Cardiac telerehabilitation enhances exercise capacity in CHF patients: evaluating recovery kinetics

Abstract Introduction Reduced exercise intolerance is a key hallmark of chronic heart failure (CHF) and is linked to impaired physical functional capacity, lower quality of life (QoL), and adverse clinical outcomes. Comprehensive cardiac telerehabilitation (CTR) programmes have shown to improve exercise capacity, enhance QoL, and contribute to more favourable long-term cardiovascular outcomes. Heart rate (HR) and oxygen-kinetic measures derived from cardiopulmonary exercise testing provide objective means of assessing the degree of exercise capacity and the therapeutic effect of a CTR programme. Purpose The purpose of this sub-analysis of the Tele-ADHF trial was to assess the impact of a CTR programme on exercise capacity evaluated by exercise-related parameters on HR and oxygen-kinetics obtained from a Constant-Load Exercise Test (CLET). Method In this prospective, randomized controlled trial, patients recently hospitalized for acute decompensated heart failure (HF) were randomized to either CTR group or control group receiving no CTR, once stable HF was reached (defined as optimal medical therapy and stable HF symptoms). The intervention consisted of an 18-week comprehensive CTR programme comprising exercise, nutritional, psychosocial, and occupational therapy in the home-setting. The intervention’s effect on objective exercise-derived HR-, and oxygen-kinetics was assessed via a CLET at 50% of each participant’s peak workload, both at randomisation and after 18-weeks. From the VO2 and HR recovery responses, time constants for oxygen uptake (τO2-rec) and heart rate (τHR-rec) were calculated using mono-exponential fitting, based on previous reported methodologies1,2 (Figure 1). Additional exercise variables included peak oxygen consumption (VO2), maximum ventilation (V̇E), the ventilatory equivalent for carbon dioxide (V̇E/V̇CO2 slope), and systolic and diastolic blood pressure during the constant-load phase. Results Of the original 62 randomised patients, CLET-derived exercise parameters were available for 28 patients (intervention: n = 20, control: n = 8). Within the intervention group both τO2-rec and τHRrec improved from 68.20 to 58.5 seconds (p = 0.04) and from 88.7 to 75.3 seconds (p = 0.03), respectively. Minute ventilation at peak exercise (V̇E) increased significantly from 44.1 to 48.9 L·min−¹ ( p = 0.05). No significant within-group changes were found in peak VO2, V̇E/V̇CO2 slope, or systolic and diastolic blood pressure. In the control group, none of the exercise-related parameters changed significantly over time (Table 1). Conclusion Cardiac telerehabilitation enhances exercise capacity, reflecting by significant improvements in VO2 and HR during the recovery phase of the exercise test, whereas the control group showed no significant changes.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.