Telerehabilitation in older adults with cardiopulmonary diseases and multimorbidity: a randomized controlled clinical trial
DOI:
https://doi.org/10.47197/retos.v78.118765Keywords:
Comorbidity, chronic disease, functional physical performance, multicomponent exercise, telerehabilitationAbstract
Introduction. Telerehabilitation has emerged as an innovative digital health strategy aimed at expanding healthcare access and coverage for older adults with chronic diseases, particularly in settings with limited access to conventional rehabilitation services.
Objective. To compare the effects of a multicomponent telerehabilitation program versus home-based physiotherapy on functional capacity in older adults with chronic cardiopulmonary conditions and multimorbidity.
Methods. A single-center, randomized, single-blind clinical trial was conducted with 34 older adults randomly allocated to a telerehabilitation group (n = 17) or an in-person home-based physiotherapy group (n = 17). Both groups completed supervised sessions twice weekly for 12 weeks. Physical performance was assessed using the Short Physical Performance Battery (SPPB), cardiorespiratory fitness with the Six-Minute Walk Test (6MWT), and functional flexibility with the Chair Sit-and-Reach (CSR) and Back Scratch (BS) tests.
Results: Both groups significantly improved SPPB scores (p < .05). The control group improved in the 6MWT (p = .031), while the intervention group showed greater flexibility gains (p = .003). No significant between-group differences were observed (p > .05).
Conclusion: Multicomponent exercise–based telerehabilitation produced outcomes comparable to home-based physiotherapy in physical performance, cardiorespiratory fitness, and functional flexibility among adults with cardiopulmonary disease and multimorbidity.
References
Betancur Bedoya, S. P. (2025). Multicomponent Exercise Prescription Through Telerehabilitation for Older Adults With Multiple Chronic Conditions in Antioquia, Colombia. In ClinicalTrials.gov. U.S. National Library of Medicine. https://clinicaltrials.gov/study/NCT07299786
Bishop, D. J., Beck, B., Biddle, S. J. H., Denay, K. L., Ferri, A., Gibala, M. J., Headley, S., Jones, A. M., Jung, M., Lee, M. J.-C., Moholdt, T., Newton, R. U., Nimphius, S., Pescatello, L. S., Saner, N. J., & Tzarimas, C. (2025). Physical Activity and Exercise Intensity Terminology: A Joint American College of Sports Medicine (ACSM) Expert Statement and Exercise and Sport Science Australia (ESSA) Consensus Statement. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2024.11.004
Bohannon, R. W., & Crouch, R. (2017). Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. Journal of Evaluation in Clini-cal Practice, 23(2), 377–381. https://doi.org/https://doi.org/10.1111/jep.12629
Cadore, E. L., Rodriguez-Manas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of different exercise in-terventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Research, 16(2), 105–114.
Carrasco Paniagua, C., Mayordomo Cava, J., Zarralanga Lasobras, T., González Chávez, S., Ortiz Alonso, J., & Serra Rexach, J. A. (2022). Recuperación funcional al alta y a tres meses tras una interven-ción multicomponente de ejercicio físico en ancianos hospitalizados en una unidad de agudos de geriatría. Revista Española de Geriatría y Gerontología, 57(3), 156–160. https://doi.org/https://doi.org/10.1016/j.regg.2022.01.007
Charlson, M. E., Charlson, R. E., Peterson, J. C., Marinopoulos, S. S., Briggs, W. M., & Hollenberg, J. P. (2008). The Charlson comorbidity index is adapted to predict costs of chronic disease in pri-mary care patients. Journal of Clinical Epidemiology, 61(12), 1234–1240.
Chowdhury, S. R., Chandra Das, D., Sunna, T. C., Beyene, J., & Hossain, A. (2023). Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic re-view and meta-analysis. EClinicalMedicine, 57. https://doi.org/10.1016/j.eclinm.2023.101860
Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0
Colado, J. C., Pedrosa, F. M., Juesas, A., Gargallo, P., Carrasco, J. J., Flandez, J., Chupel, M. U., Teixeira, A. M., & Naclerio, F. (2018). Concurrent validation of the OMNI-Resistance Exercise Scale of percei-ved exertion with elastic bands in the elderly. Experimental Gerontology, 103, 11–16.
Collins, K. A., Huffman, K. M., Wolever, R. Q., Smith, P. J., Siegler, I. C., Ross, L. M., Hauser, E. R., Jiang, R., Jakicic, J. M., Costa, P. T., & Kraus, W. E. (2022). Determinants of Dropout from and Variation in Adherence to an Exercise Intervention: The STRRIDE Randomized Trials. Translational Jour-nal of the American College of Sports Medicine, 7(1). https://journals.lww.com/acsm-tj/fulltext/2022/01140/determinants_of_dropout_from_and_variation_in.12.aspx
Cox, N. S., Dal Corso, S., Hansen, H., McDonald, C. F., Hill, C. J., Zanaboni, P., Alison, J. A., O’Halloran, P., Macdonald, H., & Holland, A. E. (2021). Telerehabilitation for chronic respiratory disease. Coch-rane Database of Systematic Reviews, (1). https://doi.org/10.1002/14651858.CD013040.pub2
Dantas, E. H. M., Salomão, P. T., Vale, R. G. de S., Achour Júnior, A., Simão, R., & Figueiredo, N. M. A. (2008). Scale of perceived exertion in the flexibility (PERFLEX): a dimensionless tool to eva-luate the intensity. Fit Perf J, 7(5), 289–294.
Daynes, E., Barker, R. E., Jones, A. V, Walsh, J. A., Nolan, C. M., Man, W. D.-C., Singh, S. J., Greening, N. J., Houchen-Wolloff, L., & Evans, R. A. (2025). Determining the minimum important differences for field walking tests in adults with long–term conditions: a systematic review and meta-analysis. European Respiratory Review, 34(176), 240198. https://doi.org/10.1183/16000617.0198-2024
Di Lorito, C., Long, A., Byrne, A., Harwood, R. H., Gladman, J. R. F., Schneider, S., Logan, P., Bosco, A., & van der Wardt, V. (2021). Exercise interventions for older adults: A systematic review of meta-analyses. Journal of Sport and Health Science, 10(1), 29–47. https://doi.org/https://doi.org/10.1016/j.jshs.2020.06.003
Echeverri, E. R., Ulloa, D. C. G., Bedoya, S. P. B., Toro, S. G., & García, J. I. (2019). Efectividad de una in-tervención educativa en estilos de vida saludables, en el conocimiento y comportamiento en pacientes post-rehabilitación cardiaca. Revista de Investigación e Innovación En Ciencias de La Salud, 1(2), 59–75.
Fyfe, J. J., Sousa, F., Watson-Mackie, K., Jansons, P., Scott, D., & Daly, R. M. (2025). Remote physical fun-ction testing in older adults: a mixed methods study exploring test reliability, feasibility, and perceptions of participants and assessors. PLOS ONE, 20(9), e0332691-. https://doi.org/10.1371/journal.pone.0332691
Gamble, CJ, van Haastregt, JCM, van Dam van Isselt, EF, Zwakhalen, SMG, & Schols, JMGA. (2023). Ef-fectiveness of guided telerehabilitation on functional performance in community-dwelling ol-der adults: A systematic review. Clinical Rehabilitation, 38(4), 457–477. https://doi.org/10.1177/02692155231217411
Gómez, J. F., Curcio, C.-L., Alvarado, B., Zunzunegui, M. V., & Guralnik, J. (2013). Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes. Colombia Medica, 44(3), 165–171.
Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., Scherr, P. A., & Wallace, R. B. (1994). A Short Physical Performance Battery Assessing Lower Extremity Fun-ction: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission. Journal of Gerontology, 49(2), M85–M94. https://doi.org/10.1093/geronj/49.2.M85
Hassan, M. G., Mohamed Ali, A. F., Samy, H., Hamdy, M., Abdelkarim Attia, A. S., El-Din, S. S., Mahmoud Ahmed, S. S., Mabrouk Bondok, S. M., Abdelaziz, S. S., Hassan, E. J., & Hassan, S. S. (2025). Tele-rehabilitación para el síndrome del túnel carpiano: un nuevo estilo de tratamiento con nuevas posibilidades: un ensayo controlado aleatorio. Retos, 72, 1141-1150. https://doi.org/10.47197/retos.v72.117333
Hay, S. I., Ong, K. L., Santomauro, D. F., A, B., Aalipour, M. A., Aalruz, H., Ababneh, H. S., Abaraogu, U. O., Abate, B. B., Abbafati, C., Abbas, N., Abbasifard, M., Abbasi-Kangevari, M., Abd ElHafeez, S., Abda-lla, A. N., Abdalla, M. A., Abdallah, E. M., Abdeeq, B. A., Abdel Razeq, N. M. I., … Gakidou, E. (2025). Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 406(10513), 1873–1922. https://doi.org/10.1016/S0140-6736(25)01637-X
Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., Altman, D. G., Barbour, V., Macdonald, H., & Johnston, M. (2014). Better reporting of interventions: template for interven-tion description and replication (TIDieR) checklist and guide. Bmj, 348.
Man, S.-S., Wen, H., Chiu, K.-T., Wang, F., & Chan, H.-S. (2024). Effectiveness of telephysiotherapy in im-proving older adults’ physical and psychological outcomes: a systematic review and meta-analysis. Healthcare, 12(17), 1775.
Moffat, K., & Mercer, S. W. (2015). Challenges of managing people with multimorbidity in today’s healthcare systems. BMC Family Practice, 16(1), 129. https://doi.org/10.1186/s12875-015-0344-4
Ora, J., Prendi, E., Attinà, M. L., Cazzola, M., Calzetta, L., & Rogliani, P. (2022). Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Archives for Chest Disease, 92(4).
Organization, W. H. (2015). World report on ageing and health. World Health Organization. https://apps.who.int/iris/handle/10665/186463
Ozemek, C., Bonikowske, A., Christle, J., & Gallo, P. (2025). ACSM’s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.
Page, P., Hoogenboom, B., & Voight, M. (2017). Improving the reporting of therapeutic exercise inter-ventions in rehabilitation research. International Journal of Sports Physical Therapy, 12(2), 297.
Pavasini, R., Guralnik, J., Brown, J. C., di Bari, M., Cesari, M., Landi, F., Vaes, B., Legrand, D., Verghese, J., Wang, C., Stenholm, S., Ferrucci, L., Lai, J. C., Bartes, A. A., Espaulella, J., Ferrer, M., Lim, J.-Y., Ensrud, K. E., Cawthon, P., … Campo, G. (2016). Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Medicine, 14(1), 215. https://doi.org/10.1186/s12916-016-0763-7
Pollentier, B., Irons, S. L., Benedetto, C. M., DiBenedetto, A.-M., Loton, D., Seyler, R. D., Tych, M., & New-ton, R. A. (2010). Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Cardiopulmonary Physical Therapy Journal, 21(1), 13–21.
Porcari, J. P., Foster, C., Cress, M. L., Larson, R., Lewis, H., Cortis, C., Doberstein, S., Donahue, M., Fusco, A., & Radtke, K. (2021). Prediction of exercise capacity and training prescription from the 6-minute walk test and rating of perceived exertion. Journal of Functional Morphology and Kine-siology, 6(2), 52.
Project, T. jamovi. (2024). jamovi (Version 2.6) [Computer Software]. https://www.jamovi.org
Ramachandran, H. J., Jiang, Y., Tam, W. W. S., Yeo, T. J., & Wang, W. (2022). Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis. European Journal of Preventive Cardio-logy, 29(7), 1017–1043. https://doi.org/10.1093/eurjpc/zwab106
Richmond, T., Peterson, C., Cason, J., Billings, M., Terrell, E. A., Lee, A. C. W., Towey, M., Parmanto, B., Saptono, A., & Cohn, E. R. (2017). American Telemedicine Association’s principles for delivering telerehabilitation services. International Journal of Telerehabilitation, 9(2), 63.
Ross, R. M., Murthy, J. N., Wollak, I. D., & Jackson, A. S. (2010). The six minute walk test accurately es-timates mean peak oxygen uptake. BMC Pulmonary Medicine, 10(1), 31.
Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: updated guidelines for re-porting parallel group randomised trials. Journal of Pharmacology and Pharmacotherapeutics, 1(2), 100–107.
Solis-Navarro, L., Gismero, A., Fernández-Jané, C., Torres-Castro, R., Solá-Madurell, M., Bergé, C., Pérez, L. M., Ars, J., Martín-Borràs, C., Vilaró, J., & Sitjà-Rabert, M. (2022). Effectiveness of home-based exercise delivered by digital health in older adults: a systematic review and meta-analysis. Age and Ageing, 51(11), afac243. https://doi.org/10.1093/ageing/afac243
Wicks, A., & al., et. (2023). Physiotherapist-led, exercise-based telerehabilitation for older adults: A sys-tematic review. Age and Ageing, 52(11). https://academic.oup.com/ageing/article/52/11/afad207/7425518
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Copyright (c) 2026 Silvia Patricia Betancur Bedoya, Sebastian Grajales Toro, Catalina Lopera Muñeton, Lina Giccela Suarez Muñoz, Fanny Valencia Legarda, Antonia Gonzalez Garrido

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