Across 13 randomized controlled trials enrolling 958 adults with cardiovascular disease, exercise-focused telerehabilitation produced a mean improvement in VO₂ peak of 2.58 mL/kg/min (95% CI 1.16–4.00, P=.003) compared with usual care. No significant pooled effect emerged for systolic or diastolic blood pressure. Heterogeneity was substantial (I²=74.45%), and the prediction interval crossed zero, meaning the average benefit may not reliably reproduce across all clinical settings.
A 2–3 mL/kg/min gain in VO₂ peak is clinically meaningful — prior epidemiological work associates each 1 mL/kg/min increment with roughly a 10–13% reduction in cardiovascular mortality risk, suggesting this magnitude of improvement could translate to measurable survival benefit. What distinguishes this meta-analysis is its deliberate isolation of exercise as the primary therapeutic variable, stripping out bundled health education, dietary counseling, and psychological support that cloud most earlier telerehabilitation reviews — a methodologically important design choice that strengthens causal attribution to exercise itself.
Limitations are real: only 13 trials and under 1,000 participants, high between-study heterogeneity, and incomplete blood pressure data limit confidence. Evidence certainty via GRADE is likely moderate at best. The null blood pressure finding may reflect insufficient intervention duration, dose variation, or inadequate power across included trials. Still, for cardiologists and rehabilitation physicians, this adds weight to the case that remote, exercise-centered programmes can deliver cardiorespiratory gains comparable to centre-based rehabilitation — a practically important finding given access barriers.
