Tele-Rehabilitation in Cardiopulmonary Rehabilitation in India: Bridging the Gap in Access, Participation and Continuity of Care A Narrative Review

Abstract

Cardiopulmonary rehabilitation is a multidisciplinary intervention that improves exercise capacity, functional status, symptoms, quality of life, and self-management in people with cardiovascular and chronic respiratory diseases. Despite established benefits, participation in conventional centre-based rehabilitation remains limited, particularly in low- and middle-income countries. In India, limited rehabilitation services, geographical distance, transportation difficulties, financial constraints, inadequate referral pathways, and limited awareness may restrict participation. Tele-rehabilitation, including video-based rehabilitation, mobile health applications, remote monitoring, and structured home-based programmes, may help address these barriers. Recent systematic reviews indicate beneficial effects of telehealth cardiac rehabilitation on exercise capacity, adherence, and selected quality-of-life outcomes, while pulmonary telerehabilitation may improve exercise capacity, dyspnoea, and disease-specific outcomes in selected populations. However, evidence remains heterogeneous, and tele-rehabilitation should not be considered a universal replacement for face-to-face rehabilitation. Patient selection, clinical assessment, safety monitoring, digital literacy, internet connectivity, and access to appropriate devices remain important considerations. A hybrid model combining initial face-to-face assessment, remotely supervised home rehabilitation, and periodic clinical reassessment may be particularly relevant to India. This narrative review discusses the rehabilitation access gap in India, evidence for tele-rehabilitation, clinical applications, implementation barriers, safety considerations, and future directions.