ARYA Atherosclerosis Journal

Effectiveness of a comprehensive home-based cardiac rehabilitation intervention on the health promotion of patients with coronary artery disease: A randomized double-blind clinical trial

Document Type : Original Article

Authors

Zahra Teimouri-Jervekani 1
Niloufar Ebadi 2
Marjan Jamalian 3
Fereshte Rastegarnasab 4
Safoura Yazdekhasti 1
Hamidreza Roohafza 2
Hassan Okati Aliabad 5
Alireza Ansari Moghaddam 5
Masoumeh Sadeghi 1

1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

4 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

10.48305/arya.2026.45704.3108
Abstract
BACKGROUND: This study aimed to assess the efficacy of a comprehensive home-based cardiac rehabilitation (HBCR) program in promoting health outcomes among Iranian patients with coronary artery disease (CAD).
METHODS: This randomized, double-blind, clinical trial was conducted on 259 patients with CAD. Participants were allocated to receive either usual care or the HBCR program. Anthropometric indices, lipid profiles, and cardiovascular events were evaluated at baseline and during the follow-up periods.
RESULTS: Changes in serum low-density lipoprotein cholesterol (LDL-C) and arterial blood pressure did not differ significantly between the groups. Body mass index (BMI) was significantly reduced in the HBCR group compared to the control group (P = 0.004). At the study endpoint, hip circumference also demonstrated a more favorable status in the HBCR group (P = 0.002). High-density lipoprotein cholesterol (HDL-C) serum levels improved more prominently in the HBCR group (P = 0.030). Triglyceride (TG) levels showed a similar pattern in both groups, but the overall increase after 12 months was significantly higher in the control group (P = 0.019). Serum total cholesterol (TC) continuously increased in the control group, whereas it decreased in the HBCR group at 12 months, remaining significantly lower than in the control group overall (P = 0.003). Regarding cardiovascular events, mortality was significantly higher in the control group after 18 months (P = 0.007). Additionally, the rate of return to work after 6 months was significantly higher in the HBCR group (P = 0.020).
CONCLUSION: This study demonstrated that a home-based cardiac rehabilitation program is an effective intervention for patients with CAD, leading to superior clinical outcomes.

Keywords

Home-Based Cardiac Rehabilitation Intervention
Coronary Artery Disease
Lipid Profiles
Anthropometric Indexes
1. Mendis S, Puska P, Norrving B. WHO Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization; 2011.
2. Vanhees L, De Sutter J, GeladaS N, Doyle F, Prescott E, Cornelissen V, Kouidi E, Dugmore D, Vanuzzo D, Börjesson M, Doherty P; EACPR. Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I). Eur J Prev Cardiol. 2012 Aug;19(4):670-86. https://doi.org/10.1177/2047487312437059
3. Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med. 2019 Apr 1;22(4):204-10.
4. Balady GJ, Ades PA, Bittner VA, Franklin BA, Gordon NF, Thomas RJ, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011 Dec 20;124(25):2951-60. https://doi.org/10.1161/CIR.0b013e31823b21e2
5. Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46. https://doi.org/10.1016/j.jacc.2011.10.824
6. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012 Jul;33(13):1635-701. https://doi.org/10.1093/eurheartj/ehs092
7. Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA, et al. Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Clin Pract Guidel Quick Ref Guide Clin. 1995 Oct;(17):1-23.
8. Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000 Feb 17;342(7):454-60. https://doi.org/10.1056/NEJM200002173420702
9. Barber K, Stommel M, Kroll J, Holmes-Rovner M, McIntosh B. Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation. J Clin Epidemiol. 2001 Oct;54(10):1025-30. https://doi.org/10.1016/S0895-4356(01)00375-4
10. Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014 Jun 25;(6):CD007131. https://doi.org/10.1002/14651858.CD007131.pub3
11. Fernandez RS, Davidson P, Griffiths R. Cardiac rehabilitation coordinators’ perceptions of patient-related barriers to implementing cardiac evidence-based guidelines. J Cardiovasc Nurs. 2008 Sep-Oct;23(5):449-57. https://doi.org/10.1097/01.JCN.0000317450.64778.a0
12. Dunlay SM, Witt BJ, Allison TG, Hayes SN, Weston SA, Koepsell E, et al. Barriers to participation in cardiac rehabilitation. Am Heart J. 2009 Nov;158(5):852-9. https://doi.org/10.1016/j.ahj.2009.08.010
13. Poortaghi S, Baghernia A, Golzari SE, Safayian A, Atri SB. The effect of home-based cardiac rehabilitation program on self efficacy of patients referred to cardiac rehabilitation center. BMC Res Notes. 2013 Jul 23;6:287. https://doi.org/10.1186/1756-0500-6-287
14. Bergström G, Börjesson M, Schmidt C. Self-efficacy regarding physical activity is superior to self-assessed activity level, in long-term prediction of cardiovascular events in middle-aged men. BMC Public Health. 2015 Aug 25;15:820. https://doi.org/10.1186/s12889-015-2140-4
15. Jamalian M, Ansari-Moghaddam A, Roohafza H, Mohammadi M, Vakili L, Abbasi MH, et al. The effect of home-based cardiac rehabilitation on depression score in patients with ischemic heart disease: A longitudinal clinical trial study. ARYA Atheroscler. 2022 Jan;18(1):1-7. https://doi.org/10.48305/arya.v18i0.2407
16. Coghill N, Cooper AR. The effect of a home-based walking program on risk factors for coronary heart disease in hypercholesterolaemic men. A randomized controlled trial. Prev Med. 2008 Jun;46(6):545-51. https://doi.org/10.1016/j.ypmed.2008.01.002
17. Meyer M, Brudy L, García-Cuenllas L, Hager A, Ewert P, Oberhoffer R, et al. Current state of home-based exercise interventions in patients with congenital heart disease: a systematic review. Heart. 2020 Mar;106(5):333-41. https://doi.org/10.1136/heartjnl-2019-315680
18. Arthur HM, Smith KM, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. Med Sci Sports Exerc. 2002 Oct;34(10):1544-50. https://doi.org/10.1097/00005768-200210000-00003
19. Gielen S, Erbs S, Linke A, Möbius-Winkler S, Schuler G, Hambrecht R. Home-based versus hospital-based exercise programs in patients with coronary artery disease: effects on coronary vasomotion. Am Heart J. 2003 Jan;145(1):E3. https://doi.org/10.1067/mhj.2003.58a
20. Lee YH, Hur SH, Sohn J, Lee HM, Park NH, Cho YK, et al. Impact of home-based exercise training with wireless monitoring on patients with acute coronary syndrome undergoing percutaneous coronary intervention. J Korean Med Sci. 2013 Apr;28(4):564-8. https://doi.org/10.3346/jkms.2013.28.4.564
21. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010 Jan 19;340:b5631. https://doi.org/10.1136/bmj.b5631
22. Astengo M, Dahl A, Karlsson T, Mattsson-Hultén L, Wiklund O, Wennerblom B. Physical training after percutaneous coronary intervention in patients with stable angina: effects on working capacity, metabolism, and markers of inflammation. Eur J Cardiovasc Prev Rehabil. 2010 Jun;17(3):349-54. https://doi.org/10.1097/HJR.0b013e3283336c8d
23. Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc. 2015 Apr;90(4):469-80. https://doi.org/10.1016/j.mayocp.2014.12.026
24. Huang K, Liu W, He D, Huang B, Xiao D, Peng Y, et al. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol. 2015 Aug;22(8):959-71. https://doi.org/10.1177/2047487314561168
25. Frederix I, Vanhees L, Dendale P, Goetschalckx K. A review of telerehabilitation for cardiac patients. J Telemed Telecare. 2015 Jan;21(1):45-53. https://doi.org/10.1177/1357633X14562732
26. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016 Jan 5;67(1):1-12. https://doi.org/10.1016/j.jacc.2015.10.044
27. Scalvini S, Zanelli E, Comini L, Dalla Tomba M, Troise G, Febo O, et al. Home-based versus in-hospital cardiac rehabilitation after cardiac surgery: a nonrandomized controlled study. Phys Ther. 2013 Aug;93(8):1073-83. https://doi.org/10.2522/ptj.20120212
28. Dagenais GR, Rouleau JR, Christen A, Fabia J. Survival of patients with a strongly positive exercise electrocardiogram. Circulation. 1982 Mar;65(3):452-6. https://doi.org/10.1161/01.CIR.65.3.452
29. Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol. 2020 Mar;27(4):367-77. https://doi.org/10.1177/2047487319892201
30. Bravo-Escobar R, González-Represas A, Gómez-González AM, Montiel-Trujillo A, Aguilar-Jimenez R, Carrasco-Ruíz R, et al. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial. BMC Cardiovasc Disord. 2017 Feb 20;17(1):66. https://doi.org/10.1186/s12872-017-0499-0
ARYA Atherosclerosis Journal
Volume 22, Issue 3
May and June 2026
Pages 67-74

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us