Heart Recovery Exercise-Based Cardiac Rehabilitation Strongly Recommended for Patients After MI

Researchers have revealed that remote exercise-based cardiac rehabilitation is an additional option but not a replacement for centre-based rehabilitation for patients recovering after a heart attack.

Munich/Germany – Remotely delivered exercise-based cardiac rehabilitation, when added to centre-based programmes, resulted in a similar number of completed sessions as centre-based programmes only, according to results presented recently in a Hot Line session at ESC Congress 2026.

Exercise-based cardiac rehabilitation is strongly recommended for patients after a myocardial infarction (MI) in the ESC Guidelines on acute coronary syndromes and in the new ESC Guidelines on cardiac rehabilitation. “Cardiac rehabilitation improves physical and mental functioning and quality of life as well as being associated with better cardiovascular outcomes,” explained Professor Maria Bäck from Sahlgrenska University Hospital and University of Gothenburg, Sweden. “But despite the benefits, participation in cardiac rehabilitation at healthcare centres remains low. Only a minority – around 15 % – of eligible patients in Sweden and across Europe actually complete a supervised centre-based exercise programme,” she commented.

Remotely delivered cardiac rehabilitation may improve access by allowing patients to exercise at home while maintaining real-time contact with a physiotherapist. Professor Bäck noted that contemporary evidence is limited to small trials in highly selected populations that do not reflect the patients seen in real-world practice. “We conducted the Remote Exercise Swedeheart study to test the hypothe0sis that remotely delivered cardiac rehabilitation, embedded in healthcare services, may be a valuable addition to centre-based programmes, potentially increasing participation while maintaining safety and clinical effectiveness,” she said.

Remote Exercise Swedeheart is an ongoing registry-based, cluster-randomized crossover trial including patients with type 1 MI aged 18–79 years. During 15-month intervention periods, 23 Swedish centres offered patients remotely delivered exercise, centre-based exercise or a combination of both, according to patient preference. During control periods, patients were offered centre-based exercise only. After 15 months, each centre crossed over to the alternate mode for a further 15 months. Both remote and centre-based exercise followed the same principles of individually prescribed aerobic and resistance training, with progression based on clinical assessment and established cardiac rehabilitation guidelines. Remotely delivered cardiac rehabilitation consisted of real-time, group-based video sessions, where patients exercised at home while a physiotherapist at the hospital supervised and led the session.

The analysis included 3,112 patients, with a mean age of around 67 years and approximately one-quarter were women.

The researchers found that remotely delivered exercise did not significantly increase the mean number of completed exercise sessions. The proportion of patients who completed the full exercise programme was very similar: 13.8 % during the intervention period and 13.6 % during the control period.

However, it was noted that remote exercise was clearly used when it was available. During intervention periods, approximately 38 % of recorded exercise sessions were performed remotely, while approximately 62 % were performed at a centre. Both groups improved their physical capacity after finishing the exercise programme, with no significant difference between the groups. “This suggests that remote exercise was a relevant option for a substantial proportion of patients, even though it did not increase overall participation at a population level,” commented Professor Bäck.

Safety was actively monitored and the number of serious events was small. The rate of exercise-related serious adverse events was 0.47 events per 1,000 patient-hours of centre-based exercise and 0.17 events per 1,000 patient-hours of remotely delivered exercise.

Discussing the implications, Professor Bäck said: “Our findings suggest that remotely delivered exercise-based cardiac rehabilitation should be viewed as an additional patient-centred option, rather than a replacement for centre-based rehabilitation or a stand-alone solution for poor uptake. It appears that there are other participation barriers that are not related to travelling, which may include other co-existing diseases, language barriers, socioeconomic factors and varying levels of digital health literacy.” Follow-up will continue and data from a wider group of patients from the Swedeheart registry will also be analyzed.

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