# The Use of Modern Technologies in Post-COVID-19 Cardiopulmonary Rehabilitation
## 4 Medical Technologies Used in Post-COVID-19 Cardiopulmonary Rehabilitation
### Telemedicine-Based Cardiopulmonary Rehabilitation  
The Internet and mobile applications are currently the most widely used technologies in cardiopulmonary rehabilitation, especially in the COVID-19 era, offering patients a wide range of programs. In this sense, it is expected that all groups of cardiac or cardiopulmonary patients will benefit from this type of treatment [31]. In this case, more and more studies show that telemedicine has been applied as a screening option to provide treatment to patients. Telemedicine can be considered as personal protective equipment that reduces the risk of exposure and contamination for both patients and practitioners [32]. The COVID-19 pandemic has highlighted the importance and usefulness of telemedicine in providing a way to connect patients and healthcare professionals when a personal consultation is not possible [33]. Tele-consultations are a safe and effective way to assess suspected cases of COVID-19 and to guide the patient's diagnosis and treatment, minimizing the risk of disease transmission. Telemedicine also allows many of the key clinical services to continue to operate regularly and without interruption during a public health emergency [34]. Telemedicine legislation varies across countries, but any healthcare institution interested in implementing telemedicine services must assess its technological level before doing so [35]. Digital health technologies use computing platforms, connectivity, software and sensors for health care and related uses [36]. Post-COVID-19 cardiopulmonary tele-rehabilitation has been shown to be effective in several recent studies [37]. [PERSON] et al. developed a tele-rehabilitation program with a duration of 24 session [38]. At the beginning and the end of the rehabilitation program, all patients were evaluated in a primary care center. The tele-rehabilitation sessions were done at the home of the patient. The program included a warm-up (5 min), breathing exercises (3 min), aerobic and/or strength exercises (20-30 min) and stretching (5 min). The protocol was based on the recommendations of the Colegio Professional de Fisioterapeutas de la Comunidad de Madrid [39] and on the recommendations of the American College of Sports Medicine [40]. The recovery program included weekly phone calls to assess the patients. Physiotherapists performed exercises at the same time as the patients using the online environment and using household objects, constantly assessing the patient's condition using the Borg scale [41]. [PERSON] et al. showed that breathing exercise programs offered by tele-rehabilitation may improve functional capacity and reduce dyspnea in both patients with COVID-19 in the acute phase and in post-COVID-19 disorders. Tele-rehabilitation seems to be a safe environment for the patient, considering that adverse events occurred were generally mild or moderate. Tele-rehabilitation has also been shown not to increase hospital readmissions in patients infected with COVID-19. Breathing exercises delivered by tele-rehabilitation improved the results of the 6-min walking test, the score on the dyspnea questionnaire and the effort perceived by the patient from 0 to 10 on the Borg Scale [42]. [PERSON] suggests scheduling home visits for patients included in a tele-rehabilitation program at the time of inclusion in the program, at 6 weeks (post-treatment) and at 24 weeks (follow-up). Additional assessments were used for dyspnea performed by consultation by mobile phone or WeChat voice call at 2 and 4 weeks. They also used the 6-min walk test and devices for the monitoring of blood pressure, heart rate, oxygen saturation and lung function [43]. Another method proposed by [PERSON] et al. assumes that, upon admission to the tele-rehabilitation program that lasts a month, patients receive a pulse oximeter, a journal in which they will note their daily evolution and a leaflet and instructions with the types of exercises indicated. A physiotherapist contacts patients by video-call twice a week to monitor and determine the intensity of the exercise.