The COVID-19 pandemic significantly changed the way cardiac rehabilitation (CR) patient care was delivered. More specifically, this impacted center-based programs that host several CR classes per day as hospital restrictions and social distancing were enforced. These guidelines encouraged providers to develop new ways to deliver CR care while ensuring patient safety. The concept of virtual CR existed for decades, but the pandemic accelerated its widespread adoption. Healthcare systems and hospitals from across the nation quickly and creatively found ways to continue classes and care online using video platforms, allowing patients to exercise at home while being monitored in real-time with a provider thanks to the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Prominent hospital and healthcare systems across the nation rapidly developed virtual CR programs to maintain patient care despite in-person closures. Since that time, other virtual companies have arisen, each using their own innovative products and apps to develop ways to provide virtual CR care in the rapidly changing healthcare environment.
The changing landscape of healthcare delivery, especially with the emergence of virtual venture capital–backed companies providing CR services, underscores the importance of careful oversight to maintain quality care and ensure proper recognition of ACSM Certified Clinical Exercise Physiologists (ACSM-CEPs). To address this, the Clinical Exercise Physiology Association (CEPA) acknowledged the need for a dedicated committee to oversee these virtual initiatives and advocate for ACSM-CEPs within this digital space. The Virtual Ventures Oversight Committee (VVOC) was created with a mission to monitor these emerging digital models and advocate for the vital role of ACSM-CEPs in virtual healthcare where appropriate.
Center-Based and Virtual Cardiac Rehabilitation: What’s the Difference?
Cardiac rehabilitation (CR) plays a vital role in recovery for patients post-cardiac event or intervention, promoting healthy habits like exercise, nutrition, and stress management. Traditionally, center-based CR involves supervised exercise sessions (aerobic, strength, stretching) in a hospital or clinic, with real-time vital sign and telemetry monitoring by ACSM-CEPs and nurses, overseen by a cardiologist. These sessions, typically 30-40 minutes, occur three times a week, offering a supportive community environment.
Conversely, virtual CR delivers care remotely via technology such as videoconferencing, apps, and wearables, with similar enrollment indications but some safety restrictions. Patients receive a personalized exercise plan and connect weekly with their healthcare team. Virtual CR can be synchronous (real-time group exercise with provider monitoring) or asynchronous (wearable data collection and weekly review). Both models provide education on heart-healthy lifestyles, but virtual options offer enhanced convenience and accessibility, allowing patients to integrate exercise into their routine independently. While facilitated by similar professionals, standardized requirements for virtual CR professionals are still evolving.
| Feature | Center-Based Cardiac Rehabilitation | Virtual Cardiac Rehabilitation |
| Location | Conducted in a hospital, clinic, or rehabilitation facility. | Delivered remotely through videoconferencing, apps, and wearable devices. |
| Exercise Supervision | Real-time in-person guidance by ACSM-CEPs and nurses, with cardiologist oversight. | Guidance provided via phone or video sessions; real-time or weekly review depending on the model. |
| Monitoring | Continuous vital sign and telemetry monitoring during sessions. | Monitoring may be done through wearable devices, self-reporting, or periodic data uploads through mobile apps. |
| Session Structure | Structured 30-40 minute sessions, typically three days per week, in a group setting. | Personalized exercise plans completed at home, with weekly check-ins or live virtual sessions. |
| Patient Support | Strong on-site community and peer support environment. | Support provided through virtual communication; community engagement varies by program. |
| Education | Delivered during in-person sessions covering exercise, nutrition, medication management, and stress management. | Education offered via virtual classes, digital resources, and telehealth appointments. |
| Professional Requirements | Well-established standards for ACSM-CEPs and interdisciplinary team training and supervision. | Requirements are emerging and may vary; still evolving across programs and healthcare systems. |
| Accessibility | May require travel, time off work, and fixed scheduling; best for patients who need close clinical supervision. | Highly convenient; reduces travel and scheduling barriers; beneficial for patients who are stable, motivated, and comfortable exercising independently. |
| Appropriate Patient Population | Ideal for higher-risk patients needing close monitoring | Suitable for lower-risk, stable patients who can self-monitor and follow guidance independently. |
Virtual ACSM-CEP Standards and Requirements: What Qualifications Does an ACSM-CEP Need to Work in the Virtual Space?
Aligning ACSM-CEP job standards and requirements across all ACSM-CEP roles has been a longstanding objective of CEPA. With virtual care growing in popularity, ensuring ACSM-CEPs are entering the workforce with proper education and skillsets is paramount to maintaining patient outcomes and safety across center-based and virtual delivery models. Specific role specifications have been observed to be absent in many virtual ACSM-CEP job posts and are rarely unified across healthcare systems or industries. CEPA asserts that the below qualifications are suggested minimum qualifications for roles supporting clinical populations, such as those served in cardiac rehabilitation programs.
Education and certification requirements
- BS in Exercise Science or Physiology or equivalent
- MS in Exercise Physiology preferred
- BLS
- ACSM Clinical Exercise Physiologist Certification
Relevant experience
- Minimum 2+ years of relevant clinical experience in a cardiopulmonary rehab setting
- Proficiency with mobile technology preferred
- Experience in a virtual care setting preferred
Looking Ahead: Future Projects and Goals
The creation of the VVOC within CEPA represents an essential initiative to ensure that ACSM-CEPs are actively included in the expanding field of virtual cardiac rehabilitation. Through oversight and advocacy, the VVOC aims to uphold high standards of care while promoting the professional development of ACSM-CEPs within this evolving healthcare environment. The committee is working toward creating a toolkit to equip both students and practicing professionals with the tools and resources necessary to strengthen their skills and confidently step into these emerging roles. The committee also plans to host a virtual panel featuring members who work as virtual ACSM-CEPs, offering their insights and experiences to those interested in pursuing virtual care roles.
Explore CEPA’s website and upcoming educational offerings to learn more about how CEPA is taking a leadership role in advocacy for ACSM-CEPs working in virtual cardiac rehab: https://www.acsm-cepa.org/
