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Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
Open accessAbstract
Objective: Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD). Methods: Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O 2 max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O 2 max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes. Results: 162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O 2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20). Conclusion: REMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.
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“Home-based cardiac telerehabilitation using wearable sensors is equivalent or better than centre-based rehabilitation and can increase access to cardiac rehabilitation and reduce the cost”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [85]
In the citing paper
“A non-inferiority, randomized trial comparing REMOTE-CR — a real-time, remote telerehabilitation platform that includes the use of a chest-worn wearable sensor (BioHarness 3, Zephyr Technology, USA) — with a centre-based programme showed that REMOTE-CR was associated with less sedentary time at 24 weeks and was more cost-effective than the centre-based programme85.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [85]
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“The authors demonstrated that the intervention was an effective and cost-effective delivery model that could potentially improve overall CR utilisation rates by increasing reach and satisfying unique participant preferences.30”
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Evidence of Efficacy in Cardiac Telerehabilitation
Amiya, E. (2023) · リハビリテーション医学 : 日本リハビリテーション医学会誌 · doi:10.2490/jjrmc.60.320
Sinkkonen, E., Korpi, H., & Sjögren, T. (2023) · European Journal of Physiotherapy · doi:10.1080/21679169.2023.2233563
“Other previous studies [27,28,30,31] have also reported equal increments following fully remote technology-executed cardiac rehabilitation and standard rehabilitation.”
Telerreabilitação cardiovascular
Nacarato, D. (2022) · doi:10.47749/t/unicamp.2022.1262332
Crozier, A., Cocks, M. S., Hesketh, K. L., Miller, G., McGregor, G., Thomas, L., & Jones, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-076734
“Whilst these studies were conducted to compare supervised in93 person CR and remote CR, they demonstrated that mHealth technology is 94 acceptable in this patient group [17, 18].”
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Bashar, N., Aamdani, S. S., Khalid, S., Sattar, S., Samad, Z. Z., & Kamal, A. K. (2024) · doi:10.2196/preprints.58150
Maddison, R., Subedi, N., Li, P., Lamb, K. E., Ball, K., Oldenburg, B. F., Chow, C. K., McNaughton, S. A., Geroge, E., Gao, L., et al. (2024) · doi:10.2196/preprints.66069
Self-citationTelerehabilitation Methods in Cardiopulmonary Rehabilitation
Nalbant, S., Korkmaz, E., & Tuğay, B. U. (2024) · TELe-Health · doi:10.1007/978-3-031-69080-8_6
App-Timizing Cardiac Rehabilitation: Enhancing Patient Engagement with Mobile Health Applications
Tayon, K. G., Carlisle, A. E., Taylor, B. J., Cornwell, W. K., Shapiro, B. P., Thomas, R. J., & Dineen, E. H. (2024) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-024-00751-8
Remote Cardiac Rehabilitation for Cardiovascular Disease
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“It is suitable for patients with cardio-vascular diseases [31].”
Kim, G. K., & Shim, M. (2024) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2023-0091
Effects of Exercise on Elderly Heart Health: A Comprehensive Analysis
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Jones, T., Edbrooke, L., Rawstorn, J. C., Denehy, L., Hayes, S. C., Maddison, R., Sverdlov, A. L., Koczwara, B., Kiss, N. K., & Short, C. E. (2024) · JMIR Cancer · doi:10.2196/51536
“A recent randomized controlled trial involving participants with coronary heart disease demonstrated the non-deidenti-fied inferiority of a remotely-delivered cardiac rehabilitation intervention compared with standard face-to-face rehabilitation [17].”
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“Kraal (22) and Maddison (19) studied and compared the ef fi cacy and cost-effectiveness of telecardiac rehabilitation vs. traditional CR.”
Integration of IoT and Machine Learning in Biomedical Signal Processing
Bansal, H., Nautiyal, Y., & Gujar, A. (2025) · IGI Global eBooks · doi:10.4018/979-8-3693-6864-0.ch005
Telerehabilitation to Support Post-Discharge Recovery in Patients with Heart Disease
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“Randomized controlled trials have shown that tele-CR is non-inferior to traditional CR in terms of improving exercise capacity, reducing cardiovascular risk factors, and enhancing health-related quality of life 10, 11 ) .”
Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism
Dharmavaram, N. L., Esmaeeli, A., Jacobson, K. M., Brailovsky, Y., & Raza, F. (2025) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2024.12.004
Sivertsson, B. C. P., Gartner, A. V., Takahashi, T., & Secher, P. H. (2025) · Telemedicine Reports · doi:10.1177/26924366251362187
“52,75 Unlike more complex systems that require multiple connected devices, the b-near offers a simpler alternative, particularly for elderly CABG patients.”
Мишина, И. Е., Blinova, K. A., Parfenov, A. S., Березина, Е. В., Khoroshilova, О. V., & Zhaburina, M. V. (2025) · Perm Medical Journal · doi:10.17816/pmj4245-19
The role of wearable technology in improving the care of pediatric heart failure
Edelson, J. B., Gao, S., Gandla, D., & Keating, B. J. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13279-7.00035-3
The Economics of Cardiac Rehabilitation in North, Central, and South America: A Narrative Review
Decker, S. R. R., & Kazi, D. S. (2025) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2025.10.013
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“However, for most patients, frequent trips are time-consuming and tedious [33, 34].”
Salarvand, S., Farzanpour, F., & Gharaei, H. A. (2024) · Figshare · doi:10.6084/m9.figshare.26682781
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Wood, G., Scheer, A., Saundankar, J., Tran, D., Cordina, R., & Maiorana, A. (2024) · Figshare · doi:10.6084/m9.figshare.26702824
Salarvand, S., Farzanpour, F., & Gharaei, H. A. (2024) · Figshare · doi:10.6084/m9.figshare.26682778
Wood, G., Scheer, A., Saundankar, J., Tran, D., Cordina, R., & Maiorana, A. (2024) · Figshare · doi:10.6084/m9.figshare.26702827
Metadata
- Authors
- Maddison, R., Rawstorn, J. C., Stewart, R. A. H., Benatar, J., Whittaker, R., Rolleston, A., Jiang, Y., Gao, L., Moodie, M., Warren, I., Meads, A., & Gant, N.
- Affiliations
- Deakin University (AU)
- Auckland City Hospital (NZ)
- University of Auckland (NZ)
- The Centre for Health (New Zealand) (NZ)
- Corresponding author
- Rawstorn, Jonathan Charles
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2018-08-27
- Volume
- 105
- Issue
- 2
- Pages
- 122-129
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC6352408
- OpenAlex
- W2889374857
- Cited by
- 320
- References
- 32
- Citations by year
- 2026: 27 · 2025: 47 · 2024: 52 · 2023: 55 · 2022: 59 · 2021: 36 · 2020: 25 · 2019: 14 · 2018: 5
- FWCI
- 15.13
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Heart (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Auckland Medical Research Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- cardiac telerehabilitation, coronary artery disease, exercise-based cardiac rehabilitation, VO2max, sedentary behavior, cardiovascular risk factors, health-related quality of life, drug costs, non-inferiority, behavioral strategies, exercise adherence, motivation, New Zealand
- MeSH terms
- Coronary Disease, Cost-Benefit Analysis, Exercise Therapy, Female, Humans, Male, Middle Aged, New Zealand, Quality of Life, Rehabilitation Centers, Treatment Outcome, Telemedicine, Internet
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