Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with coronary heart disease requiring cardiac rehabilitation |
| I — Intervention | Personalized structured telemedicine-based exercise cardiac rehabilitation (exCR) |
| C — Comparator | Centre-based exercise cardiac rehabilitation or usual care |
| O — Outcomes | Exercise capacity, physical activity levels, cardiovascular risk factors (blood pressure, BMI), quality of life, and depression scores |
Bottom Line
This well-conducted systematic review and meta-analysis of 19 RCTs involving 2219 CHD patients provides strong evidence that personalized telemedicine-based exercise cardiac rehabilitation is non-inferior to traditional centre-based programs across key outcomes including exercise capacity, cardiovascular risk factors, and quality of life. More importantly, telemedicine-based cardiac rehabilitation demonstrates significant superiority over usual care, with clinically meaningful improvements in exercise capacity, physical activity levels, blood pressure control, and depression scores. The low heterogeneity across studies strengthens confidence in these findings. For Australian clinicians, this evidence strongly supports telemedicine-based cardiac rehabilitation as an effective alternative delivery model, particularly valuable for patients facing geographic, mobility, or other access barriers to traditional programs. The intervention appears ready for broader clinical implementation, though individual patient assessment for digital literacy and technology access remains important.
Key Findings
P Value: P < 0.0001
Effect Size: SMD = 0.23 (small to moderate effect)
Primary Outcome: Exercise capacity improvement with telemedicine-based exCR vs usual care
Nnt Or Sensitivity: Non-inferiority demonstrated compared to centre-based cardiac rehabilitation across all measured outcomes
Confidence Interval: 95% CI: 0.12 to 0.35
Clinical Application
High feasibility given widespread telehealth adoption post-COVID-19, though requires adequate technology infrastructure and patient digital literacy Highly relevant to Australian practice given geographic barriers to cardiac rehabilitation access, supported by Medicare telehealth items, and aligns with National Heart Foundation guidelines promoting alternative delivery models CHD patients suitable for cardiac rehabilitation, particularly those with access barriers to traditional centre-based programs
Abstract
AIMS: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). METHODS AND RESULTS: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. CONCLUSION: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. REGISTRATION: PROSPERO: CRD42024521465.
References
- 1.Liu, Y., Wang, X., Li, J., Huang, X., Yu, J., & Chen, M. (2026). Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvaf195
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