Background and Aims:

Cardiac Rehabilitation Programs (CRP) have been proven to reduce CVD risk, decrease health care cost and decrease mortality by 25%. However, despite the benefits of these programs, it is believed that as little as 10%-25% of eligible patients actually attend. Barriers to this reported low attendance include accessibility and availability of programs. With current waitlists of 2 to 5 months and the inaccessibility of CRP to suburban and rural patients, conducting cardiac rehabilitation through the Internet may decrease barriers related to distance and service delivery and allow patients from around the province to interact with cardiac rehabilitation specialists, essentially bridging the treatment gap. The purpose of this study was to pilot test the delivery of an interactive, 12-week CRP through the internet to assess patient safety and changes in cardiovascular risk factors.

Methods and Materials:

The virtual cardiac rehabilitation program (vCRP) was a randomized controlled trial (n = 15) investigating a 12-week web-based CRP. Patients with diagnosed cardiovascular disease were recruited from the waiting list of a hospital-based CRP. Those in the intervention underwent an online baseline assessment and were prescribed a home exercise program. The vCRP website was designed to include interactive heart rate, blood pressure and exercise upload components, live chats with specialists and weekly education sessions. The primary outcome investigated was change in exercise capacity (total time on an exercise stress test). Secondary outcomes included changes in physical activity participation, lipid profiles, diet composition and level of self-efficacy. Patient interviews were also conducted to evaluate user satisfaction.

Results:

Significant findings within the intervention group only included the lipid values for HDL-C (P < 0.025), TG (P < 0.012), TC/HDL-C ratio (P < 0.012), self- efficacy (P < 0.018) and physical activity participation (P < 0.018).There was an improvement in both groups with exercise stress test performance with the intervention group improving by 2.9 METs from baseline with an increase in total time on the stress test of 58 seconds greater than that of the control group. There were no statistically significant findings between groups. There were no adverse events reported in the intervention group. Other reported outcomes from patient interviews indicate overall satisfaction with the program and a noted positive behaviour change.

Conclusions:

The improvements in exercise capacity and lipids in the intervention group were similar to that reported from current face-to-face CRP. The improvement of exercise capacity in the intervention group, above and beyond the control group, was deemed to be of clinical relevance. In this pilot study, the vCRP provided safe and effective delivery of cardiac rehabilitation at a distance. Future directions include further investigation in a larger study sample and development in the delivery of telehealth services for cardiac rehabilitation and other chronic conditions

Section Description

For more information, contact Marilyn Thomas (204) 488-5854