Abstract 1248: Home-based Cardiac Rehabilitation Program Led by A Clinical Nurse Specialist And Optimisation of Adherence to Physical Activity, Cardiovascular Risk Factors and Quality of Life: A Randomized Clinical Trial
Adherence to physical activity (PA), control of cardiovascular risk factors (CRF) and improvement of quality of life (QOL) are a great concern in preventive cardiology. The main purpose of this study was to evaluate the impact of a home-based cardiac rehabilitation (CR) program led by a clinical nurse specialist (CNS) on PA behaviour. Secondary end-points were to assess the impact of this program on CRF and on QOL during the first year after an acute coronary syndrome (ACS).
Method: We randomized 66 subjects during hospitalisation due to an ACS in a control group (CG) (n=34) receiving usual care or in an experimental group (EG) (n=32) receiving the intervention managed by a CNS. The intervention during 12 months consisted of used a psychosocial approach and a pedometer (SW 200) to enhance self efficacy expectation. PA behaviour was measured by blinded pedometers with a 7-day memory (NL 2000) associated with a log. CRF were evaluated and treated according to current guidelines. QOL was evaluated with a cardiac version of a QOL Index questionnaire.
RESULTS: Both groups were similar regarding socio-demographic, health characteristics and CRF. At baseline, PA was comparable between groups and all subjects increased significantly their level of PA at 3 months follow-up (p<0.01). The EG maintained PA until 12 months; whereas the CG decreased their PA to baseline level after 6 months. PA was different (p<0.05) between groups at 6, 9 and 12 months of follow-up. Increment of PA in the EG corresponds to a 30 minutes per day of exercise at moderate intensity. Targets regarding lipid and metabolic profiles were maintained in both groups. Nevertheless, LDL-C, TC/HDL-C and waist circumference showed a more favourable evolution after 6 months in the EG than in the CG (p<0.05). At 12 months follow-up, QOL overall and in domains of Health/Functioning and Psychological/Spiritual were increased significantly in the EG only.
CONCLUSION: Home-based CR program led by a CNS is associated with better maintenance of PA until 12 months after an ACS. This effect was accompanied by a more appropriate evolution of CRF and increment of QOL. This program may be an efficient addition to a traditional CR program to improve global health after ACS.