Effects of a 12-Week Home-Based, Online Supervised Exercise Program in Improving Cardiorespiratory Fitness in People with Coronary Artery Disease

This study aimed to assess the effects of a 12-week home-based, online-supervised exercise program, incorporating sit-to-stand and brisk walking, on cardiorespiratory fitness, participant-reported outcomes, and biochemistry markers in people with CAD. In addition, the effect of the program on reducing frailty was also investigated. 

A total of 122 people with CAD were randomly allocated into a control group (CG) and an intervention supervised group (SG). Questionnaires, blood biochemical analysis, functional performance testing, and cardiopulmonary exercise testing (CPET) were administered at the baseline. Questionnaires included the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV), Chinese version of the Mediterranean Diet Scale (MDS-Chinese), Seattle Angina Questionnaire (SAQ) and Mini-mental State Examination (MMSE). Frailty was assessed by the Essential Frailty Toolset (EFT). The CG received traditional education, while the SG had an additional HOSEP. Daily online guidance included lower limb resistance training (sit-to-stand exercises, twice daily, 2-3 sets of 20-30 repetitions) and aerobic exercise (brisk walking, once daily for 30-60 minutes). All assessments were repeated after 12 weeks.

All participants completed the retests after 12 weeks intervention, and no serious adverse cardiovascular events occurred. ①Both the SG and CG showed significant improvements in questionnaire scores compared to baseline, with no statistically significant differences between groups.  ②In terms of biochemical markers, hemoglobin levels improved more significantly in the SG compared to the CG (4.41±9.66 g/L versus 0.55±9.31 g/L, p = 0.029).③CPET results indicated that both groups improved MET peak and VO₂peak; however, the SG demonstrated a significantly greater increase in MET peak compared to the CG [0.50 (0.20, 0.80) MET versus 0.20 (0.00, 0.50) MET, p 0.001]. Additionally, the SG showed a significantly larger increase in VO₂peak [112.00 (47.00, 181.00) mL·min⁻¹ versus 35.00 (-27.50, 67.00) mL·min⁻¹, p 0.001]. Power improvement was also greater in the SG (8.77±10.26 Watts versus 2.75±9.07 Watts, p  0.001). ④Both groups experienced significant improvement in 5 times sit-to-stand performance  post-intervention, with no statistical intergroup differences. The reduction in frailty was more significant in the SG (31.1%) compared to the CG (14.7%).

This study demonstrates that compared to traditional education program, a 12-week home-based, online-supervised exercise programs that combined simple sit-to-stand and brisk walking showed significantly additional benefits in enhancing cardiorespiratory fitness and reducing frailty rate in people with CAD. 

Our findings support the use of home-based, online-supervised exercise program for cardiac rehabilitation in physiotherapy practice. Although education may be still necessary, additional active exercise at home, with online supervision, may have significantly better effect on improving cardiorespiratory fitness. Accordingly, training programs may be needed to equip physiotherapists with virtual rehabilitation technologies for CAD management.