Cardiac telerehabilitation requires relationship-centred, equity-oriented service design integrating digital tools, clinical workflows, and patients' everyday contexts to achieve scalable benefit.
What psychological, social, and implementation factors optimize the uptake, adherence, and effectiveness of cardiac telerehabilitation in adults with cardiovascular disease?
This narrative review highlights that optimizing cardiac telerehabilitation requires addressing psychological, social, and implementation factors through relationship-centered and equity-oriented service design.
BACKGROUND Cardiac telerehabilitation (tele-CR) uses home-based or hybrid delivery to provide multidisciplinary cardiac rehabilitation reducing travel and time barriers. However, tele-CR outcomes may be influenced by engagement, therapeutic relationships, and contextual and implementation constraints. This narrative review synthesizes evidence on psychological, social, and implementation factors that optimize tele-CR uptake, adherence, and effectiveness. METHODS We conducted a targeted literature search in PubMed, Scopus, PsycINFO, and Embase (January 2021-January 2026). We included randomized and observational studies, qualitative and mixed-methods research, and systematic reviews/meta-analyses involving adults with cardiovascular disease participating in home-based, hybrid, or fully remote tele-CR. Reporting followed the Scale for the Assessment of Narrative Review Articles (SANRA). RESULTS Tele-CR is a sociotechnical, biopsychosocial intervention in which outcomes emerge from the integration of digital tools (monitoring, feedback, interfaces), clinical workflows, and patients' everyday contexts. Self-monitoring and structured feedback can strengthen self-efficacy and habit formation when data are interpretable and linked to actionable guidance. Remote delivery can reduce non-verbal cues, but continuity may improve through routine check-ins and responsive follow-up. An equity-by-design approach tailors delivery to connectivity, privacy, health literacy, language needs, and caregiver capacity. Across studies, feasibility and acceptability were associated with usability, support, and perceived value. CONCLUSIONS Tele-CR can broaden access to cardiac rehabilitation, but scalable benefit requires relationship-centred, equity-oriented service design. Priorities include calibrating monitoring to clinical actionability, reducing cognitive load through plain-language interfaces and structured onboarding, integrating routine mental health screening and patient-reported outcomes, supporting caregivers as end-users, and embedding implementation metrics and continuous quality improvement alongside clinical outcomes.
Micheluzzi et al. (Thu,) conducted a review in Cardiovascular disease. Cardiac telerehabilitation (tele-CR) was evaluated. Cardiac telerehabilitation requires relationship-centred, equity-oriented service design integrating digital tools, clinical workflows, and patients' everyday contexts to achieve scalable benefit.