Community-based tele-rehabilitation through elderly congregation facilities improves exercise tolerance and physical performance in older adults: a cluster-assigned controlled study

Abstract Background Population ageing in Japan has led to a growing burden of cardiovascular disease and frailty. Improving exercise tolerance and maintaining lower-limb motor function, such as walking ability, are key targets in preventive care. The Japanese guidelines for cardiac rehabilitation recommend tele-cardiac rehabilitation (tele-CR) as an effective approach to enhance exercise tolerance; however, in older adults, limited digital literacy and difficulty operating tele-CR devices remain major barriers to implementation. Delivering tele-CR within community settings where older adults regularly gather may help overcome these challenges. Purpose To evaluate whether tele-CR delivered in community congregation facilities improves exercise tolerance and lower limb physical performance in older adults, compared with usual care. Methods Community-dwelling older adults attending congregation facilities were enrolled. Facilities were cluster-assigned to an intervention or non-intervention group. All participants underwent a baseline symptom-limited exercise stress test. Individualised interval exercise programmes, based on fall risk and cardiovascular risk stratification, were prescribed for each participant. In the intervention group, tele-CR sessions were delivered one-to-one by physiotherapists via video communication once weekly for 30 minutes over 20 weeks; blood pressure and body weight were monitored remotely before and after each session. Participants in the non-intervention group continued their usual activities at the facility. Peak oxygen uptake (peakVO2, ml/kg/min) and Short Physical Performance Battery (SPPB) scores were assessed at baseline and after 20 weeks. Changes over time between groups were analysed using two-way repeated measures analysis of variance. Results Eight congregation facilities participated, with tele-CR implemented in four. Of 57 enrolled participants, 54 (mean age 80.9 ± 7.4 years) completed follow-up. In the intervention group, peakVO2 increased from 13.1 ± 3.4 to 14.4 ± 3.6 ml/kg/min (main effect p=0.003, interaction p=0.017), whereas no significant change was observed in the non-intervention group. SPPB scores in the intervention group improved from 10.2 ± 1.7 to 11.3 ± 1.2 points (interaction p=0.024), again with no significant change in the non-intervention group. Conclusion Tele-CR delivered within community congregation facilities was feasible in very old adults and produced clinically meaningful improvements in exercise tolerance and lower limb function, even in participants with relatively high baseline performance. Implementing tele-CR in shared facilities, where staff or peers can assist with equipment operation, may help to overcome digital literacy barriers and support wider dissemination of preventive cardiology programmes for older populations.