Mobile and Home-Based Cardiac Rehabilitation Versus Center-Based Care in Ischemic Heart Disease

Background: Center-based cardiac rehabilitation (CR) remains underutilized due to geographic, financial, and scheduling barriers, particularly among older adults and underserved populations. Mobile health (mHealth) and home-based telerehabilitation are emerging alternatives, but the magnitude of benefit on functional capacity and how it varies by age remains unclear. Hypothesis: We hypothesized that mHealth or home-based telerehabilitation improves functional capacity in adults with ischemic heart disease (IHD) compared with center-based CR and usual care, and that the effect is moderated by participant age. Methods: Following PRISMA 2020, we searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science for randomized controlled trials published January 2023 to February 2026 evaluating digitally delivered or monitored exercise rehabilitation in adults post-myocardial infarction or post-percutaneous coronary intervention. Primary outcomes were six-minute walk distance (6MWD) and peak oxygen uptake (VO2 peak). Random-effects models with REML estimation pooled Hedges' g and weighted mean differences. Heterogeneity was assessed with I 2 , robustness with leave-one-out analyses, age effects with mixed-effects meta-regression, and certainty with GRADE. Results: 12 trials enrolling 1,631 participants from 8 countries were included. Pooled walking distance increased by 38.82 m (95% CI, 15.83 to 61.81; p<0.001; k=5; I 2 =89.3%; GRADE moderate), exceeding the accepted minimal clinically important difference for 6MWD. VO2 peak improved by 1.56 mL/kg/min (95% CI, 0.51 to 2.61; p=0.004; k=5; I 2 =63.4%; GRADE low). Versus center-based CR, telerehabilitation yielded a moderate standardized benefit (g=0.70; 95% CI, 0.07 to 1.33; p=0.028; I 2 =83.1%), which remained significant after excluding the most influential study (g=0.34; 95% CI, 0.09 to 0.60; p=0.009; I 2 =17.1%). Versus usual care, the pooled effect was g=1.82 (95% CI, 0.00 to 3.64; p=0.049), attenuating to g=0.91 (95% CI, 0.60 to 1.22; p<0.001) when an extreme outlier was removed. Meta-regression showed adults under 65 years gained 57.30 m (95% CI, 30.84 to 83.75; p<0.001), with older adults gaining 37.32 m less (p=0.051); age explained 40.9% of between-study variance for walking but did not moderate VO2. Conclusions: Digital and home-based CR produces clinically meaningful improvements in walking-based functional capacity in adults with IHD, comparable to center-based programs in younger adults but smaller in those aged 65 and older. However, cardiorespiratory fitness improved similarly across age groups, suggesting physiological benefit is preserved in older adults despite smaller walking gains. Heterogeneity across protocols and technologies warrants standardization before broad implementation.