Remote Cardiac Rehabilitation Research Articles

Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study

Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR. We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre-Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program. In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed. In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study. This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs. RR2-10.2196/31855.

A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.

Remote Cardiac Rehabilitation With Wearable Devices

Remote Cardiac Rehabilitation With Wearable Devices

Feasibility of a smartphone app for prescribed exercise tutoring in patients with stable coronary heart disease.

Digital health technologies have potential to address the challenges associated with traditional cardiac rehabilitation (CR). However, it is not complete enough for prescribed exercise guidance and remote monitoring. We aimed to evaluate the feasibility of a smartphone app for prescribed exercise tutoring by exercise videos combined with wearable devices to monitor heart rate in patients with stable coronary heart disease (CHD). The study is a quasi-experimental design study with a single group. A total of 31 patients were included with an average age of 56.2 years (SD 13.4). They participated in a 12-week remote digital CR program. We employed a wearable heart rate monitoring device connected with an app to monitor the patients' exercise intensity. The app can display the videos corresponding to an exercise prescription to guide the exercise. Cardiorespiratory endurance, blood pressure, blood glucose, cholesterol, blood uric acid, left ventricular ejection fraction and quality of life (QoL) were assessed at the beginning and end of the intervention. Compliance and safety events were recorded as well. Completion rate reached 90.3%. Average daily effective exercise time was 39.4 min (SD 17.8), and 92.9% of the patients could exercise in the prescribed intensity for at least 20 min per day. Average effective exercise days per week were 4.6 days (SD 2.2), and 67.9% of the patients could exercise in the prescribed intensity for at least 3 days per week. Patients' peak VO2 (P = 0.041) and peak metabolic equivalents (P = 0.018) were significantly increased, low-density lipoprotein (P = 0.036) and diastolic blood pressure at rest (P = 0.044) were significantly decreased, and depression (GAD-7, P = 0.014) and anxiety (PHQ-9, P = 0.013) were significantly improved. It is feasible, safe, and helpful for stable CHD patients to use the app for prescribed exercise tutoring with videos combined with wearable devices to monitor heart rate. ChiCTR1800019144.

Israel's first national remote cardiac rehabilitation program: A retrospective analysis.

Cardiac rehabilitation is an essential component of secondary prevention consistently unexploited by most eligible patients. Accordingly, the remote cardiac rehabilitation program (RCRP) was developed to create optimal conditions for remote instruction and supervision for patients to enable successful completion of the program. This study comprised 306 patients with established coronary heart disease who underwent a 6-month RCRP. RCRP involves regular exercise, monitored by a smartwatch that relays data to the operations center and a mobile application on the patient's smartphone. A stress test was performed immediately before the RCRP and repeated after 3 months. The aims were to determine the effectiveness of the RCRP in improving aerobic capacity, and correlating the program goals and first-month activity, with attaining program goals during the last month. Participants were mostly male (81.5%), aged 58 ± 11, enrolled in the main after a myocardial infarction or coronary interventions. Patients exercised aerobically for 183 min each week, 101 min (55% of total exercise) at the target heart rate. There was a significant improvement in exercise capacity, assessed by stress tests, metabolic equivalents which increased from 9.5 ± 3 to 11.4 ± 7(p < 0.001). Independent predictors of RCRP goals were older age and more minutes of aerobic exercise during the first program month (p < 0.05). Participants succeeded in performing guideline recommendations, resulting in a significant improvement in exercise capacity. Older age and increased volume of first month of exercise were significant factors associated with a greater likelihood to attain program goals.

Effects of the COVID-19 pandemic on offering and acceptance in a cardiac rehabilitation programme: introduction of a remote CR programme

Abstract Background The impact of the COVID-19 pandemic on multimodal cardiac rehabilitation (CR) programmes has forced a continuous readjustment of clinical practice. Our regional healthcare system was faced with providing quality remote CR to ischaemic heart disease (IHD) patients in a scattered, mostly rural population, for which three new CR modalities replaced the previous in-person CR program: 1) telephone follow-up programme, 2) TELEA online platform for patient follow-up and 3) TELEA online follow-up &amp; online training sessions. Purpose To study the impact of the COVID-19 pandemic on CR offering and acceptance and the reasons for patient refusal, and to assess the outcome of new remote CR modalities in this setting. Methods Single center, observational retrospective study from all consecutive patients with IHD eligible for CR from 2015 to 2021. A descriptive analysis of patient baseline characteristics, CR modality, offering and acceptance rates, and reasons for refusal per year was performed. Additionally, a comparative analysis of “pre-COVID period” (Jan 2015–Feb 2020) vs. “COVID period” (Mar 2020–Dec 2021) was performed to assess the impact of the pandemic on patient recruitment and the usefulness of remote CR modalities to enhance participation. Results N=2626 patients (20% women, 69.7±45.8 years) were offered CR from 2015 to 2021. CR offering decreased from the pre-COVID (78.6%) to the COVID period (52.6%), while participation increased (67.9% and 79.7%, respectively) Figure 1. Reasons for CR refusal significantly changed with an odds ratio (OR) of 5.63 and confidence interval (CI) 95% (3.2–9.9). In the pre-COVID period main reasons for CR refusal was “transportation difficulties” (47%); while during the COVID-19 period, the main reason shifted to “lack of interest” (78.2%) (Table 1). Conclusions Offering CR decreased during the COVID pandemic possibly due to stricter inclusion criteria. However, the implementation of new remote CR modalities allowed not only to maintain similar levels of acceptance but also to improve it despite the unfavourable setting, and helped to amend transportation difficulties as the leading reason for refusal. Remote CR may be a useful tool, combined with in-person programs, to enhance participation in CR. Funding Acknowledgement Type of funding sources: None.

The impact of COVID-19 pandemic on cardiac rehabilitation of patients following acute coronary syndrome.

Cardiac rehabilitation improves prognosis and symptoms in cardiac patients. In 2020, due to the COVID-19 pandemic, cardiac rehabilitation services were temporarily suspended between April and August. We aimed to investigate the effect of cardiac rehabilitation suspension during the COVID-19 pandemic on patients' exercise capacity and metabolic parameters. Included were patients undergoing cardiac rehabilitation following hospital admission for ACS. Exercise capacity, weight and body fat percentage were compared between baseline, pre- and post-lockdown visits. A total of 281 patients participated in the cardiac rehabilitation program prior to its suspension. Of them, only 198 (70%) patients returned to the program on its renewal and were included in the analysis. Exercise capacity improved significantly in the pre-lockdown stress test compared to baseline. However, there was a significant decrease in exercise capacity in the post compared to pre-lockdown test (8.1±6.3 and 7.1±2.1 METs in pre- and post-lockdown measurements, respectively, p<0.001). Of the 99 (50%) of patients that demonstrated at least 10% improvement in exercise capacity in the pre-lockdown test, 48(48.5%) patients returned to their baseline values in the post-lockdown test. Post-lockdown assessment demonstrated a significant weight gain (80.3 and 81.1kg, in pre- and post-lockdown measurements, respectively, p<0.001) as well as an increase in visceral fat level and body fat percentage. Cardiac rehabilitation suspension for 4 months during COVID-19 pandemic caused a significant reduction in exercise capacity and increased weight and body fat percent. These findings highlight the importance of remote cardiac rehabilitation services that can continue uninterrupted in times of pandemic.

The First National Program of Remote Cardiac Rehabilitation in Israel-Goal Achievements, Adherence, and Responsiveness in Older Adult Patients: Retrospective Analysis.

Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative Israeli national program in the field of telecardiology. RCR is included in the Israeli health coverage for all citizens. It is generally accepted that telemedicine programs better apply to younger patients because it is thought that they are more technologically literate than are older patients. It has also previously been thought that older patients have difficulty using technology-based programs and attaining program goals. The objectives of this study were as follows: to study patterns of physical activity, goal achievement, and improvement in functional capacity among patients undergoing RCR over 65 years old compared to those of younger patients; and to identify predictors of better adherence with the RCR program. A retrospective study of patients post-myocardial infarction were enrolled in a 6-month RCR program. The activity of the patients was monitored using a smartwatch. The data were collected and analyzed by a special telemedicine platform. RCR program goals were as follows: 150 minutes of aerobic activity per week, 120 minutes of the activity in the target heart rate recommended by the exercise physiologist, and 8000 steps per day. Models were created to evaluate variables predicting adherence with the program. Out of 306 patients, 80 were older adults (mean age 70 years, SD 3.4 years). At the end of the program, there was a significant improvement in the functional capacity of all patients (P=.002). Specifically, the older adult group improved from a mean 8.1 (SD 2.8) to 11.2 (SD 12.6). The metabolic equivalents of task (METs) and final MET results were similar among older and younger patients. During the entire program period, the older adult group showed better achievement of program goals compared to younger patients (P=.03). Additionally, we found that younger patient age is an independent predictor of early dropout from the program and completion of program goals (P=.045); younger patients were more likely to experience early program dropout and to complete fewer program goals. Older adult patients demonstrated better compliance and achievement of the goals of the remote rehabilitation program in comparison with younger patients. We found that older age is not a limitation but rather a predictor of better RCR program compliance and program goal achievement.

Effects of the COVID-19 pandemic on offering and acceptance in a cardiac rehabilitation programme: introduction of a remote CR programme

Abstract Background The impact of the COVID-19 pandemic on multimodal cardiac rehabilitation (CR) programmes has forced a continuous readjustment of clinical practice. Our regional healthcare system was faced with providing quality remote CR to ischaemic heart disease (IHD) patients in a scattered, mostly rural population, for which three new CR modalities replaced the previous in-person CR program: 1) telephone follow-up programme, 2) TELEA online platform for patient follow-up and 3) TELEA online follow-up &amp; online training sessions. Purpose To study the impact of the COVID-19 pandemic on CR offering and acceptance and the reasons for patient refusal, and to assess the outcome of new remote CR modalities in this setting. Methods Single center, observational retrospective study from all consecutive patients with IHD eligible for CR from 2015 to 2021. A descriptive analysis of patient baseline characteristics, CR modality, offering and acceptance rates, and reasons for refusal per year was performed. Additionally, a comparative analysis of “pre-COVID period” (Jan 2015–Feb 2020) vs. “COVID period” (Mar 2020–Dec 2021) was performed to assess the impact of the pandemic on patient recruitment and the usefulness of remote CR modalities to enhance participation. Results N=2626 patients (20% women, 69.7±45.8 years) were offered CR from 2015 to 2021. CR offering decreased from the pre-COVID (78.6%) to the COVID period (52.6%), while participation increased (67.9% and 79.7%, respectively) Figure 1. Reasons for CR refusal significantly changed with an odds ratio (OR) of 5.63 and confidence interval (CI) 95% (3.2–9.9). In the pre-COVID period main reasons for CR refusal was “transportation difficulties” (47%); while during the COVID-19 period, the main reason shifted to “lack of interest” (78.2%) (Table 1). Conclusions Offering CR decreased during the COVID pandemic possibly due to stricter inclusion criteria. However, the implementation of new remote CR modalities allowed not only to maintain similar levels of acceptance but also to improve it despite the unfavourable setting, and helped to amend transportation difficulties as the leading reason for refusal. Remote CR may be a useful tool, combined with in-person programs, to enhance participation in CR. Funding Acknowledgement Type of funding sources: None.

Effect of real-time remote-based cardiac rehabilitation on subjective satisfaction and objective performance during the coronavirus disease 2019 pandemic

Abstract Background Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Methods We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [Δ]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Results Sixteen patients (72.2±10.4 years) completed remote-based CR and fifteen patients (77.3±4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0±2.7 mL min–1 kg–1; after: 14.9±3.9 mL min–1 kg–1; p&amp;lt;0.05) and the WHOQOL-BREF score (before: 77.4±12.8 points; after: 93.9±12.9 points; p&amp;lt;0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9±13.2 points; after: 11.3±6.8 points; p&amp;lt;0.05) after rehabilitation than at baseline. The post-CR physical function differed significantly between the two groups (Δpeak VO2, remote: 2.8±3.0 mL min–1 kg–1; hospital: 0.84±1.8 mL min–1 kg–1; p&amp;lt;0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (ΔWHODAS 2.0 score, remote: –8.56±14.2 points; hospital: 2.14±7.6 points; p&amp;lt;0.01). Conclusions Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanei Medicis company.

Telecardiología. De la prevención primaria a la secundaria

Remote cardiology or telecardiology is constantly evolving parallel to the development of tools in different aspects of the specialty. Real-time remote consultation, detection of atrial fibrillation with a smartphone or smartwatch, potential possibilities in ischemic heart disease, development of remote cardiac rehabilitation programs, telemonitoring in heart failure, and invasive monitoring features included in implantable devices are the central aspects included in this review.

O5-7 Feasibility Study- A physiotherapy led remote ACHD Cardiac Rehabiliation Program

ProblemPrevalence of adult congenital heart disease (ACHD) is growing. Exercise is safe and effective at enhancing exercise capacity and quality of life (QOL) for ACHD patients but they are predominately sedentary with reduced exercise capacity and obese compared to peers. ACHD patients are concerned about their inactivity, however are uncertain of exercise suitability and safety and are unable to access specialist advice or cardiac rehabilitation (CR). Many ACHD patients are managed in specialist centres covering vast areas meaning classes are inappropriate. Acquired heart disease CR is cost-effective, improving QOL, exercise capacity, mortality and morbidity. ACHD patients potentially gain the same benefits. Remote cardiac rehabilitation (RCR) using technology could be a feasible model providing accessible specialist knowledge and individualised exercise prescription.Description of the problemCardiologists referred sedentary, complex ACHD patients for a 12-week RCR providing individualised exercise prescription, education and motivation via telephone clinics and free apps (PT Momentum, Pacer and Active 10). Initially, habitual exercise was encouraged, participants were coached to achieve the recommended UK PA guidelines. Self-efficacy for Exercise (SEE) and Satisfaction with Life Score (SWLS) were assessed comparing patients' responses upon program completion to baseline. To determine the feasibility and acceptability of RCR to ACHD patients and quanitfy the impact of RCR on patient's physical activity (PA) and QOL.To discover if technology supported programme can increase the PA level of ACHD patients.ResultsFrom 23 referrals, 11 completed the program becoming more physically active, fulfilling the guidelines. Improvements were seen in both SEE (mean 30) and SWLS (mean 10). Patients deemed RCR an acceptable service delivery.Participants (9) responded well to apps. Reasons for not using apps included data capacity (1) or no device (2).LessonsACHD patients engaged with RCR making it; viable, acceptable and practical solution improving PA levels and QOL.RCR using app's is a feasible model however, alternatives are required.Main MessagesRCR enables ACHD patients to receive specialist knowledge, individualised, accessible and effective exercise prescription improving QOL and PA levels.RCR potentially leads to substantial cost savings and improvements in morbidity and mortality of ACHD patients.

Telemedicine and Remote Rehabilitation for Patients with Cardiac Disease Post COVID-19 Era

Background The COVID-19 pandemic has accelerated the changes of daily practice in medical care worldwide. Telemedicine is one of the most stimulated fields among these changes, even in the cardiovascular disease care. In the past decade, remote monitoring has become an important tool that provides valuable clinical information via respiratory assist devices and implantable pacemakers from patients at home. Objective The objective of our study was to investigate whether these remote monitoring approaches could include a broader spectrum of patients with cardiac disease with the development of noninvasive monitoring devices. Methods Several pilot studies of telemedicine-based monitoring systems using commercially available digital devices were conducted in the infectious disease wards and other clinical settings during the COVID-19 pandemic. We evaluated the effectiveness of a remote heart monitoring system that provides real-time electrocardiogram and other vital signs monitoring in patients with cardiovascular disease. A newly developed remote cardiac rehabilitation system was also evaluated. Results We found that current remote monitoring technology could provide sufficient monitoring of vital signs, suggesting a potential to predict a worsening of heart failure in advance. Remote cardiac rehabilitation could be effectively and safely provided in patients with low to medium risk. Conclusions Telemedicine and remote cardiac rehabilitation possess a great potential in the cardiovascular disease practice post COVID-19 era; however, there are several unsolved issues regarding their implementation in the real-world clinical practice.

Reviews Evaluating Information Technology-Based Cardiac Rehabilitation Programs and Support: A Systematic Review.

Background:Application of technology in virtual or remote cardiac rehabilitation programs can resolve the challenge of accessing healthcare services and reduce access level inequalities. This study aimed to evaluate the effect of technology on different clinical outcomes in cardiac rehabilitation programs used for cardiovascular (CVD) patients.Methods:Preferred Reporting Items for Systematic Reviews and Meta-Analyses and a comprehensive evidence map of overview was used. Two researchers searched electronic databases such as Science Direct, Medline / PubMed, Web of Science, Scopus, ProQuest, Google Scholar and Cochrane library at the time of publication until Mar 21, 2021.Results:Of 51 reviews published, most of them have reported that the virtual or remote cardiac rehabilitation had a positive effect on most outcomes compared to usual care, and the difference in the type of comparison group and the high heterogeneity in reviews with inconsistent results are due to different technologies used in the interventions, follow-up duration, the type of heart disease, tools, and reporting methods, the quality of the reviews, and the quality of the primary studies included in the reviews.Conclusion:Two important factors before choosing the remote cardiac rehabilitation technology include the complexity of technology and the level of satisfaction and acceptability of the interventions among participants. The simplicity of the interventions increases the acceptability level, and the more complex design and advanced monitoring level during the interventions and the need for specific equipment affect cost saving, so it is important to consider the above cases while choosing the type of technology.

Rehabilitation of the unmotivated: remote cardiac rehabilitation among patients of all risk levels who reported unwillingness to participate in hospital-based rehabilitation

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Cardiac Prevention and Rehabilitation Institute, Leviev Heart Center, Sheba medical center Introduction Remote cardiac rehabilitation (RCR) is recognized as a viable alternative to conventional, center-based rehabilitation. However, to achieve meaningful functional improvement, a high level of adherence and motivation to collaborate with the healthcare team, is necessary. The feasibility of RCR among patients who actively avoid hospital rehabilitation has not been adequately investigated by randomized studies. Method This year-long prospective study enrolled 60 cardiac patients at various risk levels, including those with heart transplants and heart failure, who refused to participate in conventional rehabilitation. Accordingly, 40 participants were randomized to a 6-month RCR program, while the remaining 20 received usual care in the community. Both groups were monitored for activity and self-reported outcomes. RCR is based on behavioral theories, includes multidisciplinary support, motivational and educational content, regular exercise, controlled by a smart sports watch, and transmitted to both the medical operations center and the patients mobile phone application. The main outcome was the change in Peak VO2, measured by the Cardiopulmonary Exercise Testing, after 4 months of intervention compared to baseline. Results The study included 60 patients, 82% men, aged 55 (±12), who were admitted to the 6-month RCR program mainly after myocardial infarction or coronary interventions (44%), heart failure (29%), cardiomyopathy (13.5%) and heart transplantation (10.5%). After RCR, there was a significant increase in Peak VO2 in the intervention group (+2.46±7.1 mL/(kg·min) compared to the control group (-0.72±7.9 mL/(kg·min) (p&amp;lt;0.001). High-density lipoprotein (HDL) levels also improved significantly. The average minutes per week of aerobic exercise was 221 (±124.74), which was 147% of the goal. The average minutes at the recommended target heart rate was 117.38 (±78.36), and the percentage of intensity of training was 69.39% (±15.11) of the maximum capacity. The average aerobic sessions per week was 5 (±3), while the resistance sessions was 0.8 (±0.74). The average daily step count in the intervention group was 9145 (±3860) versus 4445 (±3005; p&amp;lt;0.001). The surveys showed a significant improvement in patients’ mental and physical perception of health in the intervention vs. control group. Conclusion The adherence and results achieved by patients in RCR who avoided conventional rehabilitation were well within guideline recommendations, resulting in a significant improvement in physical capacity. Risk level, age, and lack of motivation at the beginning of the program were not barriers to achieving goals and cooperation.

The first national program of remote cardiac rehabilitation - goal achievements, adherence, and responsiveness in elderly patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sheba medical center Background Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative program in the field of telemedicine. RCR is included in the health basket. Many believe that telemedicine programs better fit younger patients, whose technological literacy is higher than older patients. Older patients are also thought to have difficulty consuming technology-based programs and meeting program goals. The objectives of this study were as follows: 1) To study patterns of physical activity, goal achievement, and improvement in functional level among RCR participants over 65 compared with younger patients. 2) To study the variables that can predict better patient adherence and compliance with the rehabilitation program. Methods A retrospective study of post-myocardial infarction patients enrolled in six-month RCR program. The activity of the patients was monitored using a smart watch. The data were collected and analyzed by a special telemedicine system. RCR program goals were: (i)150 minutes of aerobic activity per week; (ii) 120 minutes of the activity within the target heart rate; (iii) 8000 steps per day. Predictive models were created to evaluate variables predicting adherence and compliance with the program. Results 306 participants, 80 of them were elderly (average age 70 ± 3.38). At the end of the program, there was a significant improvement (p &amp;lt;0.001) in the functional capacity of all participants. The elderly improved from 8.11 ± 2.8 to 11.25 ± 12.6 METs, while the final METs results in the elderly group were similar to other participants. During all program months, the elderly showed better achievement of program goals compared to younger ones (p &amp;lt;0.01). We found that age of patients is a clear predictor (p &amp;lt;0.01) of early dropout from the program and goals achievements – the higher the age, the fewer dropouts and better achievement. Conclusions Elderly can successfully participate in telemedicine rehabilitation programs, and such programs are beneficial for them. Age is not a limitation, but a predictor for better achievement of goals and compliance with the RCR program.

Israel's first national remote cardiac rehabilitation program - patient response and potential factors affecting successful completion

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sheba Medical Center Introduction Cardiac rehabilitation is an essential program for the reduction of future cardiac events and improve quality of life. However, many vulnerable individuals do not achieve this desired outcome due to the restrictive nature of institution-based rehabilitation. With this in mind was developed the Remote Cardiac Rehabilitation Program (RCRP). Our aim was to create the optimal conditions so that our patients are guided and stimulated in order to successfully complete the program. Material and method This study involved 306 patients with established CHD who underwent a six-month RCRP, three months of which were subsidized by health insurance. RCRP involves regular exercise, monitored by a smart sports watch and transferred to both the medical operations center as well as the mobile application on the patient’s smartphone. We built models to get predictors for the best patient performance in the last (third) month. Predictions were made based on their performance in the first month and some demographical data. Age and gender were taken as base features to all the models. Results and discussion The study involved patients, 81.5% men, aged 57.59 (±10.62), who were admitted to the RCRP mainly after myocardial infarction or coronary interventions (49%). The median minutes per week that patients performed aerobic exercise was 164, a median of 92 minutes at target HR (established by exercise physiologist), and the median percent of heart rate reserve was 76 % across exercise training. The median number aerobic sessions per week was 4, while the median daily steps was 8,370. Values had no significant differences across the 24 weeks. Following the 24-weeks of intervention, there was a significant improvement in exercise capacity, assessed by estimated METS using pre and post exercise stress tests from 9.95±2.57 to 11.71±3.43 (p&amp;lt;0.001). The most significant predictors of program adherence were older age and the number of weekly aerobic minutes and sessions in the first weeks of training (p&amp;lt;0.005). There is a direct relationship between the patient's age and the program compliance - the older the patient, the higher the compliance. Conclusion Adherence and the performance achieved by patients in the RCRP is well within guideline recommendations, leading to a significant improvement in exercise capacity. Older age, as well as early program adherence were significant factors which led to better program completion.

Current Status and Issues of Remote Cardiac Rehabilitation Therapy

Current Status and Issues of Remote Cardiac Rehabilitation Therapy

Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study.

ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome Measure(s)Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.

Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation.

The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR). Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change. Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical ( r = 0.62) and moderate for mental ( r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70). The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.