Cardiac rehab used to mean one pretty specific thing: show up at the hospital or rehab center, get monitored, exercise, talk meds and lifestyle, repeat. The newer version is more like the hybrid work model of healthcare. Some of it still happens with the team, and some of it happens from home. Same mission, different logistics. One is the supervised team practice. The other is the playbook plus remote coaching. And just like in sports, the interesting question is not which setup looks cooler on paper. It is which one actually helps people get results.
That is what this prospective cohort study set out to examine. Researchers compared traditional centre-based cardiac rehabilitation, or cbCR, with hybrid cardiac telerehabilitation, or hCTR, in people with cardiovascular disease. The headline is pretty straightforward: patients who chose the hybrid option started out a bit younger and healthier, but both rehab approaches led to similar gains in most physical and mental health outcomes. The main exception was cholesterol control, where centre-based rehab came out ahead.
Why cardiac rehab matters in the first place
Cardiac rehab is one of those things clinicians love recommending and patients often underestimate. It is not just treadmill time with a clipboard nearby. A solid rehab program usually combines exercise training, education, risk factor management, medication support, and help getting confidence back after a heart event or ongoing cardiovascular illness.
As a former paramedic, I can tell you the medical system is very good at the dramatic part. Lights, alarms, scans, stents, the whole orchestra. What is harder is the slow, unglamorous part afterward: rebuilding endurance, taking the right meds, changing routines, and keeping blood pressure, cholesterol, and blood sugar in range when nobody is standing over your shoulder. That is where rehab earns its keep.
The problem is that traditional centre-based rehab can be hard to attend. Travel, work schedules, caregiving, mobility issues, and plain old life can get in the way. Hybrid telerehab tries to lower that barrier by bringing part of the process home.
What the study looked at
The study enrolled consecutive patients at a tertiary center between May 2022 and December 2023 into a 3-month rehab program. Patients entered either centre-based rehab or hybrid telerehabilitation through shared decision-making, meaning they chose their path with input from the care team rather than being randomly assigned.
Out of 1,292 patients screened, 406 were eligible and completed the study. About 21 percent were female, and the average age was 60.4 years. Most patients, 72 percent, chose centre-based rehab. The remaining 28 percent chose the hybrid option.
Researchers then compared how the two groups changed from the start of rehab to discharge. They looked at exercise capacity, anxiety, depression, health-related quality of life, and whether patients hit guideline-based targets for blood pressure, LDL cholesterol, and HbA1c in those with diabetes.
That is a good set of measures because it covers both how people feel and how their cardiovascular risk profile is moving. In other words, not just "Can you walk farther?" but also "Are the numbers getting better?"
Who picked which option
This is where the study gets especially interesting. People who chose hybrid telerehab were, on average, about 3 years younger. They also had better baseline peak VO2, better health-related quality of life, and lower depression and anxiety scores at the start.
That matters because the groups were not starting from the same spot. The hybrid group was not exactly playing on rookie mode, but they did walk onto the field with fresher legs.
This is one of the built-in challenges of studying self-selected care models. Choice is valuable in the real world, but it also means the comparison is not perfectly apples to apples. People who feel stronger, more independent, or more comfortable with remote care may naturally lean toward hybrid programs.
What improved, and what did not differ much
Despite those baseline differences, both groups improved similarly on most major outcomes.
Researchers found no significant differences between centre-based and hybrid rehab in changes in physical functioning or mental functioning. That includes exercise-related improvement as well as changes in anxiety, depression, and overall quality of life. Blood pressure target achievement and HbA1c target achievement in patients with diabetes were also similar between groups.
That is a meaningful result. It suggests hybrid telerehab can deliver much of the same benefit as traditional centre-based rehab for many patients, at least over a 3-month period. For health systems trying to expand access, that is not a minor detail. It is the difference between one-size-fits-most and something more flexible.
From a patient perspective, that flexibility matters. If getting to rehab means taking half a day off work, arranging rides, or coordinating family schedules like an air traffic controller, a hybrid model may make sticking with rehab more realistic.
The cholesterol wrinkle
There was one notable difference. A smaller proportion of patients in hybrid telerehab reached the LDL cholesterol Step I target at discharge. In the centre-based group, 69 percent hit that goal. In the hybrid group, 56 percent did.
That gap does not necessarily mean hybrid rehab is weak. It may mean that some parts of rehab are easier to reinforce face to face, especially medication counseling, adherence nudges, and the small repeated conversations that slowly move the needle. Anyone who has worked in healthcare knows that "Take this every day" can require about seventeen follow-up conversations, two reminder calls, and one deeply personal relationship with a pill organizer.
The authors suggest tighter lipid control in the centre-based group could be linked to more intense counseling or to differences in patient preference. That is a sensible interpretation. It also points to an area where hybrid programs may need to get sharper, especially around cholesterol management.
What this means in the real world
The big takeaway is not that one format crushed the other. It is that hybrid cardiac telerehabilitation appears to be a legitimate option for many patients, particularly when access or convenience is a limiting factor.
That matters because participation in cardiac rehab has always had a logistics problem. The benefits can be clear, but the path to getting those benefits is not always easy. Hybrid models may help more people actually engage with rehab instead of admiring it from a distance like a gym membership they swear they are going to use next Monday.
At the same time, this study is a reminder that convenience and clinical follow-through are not always the same thing. If hybrid rehab expands, programs may need stronger systems for monitoring cholesterol management, adjusting medications, and keeping patients engaged with the less glamorous parts of prevention.
A fair reading of the study
This was a prospective cohort study, not a randomized trial, so it cannot prove the two approaches are interchangeable in every setting or for every patient. The fact that healthier, younger patients were more likely to choose hybrid care is a real limitation when interpreting results.
Still, that self-selection is also part of the point. In actual practice, patients do make choices based on comfort, schedule, confidence, and support at home. So while the design is less tidy than a randomized study, it may reflect real clinical life better than the neat version we all pretend exists.
For patients and clinicians, the message is practical. Hybrid rehab is not just a backup plan for when the clinic is inconvenient. It may be a strong option in its own right. But if a patient needs more hands-on support, especially around medication and lipid goals, centre-based rehab may still offer an edge.
This blog post discusses research findings and should not be taken as medical advice. If you have concerns about heart disease or cardiac rehabilitation, please consult a healthcare provider. Research discussed here represents ongoing scientific investigation and clinical validation is still in progress.
All images used in this post are decorative illustrations only and do not represent or reflect the accuracy, reality, or correctness of the referenced research.
Primary Source: PubMed Record 40184412. Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study. https://pubmed.ncbi.nlm.nih.gov/40184412/