Supervised versus unsupervised exercise training following myocardial infarction and myocardial revascularisation...

Exercise training is an important component of rehabilitative care for patients following myocardial infarction or myocardial revascularisation procedures. Participation of the patient in supervised exercise training, however, is not always practical, and home exercise training may be a reasonable alternative for low-risk patients. The relatively routine predischarge exercise test, performed for risk stratification, can identify low-risk patients and guide their exercise prescription during the early weeks at home. Advantages of home exercise training include increased availability and convenience and lower cost. Comparable improvements in functional capacity have been documented to result from home exercise and supervised group programmes. Drawbacks, however, involved the limited ability to teach patients the necessary safety precautions for exercise, the lack of opportunity to teach and encourage modification of coronary risk-related behaviours and lifestyles, and the lack of peer support. Several techniques have been proposed to overcome some limitations of home exercise and to encourage long-term adherence to the exercise regimen. Among these are telephone interaction between patients and nurses or other health professionals, transtelephonic exercise ECG recording, and the use of home exercise training videocassette. Comparative studies of the safety, efficacy, and costs of these approaches are needed; and means must be devised to provide the nonexercise-related information and counselling available to coronary patients in a supervised exercise setting.