Feasibility of a home-based telerehabilitation exercise program for heart failure patients – a prospective randomized controlled trial

Abstract

Background Chronic heart failure (CHF) is a prevalent disease, and CHF patients are recommended to participate in cardiac rehabilitation programs. Due to frailty and rural living, many CHF patients refuse to do so. To meet these challenges, there is need of a more convenient and efficient rehabilitation system. A home-based telerehabilitation program was designed to enable CHF patients to exercise via video-conferencing in their homes, allowing two-way communication with their therapist, and for patients to exercise together. Purpose We aimed to evaluate the feasibility of a home-based telerehabilitation exercise program designed for CHF patients. Methods 67 subjects were included in a two-arm prospective randomized controlled trial if they had stable CHF, were on optimal medical therapy, and refused to participate in standard outpatient rehabilitation. All subjects participated in a 2-day “Living with heart failure” course. The intervention group (n=30) was educated in the use of a tablet computer, a video-conferencing app, and an app with exercise videos, before they received home-based telerehabilitation exercise twice a week for 3 months. Each exercise session consisted of 20 min warm-up, followed by 4x4 min high intensity intervals with 3 min active breaks, and 15 min calm down. Outcomes, measured at baseline and 3 months, included the 6-minute walk test, the Minnesota living with heart failure Questionnaire (MLHFQ), adherence, adverse events, satisfaction, and patient reported measures of safety, technical aspects, and motivational factors. Results Mean age was 68 (65.6–71.1) years (82% male). By the 6-minute walk test, the exercise group increased their walking distance with 18 m from baseline 451 m, p=0.07. No change (+0.8 m) was seen in the control group from baseline (478 m) to 3 months, but no significant difference between groups (p=0.20). We found a significant decrease in MLHFQ score for the exercise group (baseline 42.6, change −13.8, p=0.003), and for the control group (baseline 41.2, change −12.6, p=0.002), with no difference between groups (p=0.83). ≥80% fulfilled 80% of 24 exercises. One drop-out was registered, and no adverse events were reported during exercise. In total 96% (26/27) reported that they felt safe during home-based exercise via videoconferencing and 96% (24/25) reported that the intervention gave motivation to continue exercising on their own. Some minor technical issues with the videoconference software was present in 58% (15/26). Conclusion Home-based exercise training supported by real-time supervision by telemedicine was feasible, with high adherence and high level of patients' satisfaction. Telerehabilitation increased 6-minute walking distance and quality of life in CHF patients, but the changes were not statistically significant compared to controls. Despite some technical issues with the software and equipment used, the participants reported high motivation to further exercise. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Central Norway Regional Health Authority

Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review

“…50 Telerehabilitation guidance frequency ranged from as often as two times daily to the minimum of once weekly. Nine studies had a guidance frequency of three times weekly, 18,19,51,54,55,60,67,69,71 six studies had a guidance frequency of two times weekly, 17,57,59,63,64,70 seven studies had a guidance frequency of once weekly 50,52,53,58,61,62,68 and two studies had a guidance frequency of two times daily. 20,56 Study intervention durations varied from 3 weeks to 6 months, with the majority being 12 weeks.…”

“…20,56 Study intervention durations varied from 3 weeks to 6 months, with the majority being 12 weeks. 20,50,[52][53][54][55]59,64,70 The duration of individual rehabilitation sessions varied from 20 to 60 minutes, with the majority being 60 minutes. 17,20,51,59,60,63,69,70 Rehabilitation contents varied across studies: a combination of endurance and resistance training, 19,[58][59][60][61][62]65,68,70 a combination of exercises for improving function, 17,56,57,63,64 a combination of resistance, endurance and balance training, 53 a combination of resistance, balance training and stretching, 67 a combination of resistance and balance training, 55,71 a combination of resistance training and stretching, 52 only resistance training, 54 only endurance training, 69 only balance training, 18 a combination of chair-based exercises with cognitive tasks, 66 a combination of physical exercise with electromyography-triggered neuromuscular stimulation technique, 20 Tai-Chi specific exercises 51 and one study was unclear about the specifics of...…”

“…50 Lastly, one study specifically mentioned using cognitive behavioural techniques in the rehabilitation intervention. 52 Ten studies [17][18][19][20]53,59,61,62,66,70 accounted for safety measures during telerehabilitation interventions, which generally required a family member or caregiver to be present to assist if necessary. Lundgren et al 70 described performing preintervention exercise testing and monitoring all exercises performed real-time in front of the tablet computer, while having addresses and telephone numbers readily available.…”

“…52 Ten studies [17][18][19][20]53,59,61,62,66,70 accounted for safety measures during telerehabilitation interventions, which generally required a family member or caregiver to be present to assist if necessary. Lundgren et al 70 described performing preintervention exercise testing and monitoring all exercises performed real-time in front of the tablet computer, while having addresses and telephone numbers readily available. Bernocchi et al 61 also had a nurse tutor available 24h a day in the case of urgent need or an emergency.…”

“…Ten studies 18,20,50,[58][59][60][61]68,70,71 provided preintervention training or familiarity sessions with the intervention technology. Hong et al 54,55 described providing a PC-operation manual and TeamViewer remote assistance but no in-person information session, while Tousignant et al 17 Fifteen studies used usual care for their studies' respective medical condition as the control group type.…”