., Heldt, K., Gindrat, P., Farpour-Lambert, N., l’Allemand, D. (2017) Design and Evaluation of a Mobile Chat App for the Open Source Behavioral Health Intervention Platform MobileCoach, In: Maedche A., vom Brocke J., Hevner A. (eds) Designing the Digital Transformation. DESRIST 2017. Lecture Notes in Computer Science, vol 10243. Springer: Berlin; Germany, 485-489. (Paper-PDF | Poster-PDF | Slide-PDF | Screencast)

World Health Organization, WHO (2016) Cardiovascular diseases (CVDs). Retrieved from

Filler, A., Kowatsch, T., Haug, S., Wahle, F., Staake, T. & Fleisch, E. (2015) MobileCoach: A Novel Open Source Platform for the Design of Evidence-based, Scalable and Low-Cost Behavioral Health Interventions – Overview and Preliminary Evaluation in the Public Health Context. Wireless Telecommunications Symposium 2015 (WTS 2015), New York, USA. ***Outstanding Paper Award & Best Graduate Student Paper Award*** PDF

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CDHI Research Team

Prabhakaran Santhanam, Michael Klemmer & Prof. Dr. Tobias Kowatsch


Jun 2017 – Dec 2019


Tania Bermudez, Walter Bierbauer, Prof. Dr. Dr. Andreas Maercker & Prof. Dr. Urte Scholz (University of Zurich), PD Dr. med. Matthias Hermann (Rehazentrum Wald), PD Dr. med. Artur Bernardo (Klink Gais)