Do patients with cardiovascular diseases undergoing telemonitored, indirect supervised exercise training sessions achieve a personalized training heart rate range and improvement in physical capacity?

Abstract Background Achieving a defined, personalized training heart rate range during a training session is crucial for obtaining beneficial effects after completing a cardiac rehabilitation program. However, little is known about how this aspect is addressed in the case of cardiac telerehabilitation when training supervision is indirect and conducted remotely. Purpose The aim of the study was to evaluate the percentage of training sessions in which the patient achieved the designated personalized training heart rate range during remotely monitored training sessions conducted as part of home-based cardiac telerehabilitation in patients with cardiovascular diseases, and the association of this parameter with improvement in physical capacity. Methods The study enrolled 98 patients with cardiovascular diseases (86% post-myocardial infarction, 70 males, aged 61.7 ± 8.9 years) who underwent a 6-week telerehabilitation program based on Nordic walking training. Telerehabilitation was telemonitored with a device designed to continuously record an electrocardiograms (ECG) and transmit data via a mobile phone network to the monitoring center. Additionally, the device allows for supervised exercise training based on heart rate. The wearable device has training sessions preprogrammed individually for each patient (defining exercise duration, breaks, and training heart rate). The planned training sessions are executed with the device indicating what should be done with sound signals and verbal comments, meaning that the patient should exercise at an appropriate intensity which allows achieving the target training heart rate. The training heart rate was calculated individually for each patient based on an exercise test as the sum of the resting heart rate and 40–80% of the heart rate reserve -HRR (HRR = maximum exercise heart rate – resting heart rate). The influence on physical capacity was assessed by comparing changes in workload MET and workload duration sec in the exercise test. Measurements were made before and after telerehabilitation. Results We analyzed 2352 ECG recordings during exercise sessions. There were 71.2% of training sessions within the training heart rate range, 20.4% above, and 8.4% below the range, respectively. Achieving the training heart rate range resulted in a significant improvement in physical capacity and workload duration in the exercise test (Table 1). An inverse trend was observed between a higher percentage of training sessions below the training heart rate range and the improvement in physical capacity (Table 2). Conclusion The vast majority of patients during telemonitored and supervised exercise training sessions achieved or even exceeded the defined target heart rate range, leading to a significant improvement in physical capacity. A higher percentage of training sessions performed below the target heart rate range was associated with a trend toward a lack of improvement in physical capacity.