Noninferiority of Randomly Assigned Telehealth and Center-Based Regional Exercise-Based Cardiac Rehabilitation Programs When Delivered With High Fidelity.

IF 2.9 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiopulmonary Rehabilitation and Prevention Pub Date : 2026-06-09 DOI:10.1097/HCR.0000000000001035

Blake E G Collins, Brett A Gordon, Daniel W T Wundersitz, Jayden R Hunter, Lisa C Hanson, Michael Kingsley

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引用次数: 0

Abstract

Purpose: Telehealth-delivered exercise-based cardiac rehabilitation programs (ExCRP) enhance enrollment but lack objectively measured exercise volume to facilitate valid assessment of program effectiveness. The aim of this project was to explore whether changes in cardiorespiratory fitness following telehealth ExCRP are noninferior to center-based ExCRP when delivered with comparable fidelity.

Methods: Adults with coronary heart disease randomly allocated to telehealth or center-based ExCRP were prescribed 30 minutes of continuous aerobic exercise on 3 days per week for 6 weeks, supported by weekly motivational interviewing and cognitive behavioral therapy sessions. Outcomes assessed at baseline and completion of ExCRP included peak oxygen uptake (), exercise volume, cardiovascular function, sleep quality, and quality of life. A between-group difference in of less than 3.5 mL·kg-1·min-1 was hypothesized to demonstrate noninferiority.

Results: Telehealth was noninferior to center-based ExCRP (95% confidence interval, -1.6 to 1.3 mL·kg-1·min-1). There was a significant time effect on in the ExCRP group (F1,47 = 13.800, P > .001, η2 = 0.227). Exercise sessions (t47 = 0.337, P = .738) and intensity (t47 = -0.645, P = .207) were equivalent, while the telehealth group exceeded prescribed exercise duration (40 ± 9 vs 30 ± 0 minute; t47 = -5.077, P < .001). Time effect was observed for quality of life (F1,47 ≥ 4.249, P ≤ .045) and vascular augmentation index (F1,45 = 6.781, P = .012). No significant differences existed in heart rate variability or actigraphy sleep assessment (F1,47 ≤ 1.436, P > .237).

Conclusion: When completed with equivalent exercise intensity and sessional adherence, telehealth ExCRP is noninferior to center-based ExCRP for effect on cardiorespiratory fitness. Wearable activity monitoring combined with motivational interviewing and cognitive behavioral therapy can support the delivery of high-fidelity ExCRP in regional populations.

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随机分配的远程医疗和以中心为基础的区域运动为基础的心脏康复计划在高保真度下的非劣效性。

目的：远程医疗提供的基于运动的心脏康复计划（ExCRP）增加了登记人数，但缺乏客观测量的运动量，以促进有效评估计划的有效性。该项目的目的是探讨远程医疗ExCRP后心肺功能的变化是否不逊于以中心为基础的ExCRP，并且提供了相当的保真度。方法：随机分配到远程医疗组或基于中心的ExCRP组的成年冠心病患者，每周3天进行30分钟的连续有氧运动，持续6周，每周进行动机访谈和认知行为治疗。在基线和完成ExCRP时评估的结果包括峰值摄氧量（）、运动量、心血管功能、睡眠质量和生活质量。假设组间差异小于3.5 mL·kg-1·min-1为非劣效性。结果：远程医疗不逊于基于中心的ExCRP（95%置信区间为-1.6 ~ 1.3 mL·kg-1·min-1）。ExCRP组的时间效应显著（F1,47 = 13.800, P < 0.001, η2 = 0.227）。运动时间（t47 = 0.337, P = .738）和强度（t47 = -0.645, P = .207）相等，而远程医疗组超过规定的运动时间（40±9 vs 30±0分钟；t47 = -5.077, P < .001）。生存质量（F1,47≥4.249,P≤0.045）和血管增强指数（F1,45 = 6.781, P = 0.012）存在时间效应。心率变异性和活动描记睡眠评估无显著差异（F1,47≤1.436,P > .237）。结论：当完成相同的运动强度和疗程坚持时，远程医疗ExCRP对心肺健康的影响不逊于基于中心的ExCRP。可穿戴式活动监测与动机访谈和认知行为疗法相结合，可以支持在区域人群中提供高保真的ExCRP。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiopulmonary Rehabilitation and Prevention 医学-心血管系统

CiteScore

5.40

自引率

34.20%

发文量

164

审稿时长

6-12 weeks

期刊介绍： JCRP was the first, and remains the only, professional journal dedicated to improving multidisciplinary clinical practice and expanding research evidence specific to both cardiovascular and pulmonary rehabilitation. This includes exercise testing and prescription, behavioral medicine, and cardiopulmonary risk factor management. In 2007, JCRP expanded its scope to include primary prevention of cardiovascular and pulmonary diseases. JCRP publishes scientific and clinical peer-reviewed Original Investigations, Reviews, and Brief or Case Reports focused on the causes, prevention, and treatment of individuals with cardiovascular or pulmonary diseases in both a print and online-only format. Editorial features include Editorials, Invited Commentaries, Literature Updates, and Clinically-relevant Topical Updates. JCRP is the official Journal of the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.