Impact of phase II cardiac telerehabilitation on physical capacity in coronary heart disease: a systematic review and meta-analysis

Abstract

Aims Coronary heart disease (CHD) is the leading cause of death globally. Cardiac rehabilitation (CR) reduces cardiovascular mortality, hospital readmissions, and improves quality of life, yet participation in centre-based programmes remains low. Therefore, the aim of this systematic review and meta-analysis was to evaluate the clinical benefits of cardiac telerehabilitation (CTR), using exercise as the primary intervention, on physical capacity compared with centre-based cardiac rehabilitation (CBCR) or usual care in patients with CHD. Methods and results This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251160310). Five databases (PubMed, Embase, Scopus, CINAHL, CENTRAL) were searched from January 2000 to 15 October 2025. Eligible studies were randomized controlled trials (RCTs) enrolling adults with CHD in phase II CTR, with exercise training as a mandatory core component, optionally supplemented by other CR elements. Outcomes were cardiorespiratory fitness (CRF) (peak VO2) and functional capacity (6MWT, ISWT) between CTR and CBCR or usual care. For outcomes with substantial heterogeneity (I-2 > 50%), random-effects meta-analyses were conducted using inverse-variance weighting, restricted maximum-likelihood estimation, and Knapp-Hartung adjustment. Twenty-five studies (n = 2717) were included. Compared with CBCR, no statistically significant difference was observed between CTR and CBCR in improvements VO2peak (mean difference (MD): 1.55, 95% CI: -1.60 to 4.70; I-2 = 83.7%; P = 0.168) and 6MWT (MD: 15.01, 95% CI: -7.30 to 37.33; I-2 = 0.0%; P = 0.187) at short-term (ST; 3 months). These comparable improvements persisted long-term (LT; 6-12 months). By contrast, CTR led to a significantly greater improvement compared with usual care in VO2peak (MD: 3.86, 95% CI: 3.03-4.69; I-2 = 0.0%; P < 0.0001) and 6MWT (MD: 37.83, 95% CI: 22.12-53.53; I-2 = 62.3%; P = 0.001) in the short term. Conclusion CTR provides improvements in CRF and functional capacity with no statistically significant difference compared with CBCR, and significantly greater improvements compared with usual care.