Remotely delivered exercise-based cardiac rehabilitation serves as a safe and effective additional option for patients recovering from a heart attack, matching centre-based programmes in completed sessions and physical capacity improvements, according to findings presented at the ESC Congress 2026 by Professor Maria Bäck.
Supervised exercise recovery programmes are important for recovery following a myocardial infarction, commonly known as a heart attack. Yet, participation rates in Sweden and across Europe remain low, with only a minority – around 15% – of eligible patients completing a supervised centre-based exercise programme. As health systems grapple with how to bridge this adherence gap without compromising clinical safety, recent registry-based clinical trials offer a pragmatic path forward. Integrating tele-rehabilitation models into routine cardiovascular care allows patients to exercise from home while keeping real-time clinical oversight, altering how modern cardiology approaches post-acute recovery.
In Plain English: The Clinical Takeaway
- What was studied: Clinical evaluations, including the Remote Exercise SWEDEHEART study, assessed whether home-based, video-supervised exercise could match traditional hospital-based cardiac rehabilitation.
- The main finding: Patients given the option of remote exercise completed a similar total number of sessions and achieved similar gains in physical capacity compared to those restricted entirely to centre-based programmes.
- Safety profile: Serious exercise-related adverse events were uncommon, estimated across systematic reviews at approximately 1 adverse event per 53,770 patient-hours of remote exercise.
Evaluating the Evidence: The Remote Exercise SWEDEHEART Trial
Unveiled during a Hot Line session at the ESC Congress 2026 in Munich, Germany, the Remote Exercise SWEDEHEART study sought to test whether remotely delivered cardiac rehabilitation embedded within existing healthcare services could be a valuable addition to centre-based programmes, potentially increasing participation while maintaining safety and clinical effectiveness. Led by Professor Maria Bäck of Sahlgrenska University Hospital and the University of Gothenburg, the registry-based, cluster-randomised crossover trial examined type 1 myocardial infarction patients aged 18 to 79 years across 23 Swedish clinical centres.
During designated 15-month intervention periods, participating clinical sites offered patients a flexible choice of remotely delivered exercise, traditional centre-based exercise, or a hybrid combination based on individual patient preference. During control periods, the same centres offered centre-based exercise only. Both intervention and control pathways adhered to identical physiological principles: individually prescribed aerobic and resistance training based on clinical assessment and established cardiac rehabilitation guidelines.
The analysis captured 3,112 patients with a mean age of 67 years, approximately one-quarter of whom were women. The data revealed that offering remote exercise did not significantly increase the mean number of completed exercise sessions—standing at 13.8% during the intervention period versus 13.6% during the control period. However, patient utilization patterns proved telling. When remote video sessions were made available, roughly 38% of all recorded exercise sessions were performed remotely at home under the real-time supervision of a hospital physiotherapist, while 62% remained centre-based. Crucially, improvements in physical capacity were comparable across both delivery modes.
Safety, Adherence, and Long-Term Clinical Outcomes
Safety is a primary metric when evaluating decentralised care models for cardiovascular cohorts. Systematic reviews examining remotely delivered cardiac rehabilitation in coronary heart disease populations—spanning databases from PubMed to the Cochrane Central Register of Controlled Trials—demonstrate a low incidence of serious adverse events. Across extensive patient-hour tracking, severe complications remain uncommon, and longitudinal data indicate a non-statistically significant reduction in re-hospitalization rates and no exercise-related deaths compared to traditional settings.
These findings reinforce current guidelines from major professional bodies. Exercise-based cardiac rehabilitation is strongly recommended for patients following acute coronary syndromes in both the European Society of Cardiology (ESC) Guidelines on acute coronary syndromes and the ESC Guidelines on cardiac rehabilitation. By providing real-time contact with a physiotherapist via structured video links, remote delivery addresses the substantial drop-off in participation caused by barriers to centre-based programmes.
| Parameter | Centre-Based Rehabilitation | Remotely Delivered Rehabilitation |
|---|---|---|
| Supervision Level | In-person hospital or clinic oversight | Real-time group video sessions supervised by physiotherapists |
| Target Population | Eligible post-MI patients (low uptake ~15%) | Eligible post-MI patients seeking flexible access |
| Efficacy / Physical Capacity | Established improvement in cardiovascular fitness | Comparable improvement in physical capacity |
| Safety Metrics | Standard clinical monitoring | Low serious adverse event rate (~1 per 53,770 patient-hours) |
Contraindications & When to Consult a Doctor
While decentralised exercise recovery broadens clinical reach, remote rehabilitation is not appropriate for every cardiac patient.
References
- European Society of Cardiology (ESC). ESC Guidelines on acute coronary syndromes and cardiac rehabilitation. Presented at ESC Congress 2026, Munich, Germany.
- Remote Exercise SWEDEHEART trial data and registry-based analyses. Sahlgrenska University Hospital and University of Gothenburg, Sweden.
- International Prospective Register of Systematic Reviews (PROSPERO). Protocol CRD42023455471: Safety and long-term outcomes of remotely-delivered cardiac rehabilitation interventions.
- PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Systematic evaluations of remotely-delivered cardiac rehabilitation in coronary heart disease cohorts (2012–2023).
Disclaimer: This article is intended for informational and educational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
