Implementation and functional capacity outcomes of a two-phase hybrid cardiac rehabilitation programme: a mixed-methods study

Background

Cardiac telerehabilitation (CTR) programmes have been shown to be a non-inferior alternative or complement to centre-based cardiac rehabilitation (CR). Although their clinical effectiveness has been established, the general implementation remains understudied.

Purpose

This study aims to assess the acceptability, appropriateness, and feasibility of a two-phase hybrid CR programme, and to describe patient satisfaction, willingness to pay and functional outcomes.

Methods

All patients initiating CR between September 2024 and April 2025 were invited to participate in a prospective, single-arm mixed method programme: (1) 3–6 months of centre-based CR combined with remote monitoring via a wearable activity tracker, followed by (2) 6 months of home-based monitoring. Individual weekly step and activity-intensity goals were defined, with daily monitoring of steps, heart rate and activity-intensity minutes. Questionnaires were completed at baseline (T0), 6 months (T1) and 12 months (T2).

Implementation outcomes were assessed using Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM) (1). Satisfaction and willingness to pay were assessed using additional questionnaires. Functional capacity was assessed by CPET (VO₂peak) at T0 and T1.

Focus groups explored patient experience and implementation barriers/enablers.

Results

A total of 239 participants were included in this study.

Implementation outcomes were high: AIM showed 88.3% agreement and 11.7% neutrality; IAM showed 79.9% agreement and 2.1% strong agreement; FIM showed 92.7% agreement and 7.3% neutrality. Satisfaction showed 95.3% agreement and 4.7% strong agreement.

There was a statistically significant difference in peak VO2 between T0 and T1 (p < 0.0001; mean difference 1.5 ± 2.9 ml/kg/min). Most participants (45.6%) were willing to pay a modest monthly fee between €1-29, while 37.5% reported no willingness to pay and only 16.9% accepted higher amounts (>€29). Focus groups revealed a preference for hybrid rehabilitation, combining remote monitoring with in-person support, and highlighted the need for clearer communication and feedback.

Conclusions

A two-phase hybrid CR programme is an acceptable, appropriate, and feasible model of CR and is associated with significant improvements in functional capacity. Participants preferred a hybrid approach, but highlighted the need for clearer communication about programme structure and more consistent feedback on their activity-intensity goals.