5.2.3. Efficacy of Cardiac Telerehabilitation

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> Meta-analyses have demonstrated that home-based cardiac telerehabilitation is not inferior to outpatient cardiac rehabilitation in terms of mortality, cardiac events, improvement in exercise capacity, modifiable risk factors, or improvement in the quality of life in patients with coronary artery disease or heart failure [21,22]. The main purpose of the study conducted by Batalik was to compare the feasibility and effectiveness of telerehabilitation and conventional outpatient programs [23]. The study group included 56 patients with coronary artery disease who participated in a 12-week phase II program randomized into telerehabilitation and outpatient groups. After 12 weeks, the patients' average intensity adherence, defined as the total average of training intensity, did not differ statistically between the groups (74.8% of heart rate reserve for the telerehabilitation group compared to 75.3% of heart rate reserve for those in the outpatient program). Moreover, the time spent at the prescribed training intensity was similar. A considerable number of studies have been published on the effectiveness and safety of cardiac telerehabilitation [24–26]. In a study by Hwang et al. involving 53 patients with heart failure receiving a 12-week, remotely monitored home-based exercise training program, there was no significant difference in the group's 6-min walk distance gains compared with those of a group participating in an outpatient program. A recent influential account of the effectiveness of telerehabilitation in heart failure patients was provided by the Telerehabilitation in Heart Failure Patients (TELEREH-HF) study, which demonstrated a significant improvement in the New York Heart Association (NYHA) class and quality of life after a 9-week remotely monitored exercise training program [27].

### *5.3. Long-Term Physical Activity*

Physical inactivity remains one of the leading causes of death around the world, according to the World Health Organization [28]. The level of adherence of the general population to recommended levels of physical activity remains unacceptably low [29,30]. On the other hand, aerobic capacity is a strong prognostic marker in healthy individuals, with each 1 MET increase in aerobic fitness reflecting a 13% decrease in all-cause mortality and a 15% decrease in the incidence of cardiovascular events [31]. Moreover, individuals with a functional capacity of less than 5 MET had a relative risk of fatal events that was four times greater compared with that of individuals with an exercise capacity of 10.7 MET or more over a period of six years [32]. Long-term physical activity after completing cardiac rehabilitation program is fundamental. Current international guidelines on physical activity recommend that individuals with increased cardiovascular risk perform at least 150 min of aerobic exercise at a moderate intensity or 75 min of high-intensity exercises three to five days a week and that individuals use a combination of moderate- and vigorous-intensity exercise to reduce all-cause mortality, cardiovascular mortality, and morbidity [2]. Moderate-intensity activities (3–5.9 MET) entail, e.g., brisk walking (4.8–6.5 km/h), slow cycling (15 km/h), and gardening, whereas examples of vigorous activities (≥6 MET) are jogging, running, and bicycling > 15 km/h. Exercise intensity prescription given in absolute measures (i.e., MET) does not take into account individual factors; older individuals exercising at a vigorous intensity of 6 METs may become exhausted, while a younger person working at the same absolute intensity may only be exercising moderately. In addition to the endurance component, moderate-intensity resistance training involving large muscle groups is recommended twice a week [1]. Those who cannot perform 150 min of moderate-intensity physical activity each week should as be active as their health condition allows, as even a low volume of moderate to vigorous exercise has been demonstrated to be sufficiently effective to reduce mortality by 22% in older adults [33]. Furthermore, to maintain an adequate physical activity level, motivational interventions should be applied. These include behavioral strategies, such as goal setting; the re-evaluation of goals; and self-monitoring utilizing new technologies—e.g., wearable activity trackers [34,35].

### **References**

1. American Association of Cardiovascular and Pulmonary Rehabilitation. *Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs*, 6th ed.; Human Kinetics Publishers: Champaign, IL, USA, 2019.

