Swedish trial finds remote cardiac rehab adds choice, not uptake

A physiotherapist at a Swedish hospital leads a group exercise session by video while patients train at home. That arrangement was used across 23 Swedish centers in the ongoing Remote Exercise SWEDEHEART trial, which tested whether remote cardiac rehabilitation could bring more people into care after a myocardial infarction, or heart attack.

The answer is measured. Among 3,112 patients with type 1 myocardial infarction, the proportion completing the full exercise program was 13.8% when remote sessions were available, compared with 13.6% when patients were offered center-based exercise only. The difference was not significant, and the average number of completed sessions did not increase.

Remote care was not ignored. During intervention periods, approximately 38% of recorded exercise sessions took place remotely and approximately 62% at a center. Both groups improved their physical capacity after completing the program, with no significant difference between them. The remote sessions used real-time group video, with hospital physiotherapists supervising individually prescribed aerobic and resistance training.

Safety results were reassuring but small in absolute terms. Exercise-related serious adverse events occurred at a rate of 0.17 events per 1,000 patient-hours for remote exercise and 0.47 events per 1,000 patient-hours for center-based exercise. Follow-up will continue, including analysis of a wider group from the SWEDEHEART registry.

So what changes in practice? Remote sessions give a substantial share of patients another way to take part without replacing the center. Professor Maria Bäck of Sahlgrenska University Hospital and the University of Gothenburg says the remaining barriers may include coexisting diseases, language, socioeconomic conditions and different levels of digital health literacy. The technology expands the menu; it does not, by itself, solve low participation.