Telemedicine-assisted exercise program (TAEP) for coronary heart disease

Abstract

Introduction & Purpose

Cardiovascular diseases (CVD) are a common cause of declining physical performance and quality of life. Despite the recommendation of physical activity as class 1A in the American Heart Association’s guidelines for cardiac rehabilitation (Pelliccia et al., 2021) and the clear need for innovative rehabilitation programs, no tele-medical exercise program has been adopted into standard care (Scherrenberg et al., 2021; Snoswell et al., 2020). Classic CVD exercise therapy typically includes group ergometer and strength training. The primary aim of this project was to integrate exercise as a pillar of therapy in the HerzMobil Tirol project, leading to the implementation of a telemedicine-assisted exercise program.

Methods

Patients enrolled in the CHD project had the opportunity to participate in TAEP. The initial and final therapeutic examinations included a medical history interview, the 1-minute sit-to-stand test (STS; Strassmann et al., 2013) and standardized EQ-5D-5L to assess the quality of life. Based on the guidelines and the classic CVD therapy the TAEP participants completed a twelve-week home-based exercise program. It included endurance training (5 days/week for 30 minutes) and video-guided strength, mobility and coordination training (2-3 times/week), where the focus was on strength training. The program was analysed and adapted individually by an exercise therapist. The intensity was controlled using the Borg scale and the talk test (Bok et al., 2022).

Results

22 patients completed the TAEP, 77% (n = 17) were male and 23% (n = 5) were female and the median age was 61 (53-71) years. During the twelve weeks, the patients completed a median of 257 (213-351) minutes per week of endurance-oriented exercise training (e.g. walking or cycling) and performed video-guided home-based strength training with a median of twice (1-2) per week. 95% of patients fulfilled the recommendations for endurance training and 64% for strength training. The TAEP participants showed a significant (p < 0.001) increase in STS with a median of 37% (18-24). There was a significant improvement in quality of life according to the EQ-5D-5L health scale with a median from 70 (60-85) to 83 (79-95; p < 0.001).

Discussion

The current literature on cardiovascular diseases and exercise as therapy continues to underline the importance of physical activity for the prevention and treatment of these conditions. Studies indicate that regular exercise can reduce the risk of cardiovascular diseases and serves as an effective complement to pharmacological therapy. The results of the present project show that the integration of exercise therapy into a telemedical care program is feasible and effective. However, the lack of a control group and the small sample size made it difficult to compare the results directly and if the observed changes are actually attributable to the TAEP.

Conclusion

In our programme, we have learned that (1) a doctor’s recommendation for exercise therapy and (2) personal contact between the exercise therapist and the patient are key to patients’ adherence to exercise therapy. The TAEP was well received by the patients and feasible irrespective of the patients’ age. In the age of digitalisation, telemedicine-supported training therapy is an option in cardiac rehabilitation, even for people in remote catchment areas.

References

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Scherrenberg, M., Wilhelm, M., Hansen, D., Völler, H., Cornelissen, V., Frederix, I., Kemps, H., & Dendale, P. (2021). The future is now: A call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology, 28(5), 524–540. https://doi.org/10.1177/2047487320939671

Strassmann, A., Steurer-Stey, C., Lana, K. D., Zoller, M., Turk, A. J., Suter, P., & Puhan, M. (2013). Population-based reference values for the 1-min sit-to-stand test. International Journal of Public Health, 58(6), 949–953. https://doi.org/10.1007/s00038-013-0504-z

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