# Personalized cardiovascular risk management for outdoor activities: a digital health application

## TL;DR

A new digital app called MOVE helps people manage cardiovascular risks while hiking by personalizing trail recommendations based on individual health and trail conditions.

## Contribution

MOVE is a novel digital health system that integrates user-specific cardiovascular risk and trail features to provide personalized hiking predictions.

## Key findings

- MOVE estimates cardiorespiratory fitness and classifies cardiovascular risk according to ESC guidelines.
- The app was widely adopted, with over 3000 hikes recorded, including users with diverse cardiovascular risk profiles.
- Nearly one-third of hikes were classified as high-effort, particularly for users with lower fitness or demanding trails.

## Abstract

Hiking is a widely practiced outdoor activity with well-known cardiovascular and mental health benefits. However, its popularity among individuals with chronic conditions and across varying fitness levels raises safety concerns, especially in mountainous environments. Current trail planning tools typically rely on generic metrics, without considering individual cardiovascular risk or functional capacity. To address this gap, a novel digital system named MOVE was developed. Based on a patented algorithm, MOVE integrates user-specific characteristics, such as age, sex, body mass index, physical activity level, cardiovascular risk factors, and chronic conditions, with trail features, such as slope, elevation, and altitude. The system provides estimated cardiorespiratory fitness (eCRF), classifies cardiovascular risk according to ESC guidelines, and generates personalized predictions of hiking time, energy expenditure, heart rate ranges, and relative effort.

Following its public release in late 2024, the app was widely adopted in spring–summer 2025, with over 3000 hikes recorded. Users included individuals with a wide range of eCRF and cardiovascular risk profiles, highlighting MOVE’s potential for real-world applicability. The app was particularly used in collaboration with Alpine tourist regions, supported by trail signage and QR codes. Nearly one-third of hikes were classified as high-effort, mainly in individuals with lower eCRF or greater trail demands.

MOVE represents a promising step towards personalized outdoor physical activity. Future developments include real-time tracking, adaptive feedback, wearable integration, and AI-driven modelling. This approach may enhance safety and accessibility of hiking, particularly for at-risk populations, supporting public health through safe engagement with nature-based exercise.

Graphical AbstractOverview of the MOVE algorithm structure and functioningThis figure illustrates the conceptual framework of the MOVE algorithm:User data (left panel): The application collects user-specific information, including mandatory and optional parameters, to estimate cardiovascular risk using the SCORE2/SCORE2-OP algorithms and to estimate cardiorespiratory fitness through validated equations. These values are then used to define individualized exercise thresholds according to the user’s estimated cardiovascular risk profile.Trail characteristics (right panel): Hiking paths are reconstructed from 3D GPX-derived maps and represented in two dimensions. The trail is segmented into multiple short fractions with known length and slope. For each segment, local slope, altitude, and carried load (e.g. backpack weight) are integrated to calculate the overall hiking effort and energy cost.App outputs (bottom panel): Based on user data and trail-specific parameters, MOVE provides four individualized predicted main outputs: hiking time, physical effort, energy expenditure, and safety recommendations according to cardiovascular risk and chronic diseases.For image description, please refer to the figure legend and surrounding text.

Overview of the MOVE algorithm structure and functioning

This figure illustrates the conceptual framework of the MOVE algorithm:User data (left panel): The application collects user-specific information, including mandatory and optional parameters, to estimate cardiovascular risk using the SCORE2/SCORE2-OP algorithms and to estimate cardiorespiratory fitness through validated equations. These values are then used to define individualized exercise thresholds according to the user’s estimated cardiovascular risk profile.Trail characteristics (right panel): Hiking paths are reconstructed from 3D GPX-derived maps and represented in two dimensions. The trail is segmented into multiple short fractions with known length and slope. For each segment, local slope, altitude, and carried load (e.g. backpack weight) are integrated to calculate the overall hiking effort and energy cost.App outputs (bottom panel): Based on user data and trail-specific parameters, MOVE provides four individualized predicted main outputs: hiking time, physical effort, energy expenditure, and safety recommendations according to cardiovascular risk and chronic diseases.

User data (left panel): The application collects user-specific information, including mandatory and optional parameters, to estimate cardiovascular risk using the SCORE2/SCORE2-OP algorithms and to estimate cardiorespiratory fitness through validated equations. These values are then used to define individualized exercise thresholds according to the user’s estimated cardiovascular risk profile.

Trail characteristics (right panel): Hiking paths are reconstructed from 3D GPX-derived maps and represented in two dimensions. The trail is segmented into multiple short fractions with known length and slope. For each segment, local slope, altitude, and carried load (e.g. backpack weight) are integrated to calculate the overall hiking effort and energy cost.

App outputs (bottom panel): Based on user data and trail-specific parameters, MOVE provides four individualized predicted main outputs: hiking time, physical effort, energy expenditure, and safety recommendations according to cardiovascular risk and chronic diseases.