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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

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

  • Kazuhiro Terashima1
  • Ruka Kanazawa1
  • Zhehao Dai2
  • Takaaki Mizuno3
  • Yuji Kono4
  • Takahiro Okumura1
  • Masanobu Yanase1
  • Yohei Otaka4
  • Hideo Izawa1
4 affiliations
  1. 1Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
  2. 2Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
  3. 3CLINIAL Co., Ltd., Tokyo 151-0053, Japan
  4. 4Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{terashima2026feasibility,
  title = {{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}},
  author = {Kazuhiro Terashima and Ruka Kanazawa and Zhehao Dai and Takaaki Mizuno and Yuji Kono and Takahiro Okumura and Masanobu Yanase and Yohei Otaka and Hideo Izawa},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218658},
  url = {https://www.mdpi.com/2077-0383/15/21/8658},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Kazuhiro Terashima
AU  - Ruka Kanazawa
AU  - Zhehao Dai
AU  - Takaaki Mizuno
AU  - Yuji Kono
AU  - Takahiro Okumura
AU  - Masanobu Yanase
AU  - Yohei Otaka
AU  - Hideo Izawa
PY  - 2026
DA  - 2026/11/06
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218658
UR  - https://www.mdpi.com/2077-0383/15/21/8658
AB  - 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.
SN  - 2077-0383
ER  -