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Peer-reviewedCC BY-NC-ND 4.0Journal of Cardiopulmonary Rehabilitation and Prevention

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

  • Blake E. G. Collins1
  • Brett A. Gordon1
  • Daniel W. T. Wundersitz1
  • Jayden R. Hunter1
  • Lisa C. Hanson1
  • Michael Kingsley1
  1. 1Author Affiliations: Holsworth Biomedical Research Centre, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia (Drs Collins, Gordon, Wundersitz, Hunter, Hanson, and Kingsley) and Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand (Dr Kingsley).
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Abstract

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 (V˙O2peak), exercise volume, cardiovascular function, sleep quality, and quality of life. A between-group difference in V˙O2peak 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 V˙O2peak 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.

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Cite

BibTeXRIS
BibTeX
@article{collins2026noninferiority,
  title = {{Noninferiority of Randomly Assigned Telehealth and Center-Based Regional Exercise-Based Cardiac Rehabilitation Programs When Delivered With High Fidelity}},
  author = {Blake E. G. Collins and Brett A. Gordon and Daniel W. T. Wundersitz and Jayden R. Hunter and Lisa C. Hanson and Michael Kingsley},
  journal = {Journal of Cardiopulmonary Rehabilitation and Prevention},
  year = {2026},
  month = jun,
  doi = {10.1097/hcr.0000000000001035},
  url = {https://doi.org/10.1097/hcr.0000000000001035},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Noninferiority of Randomly Assigned Telehealth and Center-Based Regional Exercise-Based Cardiac Rehabilitation Programs When Delivered With High Fidelity
AU  - Blake E. G. Collins
AU  - Brett A. Gordon
AU  - Daniel W. T. Wundersitz
AU  - Jayden R. Hunter
AU  - Lisa C. Hanson
AU  - Michael Kingsley
PY  - 2026
DA  - 2026/06/09
JO  - Journal of Cardiopulmonary Rehabilitation and Prevention
DO  - 10.1097/hcr.0000000000001035
UR  - https://doi.org/10.1097/hcr.0000000000001035
AB  - 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 (V˙O2peak), exercise volume, cardiovascular function, sleep quality, and quality of life. A between-group difference in V˙O2peak 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 V˙O2peak 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.
SN  - 1932-7501
SN  - 1932-751X
ER  -