Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients? The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease Cardiac rehabilitation services in England and Wales: a national survey. [The influence of the outpatient cardiologic rehabilitation on the physical fitness at patients after a STEMI]. Cardiac rehabilitation after myocardial infarction. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study How important are individual counselling, expectancy beliefs and autonomy for the maintenance of exercise after cardiac rehabilitation? The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements? Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial A Behavior Change Intervention for Women in Cardiac Rehabilitation Individualized vs. group exercise in improving quality of life and physical activity in patients with cardiac disease and low exercise capacity: results from the DOPPELHERZ trial Rehabilitation outcomes following percutaneous coronary interventions (PCI). Aerobic exercise-based cardiac rehabilitation in Chinese patients with coronary heart disease: study protocol for a pilot randomized controlled trial Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. Association of Cardiac Rehabilitation with Improvement in High Sensitive C-Reactive Protein Post-Myocardial Infarction Home-based versus hospital-based high-intensity interval training in cardiac rehabilitation: a randomized study Changes in exercise capacity and lipids after clinic versus home-based aerobic training in coronary artery bypass graft surgery patients. Multicenter randomized controlled trial of a home walking intervention after outpatient cardiac rehabilitation on health-related quality of life in women Effect of Exercise-Based Cardiac Rehabilitation on Ejection Fraction in Coronary Artery Disease Patients: A Randomized Controlled Trial Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Timeline for peak improvements during 52 weeks of outpatient cardiac rehabilitation.
Background Heart failure is a common and costly condition , particularly in the elderly . A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes . Potentially , cardiac rehabilitation models can also improve outcomes . Aim To assess the impact of a nurse-coordinated multidisciplinary , cardiac rehabilitation program to decrease hospitalizations , increase functional capacity , and meet the needs of patients with heart failure . Method In a r and omized control trial , a total of 105 patients were recruited to the study . Patients in the intervention group received an individualized , multidisciplinary 12-week cardiac rehabilitation program , including an individualized exercise component tailored to functional ability and social circumstances . The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner . This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs . Results During the study period , patients in the intervention group were less likely to have been admitted to hospital for any cause ( 44 vs. 69 % , P = 0.01 ) or after a major acute coronary event ( 24 vs. 55 % , P = 0.001 ) . Participants in the intervention group were more likely to be alive at 12 months , ( 93 vs. 79 % ; P = 0.03 ) ( odds ratio = 3.85 ; 95 % confidence interval = 1.0314.42 ; P = 0.0042 ) . Quality of life scores improved at 3 months compared with baseline ( intervention t = 4.37 , P [ 0.0001 ; control t= 3.52 , P [ 0.01 ) . Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group ( t = 3.40 ; P = 0.01 ) . Conclusion This study shows that a multidisciplinary heart failure cardiac rehabilitation program , including an individualized exercise component , coordinated by a specialist heart failure nurse can substantially reduce both all-cause and cardiovascular readmission rates , improve functional status at 3 months and exercise tolerance Background Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease . Despite the benefits associated with regular exercise , adherence with supervised exercise-based cardiac rehabilitation remains low . Increasingly powerful mobile technologies , such as smartphones and wireless physiological sensors , may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease . This study compares the effectiveness of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( REMOTE ) to st and ard supervised exercise-based cardiac rehabilitation in New Zeal and adults with a diagnosis of coronary heart disease . Methods / Design A two-arm , parallel , non-inferiority , r and omised controlled trial will be conducted at two sites in New Zeal and . One hundred and sixty two participants will be r and omised at a 1:1 ratio to receive a 12-week program of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( intervention ) , or an 8 - 12 program of st and ard supervised exercise-based cardiac rehabilitation (control).The primary outcome is post-treatment maximal oxygen uptake ( V̇O2max ) . Secondary outcomes include cardiovascular risk factors ( blood lipid and glucose concentrations , blood pressure , anthropometry ) , self-efficacy , intentions and motivation to be active , objective ly measured physical activity , self-reported leisure time exercise and health-related quality of life . Cost information will also be collected to compare the two modes of delivery . All outcomes are assessed at baseline , post-treatment , and 6 months , except for V̇O2max , blood lipid and glucose concentrations , which are assessed at baseline and post-treatment only . Discussion This novel study will compare the effectiveness of technology-supported exercise-based cardiac rehabilitation to a traditional supervised approach . If the REMOTE program proves to be as effective as traditional cardiac rehabilitation , it has potential to augment current practice by increasing access for those who can not utilise existing services . Trial registration Australian New Zeal and Clinical Trials Registry Study ID number : ACTRN12614000843651 . Registered 7 August Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of We sent a short postal question naire to 244 centres in Engl and and Wales that admitted patients with cardiac conditions . In total , 199 ( 81 % ) of the centres cl aim ed to provide a  cardiac rehabilitation service .  Of these , 25 were r and omly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services . Most ( 18 ( 72 % ) ) of the centres had commenced their rehabilitation programme within the previous 5 years , usually at the instigation of interested staff . Patient entry to cardiac rehabilitation programmes was restricted ; women ( who represented only 15 % of attenders ) , elderly people ( excluded in 10 ( 40 % ) centres ) , and those with more complex problems , such as angina or heart failure , were under-represented . The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision . Most ( 22 ( 88 % ) ) programmes were hospital out-patient based , one ( 4 % ) was hospital in-patient based , one ( 4 % ) was community-based and one ( 4 % ) was home-based . The staffing and funding of programmes was variable , with 7 ( 28 % ) having no identified funding . There are wide variations in the re sources currently available for the rehabilitation of patients with coronary heart disease . There is a need for clearer direction of these services , in particular to determine minimum service provision . Guidelines are necessary to give a framework for this relatively new and rapidly exp and ing service UNLABELLED Myocardial infraction , sudden cardiac death next is one of the most serious clinical demonstrations of ischaemic heart diseases . It is characterized by an irreversible destruction ( necrosis ) of a part of cardiac muscle , caused by severe narrowing or blood clot ( thrombosis ) in the lumen of coronary arteries . The long-term , systematic and individually selected program of the physical rehabilitation has a beneficial effect to the improvement in the physical fitness at patients , after an myocardial infa rct ion . The aim of this work was to examine the influence of the outpatient , cardiological rehabilitation on the physical fitness and the normalization of the arterial pressure at patients after STEMI , treated with methods of invasive cardiology , and determining effects of the rehabilitation . MATERIAL AND METHODS The study included 108 patients ( 93 men and 15 women ) . An average age of patients was 53 . Examined patients were divided into 2 groups : rehabilitated ( 55 people ) and control ( 53 people ) . The program of the cardiologic rehabilitation included 24 forty-minute training sessions , for 2 - 3 times during the week . Every training session spread through 10 minutes of the general keep-fit exercise ( warm-up ) , 24 minutes of the ride on cycloergometer ( intervallic training ) with submaximal load adjusted individually for every patient , under the constant electrocardiographic scrutiny of the action of the heart , and 6 minutes of respiratory exercises . The criterion of intensity of a physical effort was determined on the basis of a Bruce test according to on the level of the 70 % of the maximum limit of the heart rate . The rehabilitation lasted about 3 months . RESULTS Obtained findings show that the outpatient , cardiologic rehabilitation has a beneficial effect for the improvement in the physical fitness and the decrease in value of the rest arterial pressure at patients after STEMI . Examinations show the increase of the maximum load ( max MET 'S ) and longer duration of the exercise test . CONCLUSIONS Above findings confirm the effectiveness of the cardiological rehabilitation , although they are not spectacular . Perhaps if they increase the frequency and intensity and number of training sessions , the results would be more significant Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment 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 : Aims : We examined whether autonomy supportive and self-efficacy enhancing individual lifestyle counselling was associated with improved maintenance of exercise and physical capacity compared with group based counselling . We also tested whether self-efficacy beliefs and autonomous motivation was associated with improved maintenance of exercise over time . Methods : R and omised controlled trial and longitudinal study of predictor variables . One hundred and seventy six ( 38 female ) patients mainly with coronary heart disease were r and omized to either have st and ard group based rehabilitation or to additionally receive the intervention . Patients were recruited from a 4-week cardiac rehabilitation programme  with two years follow-up at Krokeide Centre in Bergen , Norway . Results : We found no statistically significant between-group differences . The groups showed an overall improvement of their self-evaluated physical capacity during the two years of the study , corresponding 7 % change of score ( p<0.001 ) . The composite exercise score improved 6 % during follow-up ( p<0.001 ) . Intensity of exercise activities improved 17 % from inclusion to 24 months ' follow-up ( p<0.001 ) . Self-efficacy for increased exercise , general expectancy and autonomous motivation were significant predictors of increased exercise and physical capacity . Controlled motivation hampered physical capacity improvement . Conclusions : Among this self-selected and motivated group of rehabilitation patients we found no additional effect of adding individual counselling to group-based interventions . Based on longitudinal documentation this cardiac rehabilitation programme improves long-term maintenance of exercise and physical capacity and this maintenance is related to autonomous motivation , general expectancy and self-efficacy Objective : To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft ( CABG ) surgery . Design : Thirty subjects who received CABG surgery were r and omly assigned to enter or not enter a cardiac rehabilitation exercise programme ( cardiac rehabilitation n=15 ; control group n=15 ) . Setting : Outpatient cardiac rehabilitation centre in a national medical hospital . Interventions : Patients assigned to the cardiac rehabilitation group received 36 sessions of the exercise programme , three times a week , with the intensity design ed to achieve an individual 60 - 85 % peak heart rate in cardiopulmonary exercise test . Patients assigned to the control group did not get further advice about a specific exercise programme . Main outcome measures : Resting heart rate and recovery of heart rate over 1 min after a peak exercise test at discharge and three months later were collected . The heart rates were analysed with computer-recorded electrocardiogram . Results : At follow-up , the 15 patients in the cardiac rehabilitation group had a significantly lower resting heart rate ( 77.469± 9.49 versus 92.319± 10.18 bpm ; p B± 0.001 ) and a significantly higher recovery of heart rate over 1 min ( 16.389± 6.32 versus 11.389± 4.81 bpm ; p ± 0.03 ) compared with the control group . There were also significant reductions in resting heart rates  ( cardiac rehabilitation p ± 0.001 ; control p=0.05 ) and improvements in recovery on heart rate over 1 min  ( cardiac rehabilitation p ± 0.001 ; control p= 0.001 ) compared with baseline measurements in both the cardiac rehabilitation and control groups . Conclusion : Cardiac rehabilitation had a positive effect on the improvement of recovery on heart rate over 1 min in patients with coronary artery disease who received CABG surgery Background It is unclear how much of the reduction in cardiac mortality in coronary heart disease ( CHD ) patients with exercise training  is the result of direct effects on the heart and coronary vasculature , or to indirect effects , via primary risk factors . Objective The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature . Methods The IMPACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta- analysis of cardiac rehabilitation r and omized , controlled trials . Patients were receiving rehabilitation following an acute myocardial infa rct ion , angina pectoris or revascularization . Outcomes considered were primary risk factors ( total cholesterol , systolic blood pressure and smoking behaviour ) and cardiac mortality . Results Nineteen exercise-only cardiac rehabilitation trials ( including 2984 patients ) were identified . Across these trials , exercise training reduced pooled cardiac mortality by 28 % ( relative risk , 0.72 , 95 % confidence interval 0.55–0.95 ) , with 30 fewer deaths than in the control group . Applying the CHD model , approximately 17 ( 58 % ) of these 30 fewer deaths were attributable to reductions in major cardiovascular risk factors : 7.1 deaths ( minimum estimate 6.2 , maximum estimate 9.5 ) attributable to an 18 % reduction in smoking prevalence ; 5.9 deaths ( minimum −0.6 , maximum 12.6 ) to a 0.11 mmol/l reduction in cholesterol , and 4.4 deaths ( −1.0 minimum , 6.7 maximum ) to a 2.0 mmHg reduction in systolic blood pressure . Conclusions Approximately half of the 28 % reduction in cardiac mortality achieved with exercise-based cardiac rehabilitation may be attributed to reductions in major risk factors , particularly smoking . Eur J Cardiovasc Prev Rehabil 13:369–374 © 2006 The European Society of Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes Abstract Purpose : Important goals of cardiac rehabilitation maintenance programs ( CMP ) are to increase leisure time physical activity ( LTPA ) and improve health-related quality of life ( HRQoL ) . Elderly patients with cardiac disease and low exercise capacity are simultaneously the most severely affected and have the most to gain from exercise-based rehabilitation . Individualized combined exercise ( ICE ) may be an effective modality to achieve these goals . We compared six months of ICE to CMP in their effects on LTPA and HRQoL. Methods : Sixty patients ( 70 ± 9 years , 39 % female ) with cardiac disease and low exercise capacity ( < 6 MET ) were r and omly allocated to six months of once-weekly ICE or CMP . The patients in ICE performed moderate endurance and resistance exercise on machines , based on intensities from individual peak exercise testing . Patients in CMP performed weekly sessions of calisthenics , flexibility , coordination and relaxation activities . LTPA and HRQoL were assessed with accelerometry and question naires at baseline and six months . Results : Sixty patients completed the trial . ICE  increased vigorous PA ( ICE : Δ + 12 MET-min/d , CMP : Δ –5 MET-min/d , p = .02 ) and steps per day ( ICE : + 1586 steps/d , CMP : –838 steps/d , p < .01 ) compared to CMP after six months . ICE significantly improved in several components of HRQoL ( vitality , emotional health , social health , positive and negative affect ( all p < .05 ) compared to CMP . Conclusions : ICE result ed in significant improvements in physical activity levels and health related quality of life in moderate to high-risk patients compared to CMP . Implication s for rehabilitation Relatively low volumes and intensities of exercise may lead to substantial improvements in both physical activity levels and health-related quality of life Exercise modes in cardiac rehabilitation maintenance programs should not be limited to calisthenics and large group-based exercise Supplemental resistance exercise may improve health-related quality of life and increase physical activity levels in patients with low exercise capacity Moderate to high-risk elderly patients also benefit from individualized endurance-resistance This prospect i ve study evaluated the effect of an individualized , comprehensive , home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors , psychological well-being , functional capacity , and work resumption in 99 post-percutaneous coronary interventions ( PCI ) patients r and omized to control ( st and ard care plus telephone follow-up  , n=49 ) or intervention ( individualized , comprehensive , home-based cardiac rehabilitation , n=50 ) groups . Data were collected at time 1 ( T(1 ) ) during hospital admission , time 2 ( T(2 ) ) approximately 2 months post-PCI , and time 3 ( T(3 ) ) approximately 12 months post-PCI . Results suggest that the allocation to an individualized , comprehensive , home-based cardiac rehabilitation program provided more advantageous outcomes . At both follow-ups , the intervention group showed within-group improvement in serum cholesterol levels ( P<0.02 ; P<0.01 ) and exercise participation ( P<0.001 ; P<0.001 ) with differences in exercise participation favoring the intervention group ( P<0.01 ) at T(2 ) . Repeated measures ANOVA showed significant improvements over time in body mass index ( BMI ) ( P<0.01 ) , psychological well-being ( P<0.001 ) , and functional capacity ( P<0.001 ) for both groups . More patients in the intervention group had returned to work at T(2 ) ( P<0.001 ) and did so more quickly ( P<0.01 ) . These findings suggest that an individualized , comprehensive , home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI Background Cardiovascular disease is the leading cause of morbidity and mortality in the world , including China . Cardiac rehabilitation ( CR ) has been demonstrated to be beneficial in reducing cardiovascular mortality , myocardial infa rct ion , and cerebrovascular events . This pilot study seeks to assess the feasibility of aerobic-exercise-based CR in Chinese patients with coronary heart disease ( CHD ) and outcomes of aerobic metabolism capacity and molecular biomarkers . Methods / design This study is a single-center , pilot , r and omized , controlled study that is currently being carried out at a regional hospital in Shanghai . Forty patients with CHD who underwent percutaneous coronary intervention will be r and omly allocated into either the intervention group or control group . Participants in the intervention group will undergo 8 weeks of aerobic exercise with targeted intensity and participants in the control group will undergo 8 weeks of leisure exercise . The primary measurement is the feasibility of the trial ; the secondary measurement is the capacity of aerobic metabolism and the exploratory measurement includes additional molecular biomarkers underlying cardiovascular function . Discussion This is the first prospect i ve r and omized and controlled clinical study in China that assesses the parameters of aerobic metabolism and comprehensively screens for substantial blood biomarkers to reveal the molecular mechanisms underlying changes in cardiovascular function after aerobic exercise with targeted intensity in participants with CHD . The success of this study will contribute to guide the design of future CR studies in patients with CHD in China . Trial registration Chinese Clinical Trial Registry , ChiCTR-IPR-17010556 . Registered on 1 June 2016 OBJECTIVE To estimate the incremental effects on cost and quality of life of  cardiac rehabilitation after an acute coronary syndrome . DESIGN Open r and omised controlled trial with 1 year 's follow-up . Analysis was on an intention-to-treat basis . SETTING Two tertiary hospitals in Sydney . INTERVENTION 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor . PARTICIPANTS 113 patients aged 41 - 75 years who were self-caring and literate in English . Patients with uncompensated heart failure , uncontrolled arrhythmias , severe and symptomatic aortic stenosis or physical impairment were excluded . MAIN OUTCOME MEASURES Costs ( hospitalisations , medication use , outpatient visits , investigations , and personal expenses ) ; and measures of quality of life . Incremental cost per quality -adjusted life year ( QALY ) saved at 1 year ( this estimate combines within- study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality ) . Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival , 3 years of treatment effect on survival and variations in utility . RESULTS The estimated incremental cost per QALY saved for  rehabilitation  relative to st and ard care was 42,535 US dollars when modelling included the reported treatment effect on survival . This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included . The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective . CONCLUSIONS The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome . The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee Dear Editor , Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults.[1][2 ] Today , inflammation is regarded as the key pathogenic mechanism in both initiation and progression of atherosclerosis.[3]Inflammatory markers such as high sensitive C-reactive protein ( CRP ) have been used to identify patients at higher risk for coronary events . The prognostic value of CRP has been established for patients with acute coronary syndrome , stable coronary artery diseases[4 ] and in apparently healthy people.[5][6 ] Comprehensive cardiac rehabilitation is probably the most effective approach for cardiovascular reduction and long-term care of cardiac patients as well as subjects with multiple coronary risk factors.[7][8 ] Secondary prevention , through cardiac rehabilitation program is now regarded as an essential component of contemporary management of patients with various presentations of coronary disease.[9 ] There are some evidence s that protective effects of cardiac rehabilitation may in part be related to lowering of inflammation . The goal of this prospect i ve study was to assess the effect of cardiac rehabilitation on high sensitive CRP as a marker of increased risk of coronary artery disease . The subjects were r and omly selected from patients with recent anterior wall myocardial infa rct ion referring to Alzahra Cardiac Rehabilitation Center in Shiraz from May to December 2007 . Inclusion criteria were males and females aged 30 - 75 years with anterior wall MI in past 1 month . Patients were divided into two groups . Group A consisted of 30 participants who received cardiac rehabilitation  and group B consisting of 26 participants which did not receive any cardiac rehabilitation program .  CRP levels were assessed before starting the program and eight weeks later . We used CRP Quantitative Diagnostic Kit for serum and plasma-Photometry technique . The data were analyzed by Wilcoxon Signed Rank and Mann-Whitney tests . The cardiac rehabilitation program included 8 weeks of exercise training , education and behavior modification therapy 3 times per week . The exercise training included arm and leg ergometry and treadmills . Behavioral modifications were smoking cessation , healthy nutrition , hypertension control , etc . The average age of patients was 62.7 years old . At enrollment , 66 % ( n=20 ) of participants in cardiac rehabilitation ( group A ) had CRP levels in the intermediate and high-risk range of > 1 mg/dl and after completion of cardiac rehabilitation only 27 % ( n= 5 ) of patients had elevated CRP levels ( P=0.0009 ) . In the group B , 73 % ( n=19 ) of participants had CRP levels > 1 mg/dl and after eight weeks , 53 % ( n=14 ) of them had CRP levels > 1 mg/dl ( p=0.50 ) . A higher CRP level was observed in patients 65 years , but both age groups demonstrated significant improvements in CRP postcardiac rehabilitation . This study showed a significant decrease in CRP levels in patients with cardiac disease after participation in cardiac rehabilitation program .  The findings showed that cardiac rehabilitation decreased vascular inflammation accompanying improvement in risk factors . Regardless of gender , there was a significant decrease in CPR at the completion of cardiac rehabilitation . The decrease in inflammation along with previously described benefits of cardiac rehabilitation supports the recommendations of American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation that participation in cardiac rehabilitation should be a part of comprehensive care of cardiac patients . The findings in our study had two important clinical implication s. First , the potential independent effect of cardiac rehabilitation in lowering CRP levels was demonstrated which is independent from weight in our study . The non-pharmacologic mechanism for this observation may be due to dietary modifications , weight management and exercise components of the program . Secondly , the decrease in vascular inflammation associated with cardiac rehabilitation is evident regardless of gender , age and metabolic syndrome Background High-intensity interval training ( HIT ) as exercise therapy is gradually implemented in cardiac rehabilitation as the cardiovascular benefits from exercise is intensity dependent . However , in previous studies , HIT has been performed with strict supervision . The aim of the study was to assess the feasibility and effectiveness of different modes of HIT in cardiac rehabilitation . Design a r and omized clinical study . Methods Ninety participants with coronary artery disease ( 80 men/10 women , mean age 57 ± 8 years ) were r and omly assigned to one of three exercise modes : group exercise ( GE ) , treadmill exercise ( TE ) , or home-based exercise ( HE ) . HIT was performed twice a week for 12 weeks with an exercise intensity of 85–95 % of peak heart rate . The primary outcome measure was change in peak oxygen uptake ( peak VO2 ) . Results Eighty-three participants ( 92 % ) completed the intervention without any severe adverse events . Peak VO2 increased from 34.7 ± 7.3 to 39.0 ± 8.0 ml/kg/min , 32.7 ± 6.5 to 36.0 ± 6.2 ml/kg/min , and 34.4 ± 4.8 to 37.2 ± 5.2 ml/kg/min in TE , GE , and HE , respectively . Mean group difference for TE vs. HE was 1.6 ml/kg/min ( 95 % confidence interval , CI , 0.7 to 3.1 , p = 0.02 ) , TE vs. GE 1.1 ml/kg/min ( 95 % CI−0.5 to 2.5 , p = 0.27 ) , and GE vs. HE 0.6 ml/kg/min ( 95 % CI −1.0 to 2.1 , p = 1 ) . However , on-treatment analysis showed no significant difference between groups . Conclusion HIT was efficiently performed in three setting s of cardiac rehabilitation , with respect to target exercise intensity , exercise attendance , and increase in peak VO2 . Exercise mode was not essential for exercise capacity PURPOSE Despite the documented benefits of participating in rehabilitation programs , access to cardiac rehabilitation is limited for a large number of people with coronary artery disease ( CAD ) . There is potential to increase participation in exercise training if home-based exercise were a viable option . METHODS We conducted a retrospective data base review of 1,042 patients who took part in exercise rehabilitation following coronary artery bypass graft surgery ( CABGS ) between 1992 and 1998 . Of these , 713 patients took part in supervised exercise , and 329 were in an unsupervised , home-based group .  All exercise protocol s were based upon American College of Sports Medicine guidelines , and patients in both groups received exercise prescriptions that were similar in intensity , frequency , and duration . RESULTS There were no differences between groups at baseline . Following 6 months of exercise training , there were substantial improvements in peak VO2 , peak workload , and peak MET levels in both the supervised and unsupervised groups ( P < 0.0001 ) . Patients in the supervised group had significant improvements in both LDL and HDL-cholesterol , whereas the home-based group showed improvement in HDL-cholesterol only . When analyzed by sex , men performed better than women for all measures of exercise capacity ; however , women in both groups showed approximate 20 % improvements ( P < 0.05 ) in exercise capacity as well as improvements in HDL-cholesterol . CONCLUSION Stable post CABGS patients who receive a detailed exercise prescription to follow at home do as well as those in supervised rehabilitation Background Poor health-related quality of life ( HRQL ) has been shown to be predictive of adverse outcomes in cardiac patients . As women with coronary heart disease have been shown to have lower HRQL than men with coronary heart disease , women are at greater risk of a poor clinical outcome . This study tested the effect of a 12-week home walking intervention after completion of  outpatient cardiac rehabilitation ( OCR )  on HRQL and maintenance of physical activity among women . Design Multicenter two-group r and omized trial . Methods After completion of OCR , participants were r and omly allocated to the intervention or usual care groups . The outcomes were HRQL ( assessed using the MacNew Heart Disease HRQL instrument ) and self-reported physical activity ( assessed using the Stages of Change model of exercise behavior ) at 3 , 6 , and 12 months after OCR . Results Seventy-two women were r and omized to the intervention and 81 to usual care . Attrition was greater in the treatment group ( 13 vs. 1 % ) . HRQL scores increased relative to the base level in both arms and were significantly higher in the intervention group at 6 months , but not at 3 or 12 months . Maintenance of physical activity declined over time in both groups , however , this decline was significantly reduced among women in the intervention group . Conclusion HRQL improved in both groups , but seemed to increase earlier among women in the intervention group . As maintenance of physical activity was higher among women in the intervention group , this minimal intervention could be used to facilitate women 's progression from supervised to independent exercise Background : Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health . However , left ventricular ejection fraction ( LVEF ) is clinical ly used as a predictor of long-term prognosis in coronary artery disease ( CAD ) patients , there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF . Objective : To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients . Patients and Methods : In a single blinded , r and omized controlled trial , post-coronary event CAD patients from the age group of 35 - 75 years , surgically ( Coronary artery bypass graft or percutaneous coronary angioplasty ) or conservatively treated , were recruited from Golsar Hospital , Iran . Exclusion criteria were high-risk group ( AACVPR-99 ) patients and contraindications to exercise testing and training . Forty-two patients were r and omized either into Study or Control . The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based ( CExs ) or Home-based ( HExs ) according to the ACSM-2005 guidelines . The control group only received the usual cardiac care without any exercise training .  LVEF was measured before and after 12 weeks of exercise training for all three groups . Differences between and within groups were analyzed using the general linear model , two-way repeated measures at alfa=0.05 . Results : Mean age of the subjects was 60.5 ± 8.9 years . There was a significant increase in LVEF in the study ( 46.9 ± 5.9 to 61.5 ± 5.3 ) group compared with the control ( 47.9 ± 7.0 to 47.6 ± 6.9 ) group ( P=0.001 ) . There was no significant difference in changes in LVEF between the HExs and CExs groups ( P=1.0 ) . Conclusion : A 12-week early ( within 1 month post-discharge ) structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients 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 PURPOSE Cardiac rehabilitation is an integral component of comprehensive care for patients with coronary heart disease . Although the typical programmatic delivery of outpatient cardiac rehabilitation services often involves 36 sessions over 12 weeks , that format is based more on historical practice than on outcome data . This study aim ed to determine the point at which during 52 weeks of outpatient cardiac rehabilitation , patients achieved peak values for selected outcomes , and whether the number of supervised exercise sessions had any effect on these outcomes . METHODS In this study , 623 male patients with coronary heart disease admitted to an outpatient cardiac rehabilitation program were r and omized to one of two 52-week program formats . One format ( CR1 ) used one supervised exercise session per week over 52 weeks , and the second format ( CR2 ) used weekly supervised sessions for 26 weeks followed by one supervised session per month for the remaining 26 weeks . Both formats used four unsupervised , documented exercise sessions per week . Selected clinical , physiologic , and psychological variables were measured at baseline , then at 4 , 12 , 26 , 38 , and 52 weeks . The program costs for both the CR1 and CR2 formats were calculated from known expenses . RESULTS Because there were no significant intercohort differences between CR1 and CR2 and no significant interaction ( time x group ) , data from the two cohorts were pooled for statistical analysis . Peak oxygen intake ( VO(2peak ) ) significantly increased by 4.4 mL/kg per minute at 38 weeks , and the greatest percentage of patients ( 30.1 % ) also achieved their highest VO(2peak ) at this time . The largest gain in Medical Outcomes Survey Short Form 36 role physical scores was from baseline to 38 weeks ( 52.4 versus 85.2 ) , and the highest percentage of patients ( 72 % ) with role physical scores in the excellent category occurred at 38 weeks . Clinical depression at baseline ( Beck Depression Inventory score > 10 ) had no significant effect on the dropout rate or the gain in VO(2peak ) with exercise training . Program costs for these alternative formats of service were similar to the cost for a st and ard program format of 36 sessions . CONCLUSIONS Patients achieved their highest functional capacity after 38 weeks of outpatient cardiac rehabilitation using a program format of only 29 to 38 supervised exercise sessions . The results of this study show that an outpatient cardiac rehabilitation program combining supervised with unsupervised exercise sessions and continuing for 38 weeks results in the greatest improvement in these selected outcomes
Conclusions Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease .
While our analysis was constrained by the quality of included trials and missing information about intervention components , there appears to be little differential effect of variations in exercise intervention , particularly on mortality outcomes .
Background While the clinical benefits of exercise-based cardiac rehabilitation are well established , there is extensive variation in the interventions used within these trials .
It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes .
This study aims to systematic ally examine the relationship between individual components of the exercise intervention in cardiac rehabilitation ( such as intensity and frequency ) and clinical outcomes for people with coronary heart disease .