Effects of real-time remote cardiac rehabilitation on health and disability-related outcomes: a quasi-randomized controlled trial

AbstractBackground: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 to that of hospital-based CR on the physical function improvement as well as physical functions of improvement (Δ) to clarify the relationship to health and disability for baseline.Methods:Patients with cardiovascular disease (CVD) were enrolled (n=38) in this quasi-randomized controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR, based on quasi-randomized 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 analyzed.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 groups (ΔpeakVO2, 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 score between the groups were insignificant. The post-CR change in the WHODAS2.0-J score was 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 data from remote CR showed that the baseline social interaction level (WHODAS2.0-J) was a significant independent contributor to ΔpeakVO2(remote CR r2=0.65, p<0.001; hospital-based CR r2=0.38, p<0.05; respectively). For hospital-based CR, baseline mobility (WHODAS2.0-J) was a significant independent contributor to ΔpeakVO2(r2=0.38, p<0.05).Conclusions:Remote CR significantly improved physical function and objective performance in patients with CVD. Remote CR could be an effective treatment for stable patients who are unable to visit hospitals.Trial Registration: This interventional trial was registered in the UMIN-CTR registry (trial title: Development of remote program 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).