Please select the eligibility criteria that correspond to the clinical trial below.
Title: Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.
Brief Summary: The PREHAB study is a clinical trial where frail patients waiting for heart surgery are randomly chosen to either receive the current standard of care or to participate in an 8-week exercise/education program at a community-based cardiac rehabilitation facility. Patients can wait for elective heart surgery for as long as 3-4 months. During this time, individuals are often fearful of making things worse, causing them to stop being active and further deteriorate their physical condition. This wait period presents a potential opportunity for health care providers to engage the patient to take control of their self-managed care prior to surgery with the intent of improving post-surgical outcomes. Patients randomized to the PREHAB intervention group will participate in supervised exercise twice per week in a program designed to improve physical functioning and exercise capacity. The investigators hypothesize that the PREHAB program for frail elderly patients awaiting an elective cardiac surgery will reduce frailty, improve exercise capacity, improve physical activity behaviour, improve in-hospital outcomes, improve clinical outcomes 3 months and 1 year postoperatively, and improve overall quality of life.


Options:
A: Inclusion Criteria:

* Patients aged 60 years and older, undergoing elective isolated coronary artery bypass grafting (CABG), aortic valve repair/replacement for moderate aortic stenosis or severe regurgitation, mitral valve repair/replacement for moderate stenosis or severe regurgitation or combined CABG/valve procedures
* Patients with Clinical Frailty Score (CFS) ≥3 (vulnerable) and \< 7 (8 = very severely frail, approaching end-of-life or 9 = terminally ill) at time of acceptance for cardiac surgery
* Patients with an estimated ≥ 6 week wait time

Exclusion Criteria:

* Patients who have unstable or recent unstable cardiac syndrome as defined by:

  1. Severe heart failure (NYHA IV) or angina (CCS class IV) symptoms
  2. Critical left main (LM) coronary disease
  3. Hospitalization for arrhythmias, congestive heart failure or acute coronary syndrome prior to randomization
* Patients who have severe left ventricular obstructive disease as defined by:

  1. Severe aortic or mitral stenosis (aortic or mitral valve area \<1.0cm2 or mean gradient \> 40 mmHg or \> 10 mmHg respectively)
  2. Dynamic left ventricular (LV) outflow obstruction
* Patients who have demonstrated exercise induced ventricular arrhythmias or have experienced a recent hospitalization for arrhythmias
* Patients who have cognitive deficits that would preclude rehabilitation
* Patients who have physical limitations that would preclude rehabilitation
* Patients who are unable to attend the Prehab program
B: Inclusion Criteria:

* coronary artery disease
* type 2 diabetes

Exclusion Criteria:

* serious diabetic retinopathy, nephropathy and/ or neuropathy
* other serious diseases like cancer, stroke or MI last three months, unstable angina, decompensated heart failure, serious ventricular arrhythmia, aortic aneurism, serious valvular heart disease, chronic obstructive pulmonary disease GOLD classification IV, deep venous/ pulmonary embolism, ongoing infections, serious musculoskeletal disorders.
* other serious limitations to physical exercise
* pathological exercise stress test warranting further cardiovascular examination
C: Inclusion Criteria:

* Class I to III angina pectoris (classified according to the Canadian Cardiovascular Society \[CCS\])with documented myocardial ischemia or coronary artery disease on angiography
* Ability to read and speak English to a level allowing satisfactory completion of written questionnaires and to understand instruction during the exercise programme.

Exclusion Criteria:

* Acute coronary syndromes or recent myocardial infarction (\<2 months)
* Left main coronary artery stenosis \>25% or high-grade proximal left anterior descending artery stenosis
* Known reduced left ventricular function (ejection fraction \<40%)
* Significant valvular heart disease
* Insulin-dependent diabetes mellitus
* Occupational, orthopedic, and other conditions that preclude regular exercise
* Patients whose ECG prevents interpretation of an exercise test (LBBB, RBBB, pacemaker implantation).
* Patients who already perform greater than 30min continuous exercise three times weekly (self-reported).
D: Inclusion Criteria:

* Patient is admitted with acute myocardial infarction
* Patient is able to communicate in English or Dutch at B1 level

Exclusion Criteria:

* Body Mass Index \> 35 kg x m-2
* Included in another randomized controlled trial
* Patient is \<18 years of age
* Patient is considered an incapacitated adult
* Patient is pregnant
* Patient is unwilling to sign the informed consent form

Answer: A