The findings from the study on remote cardiac rehabilitation after valvular heart surgery are significant. What do they mean for how Indian cardiologists and hospitals should approach post-surgical recovery, and what should patients take away from them?
To understand why these findings matter, it helps to look at the growing burden of valvular heart disease. As life expectancy increases, more people are living long enough to develop problems with the heart’s valves, often alongside other cardiovascular conditions. Many undergo complex procedures and then return home, where recovery becomes the next critical phase of care.
Our hypothesis was simple: if structured remote cardiac rehabilitation could improve outcomes after complex valvular heart surgery, it could demonstrate a scalable model for post-surgical recovery more broadly.
We were fortunate to partner with Seth GS Medical College and KEM Hospital, a large tertiary-care public hospital serving patients from across Maharashtra. This was a real-world setting where many patients have limited access to physiotherapists, dietitians, or other rehabilitation services after discharge.
We compared two broadly similar patient groups over 12 weeks. One received the structured LYFE® remote rehabilitation programme, while the other received standard postoperative care. The study underwent ethics approval, regulatory review, and peer review before being published in JACC: Asia, reflecting the rigorous scientific scrutiny applied.
The broader takeaway is that recovery after surgery matters as much as the procedure itself. Hospitals are optimised for acute care, but recovery unfolds over weeks and months. For many patients, especially those travelling long distances or dependent on daily wages, frequent hospital visits are impractical and costly.
Remote rehabilitation offers a way to make evidence-based recovery support accessible at scale.
The results were compelling. Patients in the LYFE® programme improved their six-minute walk distance by approximately 243 metres, compared with 112 metres in the standard-care group, indicating substantially greater gains in functional capacity.
Quality-of-life outcomes were equally encouraging. Using a validated health-status assessment covering mobility, usual activities, pain, and emotional wellbeing, patients in the LYFE® programme reported roughly twice the improvement seen with standard care.
In practical terms, patients were not only walking farther; they were feeling healthier and returning more confidently to daily life.
The clearest differentiator was adherence. Every patient in the digital rehabilitation group exercised at least three times per week, compared with just 2 of 30 patients receiving usual care. Physical activity increased by nearly 90 per cent in the LYFE® group versus about 54 per cent with standard care.
The message for clinicians and hospitals is not that patients cannot recover without rehabilitation. They can. The question is how consistently and how well they recover. Our findings suggest that structured remote support, regular follow-up, and a programme designed for home use can significantly improve both physical recovery and patient-reported health outcomes.
For patients, the takeaway is equally important: recovery does not end at discharge. Staying engaged with a structured rehabilitation programme can meaningfully accelerate the return to normal life.
Exercise adherence appears to have been particularly strong in the programme. How was this achieved, especially among patients who may not be technologically savvy or financially well off?
Over the 12-week programme, patients received 12 supervised cardiotherapy sessions delivered remotely by trained physiotherapists via WhatsApp or Zoom. We deliberately designed the programme for real-world use, including training patients who were not particularly comfortable with technology.
The rehabilitation plan focused on rebuilding functional capacity through aerobic exercise, strength training, and breathing exercises, using resources patients already had at home. For example, a one-litre water bottle could be used in place of a one-kilogram dumbbell.
Adherence was a core design principle. A dedicated coordinator scheduled sessions, followed up with patients, and accommodated weekend appointments when needed. Patients also received exercise videos via WhatsApp to help them continue training between sessions.
This is important because rehabilitation is far more than simply advising patients to walk. Effective recovery requires a structured combination of aerobic conditioning, resistance training, breathing exercises, and ongoing guidance, elements that are difficult to deliver through a standard discharge process.
The impact was striking. Every patient in the digital rehabilitation group exercised at least three times per week, compared with just 2 of 30 patients receiving usual care. Weekly physical activity nearly doubled, increasing from approximately 230 minutes to 436 minutes.
At its core, the difference comes down to accountability. Patients commit to specific recovery goals, and someone actively supports and monitors their progress. Much like working with a trainer rather than exercising alone, regular guidance, encouragement, and follow-up can dramatically improve adherence and, ultimately, recovery outcomes.
The study also measured physical activity. What did the data show about patients’ activity levels before and after the intervention?
At baseline, physical activity levels were broadly similar. Patients in the LYFE® group were doing around 230 minutes of physical activity a week, compared with approximately 207 minutes in the standard-care group.
After 12 weeks, activity in the LYFE® group increased to approximately 436 minutes a week—an increase of 89.6 per cent. In the standard-care group, it increased to around 318 minutes, or about 54 per cent.
Some improvement in the standard-care group is expected. Patients feel better after surgery and naturally become more active. The difference is in the extent of improvement and the consistency with which patients were able to follow a structured rehabilitation programme.
How can remote digital therapeutics help overcome geographical barriers, particularly for patients outside metros? What does personalised, doctor-connected rehabilitation look like once care moves from the hospital to the home?
The simplest way to describe remote digital therapeutics is that we bring the hospital to the patient, rather than asking the patient to repeatedly travel back to the hospital.
Traditional healthcare is constrained by geography. Access to specialists, rehabilitation services, and follow-up care often depends on where a patient lives. While complex procedures will continue to be performed in hospitals, the real question is whether recovery can be delivered effectively after the patient returns home.
Our view is that it can. Whether a patient lives in Maharashtra, Gujarat, or the Northeast, the fundamentals of recovery remain the same. What matters is having access to the right multidisciplinary support. Our care model connects patients to a team that includes a doctor acting as care manager, a nutritionist or health coach, a physiotherapist or cardiopulmonary rehabilitation specialist, a mindfulness coach, and paramedics available 24×7.
Because our teams collectively speak around 15 Indian languages, patients can receive support in their preferred language while following evidence-based care pathways and rehabilitation protocols.
Today, we support patients across nearly 410 districts in India, despite physically recruiting patients in only 25-30 cities where most cardiac procedures are performed. Patients travel to these centres for treatment, then return home while continuing their rehabilitation remotely.
In fact, patients who face the greatest barriers to accessing healthcare often benefit the most. For someone travelling from Beed, Latur, or Dharashiv to Mumbai, every follow-up visit involves significant time, cost, and logistical effort. Remote rehabilitation removes much of that burden.
The programme is intentionally simple. If a patient can use WhatsApp, they can participate. Doctor consultations, follow-ups, and nutrition counselling can be conducted over phone or video, while physiotherapy sessions are delivered through live video interactions.
Technology also enables clinical monitoring from a distance. For example, smartphone GPS can be used to conduct a six-minute walk test remotely, allowing clinicians to track recovery and functional capacity without requiring patients to return to the hospital for routine assessments.
More broadly, India has shown remarkable adoption of digital technologies. That creates an opportunity to expand access to high-quality, structured rehabilitation without first building extensive physical infrastructure.
The key takeaway is that personalised, doctor-connected rehabilitation does not have to end when a patient leaves the hospital. With the right care team, technology, and clinical protocols, recovery can continue seamlessly at home, making specialist support accessible regardless of where a patient lives.
How do real-time vital tracking and AI-driven adherence tools work alongside remote physiotherapist and cardiologist oversight? What evidence do you have that this combination improves compliance and reduces readmissions?
There are essentially two different aspects to the problem.
One is the patient who is steadily improving and wants to regain fitness and return to work. For that patient, rehabilitation becomes very important. Exercise, diet and medication adherence all contribute to recovery.
The other is a patient who may have multiple co-morbidities and develops symptoms after returning home. That patient may need symptom triage and monitoring. They may experience breathlessness or another symptom and need to know whether they should immediately go to the hospital, visit an outpatient department or simply monitor the situation.
In reality, most patients don’t fit neatly into one of these categories. They can be improving for several days and then suddenly develop a symptom. So rehabilitation and monitoring cannot be treated as separate requirements.
That is why we have been building a more comprehensive model. When patients are feeling well, the focus is on helping them improve through exercise, nutrition and medication adherence. When something changes, the system needs to identify that change and connect the patient to the appropriate clinical support.
Even within rehabilitation, there is sometimes a tendency to equate it with exercise alone. But diet and medication adherence are also important. For example, a patient who has undergone a mechanical valve replacement may need blood thinners, and their diet may also need to be managed because vitamin K-rich foods can interact with certain blood-thinning medications. These aspects of recovery are interconnected.
We have therefore increasingly focused on symptom capture, triage and paramedical support, including helping patients understand when and where they need to return to a hospital.
We have a clinical nerve centre led by an MD doctor with 15 years of experience, who has been involved in developing these processes.
And we have seen encouraging results across our broader cardiac patient experience. Medication adherence has reached 81.9 per cent, compared with 57.9 per cent under standard care, while diet adherence was 78.1 per cent versus 50.9 per cent. We have also seen a 34 per cent relative reduction in unplanned emergency-department visits for cardiovascular issues and a 35 per cent relative reduction in re-hospitalisation.
The important point is that this isn’t simply about putting a patient on an app. The technology keeps the patient engaged and captures information, but the clinical team provides the interpretation, accountability and intervention when something changes. That combination of digital monitoring with human clinical oversight is what makes the model meaningful.
We are currently connected with a large and growing network of hospitals across India, including several major hospital groups. I wouldn’t be able to name individual partners because many of our hospital relationships are covered by confidentiality agreements.
Building these programmes within hospitals takes time because every hospital has its own workflows and operating processes. Large hospital groups may also have different ways of working across individual facilities. Building the right clinical processes and earning the confidence of doctors and other stakeholders is therefore an important part of scaling these programmes.
And for the specific JACC: Asia study, the evidence was focused on functional capacity, quality of life and physical activity after valvular surgery. The re-admission figures I’m referring to here come from our broader experience, not from that particular study.