Review Article

A Review of the Digital Era of Cardiac Rehabilitation: From Centres to Screens

Abstract

Introduction: Cardiac rehabilitation (CR) is a vital measure aimed at improving the quality of life (QoL) and preventing secondary complications and recurrence in individuals with a high cardiac risk profile. As an alternative to traditional CR, e-rehabilitation (e-rehab) using smartphones or web-based platforms is a modern solution for effective CR. This study aimed to identify its implementation and evaluate its effectiveness on functional capacity, adherence, and QoL.
Materials and Methods: A systematic search of randomized controlled trials (RCTs) was conducted in electronic databases, such as Medline, Embase, and Cochrane Central Register of Controlled Trials, between January 2015 and January 2025. The selected studies included e-rehab as an intervention, implemented through a hybrid model, among a heart disease population. A total of 210 studies were identified, of which 13 with higher-quality evidence were selected as appropriate to our scope.
Results: CR using the e-rehab protocol improved functional capacity and QoL. Participants’ follow-up rates and interest were noticeably lower in traditional CR compared to e-rehab.
Conclusion: Overall, e-rehab-based CR was effective, but when implemented alongside telemonitoring devices, it may reduce the risk of physical activity-induced adverse reactions. Such a model enhances patients’ willingness to enroll in exercise-based CR.

Safiri S, Karamzad N, Singh K. Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019. European Journal of Preventive Cardiology. 2022; 29(2):420-31. [DOI:10.1093/eurjpc/zwab213] [PMID]

Graham H, Prue-Owens K, Kirby J, Ramesh M. Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II. Rehabilitation Process and Outcome. 2020; 117957272094183. [DOI:10.1177/1179572720941833] [PMID]

Babu AS, Turk-Adawi K, Supervia M, Jimenez FL, Contractor A, Grace SL. Cardiac rehabilitation in India: Results from the international council of cardiovascular prevention and rehabilitation’s global audit of cardiac rehabilitation. Global Heart. 2020; 15(1). [DOI:10.5334/gh.783] [PMID]

Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease: A meta-analysis. European Heart Journal. 2023; 44(6):452-69. [DOI:10.1093/eurheartj/ehac747] [PMID]

Madan K, Babu AS, Contractor A, Sawhney JP, Prabhakaran D, Gupta R. Cardiac rehabilitation in India. Progress in Cardiovascular Diseases. 2014; 56(5):543-50. [DOI:10.1016/j.pcad.2013.11.001] [PMID]

Johnson T, Isakazde N, Mathews L, Gao Y, MacFarlane Z, Spaulding EM, et al. Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned. Cardiovascular Digital Health Journal. 2022; 3(4):158-60 [DOI:10.1016/j.cvdhj.2022.06.002] [PMID]

Racodon M, Vanhove P, Bolpaire R, Masson P, Porrovecchio A, Secq A. Is hybrid cardiac rehabilitation superior to traditional cardiac rehabilitation? Acta Cardiologica. 2023; 78(7):773-7. [DOI:10.1080/00015385.2023.2215610] [PMID]

Chimura M, Koba S, Sakata Y, Ise T, Miura H, Murai R, et al. Evaluation of the efficacy and safety of an integrated telerehabilitation platform for home-based cardiac REHABilitation in patients with heart failure (E-REHAB): Protocol for a randomised controlled trial. BMJ Open. 2023; 13(8). [DOI:10.1136/bmjopen-2023-073846] [PMID]

Jay Widmer R, Senecal C, Allison TG, Lopez-Jimenez F, Lerman LO, Lerman A. Dose-response effect of a digital health intervention during cardiac rehabilitation: Subanalysis of randomized controlled trial. Journal of Medical Internet Research. 2020; 22(2). [DOI:10.2196/13055] [PMID]

Arrieta-Bartolomé G, Supervia M, Velasquez ABC, Delgado-Montero A, Méndez I, Orduñez MÁO, et al. Evaluating the effectiveness of a comprehensive patient education intervention in a hybrid model of cardiac rehabilitation: A pilot study. PEC Innovation. 2022; 1. [DOI:10.1016/j.pecinn.2022.100054] [PMID]

Oclaman JM, Murray ML, Grandis DJ, Beatty AL. The Association Between Mobile App Use and change in functional capacity among cardiac rehabilitation participants: Cohort study. JMIR Cardio. 2023; 7. [DOI:10.2196/44433] [PMID]

Pakrad F, Ahmadi F, Grace SL, Oshvandi K, Kazemnejad A. Traditional vs Extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2021; 102(11):2091-101.e3. [DOI:10.1016/j.apmr.2021.04.026] [PMID]

Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, et al. Efficacy and adherence rates of a novel community-informed virtual world-based cardiac rehabilitation program: protocol for the destination cardiac rehab randomized controlled trial. Journal of the American Heart Association. 2023; 12(23). [DOI:10.1161/JAHA.123.030883] [PMID]

Picorelli AMA, Pereira LSM, Pereira DS, Felício D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: A systematic review. Journal of Physiotherapy. 2014; 60(3):151-6. [DOI:10.1016/j.jphys.2014.06.012] [PMID]

Widmer RJ, Allison TG, Lennon R, Lopez-Jimenez F, Lerman LO, Lerman A. Digital health intervention during cardiac rehabilitation: A randomized controlled trial. American Heart Journal. 2017; 188:65-72. [DOI:10.1016/j.ahj.2017.02.016] [PMID]

Bernocchi P, Vitacca M, La Rovere MT, Volterrani M, Galli T, Baratti D, et al. Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: A randomised controlled trial. Age and Ageing. 2018; 47(1):82-8. [DOI:10.1093/ageing/afx146] [PMID]

Snoek JA, Prescott EI, Van Der Velde AE, Eijsvogels TMH, Mikkelsen N, Prins LF, et al. Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation among Elderly Patients in Europe: A Randomized Clinical Trial. JAMA Cardiology. 2021; 6(4):463-8. [DOI:10.1001/jamacardio.2020.5218] [PMID]

Vieira Á, Melo C, Machado J, Gabriel J. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: A randomized controlled trial. Disability and Rehabilitation. Assistive Technology. 2018; 13(2):112-23. [DOI:10.1080/17483107.2017.1297858] [PMID]

Lunde P, Bye A, Bergland A, Grimsmo J, Jarstad E, Nilsson BB. Long-term follow-up with a smartphone application improves exercise capacity post cardiac rehabilitation: A randomized controlled trial. European Journal of Preventive Cardiology. 2020; 27(16):1782-92. [DOI:10.1177/2047487320905717] [PMID]

Dalli Peydró E, Sanz Sevilla N, Tuzón Segarra MT, Miró Palau V, Sánchez Torrijos J, Cosín Sales J. A randomized controlled clinical trial of cardiac telerehabilitation with a prolonged mobile care monitoring strategy after an acute coronary syndrome. Clinical Cardiology. 2022; 45(1):31-41. [DOI:10.1002/clc.23757] [PMID]

Su JJ, Yu DS. Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: A randomised controlled trial. International Journal of Nursing Studies. 2021; 122:104040. [DOI:10.1016/j.ijnurstu.2021.104040] [PMID]

Bravo-Escobar R, González-Represas A, Gómez-González AM, Montiel-Trujillo A, Aguilar-Jimenez R, Carrasco-Ruíz R, et al. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial. BMC Cardiovascular Disorders. 2017; 17(1):66. [DOI:10.1186/s12872-017-0499-0] [PMID]

Dibben GO, Hillsdon M, Dalal HM, Tang LH, Doherty PJ, Taylor R. Home-based cardiac rehabilitation and physical activity in people with heart failure: A secondary analysis of the REACH-HF randomised controlled trials. BMJ Open. 2023; 13(2):e063284. [DOI:10.1136/bmjopen-2022-063284] [PMID]

Su JJ, Wong AK, Zhang LP, Bayuo J, Lin R, Abu-Odah H, et al. technology-assisted cardiac rehabilitation for coronary heart disease patients with central obesity: A randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2023; 60(1):95-103. [DOI:10.23736/S1973-9087.23.08111-X] [PMID]

Dorje T, Zhao G, Tso K, Wang J, Chen Y, Tsokey L, et al. Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): A parallel-group, single-blind, randomised controlled trial. The Lancet. Digital Health. 2019; 1(7):e363-74. [DOI:10.1016/S2589-7500(19)30151-7] [PMID]

Claes J, Cornelissen V, McDermott C, Moyna N, Pattyn N, Cornelis N, et al. Feasibility, acceptability, and clinical effectiveness of a technology-enabled cardiac rehabilitation platform (physical activity toward health-I): Randomized controlled trial. Journal of Medical Internet Research. 2020; 22(2):e14221. [DOI:10.2196/preprints.14221]

Lahtio H, Heinonen A, Paajanen T, Sjögren T. The added value of remote technology in cardiac rehabilitation on physical function, anthropometrics, and quality of life: Cluster randomized controlled trial. Journal of Medical Internet Research. 2023; 25:e42455. [DOI:10.2196/42455] [PMID]

Mousavi Baigi SF, Sarbaz M, Sobhani-Rad D, Mousavi A, Dahmardeh F, Kimiafar K. Investigating the effects of telerehabilitation on improving the physical activity of individuals with multiple sclerosis: A systematic review of randomized controlled trial. Journal of Modern Rehabilitation. 2024; 18(1):1-14. [Link]

Szczepańska-Gieracha J, Józwik S, Cieślik B, Mazurek J, Gajda R. Immersive virtual reality therapy as a support for cardiac rehabilitation: A Pilot randomized-controlled trial. Cyberpsychology, Behavior and Social Networking. 2021; 24(8):543-9. [DOI:10.1089/cyber.2020.0297] [PMID]

Tucker WJ, Lijauco CC, Hearon CM Jr, Angadi SS, Nelson MD, Sarma S, et al. Mechanisms of the improvement in peak vo2 with exercise training in heart failure with reduced or preserved ejection fraction. Heart, Lung & Circulation. 2018; 27(1):9-21. [DOI:10.1016/j.hlc.2017.07.002] [PMID]

Seron P, Oliveros MJ, Marzuca-Nassr GN, Morales G, Román C, Muñoz SR, et al. Hybrid cardiac rehabilitation program in a low-resource setting: A randomized clinical trial. JAMA Network Open. 2024; 7(1):e2350301. [DOI:10.1001/jamanetworkopen.2023.50301] [PMID]

Chockalingam P, Rajaram A, Maiya A, Contractor A. A multicentre retrospective study on quality and outcomes of cardiac rehabilitation programs in India. Indian Heart Journal. 2020; 72(1):55-7. [DOI:10.1016/j.ihj.2020.03.002] [PMID]

Dalal HM, Taylor RS, Jolly K, Davis RC, Doherty P, Miles J, et al. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. European Journal of Preventive Cardiology. 2019; 26(3):262-72. [DOI:10.1177/2047487318806358] [PMID]

Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the internet. Circulation. Cardiovascular Quality and Outcomes. 2014; 7(6):952-9. [DOI:10.1161/CIRCOUTCOMES.114.001230] [PMID]

Turk-Adawi K, Supervia M, Lopez-Jimenez F, Pesah E, Ding R, Britto RR, et al. Cardiac Rehabilitation Availability and Density around the Globe. EClinicalMedicine. 2019; 13:31-45. [PMID]

Batalik L, Dosbaba F, Hartman M, Batalikova K, Spinar J. Rationale and design of randomized controlled trial protocol of cardiovascular rehabilitation based on the use of telemedicine technology in the Czech Republic (CR-GPS). Medicine (United States). 2018; 97(37):e12385. [DOI:10.1097/MD.0000000000012385] [PMID]

Tamulevičiūtė-Prascienė E, Beigienė A, Lukauskaitė U, Gerulytė K, Kubilius R, Bjarnason-Wehrens B. Effectiveness of additional resistance and balance training and telephone support program in exercise-based cardiac rehabilitation on quality of life and physical activity: Randomized control trial. Clinical Rehabilitation. 2022; 36(4):511-26. [DOI:10.1177/02692155211065632] [PMID]

Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco LV, Fleisch E, et al. User-centered design of a telehealth-enhanced hybrid cardiac rehabilitation program as hospital quality improvement. Research Square [Preprint]. 2023. [DOI:10.21203/rs.3.rs-2475875/v1]

Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco L V., Fleisch E, et al. Applying user-centered design and implementation science to the early-stage development of a telehealth-enhanced hybrid cardiac rehabilitation program: Quality improvement study. JMIR Formative Research. 2023 ; 7:e47264. [DOI:10.2196/47264] [PMID]

Files
IssueVol 20 No 2 (2026) QRcode
SectionReview Article(s)
DOI https://doi.org/10.18502/jmr.v20i2.21709
Keywords
E-rehabilitation Tele-rehabilitation Hybrid model of cardiac rehabilitation Virtual rehabilitation Remote cardiac rehabilitation Cardiac rehabilitation Cardiovascular disease

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Pichai A, Govindarajan SKT, Sadhanandham S, Karthik R. A Review of the Digital Era of Cardiac Rehabilitation: From Centres to Screens. jmr. 2026;20(2):134-145.