A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring.
OBJECTIVE
The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation.


BACKGROUND
Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity, decrease cardiovascular symptoms, improve psychosocial status, and decrease total and cardiovascular mortality rates in patients with coronary heart disease. Because of multiple factors, national overall participation is only at 15% of eligible patients.


METHODS
Effects of a 3-month home-based, transtelephonically monitored rehabilitation program (n = 83 patients) with simultaneous voice and electrocardiographic transmission to a centrally located nurse coordinator were compared with effects of a standard on-site rehabilitation program (n = 50 patients). The study design was a multicenter, controlled trial. Primary outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire.


RESULTS
Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%). Quality of life domains of physical functioning, social functioning, physical role limitations, emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. There were no circulatory arrests or other major exercise-related medical events in either group. A total of 3100 hours of home exercise were transtelephonically monitored.


CONCLUSIONS
Patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs.
Ades
P A
PA
Division of Cardiology, Fletcher-Allen Health Care, University of Vermont College of Medicine, VT, USA. Philip.Ades@vtmednet.org
Pashkow
F J
FJ
Fletcher
G
G
Pina
I L
IL
Zohman
L R
LR
Nestor
J R
JR
D000367:Age Factors; D015992:Body Mass Index; D001835:Body Weight; D003327:Coronary Disease / Q000534:rehabilitation*; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006439:Hemodynamics; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D015397:Program Evaluation; D011788:Quality of Life; D012737:Sex Factors; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome