Home-based and remote functional exercise testing in cardiac conditions, during the covid-19 pandemic and beyond: a systematic review

Background With the change in healthcare to one that adopts a greater reliance on remote delivery, guidance regarding functional exercise testing, either in-person in the home or performed remotely, is urgently needed for people with cardiac conditions. Objectives To identify functional exercise tests that have been conducted in the home or remotely in patients with cardiac conditions. Data sources A search was undertaken across four electronic databases and grey literature for English language publications without time restrictions. Study eligibility criteria Studies of any designs were selected if they reported an exercise test conducted at home or remotely in patients with cardiac conditions. Study appraisal and synthesis Studies were independently screened and graded by two reviewers according to the Downs and Black checklist. A narrative synthesis of the included studies was undertaken. Results Five studies (six articles) were included, with a total of 438 patients with cardiac conditions. Tests used at home or remotely were the 6-minute walk test (6MWT, five studies) and the timed up and go test (one study). No studies reported the use of step tests in the home or remotely. The 6MWTs were administered via a smartphone application, rope, videoconferencing and accelerometer and proved to be feasible, valid and reliable. Conclusions Despite a marked demand for home-based exercise programs, the 6MWT remains the most commonly administered functional exercise test for people with cardiac conditions. Surprisingly few studies have explored alternative tests for this patient population that may be more suitable for home or remote performance.