Journal of Clinical Exercise Physiology · Mar 2026
The iATTEND Trial: Hybrid Versus Standard Cardiac Rehabilitation in Older Adults
By Keteyian SJ, Grimshaw C, Ehrman JK et al.
Background: Among older patients eligible to participate in cardiac rehabilitation (CR), both attendance and completion rates decrease with increasing age. This study is a secondary analysis of data from the iATTEND (Improving Attendance to Cardiac Rehabilitation) trial and explores the effects of traditional, facility-based only CR (FBCR) vs. hybrid CR (HYCR) with synchronized virtual sessions in older patients. Methods: Patents age 65 years or older (n = 95) participated in FBCR or a combination of in-facility and virtual CR sessions (i.e., HYCR). Virtual CR was supervised by CR staff via synchronized audiovisual technology. Patients in HYCR were asked to complete no more than 12 of their CR sessions in a facility, with the balance completed at home or in the community. Testing at baseline and after CR assessed changes in exercise capacity (i.e., 6-min walk distance, peak oxygen uptake) and health status (Dartmouth Cooperative). Results: Neither the total number of CR sessions completed per patient (32 ± 9 vs. 30 ± 11, adjusted P = 0.87) nor the percentage of patients completing 36 sessions (71% vs. 63%, adjusted P = 0.68) was different between FBCR versus HYCR, respectively. Within both study groups, the changes in exercise capacity were significant ( P < 0.005), with no significant differences between groups. Similarly, no significant between-group differences were observed for self-reported health status. Conclusion: HYCR with virtual CR sessions is likely associated with similar attendance rates when compared with in-person FBCR, along with similar improvements in exercise capacity and health status. For older persons, virtually supervised CR could be considered an effective alternative to FBCR.