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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
The Impact of Reduced Cardiac Rehabilitation on Maximal Treadmill Exercise Time: A RANDOMIZED CONTROLLED TRIAL
Alejandra Farias-Godoy1, Sammy Chan, Victoria E Claydon
1Department of Biomedical Physiology and Kinesiology (Drs Farias-Godoy, Claydon, and Lear) and Faculty of Health Sciences (Ms Mendell and Dr Lear), Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Healthy Heart Program, St Paul's Hospital, Vancouver, British Columbia, Canada (Drs Chan, Ignaszewski, Singer, and Lear); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Ms Park and Dr Singer).
Insights
Reducing cardiac rehabilitation program sessions improves exercise capacity and cardiac risk factors in low- to moderate-risk patients. This modified cardiac rehabilitation program (rCRP) is as effective as standard CRP (sCRP).
Area of Science:
- Cardiology
- Preventive Medicine
- Exercise Physiology
Background:
- Cardiac rehabilitation programs (CRPs) are underutilized due to access barriers.
- Evaluating modified CRPs (rCRP) with fewer center-based sessions is crucial for improving accessibility.
- Standard CRP (sCRP) involves extensive on-site sessions, potentially limiting patient participation.
Purpose of the Study:
- To evaluate a reduced cardiac rehabilitation program (rCRP) compared to a standard CRP (sCRP).
- To assess changes in exercise capacity and cardiac risk factors between sCRP and rCRP.
- To determine if rCRP is non-inferior to sCRP in improving patient outcomes.
Main Methods:
- A randomized controlled noninferiority trial involving primary and secondary prevention patients.
- Participants were randomized to either sCRP (32 sessions) or rCRP (10 sessions) over 4 months.
- Primary outcome: change in exercise capacity (maximal treadmill test time) at 4 and 16 months. Noninferiority testing used a mixed-effects model.
Main Results:
- Attendance was significantly higher in the rCRP group (97% ± 63%) compared to the sCRP group (71% ± 22%).
- Both groups showed significant increases in exercise test time over 16 months.
- The rCRP was non-inferior to the sCRP regarding changes in treadmill test time and improvements in metabolic and anthropometric risk factors.
Conclusions:
- Reducing the number of center-based sessions in cardiac rehabilitation programs is feasible for selected low- to moderate-risk patients.
- Modified CRPs can maintain or improve exercise capacity and reduce cardiovascular risk factors effectively.
- This approach enhances accessibility and adherence to cardiac rehabilitation.
Purpose:
Cardiac rehabilitation programs (CRPs) remain underutilized partly because of access barriers. We therefore evaluated a CRP with fewer center-based sessions (rCRP) compared with standard CRP (sCRP) with respect to changes in exercise capacity and cardiac risk factors.
Methods:
In this randomized controlled noninferiority trial, primary and secondary prevention patients at low and moderate risk were randomized to an sCRP (n = 60) or an rCRP (n = 61). Over 4 months, sCRP and rCRP participants attended 32 and 10 on-site cardiac rehabilitation sessions, respectively. The primary outcome was the difference in the change in exercise capacity from baseline at 4 and 16 months between the groups measured in seconds from a maximal treadmill exercise test. Noninferiority of the rCRP was tested with mixed-effects model analysis with a cut point of 60 seconds for the upper value of the group estimate.
Results:
Attendance was higher for the rCRP group (97% ± 63% vs 71% ± 22%, P = .002). Over 16 months, exercise test time increased for the sCRP (524 ± 168 to 604 ± 172 seconds, P < .01) and the rCRP (565 ± 183 to 640 ± 192 seconds, P < .01). The rCRP was not inferior to the sCRP regarding changes in treadmill time (48.47 seconds, P = .454). The rCRP was not inferior to the sCRP regarding metabolic and anthropometric risk factors.
Conclusion:
Our findings suggest that, for a selected group of low-/moderate-risk patients, the number of center-based CRP exercise sessions can be decreased while maintaining reduced cardiovascular risk factors.
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