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

INTRODUCTION & AIMS Videoconferencing exercise interventions (VC) involve the synchronous and remote delivery of exercise via a video-linked appointment. A 2022 review investigated the effectiveness and feasibility of VC for people with chronic disease. Considering the emergence of recent trials, this review aimed to investigate these findings with high-quality contemporary evidence. METHODS Databases were searched from 1st August 2021 (last date searched in previous review) to April 30th 2023 for randomised controlled trials (RCTs) VC in chronic disease. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life for RCTs to determine effectiveness. Standardised Mean Difference (SMD) for pre-post quality of life data was used to combine assessment methods. Feasibility was assessed via session attendance rates, adherence to exercise prescription, safety, technical issues and participant satisfaction. Risk of bias was analysed using the Downs & Black (D&B) quality checklist and the certainty of evidence with GRADE. RESULTS Sixteen trials were included in the updated review. RCT-only meta-analyses identified effects favouring VC for exercise capacity (6MWT; Mean Difference (MD)=31.0m (95% CI: 8.3 to 53.6m), p=0.007) and quality of life (SMD=0.365 (95% CI: 0.096 to 0.633), p=0.008) in studies with non-exercising comparators. An effect favouring VC was observed for quality of life in exercising comparator studies (SMD=0.335 (95% CI: 0.078 to 0.592), p=0.011) but not for exercise capacity (MD=4.6m (95% CI: -7.4 to 16.7m), p=0.451). The RCT-only analysis identified good risk of bias (D&B: 20.7±2.7/28), with GRADE certainty ratings of ‘Moderate’ for quality of life and exercise capacity outcomes. Of the new RCTs, session attendance was 74%, no serious adverse events related to VC were identified, 33% of sessions experienced technical issues and positive satisfaction outcomes were identified. CONCLUSION In patients with chronic disease, videoconferencing exercise interventions are feasible and effective for improving exercise capacity and quality of life.