Feasibility, Safety, Adherence, and Functional Outcomes of a Mobile Application-Facilitated, Unsupervised Remote Cardiac Rehabilitation Program with Exercise Intensity Optimization: A Single-Arm Clinical Trial

Background/Objectives: Cardiac rehabilitation (CR) is essential for patients with cardiovascular disease (CVD); however, participation rates remain low because of logistical barriers. We developed a mobile application-facilitated, unsupervised remote CR program with exercise intensity optimization and multidisciplinary support. This study aimed to evaluate its feasibility, safety, adherence, and associated changes in functional capacity among patients with CVD. Methods: This single-center, single-arm interventional study (jRCTs042230018) enrolled 30 patients with CVD who followed an unsupervised, home-based, mobile application-facilitated CR program for 5 months, with multidisciplinary video counseling every 2 weeks. The primary outcome was the relative change in the 6-min walk distance (6MWD). Secondary outcomes included changes in peak oxygen uptake (VO2), ventilatory anaerobic threshold (VAT), ventilation-to-carbon dioxide output slope, and Hospital Anxiety and Depression Scale (HADS) score, as well as program adherence. Results: All participants completed the 5-month follow-up and performed a median of 58.5 (interquartile range: 28.0, 77.8) sessions, corresponding to 89.5% (42.8, 118.6) of prescribed sessions (three per week). 6MWD improved from 468.3 ± 98.8 m to 542.6 ± 70.3 m; the mean absolute change was 74.3 m (95% CI, 47.8–100.7; relative change, 18.6%; p < 0.001). Peak VO2 and VAT increased by 16.7% and 30.1%, respectively. HADS scores decreased modestly. One participant was hospitalized for worsening heart failure (unrelated to the intervention); no other serious cardiovascular events occurred. Conclusions: This mobile application-based, unsupervised remote CR program was feasible and associated with improved exercise capacity in patients with CVD. Randomized trials comparing it with center-based CR are warranted.