Effects of Cardiac Telerehabilitation During COVID-19 on Cardiorespiratory Capacities in Patients With Coronary Artery Disease

Abstract

Background: The COVID-19 pandemic led to the closure of most cardiac therapy centers. One of the solutions was to adapt the existing cardiac rehabilitation (CR) program in an institute to a remote approach offered by home-based telerehabilitation. The aim of this study was to measure the cardiorespiratory effects of telerehabilitation compared to conventional center-based CR.

Methods: Patients were assigned to two 3-week CR programs: telerehabilitation and conventional center-based CR. The telerehabilitation group wore a connected watch to monitor heart rate (HR) and gave their perception of effort according to a modified Borg scale. The exercise training (four sessions/week) consisted of 1-h aerobic endurance and strength training session at the target HR zone determined by results based on cardiopulmonary exercise test (CPET) and perception of effort, respectively. The exercise protocol was the same for conventional CR participants except the duration of session that lasted 2 h instead of one. The week before and after the training program, peak oxygen uptake (VO₂ peak), oxygen uptake at first ventilatory threshold (VO₂ at VT₁), peak workload, percent of predicted maximum HR, and the absolute differences in HR and systolic blood pressure between maximum and recovery at 1 and 3 min were measured using a CPET. A two-way ANOVA with one repeated measure and one independent factor was performed.

Results: Fifty-four patients (mean age: 61.5 ± 8.6 years, 10 women) equally split in the two groups were included in this experiment. A significant increase was observed in both groups on VO₂ peak (telerehabilitation: 8.1 ± 7.8% vs. conventional: 10.1 ± 9.7%, p < 0.001), VO₂ at VT₁ (telerehabilitation: 8.8 ± 4.4% vs. conventional: 7.3 ± 19.0%, p = 0.02) and peak workload (telerehabilitation: 16.6 ± 18.9% vs. conventional: 17.2 ± 7.0%, p < 0.001) after the 3-week telerehabilitation and conventional CR, respectively. No significant difference was noticed between both groups.

Conclusion: A 3-week exercise program improved patients' cardiorespiratory fitness. Telerehabilitation was as effective and represents a safe alternative CR program during the COVID-19 period. In the future, this approach could facilitate the continuity of care for patients unable to participate in center-based CR.

Keywords: COVID-19; cardiac rehabilitation; cardiorespiratory fitness; coronary artery disease; exercise training; physical activity; telerehabilitation.

FIGURE 1

Decision flow chart. CR, cardiac rehabilitation.

FIGURE 2

Experimental design of telerehabilitation intervention.

FIGURE 3

Physical exercise intervention. VT, ventilatory threshold; HR, heart rate; CR, cardiac rehabilitation; RPE, rating of perceived exertion.

FIGURE 4

Peak oxygen uptake (A) and oxygen uptake at the first ventilatory threshold (B) before and after a 3-week exercise program between telerehabilitation (black bars) and conventional CR (white bars) groups. CR, cardiac rehabilitation; VO₂ peak, peak oxygen uptake; VO₂ at VT₁, oxygen uptake at the first ventilatory threshold. *Significantly difference between baseline (p < 0.05); ***significantly difference between baseline (p < 0.001).