PATHway I: design and rationale for the investigation of the feasibility, clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation. HEART: heart exercise and remote technologies: A randomized controlled trial study protocol Long-term Exercise Adherence After High-intensity Interval Training in Cardiac Rehabilitation: A Randomized Study. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) – the study protocol of a randomised, controlled trial Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume In-class Active Video Game Supplementation and Adherence to Cardiac Rehabilitation The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. Peak Oxygen Uptake after Cardiac Rehabilitation: A Randomized Controlled Trial of a 12-Month Maintenance Program versus Usual Care Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Effects of a Phase IV Home-Based Cardiac Rehabilitation Program on Cardiorespiratory Fitness and Physical Activity. Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Effects of a 12‐week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation What effect does a structured home-based exercise programme have on people with Huntington’s disease? A randomized, controlled pilot study Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial Effects of exercise training started within 2 weeks after acute myocardial infarction on myocardial perfusion and left ventricular function: a gated SPECT imaging study Impact of Home-Based Exercise Training with Wireless Monitoring on Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial
Introduction Exercise-based cardiac rehabilitation ( CR ) independently alters the clinical course of cardiovascular diseases result ing in a significant reduction in all-cause and cardiac mortality . However , only 15%–30 % of all eligible patients participate in a phase 2 ambulatory programme . The uptake rate of community-based programmes following phase 2 CR and adherence to long-term exercise is extremely poor . Newer care models , involving telerehabilitation programmes that are delivered remotely , show considerable promise for increasing adherence . In this view , the PATHway ( Physical Activity Towards Health ) platform was developed and now needs to be evaluated in terms of its feasibility and clinical efficacy . Methods and analysis In a multicentre r and omised controlled pilot trial , 120 participants ( m/f , age 40–80 years ) completing a phase 2 ambulatory CR programme  will be r and omised on a 1:1 basis to PATHway or usual care . PATHway involves a comprehensive , internet-enabled , sensor-based home CR platform and provides individualised heart rate monitored exercise programmes ( exerclasses and exergames ) as the basis on which to provide a personalised lifestyle intervention programme . The control group will receive usual care . Study outcomes will be assessed at baseline , 3 months and 6 months after completion of phase 2 of the CR programme . The primary outcome is the change in active energy expenditure . Secondary outcomes include cardiopulmonary endurance capacity , muscle strength , body composition , cardiovascular risk factors , peripheral endothelial vascular function , patient satisfaction , health-related quality of life ( HRQoL ) , well-being , mediators of behaviour change and safety . HRQoL and healthcare costs will be taken into account in cost-effectiveness evaluation . Ethics and dissemination The study will be conducted in accordance with the Declaration of Helsinki . This protocol has been approved by the director and clinical director of the PATHway study and by the ethical committee of each participating site . Results will be disseminated via peer- review ed scientific journals and presentations at congresses and events . Trial registration number NCT02717806 . This trial is currently in the pre- results stage Background Home-based exercise training in cardiac rehabilitation ( CR ) has the potential to improve CR uptake , decrease costs and increase self-management skills . The FIT@Home study evaluates home-based CR with telemonitoring guidance using coaching interventions including strategies for behavioural changes with the aim to maintain adherence to a healthy lifestyle and to improve long-term effects . In this interim analysis we provide short-term results on exercise capacity , quality of life and training adherence of the first 50 patients included in the FIT@Home study . Design The study design was a r and omised controlled trial . Methods Low to moderate risk CR patients were r and omised to a 12-week home-based training ( HT ) programme or a 12-week centre-based training ( CT ) programme .  In both groups , training was performed at 70–85 % of maximal heart rate ( HRmax ) for 45–60 min , 2–3 times per week . The HT group received three supervised training sessions , before commencing training with a heart rate monitor in their home environment . These patients received individual coaching by telephone weekly , based on training data uploaded on the Internet . The CT programme was performed under the direct supervision of a physical therapist . Exercise capacity and health-related quality of life were assessed at baseline and at 12 weeks . Results CT ( n = 25 ) and HT ( n = 25 ) both showed a significant improvement in peak oxygen uptake ( peak VO2 ) ( 10 % and 14 % respectively ) and quality of life after 12 weeks of training , without significant between-group differences . The average training intensity of the HT group was 73.3 ± 3.5 % of HRmax . Training adherence was similar between groups . Conclusion This analysis shows that HT with telemonitoring guidance has similar short-term effects on exercise capacity and quality of life as CT in CR patients BACKGROUND To evaluate the long-term cost-effectiveness of two home-based cardiac rehabilitation ( CR ) interventions ( Healthy Weight ( HW ) and Physical Activity ( PA ) ) for patients with cardiovascular disease ( CVD ) , who had been referred to cardiac rehabilitation ( CR ) but had not attended . The interventions consisted of pedometer-based telephone coaching sessions on weight , nutrition and physical activity ( HW group ) or physical activity only ( PA group ) and were compared to a control group who received information brochures about physical activity . METHODS A cost-effectiveness analysis was conducted using data from two r and omised controlled trials . One trial compared HW to PA ( PANACHE study ) , and the second compared PA to usual care . A Markov model was developed which used one risk factor , body mass index ( BMI ) to determine the CVD risk level and mortality . Patient-level data from the trials were used to determine the transitions to CVD states and healthcare related costs . The model was run for separate cohorts of males and females . Univariate and probabilistic sensitivity analysis were conducted to test the robustness of the results . RESULTS Given a willingness-to-pay threshold of $ 50,000/QALY , in the long run , both the HW and PA interventions are cost-effective compared with usual care . While the HW intervention is more effective , it also costs more than both the PA intervention and the control group due to higher intervention costs . However , the HW intervention is still cost-effective relative to the PA intervention for both men and women . Sensitivity analysis suggests that the results are robust . CONCLUSION The results of this paper provide evidence of the long-term cost-effectiveness of home-based CR interventions for patients who are referred to CR but do not attend . Both the HW and PA interventions can be recommended as cost-effective home-based CR programs , especially for people lacking access to hospital services or who are unable to participate in traditional CR programs Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Cardiac rehabilitation ( CR ) is aim ed at improving health behaviors to slow or reverse the progression of CVD disease . Exercise is a central element of CR . Technologies such as mobile phones and the Internet ( mHealth ) offer potential to overcome many of the psychological , physical , and geographical barriers that have been associated with lack of participation in exercise-based CR . We aim to trial the effectiveness of a mobile phone delivered exercise-based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD . This paper outlines the rationale and methods of the trial . Methods A single-blinded parallel two-arm r and omized controlled trial is being conducted . A total of 170 people will be r and omized at 1:1 ratio either to receive a  mHealth CR program  or usual care .  Participants are identified by CR nurses from two metropolitan hospitals in Auckl and , New Zeal and through outpatient clinics and existing data bases . Consenting participants are contacted to attend a baseline assessment . The intervention consists of a theory-based , personalized , automated package of text and video message components via participants ' mobile phones and the Internet to increase exercise behavior , delivered over six months . The control group will continue with usual CR . Data collection occurs at baseline and 24 weeks ( post-intervention ) . The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks . Secondary outcomes include post-intervention measures on self-reported physical activity ( IPAQ ) , cardiovascular risk factors ( systolic blood pressure , weight , and waist to hip ratio ) , health related quality of life ( SF-36 ) , and cost-effectiveness . Discussion This manuscript presents the protocol for a r and omized controlled trial of a mHealth exercise-based CR program . Results of this trial will provide much needed information about physical and psychological well-being , and cost-effectiveness of an automated telecommunication intervention . If effective , this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally ( and internationally ) in a very short time , enhancing the translational aspect of this research . It also has potential to extend to comprehensive CR ( nutrition advice , smoking cessation , medication adherence).Trial Registration BACKGROUND AND PURPOSE Exercise adherence in general is reported to be problematic after cardiac rehabilitation . Additionally , vigorous exercise is associated with impaired exercise adherence . As high-intensity interval training ( HIT ) is frequently used as a therapy to patients with coronary artery disease in cardiac rehabilitation , the objective was to assess long-term exercise adherence following an HIT cardiac rehabilitation programme . METHODS A multicentre r and omized study was carried out . Eligible participants were adults who had previously attended a 12-week HIT cardiac rehabilitation programme , as either a home-based or hospital-based HIT ( treadmill exercise or group exercise ) .  The primary outcome was change in peak oxygen uptake ; secondary outcomes were self-reported and objective ly measured physical activity . RESULTS Out of 83 eligible participants , 76 were available for assessment ( 68 men/8 women , mean age 59 ( 8) years ) at a one-year follow-up . Peak oxygen uptake was significantly elevated above baseline values , ( treadmill exercise : 35.8 ( 6.4 ) vs. 37.4 ( 7.4 ) ml kg(-1 ) min(-1 ) , group exercise : 32.7 ( 6.5 ) vs. 34.1 ( 5.8 ) ml kg(-1 ) min(-1 ) and home-based exercise : 34.5 ( 4.9 ) vs. 36.7 ( 5.8 ) ml kg(-1 ) min(-1 ) at baseline and follow-up , respectively ) , with no significant differences between groups . The majority of the participants ( > 90 % ) met the recommended daily level of 30 minutes of moderate physical activity . The home-based group showed a strong trend towards increased physical activity compared with the hospital-based groups . DISCUSSION The results from this study have shown that both home-based and hospital-based HIT in cardiac rehabilitation induce promising long-term exercise adherence , with maintenance of peak oxygen uptake significantly above baseline values at a one-year follow-up . The implication for physiotherapy practice is that HIT in cardiac rehabilitation induces satisfactory long-term exercise adherence Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during  cardiac rehabilitation ( CR ) on exercise capacity and habitual physical activity . Design Six-year follow-up of patients who participated in a r and omised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery . Setting Outpatient CR centre in Central -South Ontario , Canada . Participants 196 Patients who participated in the original r and omised controlled trial and who attended an evaluation 1 year after CR . Interventions 6 months of home or hospital-based exercise training during CR . Main outcome measures Peak oxygen uptake ( peak Vo2 ) , Physical Activity Scale in the Elderly ( PASE ) to assess habitual activity , semi-structured interviews to assess vital status , demographic and descriptive information . Results Of the 196 eligible patients , 144 ( 75.5 % ; 74 Hospital , 70 Home ) were available for participation . Patients were predominantly male ( n=120 ; 83.3 % ) aged 70±9.5 years .  Clinical and sociodemographic outcomes were similar in both groups . While exercise performance declined over time , there were significant between-group differences in peak Vo2 ( 1506±418 ml/min vs 1393±341 ml/min ; p=0.017 ) and PASE scores ( 166.7±90.2 vs 139.7±66.5 ; p=0.001 ) at 6-year follow-up in favour of the home group . Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR . Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo2 and persistent physical activity compared with traditional hospital-based CR Background To help patients with coronary artery disease ( CAD ) benefit from the positive health effects attained by exercise-based cardiac rehabilitation ( CR ) , adherence to these programmes according to international guidelines is important . Strategies to increase adherence to exercise-based CR are mainly an unexplored area . The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy , containing goal - setting , self-monitoring and feedback , with the aim of improving rehabilitation outcomes for exercise-based CR , compared with usual care . Methods This is a r and omised , controlled trial . A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden . Patients are r and omised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy , in addition to usual care for 4 months . Outcome assessment at baseline , 4 and 12 months includes submaximal aerobic capacity ( primary outcome ) , exercise adherence , muscle endurance , level of physical activity , biomarkers , anxiety and depression , health-related quality of life , patient enablement and self-efficacy ( secondary outcomes ) . Discussion This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes . The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.Trial registration The study include all items from the World Health Organization Trial Registration Data Set . Trial registration number : NCT02895451 , 2016 - 08 - 16 , retrospectively registered Background Physical training has beneficial effects on exercise capacity , quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation . However , cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period . Home-based training has the potential to increase cardiac rehabilitation uptake , and was shown to be safe and effective in improving short-term exercise capacity . Long-term effects on physical fitness and activity , however , are disappointing . Therefore , we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home . In this way , we aim to improve self-management skills like self-efficacy and action planning for independent exercise and , consequently , improve long-term effectiveness with respect to physical fitness and physical activity . In addition , we aim to compare costs of this strategy with centre-based cardiac rehabilitation . Methods / design This r and omized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular , 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention . The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment . Participants are instructed to train at 70 - 85 % of their maximal heart rate for 45–60 minutes , twice a week . Patients receive individual coaching by telephone once a week , based on measured heart rate data that are shared through the internet . Primary endpoints are physical fitness and physical activity , assessed at baseline , after 12 weeks and after one year . Physical fitness is expressed as peak oxygen uptake , assessed by symptom limited exercise testing with gas exchange analysis ; physical activity is expressed as physical activity energy expenditure , assessed by tri-axial accelerometry and heart rate measurements . Secondary endpoints are training adherence , quality of life , patient satisfaction and cost-effectiveness . Discussion This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance . This strategy is in line with the trend to shift non-complex healthcare services towards patients ’ home environments . Trial registration Dutch Trial Register : NTR3780 . Clinical trials.gov register : Objective : To assess whether exercise volume during phase II rehabilitation affects long-term clinical benefits in patients with coronary artery disease . Design : Prospect i ve r and omized clinical trial with long-term follow-up . Setting : Hospital outpatient clinic . Subjects : Coronary artery disease patients ( age 65 ± 9 years , 82 % males ) attending a phase II rehabilitation programme  were r and omized into two groups of exercise volumes : 40- versus 60-minute training sessions . Patients exercised for three days per week for seven weeks , at 65 % of baseline oxygen uptake capacity . Next , they were followed up for 18 months . Out of 165 patients with coronary artery disease who completed the exercise intervention  , 119 attended the 18-month follow-up assessment . Main measurements : Body anthropometrics , resting haemodynamics , blood lipid profile , glycaemia , and C-reactive protein level , smoking behaviour , habitual physical activity , cardiovascular disease incidence and mortality . Results : In total population , a significant worsening of various cardiovascular disease risk factors was found at 18 months follow-up ( P<0.05 ) , and few patients ( 27 % of total group ) adhered to the recommended minimal physical activity level . No difference in change of body anthropometrics , resting haemodynamics , blood lipid profile , glycaemia , and C-reactive protein level , and smoking behaviour was seen between different exercise volumes ( P>0.05 ) . In addition , total cardiovascular disease incidence ( 13 % versus 22 % in 40- versus 60-minute group , respectively ) and habitual physical activity were not different between groups ( P>0.05 ) . Conclusion : In patients with coronary artery disease following cardiac rehabilitation , the cardiovascular disease risk profile worsened significantly during long-term follow-up . A smaller exercise volume during phase II rehabilitation generated equal long-term clinical benefits compared to a greater exercise volume Purpose : The application of active video games ( AVGs ) during cardiac rehabilitation ( CR ) sessions could potentially facilitate patient adherence . The feasibility , safety , and efficacy of in-class AVG supplementation as an alternative to conventional phase 2 programs were investigated . Methods : A pilot , evaluator-blinded , intention-to-treat , r and omized controlled trial recruited 32 low-moderate risk CR participants and allocated them to conventional or AVG-supplemented exercise . Both groups experienced equal exercise loads for 6 weeks . Patients were assessed at baseline , end of the program , and after an 8-week followup . Adherence and safety-related outcomes were the primary endpoints . Secondary outcomes included change in exercise capacity , daily physical activity ( PA ) , energy expenditure ( EE ) , and psychometric profiling . Results : Patients ( males 81 % ; 60 ± 10 years ) presented with typical cardiovascular risk factors and similar baseline characteristics . Participants did not perceive an increased risk of injury and were more interactive . At the end of the program , there was a lower tendency for dropping out ( 6 % vs 19 % , P > .05 ) , a significant improvement in PA ( 322 vs 247 arbitrary acceleration units/min , P = .047 ) and related EE per body weight ( 13 vs 11 kcal/kg/d , P = .04 ) among AVG participants compared with controls . No significant differences between groups for adverse medical events , exercise capacity , affect toward exercise , anxiety , depression , or quality -of-life changes were reported . Conclusions : The additional use of AVGs during CR sessions is feasible , safe , and significantly improved daily PA and EE . A dropout reduction trend among its users , which needs to be confirmed in a larger trial , raises awareness to AVG supplementation as a promising strategy to increase CR adherence AIMS To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity , psychological well-being and quality of life in patients with coronary heart disease . BACKGROUND Cardiac rehabilitation ( CR ) in short term improves exercise capacity and quality of life in patients with cardiac disease . However , the long-term benefits of CR are inconclusive . DESIGN A prospect i ve CR programme with repeated measures follow-up over 12 months . METHODS A six-week outpatient cardiac rehabilitation programme  was conducted including 147 patients with coronary heart disease . Patients completed the  physical activity energy expenditure ( seven-day recall activity ) , MacNew Heart Disease Health-Related Quality of Life ( MacNew ) and Hospital Anxiety and Depression scale ( HADs ) at baseline , six weeks , six and 12 months . RESULTS One hundred and five ( 71 % ) patients ( 76 male ) mean age of 61.8 ( SD 9.7 ) completed the four-measurement points . Analysis of variance revealed that total energy expenditure ( F ( 2 , 231 ) = 131 , p < 0.001 ) , HADs ( F ( 2 , 237 ) = 19.3 , p < 0.001 ) , depression score ( F ( 2 , 235 ) = 21.06 , p < 0.001 ) , anxiety score ( F ( 2,237 ) = 17.02 , p < 0.001 ) and MacNew ( F ( 2 , 197 ) = 77.02 , p < 0.001 ) were all statistically significant over time . Bonferroni pairwise follow-up confirmed significant positive differences ( p < 0.05 ) between baseline values and all subsequent measures over time . Depression was independently explained in 22 % of the variance in quality of life at 6 or 12 months . The energy expenditure was significantly higher for men compared to women ( F ( 1 , 103 ) = 31 , p < 0.001 ) . CONCLUSION A six-week cardiac rehabilitation programme is beneficial in improving quality of life , physical activity status , anxiety and depression . These benefits were maintained at 12 months . Elevated levels of depression were associated with impaired quality of life . RELEVANCE TO CLINICAL PRACTICE All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme . Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes Background Exercise capacity is a strong predictor of survival in patients with coronary artery disease ( CAD ) . Exercise capacity improves after cardiac rehabilitation exercise training , but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program . There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients . We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care . Material s and Methods Two-centre , open , parallel r and omized controlled trial with 12 months follow-up comparing usual care to a maintenance program . The maintenance program consisted of one monthly supervised high intensity interval training session , a written exercise program and exercise diary , and a maximum exercise test every third month during follow-up . Forty-nine patients ( 15 women ) on optimal medical treatment were included following discharge from cardiac rehabilitation . The primary endpoint was change in peak oxygen uptake at follow-up ; secondary endpoints were physical activity level , quality of life and blood markers of cardiovascular risk . Results There was no change in peak oxygen uptake from baseline to follow-up in either group ( intervention group 27.9 ( ±4.7 ) to 28.8 ( ±5.6 ) mL·kg ( -1 ) min ( −1 ) , control group 32.0 ( ±6.2 ) to 32.8 ( ±5.8 ) mL·kg ( −1 ) min ( −1 ) , with no between-group difference , p = 0.22 ) . Quality of life and blood biomarkers remained essentially unchanged , and both self-reported and measured physical activity levels were similar between groups after 12 months . Conclusions A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake  in CAD patients after discharge from cardiac rehabilitation compared to usual care . This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group . Trial Registration Clinical Trials.gov Aim : To investigate whether phase II cardiac rehabilitation ( CR ) conducted by a community model of shared care CR ( SC-CR ) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR ( H-CR ) in a r and omised controlled trial . Methods : Patients were r and omised to H-CR or SC-CR after admission for acute coronary syndrome . In SC-CR , the general practitioner took over the responsibility of the remaining rehabilitation , pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic . The Municipal Health Care Centres provided courses on smoking cessation , nutrition , and exercise training and contributed to disease education and psychosocial support . The main endpoint was adherence to the CR programme and compliance with lifestyle modifications . Results : In total , 1364 patients were screened , 327 ( 24 % ) were eligible , and 212 ( 65 % ) accepted participation . Phase II CR was completed by 192 ( 91 % ) of the participants . Full adherence to the CR programme was seen in 53 % in SC-CR versus 54 % in H-CR ( relative risk ( RR ) : 0.98 , 95 % confidence interval : 0.73–1.32 ) . In H-CR , patients had higher rates of adherence to dietary advice and health education . In SC-CR , 12 % of patients did not attend the risk factor evaluation and clinical assessment with their general practitioner . No difference in risk factor improvement was found . Exercise training was declined by 25 % in both groups . Conclusion : Adherence to phase II CR was high in both groups . SC-CR did not improve adherence and efficacy , but had comparable effects on medication and risk factors . Thus , SC-CR was safe and effective Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention BACKGROUND Cardiovascular diseases are the leading cause of death globally and sedentary lifestyle is one of the main risk factors . Home-based cardiac rehabilitation ( CR ) programs appear to be effective to improve exercise tolerance . The aim of the study , therefore , was to evaluate the effects of a phase IV ( maintenance ) home-based CR program on cardiorespiratory fitness and daily physical activity of patients recovering from an acute myocardial infa rct ion . METHODS This pilot study , with a sub-group r and omised controlled trial , included 32 individuals recovering from a myocardial infa rct ion , r and omly divided into the experimental group ( EG , n=16 ) and the control group ( CG , n=16 ) . The EG performed an exercise program , three times per week , at home during eight weeks . The two groups received health education sessions . Baseline and final assessment s included cardiorespiratory fitness , resting and peak heart rate , blood pressure and rate pressure , heart rate recovery and daily physical activity . ( Clinical Trials.gov : NCT01887080 ) . RESULTS At baseline no significant differences were observed between groups . After eight weeks of exercise , the EG significantly increased peak oxygen uptake ( p=0.02 ) , test duration ( p=0.019 ) , peak rate pressure ( p=0.003 ) , peak heart rate ( p=0.003 ) and heart rate recovery ( 0.025 ) when compared to the CG . No changes were observed on daily physical activity in both groups . CONCLUSION This specific phase IV home-based exercise program seems to improve cardiorespiratory fitness , haemodynamics at peak exercise and heart rate recovery , an indicator of cardiac autonomic function BACKGROUND participation in centre-based cardiac rehabilitation ( CR ) is known to reduce morbidity and mortality but participation rates among the elderly are low . Establishing alternative programmes is important , and home-based CR is the predominant alternative . However , no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up . METHODS r and omised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease . RESULTS seventy-five patients participated . There were no significant differences in exercise capacity after the intervention between home and centre-based CR . Adjusted mean differences of peak VO₂ = 0.9 ml/kg/min ( 95 % CI -0.7 , 2.4 ) and of 6 min walk test = -18.7 m ( 95 % CI -56.4 , 18.9 ) . In addition , no differences were found in the secondary outcomes of systolic blood pressure ( -0.6 mmHg , 95 % CI -11.3 , 10.0 ) , LDL cholesterol ( 0.3 mmol/l , 95 % CI -0.04 , 0.7 ) , HDL cholesterol ( 0.2 mmol/l , 95 % CI -0.01 , 0.3 ) , body composition , proportion of smokers and health-related quality of life . A group of patients who did not have an effect of either programmes were characterised by higher age , living alone and having COPD . At 12 months of follow-up , both groups had a significant decline in exercise capacity . CONCLUSIONS home-based CR is as  effective as centre-based CR  in improving exercise capacity , risk factor control and health-related quality of life . However , a group of patients did not improve regardless of the type of intervention . Continued follow-up is essential in order to maintain the gained improvements Background : Site‐based cardiac rehabilitation  ( CR ) provides supervised exercise , education and motivation for patients . Graduates of CR have improved exercise tolerance . However , when participation in CR ceases , adherence to regular physical activity often declines , consequently leading to worsening risk factors and clinical events . Therefore , the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR . Methods and Results : A 12‐week mHealth program was implemented using physical activity trackers and health coaching .  Twenty‐five patients were r and omized into mHealth or usual care after completing CR . The combination of a 4.7 ± 13.8 % increase in the mHealth and a 8.5 ± 11.5 % decrease in the usual care group result ed in a difference between groups ( P ≤ .05 ) for absolute peak VO2 . Usual care decreased the amount of moderate‐low physical activity minutes per week ( 117 ± 78 vs 50 ± 53 ; P < .05 ) as well as moderate‐high ( 111 ± 87 vs 65 ± 64 ; P < .05 ) . mHealth increased moderate‐high physical activity ( 138 ± 113 vs 159 ± 156 ; NS ) . The divergent changes between mHealth and usual care in moderate‐high physical activity minutes/week result ed in a difference between groups ( 21 ± 103 vs – 46 ± 36 ; P < .05 ) . Conclusions : A 12‐week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site‐based CR Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based Objective : The aim of this study was to explore feasibility , safety and outcome of an exercise intervention in people with Huntington ’s disease . Design : A r and omized controlled pilot trial . Setting : A home-based exercise programme . Subjects : A total of 25 subjects with early to mid-stage Huntington ’s disease . Intervention : Subjects were r and omly allocated to either an exercise intervention ( n = 13 ) or a control group ( n = 12 ) . Subjects in the exercise intervention group were asked to perform exercises at home three times a week for eight weeks using an exercise DVD , specifically developed for this purpose . The control group received their usual care . Measures : Adherence in the intervention group was calculated from exercise diaries . Measures of gait , balance , function , level of physical activity and quality of life were evaluated . Analysis of covariance was used to compare follow-up scores across groups after adjustment for chance baseline differences . Effect sizes were calculated . Results : Eleven participants from the intervention and ten from the control group completed the study . Mean adherence was 29.4 SD 1.8 for the 32 prescribed sessions . There were no related adverse events . Differences between groups were observed in gait speed , balance , function and level of physical activity , but not quality of life as measured by the SF36 . Effect sizes were large ( > 0.8 ) for the majority of the outcomes . Conclusions : Short-term structured home exercise programmes are feasible , beneficial and safe for people with early to mid-stage of Huntington ’s disease . Our findings support the implementation of a larger trial of longer-term home exercise Objective Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infa rct ion ( MI ) . This study aims to investigate the effect of a smartphone-based home service delivery ( Care Assessment Platform ) of CR ( CAP-CR ) on  CR  use and health outcomes compared with a traditional , centre-based programme ( TCR ) in post-MI patients . Methods In this unblinded r and omised controlled trial , post-MI patients were r and omised to TCR ( n=60 ; 55.7±10.4 years ) and CAP-CR ( n=60 ; 55.5±9.6 years ) for a 6-week CR and 6-month self-maintenance period . CAP-CR , delivered in participants ’ homes , included health and exercise monitoring , motivational and educational material delivery , and weekly mentoring consultations . CAP-CR uptake , adherence and completion rates were compared with TCR using intention-to-treat analyses . Changes in clinical outcomes ( modifiable lifestyle factors , biomedical risk factors and health-related quality of life ) across baseline , 6 weeks and 6 months were compared within , and between , groups using linear mixed model regression . Results CAP-CR had significantly higher uptake ( 80 % vs 62 % ) , adherence ( 94 % vs 68 % ) and completion ( 80 % vs 47 % ) rates than TCR ( p<0.05 ) . Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks ( TCR : 537±86–584±99 m ; CAP-CR : 510±77–570±80 m ) , which was maintained at 6 months . CAP-CR  showed slight weight reduction ( 89±20–88±21 kg ) and also demonstrated significant improvements in emotional state ( K10 : median ( IQR ) 14.6 ( 13.4–16.0 ) to 12.6 ( 11.5–13.8 ) ) , and quality of life ( EQ5D-Index : median ( IQR ) 0.84 ( 0.8–0.9 ) to 0.92 ( 0.9–1.0 ) ) at 6 weeks . Conclusions This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion . The home-based CR programme was as effective in improving physiological and psychological health outcomes  as traditional CR . CAP-CR is a viable option towards optimising use of CR services . Trial registration number ANZCTR12609000251224 Background : Several studies suggested that exercise training might improve myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization . However , these findings were obtained in patients with chronic coronary artery disease using thallium-201 myocardial perfusion scintigraphy . We evaluated whether a long-term exercise-based cardiac rehabilitation ( CR ) started early ( 9 ± 3 days ) after ST elevation acute myocardial infa rct ion ( STEMI ) improves myocardial perfusion and left ventricular ( LV ) function , evaluated by gated single-photon emission computed tomography ( SPECT ) imaging . Design : R and omized controlled study . Methods : Fifty patients with recent STEMI were r and omized into two groups : 24 enrolled in a 6-month exercise-based CR programme  ( group T ) and 26  discharged with generic instructions for maintaining physical activity and correct lifestyle  ( group C ) . All patients underwent cardiopulmonary exercise test and gated SPECT within 3 weeks after STEMI and at 6-month follow up . Results : At follow up , group T showed a significant reduction of stress-induced ischaemia ( p < 0.01 ) and an improvement in resting and post-stress wall motion ( both p < 0.005 ) and resting ( p < 0.05 ) and post-stress wall thickness ( p < 0.005 ) score indexes . At follow up , group T showed an improvement in peak oxygen consumption ( p < 0.0001 ) , O2 pulse ( p < 0.05 ) , and in the slope of increase in ventilation over carbon dioxide output ( p < 0.001 ) . No changes in myocardial perfusion parameters , LV function , and cardiopulmonary indexes were observed in group C at follow up . Conclusions : Six months of exercise training early after STEMI reduces stress-induced ischaemia and improves LV wall motion and thickness . Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with the improvement of cardiovascular functional capacity Recent studies have suggested a favorable effect of cardiac rehabilitation ( CR ) on patients with cardiovascular disease . This study aim ed to evaluate the impact of home-based exercise training with wireless monitoring on acute coronary syndrome ( ACS ) patients undergoing percutaneous coronary intervention ( PCI ) . A total of 55 ACS patients undergoing PCI were r and omly divided into home based exercise training with wireless monitoring cardiac rehabilitation ( CR , n = 26 ) and usual care ( UC , n = 29 ) . Exercise capacity and quality of life ( QOL ) were evaluated at baseline and after 12 weeks . Change of metabolic equivalent of the tasks , maximal exercise time and QOL were significantly increased ( + 2.47 vs + 1.43 , P = 0.021 ; + 169.68 vs + 88.31 sec , P = 0.012 ; and + 4.81 vs + 0.89 , P = 0.022 , respectively ) , and the change of submaximal rate pressure product , and of submaximal rate of perceived exertion were significantly decreased ( -28.24 vs -16.21 , P = 0.013 ; and -1.92 vs -1.62 , P = 0.018 , respectively ) in the CR group compared to the UC group after 12 weeks . CR using home-based exercise training with wireless monitoring led to improvement of exercise capacity and QOL relative to conventional care in ACS patients undergoing PCI . Our findings suggest that early scheduled CR may be considered in ACS patients undergoing PCI Objective To compare home-based cardiac rehabilitation ( CR ) with usual care ( control group with no rehabilitation ) in elderly patients who declined participation in centre-based CR . Design R and omised clinical trial with 12 months follow-up and mortality data after 5.5 years ( mean follow-up 4½ years ) . Setting Rehabilitation unit , Department of Cardiology , Copenhagen , Denmark . Participants Elderly patients ≥65 years with coronary heart disease . Intervention A physiotherapist made home visits in order to develop an individualised exercise programme that could be performed at home and surrounding outdoor area . Risk factor intervention , medical adjustment , physical and psychological assessment s were offered at baseline and after 3 , 6 and 12 months . Main outcome measurements The primary outcome was 6 min walk test ( 6MWT ) . Secondary outcomes were blood pressure , body composition , cholesterol profile , cessation of smoking , health-related quality of life ( HRQoL ) , anxiety and depression . Results 40 patients participated . The study population was characterised by high age ( median age 77 years , range 65–92 years ) and high level of comorbidity . Patients receiving home-based CR had a significant increase in the primary outcome 6MWT of 33.5 m ( 95 % CI : 6.2 to 60.8 , p=0.02 ) at 3 months , whereas the usual care group did not significantly improve , but with no significant differences between the groups . At 12 months follow-up , there was a decline in 6MWT in both groups ; −55.2 m ( 95 % CI : 18.7 to 91.7 , p<0.01 ) in the home group and −52.1 m ( 95 % CI : −3.0 to 107.1 , p=0.06 ) in the usual care group . There were no significant differences in blood pressure , body composition , cholesterol profile , cessation of smoking or HRQoL after 3 , 6 and 12 months follow-up . Conclusions Participation in home-based CR improved exercise capacity among elderly patients with coronary heart disease , but there was no significant difference between the home intervention and the control group . In addition , no significant difference was found in the secondary outcomes . When intervention ceased , the initial increase in exercise capacity was rapidly lost
Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC .
Background Exercise-based cardiovascular rehabilitation ( CR ) improves exercise capacity ( EC ) , lowers cardiovascular risk profile and increases physical functioning in the short term .
However , uptake of and adherence to a physically active lifestyle in the long run remain problematic .
Home-based ( HB ) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity ( PA ) .
The current systematic review and meta- analysis aim ed to compare the longer-term effects of HB exercise programmes with usual care ( UC ) or centre-based ( CB ) CR in patients referred for CR .