Investigation of the effectiveness of different telerehabilitation applications in hypertensive individuals

Hypertension (HT) is a chronic disease characterized by impairment in exercise capacity, cardiovascular functions, and elevated blood pressure. The development of HT can be prevented and blood pressure can be controlled by improving exercise capacity. This randomized controlled study aimed to investigate the effects of 8-week calisthenic-based exercise training applied with synchronous and asynchronous telerehabilitation methods on exercise capacity, cardiovascular disease risk, physical activity level, peripheral muscle function, balance, body composition, systolic and diastolic functions, patient satisfaction and attitudes towards telemedicine, electronic health literacy, self-care level, and healthy lifestyle behaviors, and to compare the effectiveness of different telerehabilitation interventions. A total of 31 hypertensive individuals were included in the study and randomly divided into 2 groups: synchronous (n=16) and asynchronous (n=15) telerehabilitation. While the synchronous telerehabilitation group received supervised exercise training with a physiotherapist for 8 weeks, the asynchronous telerehabilitation group received the same exercise videos and asked to exercise unsupervised. Individuals' exercise capacities were assessed with the 6-minute stepper test and maximal stress test, cardiovascular disease risks with the SCORE Turkey assessment tool, physical activity level with the International Physical Activity Questionnaire and smartwatch, peripheral muscle function with the squat and plank test, balance levels with the Functional Reach Test, body composition with anthropometric measurement and bioelectrical impedance analysis, systolic and diastolic functions with echocardiography, patient satisfaction with the visual analog scale and the Telemedicine Satisfaction and Usefulness Questionnaire, electronic health literacy with the Electronic Health Literacy Scale, attitudes towards telemedicine with the Telemedicine Patient Survey, self-care level with the Hypertension Self-Care Inventory Version 3.0, and healthy lifestyle behaviors with the Healthy Lifestyle Behaviors Scale. Although there was a statistically significant improvement in exercise capacity assessed with the 6-minute stepper test and oxygen consumption predicted by the maximal stress test in all groups, the improvement was observed to be greater in the synchronous telerehabilitation group (p<0.05). Although an increase was observed in the physical activity levels of the groups, the improvement in physical activity levels was similar (p>0.05). In addition, there were improvements in peripheral muscle functions, balance, body composition, systolic and diastolic functions, self-care level, healthy lifestyle behaviors, electronic health literacy, and attitudes towards telemedicine in the synchronous and asynchronous telerehabilitation groups with exercise training (p<0.05). A high satisfaction rate was found in all groups and the satisfaction levels of the groups were similar (p>0.05). In our study of hypertensive individuals, exercise capacity, which is the primary outcome measure, increased more in synchronous telerehabilitation than asynchronous telerehabilitation (p<0.05). In hypertension, a preventable cardiac risk factor with high morbidity and mortality rates worldwide, significant improvements in exercise capacity, physical activity, and healthy living behaviors can be achieved with synchronous and asynchronous telerehabilitation applications. In the selection of the appropriate telerehabilitation method within the scope of cardiac rehabilitation applications; the desired benefits of exercise training, current conditions, and the patient's preference should be taken into consideration.