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

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 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 VO 2 ). 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 (Δ peak VO 2 , 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 Δ peak VO 2 (remote CR r 2 =0.65, p<0.001; hospital-based CR r 2 =0.38, p<0.05; respectively). For hospital-based CR, baseline mobility (WHODAS2.0-J) was a significant independent contributor to Δ peak VO 2 (r 2 =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).