Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis

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).

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].

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.

PROSPERO: CRD42024521465