Table 2.

Models of cardiac telerehabilitation for heart failure.

Type of Telehealth	Model	Input	Process	Output
Hybrid cardiac telerehabilitation (HCT) [24,25,26,27,28,29,31,32,34]	Using a mobile phone for voice communication and TR set. A TR set (Pro Plus Company, Poland) consists of EHO mini device, blood pressure monitoring, and weighing equipment.	First, patients use their phones to answer questions on their current health, including fatigue, dyspnea, symptoms, body mass, and medications taken before starting an exercise session. Second, the EHO mini will record ECG data from three precordial leads and send it to the monitoring center through a mobile phone network. Each patient’s EHO mini device features preprogrammed training sessions (defined exercise duration, breaks, timing of ECG recording). The automated ECG registration is timed to the exercise training. The device indicates what needs to be done via sound and light signals. There are bleeps and light signals from color-emitting LEDs. Bleeps and green diode blinking means that the patient needs to move. “Stop exercise” is indicated by other bleeps and blinking of a red diode. The ECG recording starts automatically coinciding with peak exercise.	Prior to allowing the beginning of the training session, health workers will evaluate data from CIED remote monitoring. Patients are permitted to begin the training session if no contraindications are detected.	Exercise: The monitoring center evaluated the safety, efficacy, and accuracy of the program. By using HR data during exercise and patients’ subjective assessments of the Borg scale, experts could change the training workload or even stop the session if necessary. Psychological support: Telephone interaction was also employed for mental health. Education: All exercise training modalities (the Borg scale and how to run a TR set) were taught. Nutritional counseling, lipid management, smoking cessation, and psychosocial assistance were also included. All outcomes were assessed at baseline and after completing the 9-week program. Patients will be followed-up for a maximum of 24 months.
Home-based telerehabilitation program [22]	Telerehabilitation home-based program (Telerehab-HBP) using smartphone, oximeter, and portable one-lead ECG (Card Guard Scientific Survival Ltd., Rehovot, Israel).	With the cardiologist and pulmonologist directing the program, the nurses made a weekly structured phone call to each patient to collect information about disease status and symptoms, nutrition, lifestyle, and medications. Patients were given a pulse oximeter and a portable one-lead ECG to monitor vital signs in real time. The rehabilitation consisted of light and hard traning. Light training included 15–25 min on a mini-ergometer with no load, 30 min of callisthenic exercises three times a week, and two days of free walking. ‘Hard level’ included 30–45 min of mini-ergometer with total load (0–60 W), 30–40 min of muscle-strengthening exercises with 0.5 kg weights, and pedometer-based walking. Patients might call for any emergency conditions 24 h a day.	Patients were required to report every program’s daily performance and issues during the telephone appointment. The physiotherapist would provide changes in the number and intensity of training sessions every 4 months or when issues arose by assessing the Borg scale at the end of any training session.	General clinical condition: asthenia, muscle pain, and joint pain. Physical activity: duration of exercises and number of steps. Clinical parameters before and after training (blood pressure, heart rate, oxygen saturation, and Borg scale). Education: lifestyle changes and the importance of performing exercise. First follow-up was done 4 months after hospital discharge; 2nd follow-up was done 2 months later. Patients’ satisfaction was measured during the first follow-up. Other outcomes were assessed at both first and second follow-up.
Home-based telehealth exercise training progam [23]	An instant messaging service allows users to communicate online using text, audio, or video. The exercise training program used QQ and Wechat software to communicate and supervise.	Prior to the intervention, an instant messenger (QQ and Wechat) group was created for patients and researchers to communicate. Stage 1 (1–4 weeks) concentrated on endurance workouts, with three 20-min sessions each week. Walking was the most prevalent modality used in the first stage. Patients had 12 20-min exercise sessions three times per week. The second stage (5–8 weeks) included 5 30-min resistance and muscular strengthening sessions. The patients did endurance workouts before moving on to resistance. Walking, jogging, and calisthenics were used to train the muscles. The second stage included 20 30-min workout sessions five days a week. The participants could also contact cardiac nurses through phone or Wechat at any moment. Referral services were also provided if necessary.	During the activity training program, cardiac nurses called or texted to check on patients every week. Questions and responses were followed up with talks regarding the current situation and challenges. Physiotherapists were in charge of monitoring, assessing, and changing the training intensity as needed. The workout prescription prioritized exercise intensity. This intervention measured exercise intensity by target HR, which was determined using the HR reserve method.	Patients’ exercise intensity, evaluated by target HR. Target training HR equals 40–70% of HR reserve + resting HF. Participants were required to complete 3 surveys at discharge (as baseline), 2 months following discharge (post-test 1), and 6 months following discharge (post-test 2).
Home-based telerehabilitation [30,33]	Online video conferencing software	Exercise prescription was adjusted to each participant’s goals and reviewed continually by the treating physiotherapist. Participants could borrow a laptop computer, a mobile broadband device with 3G wireless internet, an automatic sphygmomanometer, a finger pulse oximeter, free weights, and resistance bands. In case of any questions or technical issues, participants could call for technical help by phone. Each participant was instructed to self-monitor and vocally report their blood pressure, heart rate, and oxygen saturation levels. Weight, blood sugar, peripheral edema, and general wellness were also measured if applicable.	The telerehabilitation program was provided to groups of up to four participants in their homes via a synchronous videoconferencing platform.	This 12-week heart failure rehabilitation program included 60 min of exercise at the treating hospital, twice a week. Session length was 40 min, including a 10-min warm-up, followed by a 10-min cool-down. The exercise intensity started at 9 (very mild) and progressively increased to 13 (slightly strenuous). The exercise prescription was adjusted to the participant’s goals and continually reviewed by the treating physiotherapist. Self-management, nutritional and physical activity counseling, psychological therapies, pharmaceuticals, and risk factor management were all covered by multidisciplinary healthcare. Participants were also given home workouts three times per week at the same intensity as the supervised sessions. Assessment were done at baseline, week 12 (1st follow-up), and week 24 (2nd follow up).

ECG = electrocardiography; CIEDs = cardiovascular implantable electronic devices; EHO = ECG recorder; HCT = hybrid comprehensive telerehabilitation; HR = heart rate; TR = telerehabilitation.