Exercise-based telerehabilitation improves peak oxygen uptake in adults with cardiovascular diseaseExercise-based Telerehabilitation Improves Fitness for People with Heart Disease

BACKGROUND: Cardiovascular disease (CVD) remains the leading global cause of mortality, and exercise-based cardiac rehabilitation improves cardiorespiratory fitness and reduces recurrent events. However, center-based rehabilitation is constrained. Telerehabilitation has emerged as a scalable alternative, yet prior systematic reviews have generally bundled exercise training with coequal lifestyle components such as health education, dietary counseling, behavior-change techniques, or psychological support, making it difficult to isolate the cardiometabolic contribution of exercise itself. OBJECTIVE: This systematic review and meta-analysis quantified the effects of exercise-based telerehabilitation, with exercise as the core therapeutic component, on peak oxygen uptake (VO₂ peak), systolic blood pressure, and diastolic blood pressure in adults with CVD, and examined 5 digital-health dimensions as potential moderators. METHODS: Following PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2020) and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines, PubMed, Cochrane Library, Web of Science, Embase, and MEDLINE were searched from inception to March 20, 2026, supplemented by trial registry searches and forward and backward citation searching. Randomized controlled trials comparing exercise-based telerehabilitation with usual care in adults with CVD were eligible. Risk of bias was assessed with the Cochrane RoB 2 tool (Cochrane Risk of Bias Tool version 2). Random-effects meta-analyses used the Hartung-Knapp-Sidik-Jonkman approach: between-study variance (τ²) was estimated by the Sidik-Jonkman method, and CIs were computed with the Knapp-Hartung adjustment. Prespecified meta-regression and subgroup analyses examined 5 digital-health dimensions: telemedicine modality, guidance type, technology platform, intervention duration, and intervention composition. Certainty of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). RESULTS: Thirteen randomized controlled trials (n=958) were included. Exercise-based telerehabilitation significantly improved VO₂ peak (mean difference [MD]=2.58 mL/kg/min, 95% CI 1.16 to 4.00, =4.10, =.003; 95% prediction interval -1.28 to 6.44; ²=74.45%). The prediction interval crossed 0, indicating that the average effect may not be reproduced in every clinical setting. No significant pooled effect was observed for systolic blood pressure (mean difference -1.80 mm Hg, 95% CI -7.42 to 3.81, =.42) or diastolic blood pressure (mean difference -2.00 mm Hg, 95% CI -4.76 to 0.75, =.11). Meta-regression and subgroup analyses did not identify any moderator as a significant source of heterogeneity (all Omnibus >.05), although smartphone or mHealth (mobile health) delivery and professional-led guidance produced larger and more homogeneous VO₂ peak gains. Possible small-study effects for VO₂ peak were detected (Egger test, =.03). GRADE certainty was very low across all outcomes. CONCLUSIONS: Exercise-based telerehabilitation probably improves cardiorespiratory fitness in adults with CVD but provides no convincing evidence of an antihypertensive effect. Telerehabilitation should be considered a patient-centered alternative for individuals unable to access center-based rehabilitation, rather than a uniformly equivalent substitute. Component-isolated trials and hypertensive cohort studies with standardized digital-health reporting are needed.