Home-based cardiac rehabilitation: Development and evaluation of a novel intervention with telemonitoring guidance and wearable sensors

In this thesis we have developed and evaluated the effectiveness of a home-based training intervention for cardiac rehabilitation patients that accommodates the preferences and constraints of patients while retaining the effectiveness of conventional, centre-based cardiac rehabilitation. In the first part of this thesis, we showed that the effectiveness of centre-based exercise programmes for coronary artery patients and chronic heart failure patients is mainly determined by their total energy expenditure. This means that adjustments to programme characteristics (training intensity, session duration and frequency, programme length) can be made freely, without impairing effects on exercise capacity, provided that energy expenditure as a whole is preserved. Therefore, training programmes can be tailored towards patients’ preferences and translated to the home environment.
In the second part of this thesis, we showed that wearable sensors can accurately assess physical activity levels of beta-blocker-medicated cardiac patients in the home-environment. In addition, we described a randomised controlled trial studying the clinical and cost-effectiveness of home-based cardiac rehabilitation with telemonitoring guidance compared to centre-based cardiac rehabilitation. Home-based training resulted in similar improvements in physical fitness and health-related quality life as centre-based training, with a trend towards lower costs. We concluded that home-based cardiac rehabilitation with telemonitoring guidance is a useful alternative to centrebased cardiac rehabilitation for young and motivated patients with low-to-moderate cardiac risks.