Effects of cardiac telerehabilitation versus center-based cardiac rehabilitation on cardiorespiratory fitness in patients with coronary artery disease: a meta-analysis

Background Cardiac telerehabilitation (CTR) has emerged as an alternative to center-based cardiac rehabilitation (CBCR) for patients with coronary artery disease (CAD), but its effectiveness in improving cardiorespiratory fitness remains uncertain. This meta-analysis aimed to compare the effects of CTR versus CBCR on maximal oxygen uptake (VO2max) in patients with CAD. Methods A systematic search of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and CNKI was conducted for relevant randomized controlled trials (RCTs). Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results Ten RCTs involving 896 patients were included. Overall, CTR was not associated with a significant difference in VO2max compared with CBCR (MD: 0.02 mL/kg/min, 95% CI: −0.71 to 0.74; p = 0.97; I² = 46%). Sensitivity analyses confirmed the robustness of the findings. Subgroup analyses showed consistent results across most factors. However, greater improvements were observed in studies with higher baseline VO2max (p for subgroup difference = 0.03) and longer follow-up (> 26 weeks) (MD: 0.90 mL/kg/min, 95% CI: 0.05 to 1.75; p for subgroup difference = 0.01). Meta-regression indicated that baseline VO2max and follow-up duration were positively associated with treatment effects. The certainty of evidence was rated as moderate due to imprecision, reflected by a pooled estimate close to null and CI crossing the line of no effect. Conclusions CTR provides comparable improvements in VO2max to CBCR in patients with CAD. Potential benefits may be greater in patients with higher baseline fitness and with longer follow-up, although further high-quality trials are warranted.