Evaluating the Effects of an Enhanced Strength Training Program in Remote Cardiological Rehabilitation: A Shift from Aerobic Dominance-A Pilot Randomized Controlled Trial.

(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 patients starting cardiac rehabilitation were assessed for muscle strength, aerobic capacity, and self-reported outcomes at baseline and after 16 weeks. Participants were divided into two groups: the RCR-ST group received a targeted resistance training program via a mobile app and smartwatch, while the control group received standard care with general resistance training advice. (3) Results: The RCR-ST group demonstrated significant improvements in muscle endurance, notably in leg extension and chest press exercises, with increases of 92% compared to 25% and 92% compared to 13% in the control group, respectively. Functional assessments (5-STS and TUG tests) also showed marked improvements in agility, coordination, and balance. Both groups improved in cardiorespiratory fitness, similarly. The RCR-ST group reported enhanced physical health and showed increased engagement, as evidenced by more frequent use of the mobile app and longer participation in the rehabilitation program (p < 0.05). (4) Conclusions: Incorporating a focused strength training regimen in remote cardiac rehabilitation significantly improves muscle endurance and patient engagement. The RCR-ST program presents a promising approach for optimizing patient outcomes by addressing a crucial gap in traditional rehabilitation protocols that primarily focus on aerobic training.

Home-Based Cardiac Rehabilitation Among Patients Unwilling to Participate in Hospital-Based Programs.

PURPOSE: Asynchronous home-based cardiac rehabilitation (HBCR) is a viable alternative to center-based cardiac rehabilitation (CBCR). However, to achieve significant functional improvement, a high level of adherence and activity must be achieved. The effectiveness of HBCR among patients who actively avoid CBCR has not been effectively investigated. This study aimed to investigate the effectiveness of the HBCR program among patients unwilling to participate in CBCR. METHODS: A randomized prospective study enrolled 45 participants to a 6-mo HBCR program and the remaining 24 were allocated to regular care. Both groups were digitally monitored for physical activity (PA) and self-reported outcomes. Change in peak oxygen uptake (VO 2peak ), the primary study outcome, was measured by the cardiopulmonary exercise test, immediately before program start and 4 mo thereafter. RESULTS: The study included 69 patients, 81% men, aged 55.9 ±12 yr, enrolled in a 6-mo HBCR program to follow a myocardial infarction (25.4%) or coronary interventions (41.3%), heart failure hospitalization (29%), or heart transplantation (10%). Weekly aerobic exercise totaled a median of 193.2 (110.2-251.5) min (129% of set exercise goal), of which 112 (70-150) min was in the heart rate zone recommended by the exercise physiologist.After 4 mo, VO 2peak improved by 10.2% in the intervention group versus -2.7% in the control group (+2.46 ± 2.67 vs -0.72 ± 3.02 mL/kg/min; P < .001). CONCLUSION: The monthly PA of patients in the HBCR versus conventional CBCR group were well within guideline recommendations, showing a significant improvement in cardiorespiratory fitness. Risk level, age, and lack of motivation at the beginning of the program did not prevent achieving goals and maintaining adherence.

Real-Time Artificial Intelligence-Based Guidance of Echocardiographic Imaging by Novices: Image Quality and Suitability for Diagnostic Interpretation and Quantitative Analysis.

BACKGROUND: We aimed to assess in a prospective multicenter study the quality of echocardiographic exams performed by inexperienced users guided by a new artificial intelligence software and evaluate their suitability for diagnostic interpretation of basic cardiac pathology and quantitative analysis of cardiac chamber and function. METHODS: The software (UltraSight, Ltd) was embedded into a handheld imaging device (Lumify; Philips). Six nurses and 3 medical residents, who underwent minimal training, scanned 240 patients (61±16 years; 63% with cardiac pathology) in 10 standard views. All patients were also scanned by expert sonographers using the same device without artificial intelligence guidance. Studies were reviewed by 5 certified echocardiographers blinded to the imager's identity, who evaluated the ability to assess left and right ventricular size and function, pericardial effusion, valve morphology, and left atrial and inferior vena cava sizes. Finally, apical 4-chamber images of adequate quality, acquired by novices and sonographers in 100 patients, were analyzed to measure left ventricular volumes, ejection fraction, and global longitudinal strain by an expert reader using conventional methodology. Measurements were compared between novices' and experts' images. RESULTS: Of the 240 studies acquired by novices, 99.2%, 99.6%, 92.9%, and 100% had sufficient quality to assess left ventricular size and function, right ventricular size, and pericardial effusion, respectively. Valve morphology, right ventricular function, and left atrial and inferior vena cava size were visualized in 67% to 98% exams. Images obtained by novices and sonographers yielded concordant diagnostic interpretation in 83% to 96% studies. Quantitative analysis was feasible in 83% images acquired by novices and resulted in high correlations (r≥0.74) and small biases, compared with those obtained by sonographers. CONCLUSIONS: After minimal training with the real-time guidance software, novice users can acquire images of diagnostic quality approaching that of expert sonographers in most patients. This technology may increase adoption and improve accuracy of point-of-care cardiac ultrasound.

Israel's first national remote cardiac rehabilitation program: A retrospective analysis.

Aims: Cardiac rehabilitation is an essential component of secondary prevention consistently unexploited by most eligible patients. Accordingly, the remote cardiac rehabilitation program (RCRP) was developed to create optimal conditions for remote instruction and supervision for patients to enable successful completion of the program. Methods: This study comprised 306 patients with established coronary heart disease who underwent a 6-month RCRP. RCRP involves regular exercise, monitored by a smartwatch that relays data to the operations center and a mobile application on the patient's smartphone. A stress test was performed immediately before the RCRP and repeated after 3 months. The aims were to determine the effectiveness of the RCRP in improving aerobic capacity, and correlating the program goals and first-month activity, with attaining program goals during the last month. Results: Participants were mostly male (81.5%), aged 58 ± 11, enrolled in the main after a myocardial infarction or coronary interventions. Patients exercised aerobically for 183 min each week, 101 min (55% of total exercise) at the target heart rate. There was a significant improvement in exercise capacity, assessed by stress tests, metabolic equivalents which increased from 9.5 ± 3 to 11.4 ± 7(p < 0.001). Independent predictors of RCRP goals were older age and more minutes of aerobic exercise during the first program month (p < 0.05). Conclusion: Participants succeeded in performing guideline recommendations, resulting in a significant improvement in exercise capacity. Older age and increased volume of first month of exercise were significant factors associated with a greater likelihood to attain program goals.