Efficacy of physical exercise advice to ischemic heart disease patients in the maintenance of physical exercise during phase III cardiac rehabilitation program. A cluster randomised controlled trial
Authors: Santaularia N , Arnau A , Tora N , Corzan P , Gonzalez B , Ramirez-Morros A , Vazquez-Oliva G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Col·legi de Fisioterapeutes de Catalunya [R02/2018] Health Department of Generalitat de Catalunya. Instrumental action of intensification of nursing professionals (SLT017/20/000098).

Introduction
Benefits of cardiac rehabilitation (CR) in the prognosis of patients with ischemic heart disease have been demonstrated with a class I level A recommendation. Despite this, its implementation is still very scarce in any of its three phases.

Purpose
To assess the efficacy of a phase III CR program (CRP), based on counselling in the maintenance of physical exercise, in the time of physical exercise per week in patients with ischemic heart disease who have completed a phase II of the CRP supervised physical exercise program.

Methods
We conducted an open, controlled, cluster randomised trial. Eligible patients were diagnosed with acute or chronic coronary syndrome, had completed the phase II of CRP supervised physical exercise program, without cognitive deficit, Barthel index &gt;60 and had provided signed informed consent. Patients allocated to control group (CG) received standard visits at their primary healthcare center. Patients allocated to intervention group (IG), carried out phase III of CRP with the CR reference team (a doctor and a nurse from primary healthcare center trained in CR by a hospital CRP team) by visits at 1, 3, 6 and 12 months. During these visits, physical exercise advices were given and the information on the practice of physical exercise was reinforced. The patient's interests and the available resources for the practice of exercise were considered. Patients were provided with information on the health assets available in their area. Likewise, adherence to treatment and control of cardiovascular risk factors were reinforced. The follow-up period was 12 months. The main outcome was the minutes of physical exercise per week.

Results
Fourteen primary healthcare centers were randomized, 7 in the CG and 7 in the IG. Fifty-four patients from the CG [85% men; 59 years (SD 3)] and 45 from the IG [87% men; 60 years (SD 10)] were analyzed. Fifty percent of the CG and 35.6% of the IG were at moderate-high risk(p=0.149). At the end of phase II, 72.2% and 88.9% (p=0.04) of CG and IG patients respectively practiced ≥150 minutes of moderate activity and/or ≥75 minutes of vigorous activity. At 12 months of follow-up, 58.5% of CG patients and 80.0% of IG patients (p=0.02) reached the recommended levels of physical activity. Related to strengthening activities, CG practiced 9.1 minutes/week (SD 25.6) versus 27.8 (SD 43.2) in the IG (p= 0.001). Related to flexibility activities, CG practiced 15.4 minutes/week (SD 26.3) versus 24.5 (SD 29.2) in the IG (p= 0.049).

Conclusions
Despite observing an expected decrease in the practice of physical exercise over time, at 12 months of follow-up, a higher percentage of patients in the IG performed the recommended levels of physical exercise. Similarly, the IG spent more minutes performing strengthening and flexibility activities compared to the control group.