Efficacy of remotely monitored cardiac rehabilitation in patients after cancer treatment: A pilot study

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Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705). Background Cardiovascular diseases are usually a partial cause of mortality in patients after cancer treatment. The increased cardiovascular risk in cancer patients is obtained from the cumulation of risk factors and the side effects of anticancer therapy. A multimodal model of cardiac rehabilitation (CR) can improve cardiorespiratory fitness (CRF), cardiovascular risk, and prognosis in this population. Despite the benefits of CR, patient participation in CR programs is very low. One of the main reasons for the low utilization and completion is the geographical distance from a specialized CR center. The remotely monitored CR method can solve a fundamental barrier that prevents CR programs' extensive and effective use. Purpose To examine the feasibility of remotely monitored CR as an alternative approach in hemato-oncological patients after cancer treatment. We assumed that the 12 weeks of remotely monitored CR would be feasible and improve the CRF. Methods From March to September 2021, a 12-week study of remotely monitored CR was performed in hemato-oncology patients after cancer treatment. The intervention was based on the principles of phase II CR and consisted of standardized exercise-based in a home-based model with regular telemonitoring and remote supervision. After a cardiovascular assessment, echocardiogram, troponin, brain natriuretic peptides, cardiopulmonary exercise test-CRF were examined, patients were instructed to perform prescribed exercise 3 times per week, for 30 - 50 minutes, at the target heart rate (HR) zone (70 - 90% HRmax) determined by baseline cardiopulmonary exercise testing. Patients were instructed to record their exercise training intensity using a HR monitor and the Borg scale (level 12 - 14 out of 20). Results Eight hemato-oncological patients (50% males; mean age 59.4 ± 12.0 years) enrolled in a remotely monitored CR program. All patients were post-cancer treatment, including cancer systemic chemotherapy-based treatment with recommended supportive care. The analysis showed a statistically significant increase in CRF by 13.7% (∆ 20.5 watts, p < 0.05, Abstract Figure). Overall training adherence was high (33.25 / 36 sessions). No exercise-related adverse events were recorded. Conclusions The pilot study results support the feasibility assumption of remotely monitored CR in hemato-oncological patients after cancer treatment. CR could lead to significant improvements in CRF. The study results can be useful for sample size estimation of future controlled studies to explore more significant evidence in this area.