Each year nearly 5 million Americans are affected with heart failure (HF), it is the leading cause of death in the United States, and it is the single most costly healthcare challenge. Evidence-based practice guidelines from the American College of Cardiology/American Heart Association identified exercise as a key factor for managing HF. A fundamental symptom of HF is exercise intolerance, presenting limitations on functional status and quality of life (QOL). Historically, HF rehabilitation program implementation has been challenging. A user-centered telehealth-supported home-based exercise program with frequent feedback may increase adherence and improve exercise tolerance, HF symptoms, and QOL. Therefore, the purpose of this prospective 2-group experimental study was to compare effects of a 12-week telehealth disease management and home exercise rehabilitation program with usual treatment.
It was hypothesized that experimental subjects would exhibit greater improvements in functional performance, psychological well-being, and QOL than those in the control group. The Telehomecare Model for Optimizing Rehabilitation Outcomes guided this study. Twenty-six of 36 subjects with Class II or III HF have completed the study. All subjects completed submaximal 15-W constant exercise testing and were provided with an exercise prescription. A semirecumbent stationary bike, exercise logs, and telemonitoring equipment were provided to experimental subjects. Heart rate (HR), blood pressure (BP), oxygenation (SPo2), and weights were monitored daily for experimental subjects, in order to ensure that they were safe to exercise and assist in disease management. Telecoaching and telesupport also were provided to experimental subjects by means of videoconferencing. Biweekly telephone calls were made to control subjects.
Statistical analysis has provided empirical evidence for the efficacy and effectiveness of this telehealth-based home exercise program for persons with moderate heart failure. Exercise adherence has been high, and improvements in physical quality of life (MLHF) (P = .04), functional performance (6 MWT) (P = .05), and psychological well-being (POMS) (P <= .05) have been demonstrated. Participant satisfaction has been high. Average cost for delivering the 12-week telehealth home exercise program for the experimental group was approximately $850. A telehealth home exercise program may provide a cost-effective means for addressing selected cardiac rehabilitation needs in this population.