Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

Abstract

Background The impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline. Methods Patients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed. Results Sixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β = − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01). Conclusions Remote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals. Trial registration This interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564; registration date: 2020/09/09).

Assessing the Effectiveness of Rehabilitation Interventions through the World Health Organization Disability Assessment Schedule 2.0 on Disability—A Systematic Review

“…The rehabilitation interventions in this review showcase a remarkable range of approaches, as seen in Table 3 . Virtual reality (VR) with conventional rehabilitation therapy (CnvT), compared to CnvT plus additional therapies like iodine–bromine baths and oxygen therapy [ 21 ]; remote versus hospital-based cardiac rehabilitation (CR) [ 22 ]; the SIDERA^B program, a comprehensive telerehabilitation system that includes various forms of training such as endurance, resistance, and neuromotor training, tailored for home-based management of chronic conditions [ 23 ]; problem-solving treatment (PST) and health education (HE) via telephone [ 25 ]; use of existing healthcare system services in Taiwan [ 26 ]; robot-assisted arm training (RAT) compared to CnvT [ 27 ]; low-frequency sinusoidal sound vibration and self-care treatment [ 28 ]; diet quality modification [ 29 ]; the CaRE@Home program, with aerobic, resistance, and flexibility training, plus e-learning and health coaching [ 30 ]; functional training, bicycle exercises, and exergaming [ 32 ]; home-based resistance exercises [ 33 ]; dance classes versus kinesiotherapy [ 35 ]; powered mobility devices (PMDs); day care service with a range of medical and rehabilitative services [ 36 ]; an online psychosocial program [ 38 ]. These results reflect a broad spectrum of rehabilitation strategies and their varied impacts on different patient groups and conditions.…”

“…For example, scores generally decrease (improve) after interventions and over follow-up periods, as seen in Table 3 . In some cases, the scores between the intervention group (IG) and control group (CG) are similar [ 21 ], whereas in others, there are significant differences [ 22 , 24 , 26 , 34 ]. The effectiveness of rehabilitation interventions also varies depending on the time elapsed since the intervention [ 25 , 30 , 32 , 36 , 37 , 38 ], and also with the rehabilitation intervention used [ 33 ], as seen in Table 3 .…”

“…Additionally, Table 3 includes various evaluation tools used alongside WHODAS 2.0 in the included studies. These tools provide a thorough assessment of different health outcomes, evaluating patients’ physical, cognitive, and psychosocial functioning, as well as their QoL, in response to diverse rehabilitation interventions, which include the following: Cognitive assessments: MMSE (minimal mental state examination), MoCA (Montreal Cognitive Assessment) [ 21 , 27 ]; Functional independence measures: BI (Barthel Index), EBI (Extended BI), FAC (Functional Ambulatory Category), FIM (functional independence measure), and ADL (activities of daily living) [ 21 , 24 , 27 , 34 , 35 ]; Balance and mobility tests: BBS (Berg Balance Scale), 6MWT (6 min walk test), 10MWT (10 m walk test), FTSST (Five-Time Sit-to-Stand Test), and TUG (Timed Up and Go) [ 21 , 32 , 33 ]; QoL: WHOQOL-BREF (shortened World Health Organization QoL scale), SF-36 (Self-administered Short Form Health Survey), EQ-VAS (EuroQol Visual Analogue Scale), and SIP (Sickness Impact Profile) [ 22 , 31 , 33 , 37 , 38 ]; Disease-specific scales: PDQ-39 (Parkinson’s Disease Questionnaire-39) for PD [ 32 ]; Usability and acceptance scales: SUS (System Usability Scale), TAM3 (Technology Acceptance Model 3), and SUTAQ (Service User Technology Acceptance Model) [ 23 ]; Physical activity and diet measures: Physical Activity Questionnaire, DASH-Q (Dietary Approaches to Stop Hypertension Quality questionnaire), IPAQ-SF (International Physical Activity Questionnaire, short version) [ 29 ]; Other assessments: VAS (Visual Analogue Scale) for pain, Beck’s Depression Inventory-II, Hospital Anxiety and Depression Scale for mental health [ 28 , 31 ]. …”

Evaluating the Effects of an Enhanced Strength Training Program in Remote Cardiological Rehabilitation: A Shift from Aerobic Dominance—A Pilot Randomized Controlled Trial

“…This study aimed to address a critical gap in existing distance rehabilitation programs, which tended to focus on aerobic exercise with a limited focus on strength training [ 2 , 6 , 7 ] In our study, we presented an intervention program specifically aimed at developing muscle endurance in low-risk cardiac patients undergoing remote rehabilitation.…”

“…Remote cardiac rehabilitation (RCR) has gained prominence in recent years as an effective means of enhancing physical work capacity, patient engagement, and overall satisfaction during the rehabilitation process [ 4 , 5 ]. Previous studies have consistently demonstrated its efficacy, often assessing improvements in physical work capacity through stress tests, yet with a predominant focus on aerobic exercises [ 6 ]. The traditional approach to RCR frequently quantified patient progress based on the cumulative minutes of aerobic activity per week, leaving strength training largely overlooked or underperformed [ 7 , 8 ].…”