Heart failure (HF) is a prevalent condition, affecting about 26 million patients worldwide.^1,2 Guidelines of the European Society of Cardiology, American Heart Association, and American College of Cardiology suggest creation of holistic management for patients with HF, which contains appropriate pharmacological and device therapy, cardiac rehabilitation (CR), remote monitoring of cardiovascular implantable electronic devices (CIEDs), and regular follow-up.^1-5 The ideal would be to organize ambulatory outpatient care, enabling patients with HF to maintain the improvement obtained during hospitalization. For this reason, the novel HF care model should focus on the optimal outpatient care to reduce rehospitalizations and improve the prognosis of patients with HF, leading to beneficial effects on patients’ conditions and health care system cost reduction.^1-4 Guidelines recommend CR that uses patient education, health behavior modification, and exercise training (an 1A recommendation) to improve secondary prevention outcomes in patients with HF.^1-4,6 Unfortunately, CR programs are considerably underused, with only about 20% of eligible patients participating in one.^7,8 Factors hindering CR include a lack of resources (eg, a lack of caregivers, long waiting lists) as well as logistical and psychological problems (eg, transportation issues, the need to be assisted by relatives or partners, a lack of motivation, nonacceptance of the proposed CR models).^9,10 The development of new technologies provides the opportunity to include telemedicine in the organization of outpatient HF care.^10,11 However, the results of studies focused on remote management of patients with HF have been inconsistent.^12-18 A new promising solution that overcomes the barriers to CR and at the same time provides guideline-consistent monitoring of physical training in patients at moderate and high risk is telerehabilitation.^6,10,11,19 Yet, to date, only a handful of single-center studies have demonstrated that telerehabilitation is safe, effective, and noninferior to a hospital-based or outpatient-based rehabilitation of patients with HF.^19-24 Therefore, the consensus document of the European Society of Cardiology Heart Failure Association Working Group⁴ and scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology⁶ indicate that home-based CR using telemedicine is a promising direction, but the results should be confirmed by multicenter studies.

Comprehensive cardiac rehabilitation (CR) is a mainstay of the secondary prevention of cardiovascular disease. In the European Society of Cardiology guidelines, comprehensive cardiovascular rehabilitation has the highest class of recommendation and level of evidence as an effective method for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndrome, for CVD prevention in clinical practice, and in patients with heart failure (HF). This document presents an expert opinion of the Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society concerning the definition, goals, target population, organization of rehabilitation services, standard clinical indications and methods of implementation. Moreover, it describes psychosocial risk factors influencing the course of CR and secondary prevention of cardiovascular disease in patients undergoing CR. Comprehensive CR is as a process that should be implemented as soon as possible, continued without interruption, and consist of multiple stages. Moreover, it should be tailored to the individual clinical situation and should be accepted by the patient and their family, friends, and caregivers.

Background: The COVID-19 pandemic forced reorganization of the multidisciplinary healthcare system for Duchenne muscular dystrophy. Digital solutions seem to be optimal for providing rehabilitation at this time. The aim of this study was to investigate whether it is possible to conduct respiratory physical therapy with the use of telerehabilitation in Duchenne muscular dystrophy. Methods: The study was conducted during an online conference for families with DMD. During the physical therapy panel we showed the video with the instructions of respiratory exercises. All participants (n = 152) were asked to fill in the online survey evaluating the quality, acceptance, and understanding of the instructions. Results: The survey was filled in by 45 (29.6%) participants. The mean rating of satisfaction was 4.70/5, and for intelligibility was 4.78/5. Thirty-seven (82.2%) patients declared that they had performed the exercises, all caregivers declared that it was possible to perform the proposed exercises a few times a week or daily, and only two respondents replied to invitations to individual online sessions. Conclusions: Findings from the study show that respiratory telerehabilitation may be implemented for DMD patients; however, the interest in digital rehabilitation among caregivers of DMD boys in Poland is low. The reasons for this situation require further research.

Aims The aim of our study was to analyse the benefits of a 9 week hybrid comprehensive telerehabilitation (HCTR) programme in heart failure (HF) patients according to aetiology, as a subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH‐HF) trial. Methods and results Overall, 555 (65.3%) patients with ischaemic (IS) and 295 (34.7%) patients with non‐ischaemic (NIS) HF aetiology were randomized. There were no differences between the effect of HCTR and usual care (UC) on the primary outcome of number of days alive and out of the hospital in 26 months from the time of randomization in either aetiology (Wilcoxon–Mann–Whitney test), and no heterogeneity of effect between the aetiologies was noted (van Elteren test, P = 0.746). In Cox proportional hazards regression analysis, treatment was not independently associated with the secondary outcomes. For all‐cause mortality, the adjusted hazard ratio for HCTR vs. UC was 0.90 (95% confidence interval, 0.54–1.51) in IS and 1.42 (95% confidence interval, 0.69–2.94) in NIS (P interaction = 0.316). Differences between HCTR and UC in terms of change in the 6 min walk test distance and cardiopulmonary exercise test time after 9 weeks reached statistical significance in the IS arm (P = 0.015 and P < 0.001, respectively), but not in the NIS arm; however, tests of heterogeneity indicated no statistically significant differences. Conclusions The trial showed no difference between HCTR and UC in the primary outcome of percentage of days alive and out of the hospital for either IS or NIS aetiology. Moreover, the magnitude of changes in the clinical and functional statuses of the HF patients did not differ by aetiology. HCTR might have had beneficial effects on the 6 min walk test distance and cardiopulmonary exercise test time after 9 weeks in the IS patients; however, the effect was not statistically significantly different from that observed in the NIS patients.

Background: Duchenne muscular dystrophy (DMD) is the most common, progressive, irreversible muscular dystrophy. Pulmonary function is crucial for duration of life in this disease. Currently, the European Respiratory Society is focused on digital health, seeking innovations that will be realistic for digital respiratory medicine to support professionals and patients during the COVID-19 pandemic. Aims: The aim of this study was to investigate whether it is possible to monitor pulmonary function at home using an individual electronic spirometry system in boys with Duchenne muscular dystrophy. Materials and methods: In this observational, prospective study, conducted from March 2021 to June 2021, twenty boys with DMD (aged 8–16) were enrolled. The patients were recruited from the Rare Disease Centre, University Clinical Centre, of Gdańsk, Poland. Medical history and anthropometric data were collected, and spirometry (Jaeger, Germany) was performed in all patients at the start of the study. Each patient received an electronic individual spirometer (AioCare) and was asked to perform spirometry on their own every day, morning and evening, at home for a period of 4 weeks. The number of measurements, correctness of performing measurements, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were evaluated. Results: Finally, 14 out of 20 boys enrolled in the study with a mean age of 12.5 years (7 non-ambulatory) applied and received a home spirometer (AioCare). A total of 283 measurements were performed by all patients at home for 4 weeks. Half of the patients were able to perform measurements correctly. There were no significant differences between mean values of FVC, FE1, PEF between home and hospital spirometry (p > 0.05) expect PEF pv% (p < 0.00046). Patients with higher FEV1 (p = 0.0387) and lower BMI (p = 0.0494) were more likely to take home spirometer measurements. The mean general satisfaction rating of home-spirometry was 4.33/5 (SD 0.78), the mean intelligibility rating was 4.83/5 (SD 0.58). Reasons for irregular measurements were: forgetting (43%), lack of motivation (29%), difficulty (14%), lack of time (14%). Conclusion: Home electronic monitoring of pulmonary function in patients with DMD is possible to implement in daily routines at home. This protocol should be introduced as early as possible in patients 7–8 years old with good, preserved lung function. Patients accept this form of medical care but require more education about the benefits of e-monitoring. There is a need to implement a system to remind patients of the use of electronic medical devices at home, e.g., via SMS (short message service).

Proper posture provides the best balance and body stability at minimal muscular effort. It is constantly controlled by the central nervous system, which integrates the stimuli from the proprioceptors (deep feeling sensors), vision receptors, and balance receptors through the subcortical structures. The main purpose of the study was to describe single stance stability and its correlation with the degree of scoliosis and trunk rotation among patients suffering from idiopathic scoliosis and in the control group without scoliosis. The study included 80 patients (69 girls and 11 boys) and 40 healthy children without scoliosis (21 girls and 19 boys). The Cobb angle technique was used to determine the magnitude of the deformity. All subjects were divided into three subgroups according to Bogdanov’s classification. Single stance stability with eyes open and eyes closed was assessed with an electronic postural station—Delos Postural Proprioceptive System (DPPS). In case of multiple group comparisons for variables with normal distribution ANOVA with Scheffe, post hoc test was used or Kruskal‐Wallis test was used as the nonparametric equivalent. The relationship between the two continuous variables was investigated using either Pearson product‐moment correlation or Spearman’s rank correlation. In all these calculations, the statistical significance level was set to p < 0.05. The single stance test showed a significant difference between the stability index with eyes open and stability index with eyes closed in study and control groups. The character of these alterations is influenced by the degree of trunk rotation. The degree of scoliosis according to Bogdanov classification does not determine the decrease in stability indexes. In summary, significantly lower values of the stability index during one‐leg standing with eyes closed indicated balance impairment, which is mainly connected with inadequate functioning of the proprioceptive system.