Feasibility, Safety, and Efficacy of Pediatric Cardiac Telerehabilitation in Adolescents With Heart Disease

BACKGROUND AND OBJECTIVES Cardiac telerehabilitation is an important pediatric therapy; however, quality data from randomized controlled trials (RCTs) are lacking. Through this prospective RCT we demonstrate feasibility, efficacy, and safety of pediatric cardiac telerehabilitation (PCTR) in a clinically diverse population of pediatric patients with heart disease. METHODS Cardiopulmonary exercise testing, questionnaires, and activity data (Fitbit) were collected before and after 12 weeks of semisupervised virtual PCTR consisting of 2 to 3 exercise sessions per week. Participants received an electrocardiogram monitor, Fitbit, exercise prescription, and exercise equipment. The control group performed regular activities and received a Fitbit. All participants had weekly check-ins. RESULTS Forty-three out of 49 enrolled participants completed the study (25 PCTR, 18 control), median age 15 years (IQR 13–17); 37% were female; 44% had pulmonary hypertension, 35% had congenital heart disease, and 21% had undergone orthotopic heart transplant. Adverse events included: nosebleeds, ventricular ectopy that improved with exercise modification, chest pain when prescribed heart rate range was exceeded, and skin irritation from the Fitbit. Eighty-seven percent of participants completed all 12 supervised sessions. Virtual PCTR improved scores for anxiety (P = .007), quality of life (P = .009), peak exercise time (P < .001), and peak O2 pulse (P = .003). Increases in anaerobic threshold time (P = .01) and heart rate (P = .04) were significantly greater in the PCTR group than in the control group when adjusted for age, sex, and diagnosis. CONCLUSION CTR is feasible, effective, and safe across a clinically diverse group of young patients with heart disease, more so than weekly check-ins and activity trackers alone.