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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]
In the citing paper
“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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“The SCRAM intervention improved upon our earlier REMOTE-CR intervention [23] by adding multifactorial behavior change education and support.”
InfluentialSelf-citationHome-Based Telerehabilitation Through a Modular, Sensor-Integrated Virtual Monitoring System
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“The content of the SMS text messages was based on previous studies that aimed to promote behavior change among patients attending CR [22,23].”
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“Outcome measurement was also considered to be at low risk of bias in nine studies because VO 2max was assessed using standardized CPET protocols [17–21, 23 –26 ].”
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“The primary outcome was the proportion of patients achieving a ≥ 10% increase in peak VO 2 based on previous reports of exercise-based cardiac rehabilitation [ 14, 15].”
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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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