BACKGROUND: Cardiovascular diseases remain the most common causes of death in the world. Instructions for secondary prevention recommend multifaceted approach in cardiovascular diseases risk management. Center-based physical exercise training is considered as an important integral part of cardiac rehabilitation (CR). Despite all recognized benefits CR brings, active interest of patients remains low in many countries, including the Czech Republic. That is why there is a need to focus on more effective patients' participation in CR with respect to their preferences and needs. One of possible approaches is using telemonitoring guidance based on obtaining data via technological equipment during home exercise training. The aim of this study is to compare effectiveness of both center- and home-based exercise training with focus on participants' physical fitness and quality of life. METHODS/DESIGN: This randomized control trial intends to monitor cardiorespiratory health indicators and quality of life of patients diagnosed with a coronary artery disease (CAD) at the University Hospital Brno, Czech Republic. These patients will be randomly separated into 2 groups-a regular outpatient group (ROT) and an intervention training group (ITG). Both groups undergo a 12-week rehabilitation training program. The ROT group will undergo center-based exercise trainings in the hospital and receive feedback and support directly by their coach. The ITG group will be telemonitored during exercise training in their home environment via a wrist sport tester and Internet application.All patients will be supposed to exercise at 70% to 80% of their heart rate reserve obtained from cardiopulmonary exercise test (CPX). The primary outcome is to measure and compare physical fitness values assessed at baseline and after 12 weeks of training. Physical fitness is expressed as peak oxygen uptake assessed by the CPX test. The secondary outcomes are patients, training adherence, and their quality of life. DISCUSSION: This trial focuses on an up-to-date topic. As there have not been any similar trials in the Czech Republic yet, we expect it to bring great benefits not only for our hospital in Brno. In the long term, this method seems to be low-cost for all participants and brings a lot of benefits for those patients, who are for many reasons unable to participate in center-based CR provided by hospitals and other health care centers. Physical exercise therapy brings good results in reducing cardiovascular risk factors and improves its global impact. Thanks to its simplicity, it is expected to increase patients' training adherence as well.

Department of Rehabilitation University Hospital Brno Department of Internal Cardiology Medicine Institutions Shared with the Faculty Hospital Brno Adult Age Medicine Faculty of Medicine Brno Brno Czech Republic

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World Health Organization. World Health Statistics 2015. World Health Organization; 2015. Available at: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2015_Part2.pdf?ua=1.

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133:E38–60. PubMed

Eurostat. Causes of Death Statistics. Available at: http://ec.europa.eu/eurostat/statistics-explained/index.php?title=File:Causes_of_death_%E2%80%94_standardised_death_rate,_2014_(per_100_000_inhabitants)_YB17.png.

Czech Statistical Office. Results of the Health Accounts of the Czech Republic 2010–2015, 3. Specific results on healthcare expenditure [Výsledky zdravotnických účtů ČR 2010–2015, 3. Specifické výsledky o výdajích na zdravotní péči]. Available at: https://www.czso.cz/documents/10180/46013402/26000517k3.pdf/336a6bba-ad7c-4860-a40f-6c0731e34aef?version=1.0.

Czech Statistical Office. The most important is the treatment of heart and vascular diseases [Nejvíc stojí léčba nemocí srdce a cév]. Available at: https://www.czso.cz/csu/czso/nejvic-stoji-lecba-nemoci-srdce-a-cev.

Czech Statistical Office. Development of mortality in the Czech Republic—2006-2016 [Vývoj úmrtnosti v České republice—2006-2016]. Available at: https://www.czso.cz/csu/czso/nejvic-stoji-lecba-nemoci-srdce-a-cev.

Dunbar SB, Khavjou OA, Bakas T, et al. Projected costs of informal caregiving for cardiovascular disease: 2015 to 2035: a policy statement from the American Heart Association. Circulation 2018;137:e558–77. PubMed

Piepoli MF, Hoes AW, Brotons C, et al. Main messages for primary care from the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur J Gen Pract 2018;24:51–6. PubMed PMC

Heran BS, Chen JMH, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;1:93. PubMed PMC

Dosbaba F, Vysoký R, Bat’alík L, et al. Nearly a quarter of a century of cardiovascular rehabilitation at the Faculty Hospital in Brno, or 1500 patients in an outpatient program [Téměř čtvrt století Kardiovaskulární rehabilitace ve Fakultní nemocnici Brno, aneb 1500 pacientů v ambulantním programu]. J Medicina Sportiva Bohemica et Slovaca 2017;26:22–8.

Ragupathi L, Stribling J, Yakunina Y, et al. Availability, use, and barriers to cardiac rehabilitation in LMIC. Glob Heart 2017;12:323–34. PubMed

van Engen-Verheul M, de Vries H, Kemps H, et al. Cardiac rehabilitation uptake and its determinants in the Netherlands. Eur J Prev Cardiol 2013;20:349–56. PubMed

Mampuya WM. Cardiac rehabilitation past, present and future: an overview. Cardiovasc Diagn Ther 2012;2:38–49. PubMed PMC

Buckingham SA, Taylor RS, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis. Open Heart 2016;3:e000463. PubMed PMC

Smith KM, McKelvie RS, Thorpe KE, et al. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery. Heart 2011;97:1169–74. PubMed

Piepoli MF, Corrà U, Adamopoulos S, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol 2014;21:664–81. PubMed

Clark RA, Conway A, Poulsen V, et al. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol 2015;22:35–74. PubMed

Marcolino MS, Oliveira JAQ, D’Agostino M, et al. The impact of mHealth interventions: systematic review of systematic reviews. JMIR Mhealth Uhealth 2018;6:e23. PubMed PMC

Chow CK, Redfern J, Hillis GS, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. JAMA 2015;314:1255–63. PubMed

Frederix I, Solmi F, Piepoli MF, et al. Cardiac telerehabilitation: a novel cost-efficient care delivery strategy that can induce long-term health benefits. Eur J Prev Cardiol 2017;24:1708–17. PubMed

Maddison R, Pfaeffli L, Whittaker R, et al. A mobile phone intervention increases physical activity in people with cardiovascular disease: results from the HEART randomized controlled trial. Eur J Prev Cardiol 2015;22:701–9. PubMed

Worringham C, Rojek A, Stewart I. Development and feasibility of a smartphone, ECG and GPS based system for remotely monitoring exercise in cardiac rehabilitation. PLoS One 2011;6:e14669. PubMed PMC

Kraal JJ, Van den Akker-Van Marle ME, Abu-Hanna A, et al. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study. Eur J Prev Cardiol 2017;24:1260–73. PubMed PMC

Vysoký R, Fiala J, Dosbaba F, et al. Preventive training programme for patients after acute coronary event. correlation between selected parameters and age groups. Cent Eur J Public Health 2015;23:208–13. PubMed

Suresh K, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci 2012;5:7–13. PubMed PMC

Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016;67:1–2. PubMed

Powell R, McGregor G, Ennis S, et al. Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence. BMJ Open 2018;8:e019656. PubMed PMC

Claes J, Buys R, Budts W, et al. Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: a systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:244–56. PubMed

Ruano-Ravina A, Pena-Gil C, Abu-Assi E, et al. Participation and adherence to cardiac rehabilitation programs. A systematic review. Int J Cardiol 2016;223:436–43. PubMed

Shields GE, Wells A, Doherty P, et al. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart 2018;104:1403–10. PubMed PMC

Rawstorn JC, Gant N, Direito A, et al. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Heart 2016;102:1183–92. PubMed

Frederix I, Hansen D, Coninx K, et al. Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: a cost-effectiveness analysis. Eur J Prev Cardiol 2016;23:674–82. PubMed

Remotely monitored telerehabilitation for cardiac patients: A review of the current situation

Benefits and effectiveness of using a wrist heart rate monitor as a telerehabilitation device in cardiac patients: A randomized controlled trial

Translation and validation of the cardiac rehabilitation barriers scale in the Czech Republic (CRBS-CZE): Protocol to determine the key barriers in East-Central Europe