Effects of a Hybrid Model of Cardiac Rehabilitation on Patient Outcomes

Study Overview
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Brief Summary
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Determine if the standard of care at a cardiac rehabilitation center using what the investigators term to be hybrid model on the exercise component of cardiac rehabilitation is associated with improved adherence and outcomes. Discuss the hybrid model in comparison to traditional cardiac rehabilitation and layout a template on how to incorporate this hybrid model. Discuss factors that may lead to poor adherence and attendance to cardiac rehabilitation.

Detailed Description
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Purpose: The aim of this prospective cohort study was to determine the effectiveness of an individualized physical therapist (PT) driven hybrid model of the exercise component of cardiac rehabilitation (CR) that uses a novel intensity-recovery progression protocol (IRPP) and cardiac testing template (CTT) to assess achieved heart rate intensity (AHRI%), heart rate recovery (HRR%), and intensity-recovery total (IR%) as indicators to guide treatment. Methods: Assessment of a subjective questionnaire, vital signs, treadmill 6-minute walk (6MW), 1-minute sit-to-stand (1STS), 1-minute step (1ST), and 1-minute agility square tests (1AST) were assessed on 100 participants during the 36-visit program. The hybrid model was led by a PT, was longer in duration, added high intensity interval training (HIIT) to continuous aerobic exercise training (CAET) and resistance training, and used a 1:1 treatment ratio. Treatment intensity and progression were measured based on clinical decision making through the IRPP and CTT.

Official Title
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Effects of a Physical Therapist-driven Individualized Hybrid Model of the Exercise Component of Cardiac Rehabilitation on Patient Outcomes: a Prospective Cohort Study

Conditions
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Cardiac Surgery, Coronary Artery Bypass Graft CABG, Stent, Valve Replacement

Intervention / Treatment
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* Other: Exercise Component Of Cardiac Rehabilitation (Hybrid Model) Intensity Recovery Progression Protocol (IRPP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Underwent cardiac surgery (CABG, PCI with stent placement, and valve replacement) Surgery was within the previous 365 days Could independently ambulate into the facility. Exclusion Criteria: Implantable cardioverter defibrillator (ICD) Pacemaker (PPM) Heart Transplant Left ventricular assist device (LVAD) All other cardiac procedures not listed within inclusion criteria Diagnosed a-fib Participants who attended cardiac rehabilitation before
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cardiac Rehab Patients<br>All participants referred to the clinic meeting the inclusion and exclusion criteria who wanted to participate in the study. | Other: Exercise Component Of Cardiac Rehabilitation (Hybrid Model) Intensity Recovery Progression Protocol (IRPP)<br>* Data collected on participants who completed the intensity recovery progression protocol program<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Six Minute Walk Test | Treadmill Six Minute Walk Test | Six Minutes | 
| Timed Sit To Stand Test | A standardized test measuring how many times an individual can stand from a standardized seated position in one minute using hand support to push off. | One Minute | 
| Timed Step Test | A test measuring how many repetitions an individual can go up and down a standardized step while using bilateral arm support on a rail. | One Minute | 
| Timed Agility Square Test | Using agility ladder square to go in and out of designated two boxes | One Minute | 
| Achieved Target Heart Rate (AHRI%) | Heart rate achieved during outcome measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). Participants expected to attend the program at a frequency of 2x a week for 36 total visits. | One minute | 
| Heart Rate Recovery (HRR%) | Heart rate observed one minute after outcome measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). | One minute | 
| Intensity Recovery Total Score (IR%) | The total of the AHRI + HRR during objective measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). | One minute | 
| Subjective Questionnaire | Three questions (where higher scores denote better outcomes) Question 1: Rate your endurance (using a visual analog scale from 0-100% marked every 10%)? Question 2: Estimate how many stairs you could go up using arm support before you would have to take a break? Question 3: Estimate how many hours of exercise you completed in the previous 7 days? | From date of initiation of study up to 1 year after initiation. Collected on Visit 1, Visit 15, Visit 30 for each participant, who were expected to attend the program at a frequency of 2x a week for 36 total sessions. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical Therapy, Cardiopulmonary Rehabilitation, Cardiac Surgery, Exercise, Heart Rate, Objective Outcome Assessments