Noninferiority of Randomly Assigned Telehealth and Center-Based Regional Exercise-Based Cardiac Rehabilitation Programs When Delivered With High Fidelity

PURPOSE: Telehealth-delivered exercise-based cardiac rehabilitation programs (ExCRP) enhance enrollment but lack objectively measured exercise volume to facilitate valid assessment of program effectiveness. The aim of this project was to explore whether changes in cardiorespiratory fitness following telehealth ExCRP are noninferior to center-based ExCRP when delivered with comparable fidelity. METHODS: Adults with coronary heart disease randomly allocated to telehealth or center-based ExCRP were prescribed 30 minutes of continuous aerobic exercise on 3 days per week for 6 weeks, supported by weekly motivational interviewing and cognitive behavioral therapy sessions. Outcomes assessed at baseline and completion of ExCRP included peak oxygen uptake (), exercise volume, cardiovascular function, sleep quality, and quality of life. A between-group difference in of less than 3.5 mL·kg-1·min-1 was hypothesized to demonstrate noninferiority. RESULTS: Telehealth was noninferior to center-based ExCRP (95% confidence interval, -1.6 to 1.3 mL·kg-1·min-1). There was a significant time effect on in the ExCRP group (F1,47 = 13.800, P > .001, η2 = 0.227). Exercise sessions (t47 = 0.337, P = .738) and intensity (t47 = -0.645, P = .207) were equivalent, while the telehealth group exceeded prescribed exercise duration (40 ± 9 vs 30 ± 0 minute; t47 = -5.077, P < .001). Time effect was observed for quality of life (F1,47 ≥ 4.249, P ≤ .045) and vascular augmentation index (F1,45 = 6.781, P = .012). No significant differences existed in heart rate variability or actigraphy sleep assessment (F1,47 ≤ 1.436, P > .237). CONCLUSION: When completed with equivalent exercise intensity and sessional adherence, telehealth ExCRP is noninferior to center-based ExCRP for effect on cardiorespiratory fitness. Wearable activity monitoring combined with motivational interviewing and cognitive behavioral therapy can support the delivery of high-fidelity ExCRP in regional populations.