Cardiac Rehab via Smartphone: Closing the Gender Gap in Middle-Income Settings

Women are systematically under-represented in cardiac rehabilitation worldwide, and the gap is widest in lower- and middle-income countries where formal programmes may not exist at all. With smartphones increasingly accessible in these settings, the question is whether technology can deliver what traditional cardiac rehabilitation often cannot — to those who need it most.

The Technology-bAsed Cardiac rehabilitation Therapy (TaCT) trial recruited 100 women with stable cardiac disease and smartphone access at an Indian outpatient cardiology department. Participants were randomized 1:1 to TaCT or standard care (where cardiac rehab is rare). The 6-month comprehensive intervention was delivered via several technologies, with exercise prescriptions based on an Incremental Shuttle Walk Test (ISWT) — the primary outcome. Quality of life was assessed using the MacNew, alongside measures of functional capacity, heart-health behaviours, cardiac symptoms, and morbidity.

Results were striking and uniformly in favour of the intervention. Functional capacity improved significantly across multiple measures, and the MacNew showed gains across all subscales and the global score (all p < 0.001). Heart-health behaviours, medication adherence, and anxiety all improved. Retention was 89% — remarkable for a six-month intervention.

The MacNew was critical to the trial’s credibility: it captured improvements in emotional, physical, and social dimensions that a fitness test alone could never reveal. By bringing globally validated quality-of-life measurement to an under-served population, the study advances both clinical practice and health equity in cardiac care.

Reference:
Menezes, H. J., Grace, S. L., Padmakumar, R., Babu, A. S., Rao, R. R., Kamath, A., & D’Souza, S. R. B. (2026). Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized controlled trial. European Journal of Preventive Cardiology, 33(6), 815–826. https://doi.org/10.1093/eurjpc/zwaf147