Exercise Prescription in Cardiac Rehabilitation
Condition: Percutaneous Coronary Intervention; Myocardial Infarction; Coronary Artery Bypass Graft
MeSH terms: Myocardial Infarction; Infarction
Study type: Interventional

Summary: 
      Cardiac Rehabilitation (CR) is an effective exercise-based lifestyle therapy for patients
      with cardiac disease. There are two common methods of exercise prescription, an effort based
      exercise prescription and target heart rate based exercise prescription. The purpose of this
      research study is to identify the best way to exercise in cardiac rehabilitation. There are
      three main goals of this study. First, the investigators want to know if an exercise test
      should be done near the beginning of cardiac rehabilitation. Second, the investigators want
      to understand what type of exercises should be recommend to patients. Third, the
      investigators want to understand if a personal heart rate monitor will improve adherence to a
      target heart rate for exercise. As part of this study, some patients will undergo an exercise
      stress test on a treadmill to determine a target heart rate. These patients will be given a
      heart rate goal to use when they exercise. Some patients will be given a personal heart rate
      monitor to improve adherence.
    

Detailed description: 
      Cardiac Rehabilitation (CR) is an effective exercise-based lifestyle therapy for patients
      with cardiac disease that reduces cardiovascular morbidity and mortality, increases quality
      of life, and is cost-effective. Recent retrospective studies show that higher exercise gains
      during CR are associated with reduced long-term morbidity and mortality among patients with
      both coronary artery disease and systolic heart failure. However, it is unclear which methods
      maximize exercise gains in CR. Recent retrospective studies have suggested that performing
      stress testing early in CR may allow for better tailoring of an exercise prescription and
      thus increase exercise gains. In this study, the investigators propose to do a randomized
      controlled trial of 60 patients at Baystate Medical Center CR, in which two thirds of the
      patients will undergo exercise testing prior to starting CR. The exercise test will determine
      the initial target heart rate range (THRR) and will also influence subsequent exercise
      progression. Additionally, half of the patients undergoing a stress test will receive a
      personal heart rate monitor to help improve adherence to the exercise prescription and THRR.
      The primary outcome is to determine feasibility, protocol fidelity, and effect sizes in
      preparation for a fully powered subsequent trial that will measure the impact of stress
      testing and a target heart rage range exercise prescription on exercise gain during CR.
    

Intervention name(s): Graded Exercise Stress test (GXT) with Target Heart Rate Range; Heart rate monitors
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patients assigned to one of two intervention groups will complete a GXT prior to the 4th CR session. The GXT will be completed in Baystate Medical Center's stress lab using standard protocols. This test will be used to set the target heart rate range, which will guide exercise intensity for the remainder of exercise training in cardiac rehabilitation.; Heart rate monitors (HRM) will be given to half of the patients randomly assigned to exercise stress testing group. Patients will receive a polar heart rate chest strap and polar watch. Patients will be asked to wear both, the chest strap and the watch during cardiac rehabilitation. Ultimately, we hope that the use of HRM is not necessary, but it may be needed to assure that patients in the THHR are able to consistently know their HR and adjust their exercise prescription. This will also increase the likelihood that there is a difference in heart rates between the THRR group from the RPE group.
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Graded exercise testing; Cardiac rehab; Exercise Prescription; Target heart rate range; RPE