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Updated: Nov 17, 2025
Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification
Anusha G Bhat1, Michel Farah, Heidi Szalai
1Department of Medicine (Drs Bhat, Farah, Lindenauer, Visintainer, and Pack) and Division of Cardiovascular Medicine (Ms Szalai and Dr Pack), University of Massachusetts Medical School, Baystate Medical Center, Springfield; Department of Public Health Practice, School of Public Health and Health Sciences, University of Massachusetts Amherst (Dr Bhat); Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Farah); Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (Dr Lagu) and Division of Hospital Medicine (Dr Lagu), Northwestern Feinberg School of Medicine, Chicago, Illinois; and Institute for Healthcare Delivery & Population Science at University of Massachusetts Medical School-Baystate, Springfield (Drs Lagu, Lindenauer, Visintainer, and Pack).
Purpose:
The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated.
Methods:
Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AE and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions.
Results:
During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. Adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared with the low- or medium-risk groups, the high-risk group was more likely to have AE (HR 3.0 [95% CI, 1.7-5.9], P = .002) and CE (HR 3.7 [95% CI, 1.5-10.8], P = .002) with fair model discrimination (area under the curve: 0.637, P < .001).
Conclusion:
The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE.
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