Barry A. Franklin, Ph.D., chair of the writing committee for the Scientific Statement “Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update from the American Heart Association, (February 2020), director of preventive cardiology and cardiac rehabilitation at Beaumont Health in Royal Oak, Michigan, and professor of internal medicine at Oakland University William Beaumont School of Medicine in Rochester, Michigan. Offering perspective on AHA Scientific Sessions 2020 Presentations P2365 and P664 copyright American Heart Association 2020 "I think the COVID-19 pandemic really revealed in my humble opinion an Achilles heel so to speak in cardiac rehab in that most of our programming for years has been outpatient, you drive to the center, you have the program and you drive back to work or back home. We realize now that patients suffered very dramatically as a result of COVID-19 and our programs also suffered very dramatically. Our program for example ABOMA was literally closed for two and a half months at the present time we're open but we're only partially open. We were dealing with a limited number of patients due to social distancing, it's a pain in the neck to wear masks for all the staff and the patients who are exercising. We realize it's necessary but the equipment really wasn't designed to wear a mask on for people who are oftentimes very limited. So, as a result, the programs are struggling from a financial standpoint because we're dealing with a smaller number of patients. I think from the patient perspective what became very apparent to me is this, everybody says, stay home, stay safe. That according to studies, I've read shows that we decrease our physical activity, we're already a sedentary society but we decrease our physical activity with this COVID epidemic by an additional 20 to 40%, we increase our sitting time by an additional 20 to 40%. And everybody, whether you're a cardiac patient or not, experiences the increased stress of this pandemic. So that increased stress also leads to unhealthy lifestyles, people sometimes may not eat as healthy people, sometimes during COVID have told me they've started cigarette smoking because they were under such stress. So for everybody, quality of life is diminished, psychological well-being has diminished and these things all highlight to me the need for virtual cardiac rehabilitation, offering it outside the conventional supervise setting which certainly has merits."