Comparing the Effectiveness of 2 Cardiac Rehabilitation Exercise Therapy Programs.

Cardiovascular diseases are among the leading causes of morbidity and mortality in Canada, highlighting the critical role of disease prevention and risk reduction programs. Cardiac rehabilitation (CR) is a key component of comprehensive cardiovascular care. Currently, more than 200 CR programs are established across the country, varying in duration, number of in-person supervised exercise sessions, and recommendations for exercise frequency at-home. In an increasingly cost-conscious healthcare environment, the effectiveness of healthcare services must be consistently reevaluated. This study evaluates the impact of 2 CR programs implemented by the Northern Alberta Cardiac Rehabilitation Program, by comparing peak metabolic equivalents achieved by study participants in each program. We hypothesize that our "hybrid" CR program, which is structured as an 8-week program with weekly in-person exercise sessions and a prescribed home exercise program, has patient outcomes similar to those of our "traditional" CR program, which required biweekly in-person exercise sessions over the course of 5 weeks. The results of this study may have implications for evaluating how to minimize barriers to both rehabilitation participation and long-term effectiveness of CR programs. The results may help inform the structuring and funding of future rehabilitation programs.

Les maladies cardiovasculaires (MCV) sont parmi les premières causes de morbidité et de mortalité au Canada d'où l'importance des programmes de prévention des MCV et de réduction du risque cardiovasculaire. La réadaptation cardiaque est un élément clé du continuum de soins cardiovasculaires. À l'heure actuelle, il existe plus de 200 programmes de réadaptation cardiaque au pays, qui diffèrent tant par leur durée, par le nombre de séances d'exercice supervisées en personne que par leurs recommandations sur la fréquence des exercices à domicile. Dans un contexte où le coût des soins de santé est de plus en plus préoccupant, l'efficience des services de santé doit constamment être réévaluée. Cette étude évalue les effets de deux programmes de réadaptation cardiaque instaurés par le Cardiac Rehabilitation Program du nord de l'Alberta en comparant l'équivalent métabolique maximal obtenu par les participants à l'étude pour chaque programme. L'hypothèse de départ était que notre programme de réadaptation cardiaque « hybride ¼, qui consiste d'une part en un programme de huit semaines de séances hebdomadaires d'exercices en personne et d'autre part en un programme d'exercices à domicile, donnerait des résultats semblables à ceux de notre programme « traditionnel ¼ de réadaptation cardiaque. Celui-ci se compose de deux séances d'exercices en personne par semaine, pendant cinq semaines. Les résultats de cette étude pourraient nous aider à réduire les obstacles qui nuisent à la participation aux programmes de réadaptation et à l'efficience à long terme de ces programmes. Nous espérons apporter un éclairage sur la structure et le financement des futurs programmes de réadaptation.

Cardiac Rehabilitation in Patients With Lymphoma Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Cardio-oncology Pilot Project.

BACKGROUND: Worldwide > 50,000 hematopoietic stem cell transplants (HSCTs) are performed annually. HSCT patients receive multiple cardiotoxic therapies (chemotherapy and radiation therapy) in addition to severe physical deconditioning during hospital admission. We hypothesized that guided exercise in a cardiac rehabilitation (CR) program following autologous HSCT is a safe and feasible intervention. METHODS: Pilot project to assess for safety, feasibility and impact of 8 weeks of CR in HSCT patients following transplant. Consecutive patients with lymphoma underwent standard activity protocol testing before HSCT, at 6 weeks following HSCT (prior to CR), and at 14 weeks following HSCT (at completion of CR), consisting of grip strength (GS), gait speed (GtS), timed up-and-go (TUG), and 6-minute walk test (6MWT). CR consisted of 8 weekly visits for guided exercise. RESULTS: Activity tolerance protocol data of 30 patients (24 male, 6 female) from December 2014 to December 2016 were analyzed using repeated measures (analysis of variance [ANOVA]) to observe for changes in GS, GtS, TUG, and 6MWT. Statistically significant improvements were found in GS (P < 0.005), GtS (P = 0.02), and 6MWT (P = 0.001). These improvements show that guided CR-based exercise may assist HSCT survivors to meet or even surpass baseline exercise levels and improve physical functioning. There were no adverse events (ie, death or injury) during the study period. Fifty-seven percent of referred patients participated in CR, exceeding documented CR adherence in cardiac populations. CONCLUSIONS: The addition of CR-based exercise programming in HSCT survivorship care of patients with lymphoma is a safe and feasible intervention to assist in recovery following transplant.

Long-term Physical Activity Behavior After Completion of Traditional Versus Fast-track Cardiac Rehabilitation.

BACKGROUND: Despite the health benefits associated with regular physical activity (PA), many cardiac patients fail to maintain optimal levels of PA after completing cardiac rehabilitation (CR). The long-term impact of different CR delivery models on the PA habits of cardiac patients is not completely understood. OBJECTIVE: The purpose of this study is to use a multisensor accelerometer to compare the long-term impact of a traditional versus fast-track CR on the PA of patients with coronary artery disease 6 months after CR entry. METHODS: Forty-four participants attended either traditional (twice a week, 12 weeks; n = 24) or fast-track (once a week, 8 weeks; n = 20) CR. Exercise capacity (ie, 6-minute walk test distance) and PA were assessed at baseline and at 12 weeks and 6 months after CR entry. RESULTS: At 12 weeks, exercise capacity increased significantly in both groups and remained elevated by the 6-month follow-up. Sedentary time decreased from baseline to 12 weeks. However, at 6 months, it was comparable with the baseline level. There was no significant change in any other PA marker (ie, steps/day, time in light and moderate-vigorous PA) over the course of the study. CONCLUSIONS: Findings support the long-term effectiveness of CR on exercise capacity irrespective of the delivery model. However, participation in CR program, whether it be a traditional or fast-track CR exercise program, may not lead to long-term PA behavior change. Thus, CR participants may benefit from structured strategies that promote long-term PA adherence in addition to facilitating exercise capacity improvement.

Quantity and Quality of Daily Physical Activity in Older Cardiac Patients.

BACKGROUND: Sedentary behaviour and the level of daily physical activity are of particular concern in cardiac patients, as diminished activity may be a strong predictor of mortality in this population. PURPOSE: In this study we assessed sedentary behaviour and the quantity and quality of daily physical activity among older cardiac patients who were at different stages of recovery following a cardiac event. DESIGN: We used a cross-sectional design and a convenience sampling technique. METHOD: Participants were recruited into three groups: an Acute group (n = 32), a Rehab group (n = 32), and a Maintain group (n = 29). Continuous minute by minute physical activity was assessed using the SenseWear Mini Armband, which was worn throughout each day for four consecutive days and provided data on steps/day, as well as time spent sedentary (waking time ≤ 1.5 METs), or in light (1.6-2.9 METs) or moderate-vigorous (≥ 3.0 METs) physical activity. FINDINGS: While the Rehab group accumulated more daily activity than the other two groups, they remained sedentary for approximately 70% of waking time. The quantity and quality of the activity in the Maintain group was comparable to that observed in the Acute group. CONCLUSIONS: Our observation of consistently elevated sedentary time regardless of whether the participant was entering, completing or were long removed from a formal cardiac rehabilitation program reinforces the need for cardiac rehabilitation nurse educators to both monitor routine daily activity and encourage coronary artery disease patients to adapt a lifestyle that is focused on reducing sedentary behaviour by incorporating planned exercise training and unstructured physical activity throughout the day.