Home-based and remote functional exercise testing in cardiac conditions, during the covid-19 pandemic and beyond: a systematic review.

Only five studies with 438 participants, four of them in chronic heart failure and 71% of participants male, so these findings may not fit other cardiac conditions or women. The studies were too few and too varied to pool, so there is no combined estimate of how well home or remote testing performs, only a description of each study. Most included studies were tests of measurement rather than trials of an intervention, so the review cannot say whether using these tests at home changes patient outcomes. Searching was restricted to English-language publications, which the authors say could bias the results towards positive findings. The authors state that the Downs and Black quality tool was the wrong choice for most of these measurement studies and that the COSMIN tool would have been more appropriate, so the quality scores should be read with that in mind. Blinding participants to an exercise test was usually impossible, and randomisation, loss to follow-up and statistical power were reported inconsistently across studies. It is unclear whether any of the home walking tests were done outdoors, where weather and temperature could affect distance. Longer-term safety and use in patients at higher risk, and in rural and remote settings, remain untested.

Funded by the Queensland Heart Failure Research and Quality Improvement Grant Scheme. The authors state this funding had no input into the study design, data management or analysis, or the decision to publish. No conflicts of interest were declared.

Do not read this as evidence that home or remote walking tests are ready to replace centre-based testing for exercise prescription or safety screening. No included study used any of these tests to set exercise intensity or judge whether exercise was safe, and the video-based 6-minute walk test agreed with face-to-face testing only within a range of −84 to 76 m, which the authors called clinically unacceptable.