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COVID Pushing Cardiac Rehab into a New Era?

Can J Cardiol. 2020 Apr 25.

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Center Stage.

Babu AS1, Arena R2, Ozemek C2, Lavie CJ3.

Author information

1 Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal – 576104, Karnataka, India. Electronic address:

2 Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, USA.

3 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, USA.

We propose that TDCR is a non-supervised delivery of CR with the assistance of any form of technology, including but not limited to smartphones, mobile apps, internet, messaging, email, websites, webcams and use of wearable sensors. Technology based CR has been shown to be beneficial with relation to reduction in risk factors, while also cost effective.9 Irrespective of the technology used, TDCR should ensure that appropriate precautions are taken in light of COVD-19 risks, while performing any type of physical activity or exercise.19 A proposed model for the use of TDCR is given in Figure 1.

At this time, the transition from traditional models of CR to TDCR is not only challenging but daunting. The utilization of resources required for establishing various network and virtual connections with individuals currently enrolled and for new cases requires the development of new standard operating procedures. These newer models will be even more challenging in resource-limited settings, especially since the delivery of CR is still not sufficient across many low and middle income countries.20, 21 Limited availability of stable and powerful internet and telephone signals may continue to hamper delivery of TDCR in rural areas. Nevertheless, in the current pandemic, all these options should be explored to ensure that delivery of CR is sustained and patients with CVD can continue to gain the associated benefits, 22, 23 and potentially get better traction, not just for coronary heart disease but also for eligible patients with HF and peripheral arterial disease. Furthermore, the use of TDCR might increase accessibility to CR in jurisdictions where services have been challenging to provide.24 This might be another case where creative solutions to a temporary problem provide long-term unanticipated benefits for longstanding challenges.


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