title: Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.
abstract: Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD).
  
  
  
  CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence.
  
  
  
  11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors.
  
  
  
  Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions.
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Jonathan C
authors.identifier: 0000-0002-9755-7993
authors.initials: JC
authors.lastname: Rawstorn
authors.affiliation: Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Nicholas
authors.identifier: 0000-0001-9740-0163
authors.initials: N
authors.lastname: Gant
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Artur
authors.identifier: 0000-0002-2236-8506
authors.initials: A
authors.lastname: Direito
authors.affiliation: Department for Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Beckmann
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Ralph
authors.initials: R
authors.lastname: Maddison
mesh_terms: D000072038:Cardiac Rehabilitation / Q000379:methods*; D016009:Chi-Square Distribution; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D010349:Patient Compliance; D020127:Recovery of Function; D012307:Risk Factors; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome