The long-term impact of a teleprehabilitation program on modifiable risk factors and quality of life after cardiac surgery

OBJECTIVES: To assess the long-term effects of teleprehabilitation on modifiable risk factors and quality of life up to one year following elective cardiac surgery. METHODS: This secondary analysis of the Digital Cardiac Counselling trial, a randomized controlled trial, compared multimodal teleprehabilitation with standard care in patients undergoing elective cardiac surgery. The teleprehabilitation program targeted physical fitness, inspiratory muscle training, psychological support, nutritional optimization, and smoking cessation. Outcomes included trajectories of modifiable risk factors and quality of life measured preoperatively and at 3, 6, and 12 months postoperatively. Generalized linear mixed models assessed differences over time between groups, with exploratory post hoc analyses for individual time points. RESULTS: Both groups showed postoperative reductions in all assessed modifiable risk factors and improvements in quality of life over time (p < 0.001), except for nutritional optimization (p = 0.173). Teleprehabilitation was associated with more favorable trajectories for smoking behavior (p = 0.045) and nutritional risk (p = 0.011), with consistently lower incidences throughout follow-up. Smoking prevalence remained significantly lower in the teleprehabilitation group at all-time points (p < 0.05), while malnutrition prevalence was lower at three months postoperatively (p = 0.012). Quality-of-life scores were consistently higher in the teleprehabilitation group throughout follow-up (p = 0.002). CONCLUSIONS: Teleprehabilitation in cardiac surgery patients not only reduces postoperative complications, but may also provide additional long-term benefits, particularly in smoking cessation, nutritional optimization, and quality of life. These findings support teleprehabilitation as a valuable addition to standard preoperative care, with possible sustained benefits on long-term lifestyle and quality of life.