Effectiveness of exercise via telehealth for chronic disease: a systematic review and meta-analysis of exercise interventions delivered via videoconferencing

Abstract

ObjectiveTo investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases.DesignSystematic review incorporating meta-analysis.Data sourcesPubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus.Eligibility criteriaThe current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Trials analysing participants with chronic disease undergoing aerobic and/or resistance exercise training over videoconferencing, with exercise capacity and/or quality of life outcomes were included. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life. Risk of bias was analysed using the Downs and Black quality checklist and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).ResultsThirty-two trials were included in this review, of which 12 were comparator trials. Small–moderate between-group (videoconferencing vs comparator) effects favouring videoconferencing were seen for studies using a non-exercising comparator for exercise capacity (standardised mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=<0.001) and quality of life (SMD=0.400, 95% CI 0.099 to 0.701; p=0.009). Small effects favouring videoconferencing were observed for studies using an exercising comparator for quality of life (SMD=0.271, 95% CI 0.028 to 0.515; p=0.029) and exercise capacity (SMD=0.242, 95% CI 0.059 to 0.426; p=0.009). Moderate risk of bias was identified for included studies (16.3±3.6/28), with GRADE certainty ratings of ‘low’ (quality of life) and ‘moderate’ (exercise capacity). Session attendance was 70% and was reported in 23 trials. No serious adverse events relating to videoconferencing were found. Nine trials documented the total number of technical issues that occurred in 17% of the sessions. Positive satisfaction outcomes were associated with ease of access and usefulness of technology.ConclusionIn patients with chronic disease, videoconferencing exercise interventions appear to be feasible and effective for improving exercise capacity and quality of life. More robust methodology is needed in future studies to improve the certainty of the evidence.PROSPERO registration numberCRD42020191243.

High-intensity Interval Training for the Management of Nonalcoholic Steatohepatitis: Participant Experiences and Perspectives

“…This may be particularly important for high priority groups including indigent, rural, and remotely located and indigenous peoples where cost and access can be key barriers to exercise adoption and maintenance. Strategies to promote affordable access to exercise support could include telehealth, mHealth or eHealth technologies [42][43][44][45] as well as group-based exercise session to reduce individual cost and/ or providing hospital community health infrastructure.…”

Emergency Management During Telehealth

“…To improve patient safety, adverse events and/or patient safety events should be consistently reported. However, reviews of in-person rehabilitation studies show that adverse events are often underreported and/or inconsistent,41,42 and this trend seems to hold true for telehealth rehabilitation studies with as low as 9% of studies in a systematic review reporting on adverse events 43,44. Such inconsistent reporting of adverse events prohibits positive growth for improving patient safety, which not only is integral to the mission of health care systems but also is a critical component of health care professionals' competencies.…”

Medicare reimbursed telehealth exercise physiology services were underutilised through the coronavirus (COVID-19) pandemic: an ecological study

“…Previous literature has suggested that the implementation of exercise-based telehealth technologies can be safe, effective and feasible for patients among various chronic disease cohorts. [25][26][27] Additionally, there is good evidence to suggest that telehealth lifestyle interventions are cost-effective when compared to usual care. 28 With these results in mind, it should be recognised that AEPs have a role to play in both the uptake and promotion of telehealth modalities for all patients.…”