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Flex RCT

The aim of this Randomised Controlled Trial is to test the impact of Vire app and a 6 month Flex programme to decrease sitting time and increase physical activity in cardiac rehabilitation participants to reduce the risk of repeat cardiac events.


A multi-centre randomised controlled trial will be conducted over a total of 24-months within the Canberra area, recruiting 144 participants. Participants will be assessed on admission to cardiac rehabilitation, and at 6 and at 12 months post intervention for re-admission to hospital. Results will inform future research in this area, potentially leading to a decrease in hospital admissions and morbidity in those with heart disease. If successful, Flex will be promoted as an adjunct to traditional cardiac rehabilitation and in other clinical rehabilitation programs.


This project introduces a 6 month localised Flex programme, presented to the user on a new iteration of the Vire smartphone application. 

Managing your health requires you to make some lifestyle changes. But this is not always easy. We all tend to stick to our habits and routines. We find it hard to change the way we have been doing things for years.

Vire app supports you in taking responsibility for your health and in making the lifestyle changes you desire.

The bubbles on the home screen represent your score: the bigger, the better. You can also see your scores over the past 14 days.

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Vire sends you Do's: small positive actions designed to disrupt some of your old habits. You receive up to 3 Do's per week for the duration of a program, depending on your personal needs.

Do's, or micro-behaviours, encourage you to step out of your comfort zone and try new behaviours. By learning new behaviours – we call it becoming more behaviourally flexible – you have more choice over how you react to different situations.

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Vire gives you insight into your existing habits in three key areas:

  • Variety: becoming flexible is necessary if you want to change habits, create diversity in daily life and be explorative

  • Activity: physical activity is important for your health, so be active and reduce the amount of time you sit still

  • Social Opportunity: socialising is important for your wellbeing, get out to meet new people and to strengthen existing relationships

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Participants using the Vire app and ToDo-CR program were 50% more likely to have a hospital admission, twice as likely to have an emergency department presentation and three times more likely to be admitted to hospital for a cardiac-related hospital admission. The analyses accounted for age, gender, diagnosis of diabetes and the presence of other chronic disease. The most frequent cause for admission was chest pain. These results may be explained by the Vire app and ToDo-CR program encouraging participants to seek medical attention if they experienced chest pain. These participants may have become more proactive in self-managing their coronary heart disease due to the prompt provided. Despite having more admissions, the intervention group costs associated with cardiac-related admissions were lower (intervention: $252.40 vs control: $859.30), meaning when they were admitted, they potentially had shorter length of stays, for less severe diagnoses, requiring less costly medical intervention and overall, less impact on the healthcare system.

There was no statistically significant difference between or within groups in sedentary behaviour at 6-months or 12-months. Both groups continued to partake in 10-hours or more sedentary behaviour throughout the study. However, the participants using the Vire app and ToDo-CR program were partaking in 20-minutes less sedentary behaviour at 12-months. Further, those using the Vire app and ToDo-CR program who had prior experience using activity trackers and apps (30 participants) spent a significantly lower percentage of their day in sedentary behaviours, had shorter bouts of sedentary behaviour and overall lower sedentary time at 6-months compared to those without prior experience. There were no differences in the usual care group based on prior experience with activity trackers or apps.


For this research project Onmi partners with University of Canberra, Canberra Hospital, Calvary Hospital, and National Capital Private Hospital. The study is funded by the Medical Research Future Fund (MRFF).

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