Remote Exercise SWEDEHEART Study — a Multicentre Registry-based Cluster Randomised Crossover Clinical Trial (RRCT)

Remote Exercise SWEDEHEART

Patient / Population Intervention / Exposure Comparison Outcome

In 3,112 patients after myocardial infarction referred to cardiac rehabilitation, a choice of video-delivered remote exercise did not increase the number of supervised sessions attended compared with centre-based exercise only.

N

3,112patients

Design

registry-based (SWEDEHEART) cluster-randomised crossover; Swedish cardiac rehabilitation centres randomised to begin as intervention or control centres for a 15-month period, then cross over; open-label; primary outcome at 3–4 months; MACE follow-up at 1 and 3 years; cost-effectiveness analysis planned

Endpoint

Mean number of supervised exercise-based cardiac rehabilitation sessions (centre-based or remote) attended per patient during months 0–4 from programme start, by centre and randomisation period

Relevance

2Important — one of several pillars.

ResultNo difference in participation: 13.8% vs 13.6% completed the full programme. Remote sessions made up about 38% of recorded exercise during the intervention periods, exercise capacity improved equally, and serious adverse events were rarer remotely (0.17 vs 0.47 per 1,000 patient-hours).

Bäck M, et al. Presented at ESC Congress 2026, Hot Line 5, 29 August.

Discussion & critique

Offering video-delivered exercise did not get more patients through cardiac rehabilitation — participation stayed at about one in seven either way. What it did was shift where the exercise happened: 38% of sessions moved home, at the same gain in capacity and with fewer serious adverse events per hour. That makes remote delivery a route for people who cannot reach a centre, not a fix for the participation problem, which is where the field keeps hoping technology will help. Cluster-randomised crossover in the SWEDEHEART registry, so what is tested is the offer, not the exercise.