Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Short Communication

Volume 13, Number 1, February 2022, pages 57-64

Remote Cardiac Rehabilitation in Older Cardiac Disease: A Randomized Case Series Feasibility Study

Figure 1. Schema of Remote-CR. Patients who participated in Remote-CR program were given tablet PC guides for exercise program staff; after completion of ambulatory CR, remote consultation program was provided to them by trained physiotherapist, once a week for 4 weeks. Remote-CR: remote cardiac rehabilitation support program.

Figure 3. Questionnaire for the satisfaction and adherence to exercise or physical activity management via Remote-CR. Remote-CR: remote cardiac rehabilitation support program.

**Table 1.** Baseline Characteristics
	Total (n = 11)	Remote-CR (n = 6)	CB-CR (n = 5)	P-value
CR: cardiac rehabilitation; LVEF: left ventricular ejection fraction; Hb: hemoglobin; eGFR: estimated glomerular filtration rate; BUN: blood urine nitrogen; Alb: albumin; TG: triglyceride; LDL: low-density lipoprotein; HDL: high-density lipoprotein; CRP: C-reactive protein; Ca: calcium; ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker.
Male, no. (%)	8 (73)	4 (67)	4 (80)	0.621
Age, years	74 (68 - 78)	74 (72 - 80)	68 (67 - 75)	0.126
Body mass index, kg/m²	22.3 (21.0 - 24.1)	23.6 (21.2 - 25.1)	22.3 (21.0 - 23.0)	0.537
Medical treatment, no. (%)				0.639
Angina	5 (45)	2 (33)	3 (42)
Myocardial infarction	3 (27)	1 (17)	2 (29)
Cardiac surgery	4 (36)	2 (33)	2 (29)
Dilated cardiomyopathy	1 (9)	1 (17)	0 (0)
Comorbidity, no. (%)
Hypertension	6 (55)	4 (67)	2 (40)	0.376
Diabetes mellitus	3 (27)	2 (33)	1 (20)	0.621
Dyslipidemia	7 (64)	5 (83)	2 (40)	0.137
LVEF, %	63 (43 - 69)	54 (33 - 72)	63 (58 - 67)	0.465
Laboratory data
Hb, mg/dL	13.9 (13.5 - 14.9)	14.9 (12.9 - 16.2)	13.9 (13.5 - 14.9)	0.917
Alb, mg/dL	4.1 (4.1 - 4.2)	4.2 (4.0 - 4.3)	4.1 (4.1 - 4.1)	0.459
eGFR, mL/min/1.73 m²	72.1 (40.2 - 76.1)	64.9 (34.9 - 78.0)	67.6 (55.2 - 73.6)	0.834
BUN, mg/dL	18.0 (11.0 - 23.5)	20.0 (10.5 - 28.0)	18.0 (16.0 - 20.5)	1.000
TG, mg/dL	84 (50 - 143)	136 (75 - 157)	119 (50 - 132)	0.175
LDL, mg/dL	64 (59 - 81)	97 (81 - 111)	64 (59 - 103)	0.753
HDL, mg/dL	56 (54 - 60)	51 (42 - 60)	55 (50 - 58)	0.841
CRP, mg/dL	0.06 (0.03 - 0.16)	0.12 (0.06 - 0.13)	0.05 (0.03 - 0.13)	0.251
Medication, no. (%)
Ca blocker	5 (45)	2 (18)	3 (60)	0.376
Beta-blocker	7 (64)	4 (57)	3 (60)	0.819
ACEI/ARB	7 (64)	3 (50)	4 (80)	0.303
Diuretics	3 (27)	2 (33)	1 (20)	0.621
Statin	9 (82)	5 (83)	4 (80)	0.347

Table 1. Baseline Characteristics

Total (n = 11)

Remote-CR (n = 6)

CB-CR (n = 5)

P-value

CR: cardiac rehabilitation; LVEF: left ventricular ejection fraction; Hb: hemoglobin; eGFR: estimated glomerular filtration rate; BUN: blood urine nitrogen; Alb: albumin; TG: triglyceride; LDL: low-density lipoprotein; HDL: high-density lipoprotein; CRP: C-reactive protein; Ca: calcium; ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker.

Male, no. (%)

8 (73)

4 (67)

4 (80)

0.621

Age, years

74 (68 - 78)

74 (72 - 80)

68 (67 - 75)

0.126

Body mass index, kg/m²

22.3 (21.0 - 24.1)

23.6 (21.2 - 25.1)

22.3 (21.0 - 23.0)

0.537

Medical treatment, no. (%)

0.639

Angina

5 (45)

2 (33)

3 (42)

Myocardial infarction

3 (27)

1 (17)

2 (29)

Cardiac surgery

4 (36)

2 (33)

2 (29)

Dilated cardiomyopathy

1 (9)

1 (17)

0 (0)

Comorbidity, no. (%)

Hypertension

6 (55)

4 (67)

2 (40)

0.376

Diabetes mellitus

3 (27)

2 (33)

1 (20)

0.621

Dyslipidemia

7 (64)

5 (83)

2 (40)

0.137

LVEF, %

63 (43 - 69)

54 (33 - 72)

63 (58 - 67)

0.465

Laboratory data

Hb, mg/dL

13.9 (13.5 - 14.9)

14.9 (12.9 - 16.2)

13.9 (13.5 - 14.9)

0.917

Alb, mg/dL

4.1 (4.1 - 4.2)

4.2 (4.0 - 4.3)

4.1 (4.1 - 4.1)

0.459

eGFR, mL/min/1.73 m²

72.1 (40.2 - 76.1)

64.9 (34.9 - 78.0)

67.6 (55.2 - 73.6)

0.834

BUN, mg/dL

18.0 (11.0 - 23.5)

20.0 (10.5 - 28.0)

18.0 (16.0 - 20.5)

1.000

TG, mg/dL

84 (50 - 143)

136 (75 - 157)

119 (50 - 132)

0.175

LDL, mg/dL

64 (59 - 81)

97 (81 - 111)

64 (59 - 103)

0.753

HDL, mg/dL

56 (54 - 60)

51 (42 - 60)

55 (50 - 58)

0.841

CRP, mg/dL

0.06 (0.03 - 0.16)

0.12 (0.06 - 0.13)

0.05 (0.03 - 0.13)

0.251

Medication, no. (%)

Ca blocker

5 (45)

2 (18)

3 (60)

0.376

Beta-blocker

7 (64)

4 (57)

3 (60)

0.819

ACEI/ARB

7 (64)

3 (50)

4 (80)

0.303

Diuretics

3 (27)

2 (33)

1 (20)

0.621

Statin

9 (82)

5 (83)

4 (80)

0.347

**Table 2.** Within and Between-Group Difference in the Functional Status
	Baseline, median (IQR)	4 weeks, median (IQR)	Within-group difference	Between-group difference*
*The change in functional status during intervention periods was determined as the absolute difference and compared the Remote-CR group with CB-CR group. IQR: interquartile range; SPPB: short physical performance battery; KCL: Kihon checklist; CR: cardiac rehabilitation; CB: center-based.
SPPB score
Remote-CR	11.50 (10.75 - 12.00)	11.50 (11.00 - 12.00)	P = 0.317	0.00 (0.00 - 0.00), P = 0.892
CB-CR	12.00 (12.00 - 12.00)	12.00 (12.00 - 12.00)	P = 0.317
Handgrip strength
Remote-CR	27.80 (22.75 - 33.00)	30.50 (25.50 - 34.00)	P = 0.072	3.00 (0.00 - 4.70), P = 0.286
CB-CR	33.00 (25.75 - 34.50)	36.00 (26.50 - 38.00)	P = 0.141
Gait speed
Remote-CR	3.345 (2.303 - 3.788)	3.220 (2.340 - 3.803)	P = 0.686	-0.01 (-0.45 - 0.18), P = 0.273
CB-CR	3.080 (2.980 - 3.680)	3.030 (2.690 - 3.330)	P = 0.138
KCL total score
Remote-CR	4.00 (2.00 - 5.00)	3.50 (1.50 - 4.00)	P = 0.083	-1.00 (-1.00 - 0.00), P = 1.000
CB-CR	3.00 (2.00 - 5.00)	2.00 (1.00 - 5.00)	P = 0.680

Table 2. Within and Between-Group Difference in the Functional Status

Baseline, median (IQR)

4 weeks, median (IQR)

Within-group difference

Between-group difference*

Baseline vs. 4 weeks

Remote-CR vs. CB-CR

P-value

Median (IQR), P-value

*The change in functional status during intervention periods was determined as the absolute difference and compared the Remote-CR group with CB-CR group. IQR: interquartile range; SPPB: short physical performance battery; KCL: Kihon checklist; CR: cardiac rehabilitation; CB: center-based.

SPPB score

Remote-CR

11.50 (10.75 - 12.00)

11.50 (11.00 - 12.00)

P = 0.317

0.00 (0.00 - 0.00), P = 0.892

CB-CR

12.00 (12.00 - 12.00)

P = 0.317

Handgrip strength

Remote-CR

27.80 (22.75 - 33.00)

30.50 (25.50 - 34.00)

P = 0.072

3.00 (0.00 - 4.70), P = 0.286

CB-CR

33.00 (25.75 - 34.50)

36.00 (26.50 - 38.00)

P = 0.141

Gait speed

Remote-CR

3.345 (2.303 - 3.788)

3.220 (2.340 - 3.803)

P = 0.686

-0.01 (-0.45 - 0.18), P = 0.273

CB-CR

3.080 (2.980 - 3.680)

3.030 (2.690 - 3.330)

P = 0.138

KCL total score

Remote-CR

4.00 (2.00 - 5.00)

3.50 (1.50 - 4.00)

P = 0.083

-1.00 (-1.00 - 0.00), P = 1.000

CB-CR

3.00 (2.00 - 5.00)

2.00 (1.00 - 5.00)

P = 0.680