title: Effects of outpatient followed by home-based telemonitored cardiac rehabilitation in patients with coronary artery disease.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) has been shown to reduce the cardiovascular mortality of patients with coronary artery disease (CAD) and help people to return to professional work. Unfortunately, limited accessibility and low participation levels present persistent challenges in almost all countries where CR is available. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR, and it seems that the hybrid form of training may be the optimal approach due to its cost-effectiveness and feasibility for patients referred by a social insurance institution.
  
  
  OBJECTIVE
  To present the clinical characteristics and evaluate the effects of hybrid: outpatient followed by home-based cardiac telerehabilitation in patients with CAD in terms of exercise tolerance, safety, and adherence to the programme.
  
  
  METHODS
  A total of 125 patients (112 men, 13 women) with CAD, aged 58.3 ± 4.5 years, underwent a five-week training programme (TP) consisting of 19-22 exercise training sessions. The first stage of TP was performed in the ambulatory form of CR in hospital; then, patients continued to be telemonitored TP at home (hybrid model of cardiac rehabilitation - HCR). Before and after completing CR, all patients underwent a symptom-limited treadmill exercise stress test. Adherence was reported by the number of dropouts from the TP.
  
  
  RESULTS
  The number of days of absence in the HCR programme was 1.50 ± 4.07 days. There were significant improvements (p < 0.05) in some measured variables after HCR in the exercise test: max. workload: 7.86 ± 2.59 METs vs. 8.88 ± 2.67 METs; heart rate (HR) at rest: 77.59 ± 12.53 bpm vs. 73.01 ± 11.57 bpm; systolic blood pressure at rest: 136.69 ± 17.19 mm Hg vs. 130.92 ± 18.95 mm Hg; double product at rest: 10623.33 ± 2262.97 vs. 9567.50 ± 2116.81; HRR1: 97.46 ± 18.27 bpm vs. 91.07 ± 19.19 bpm; and, NYHA class: 1.18 ± 0.48 vs. 1.12 ± 0.35.
  
  
  CONCLUSIONS
  In patients with documented CAD, HCR is feasible and safe, and adherence is good. Most patients were on social rehabilitation benefit, had a smoking history, and suffered from hypertension, obesity, or were overweight. A hybrid model of CR improved exercise tolerance.
authors.affiliation: Katedra Rehabilitacji, Gdański Uniwersytet Medyczny. dziel@gumed.edu.pl.
authors.forename: Dominika
authors.initials: D
authors.lastname: Szalewska
authors.forename: Piotr
authors.initials: P
authors.lastname: Zieliński
authors.forename: Jarosław
authors.initials: J
authors.lastname: Tomaszewski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Kusiak-Kaczmarek
authors.forename: Lidia
authors.initials: L
authors.lastname: Łepska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
authors.forename: Piotr
authors.initials: P
authors.lastname: Niedoszytko
mesh_terms: D000072038:Cardiac Rehabilitation; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000534:rehabilitation*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D013686:Telemetry
keywords: cardiac rehabilitation; coronary artery disease; exercise training