Abstract 10913: Design, Implementation and Evaluation of a Reduced Cardiac Rehabilitation Program
Background: Cardiac rehabilitation programs (CRP) reduce cardiac morbidity and mortality yet only a small percentage of eligible patients attend these programs. This is in part due to barriers to access (i.e. frequent travel) necessitating the development of novel CRP. Therefore, we designed a CRP with fewer sessions (rCRP) to investigate whether it is as effective as the standard CRP (sCRP) in increasing exercise capacity.
Methods: This was a randomized controlled non-inferiority trial. Primary and secondary prevention patients at low and moderate risk were randomized to either the sCRP (n=60) or to the rCRP (n=61). Over a four-month period, participants in the sCRP attended 32 on-site exercise sessions, while the rCRP consisted of 10 sessions. The primary outcome was change in exercise capacity measured as total time on a treadmill stress test and assessed at baseline, four and 16 months. Power was set at 0.8 to detect a between group difference of 60 seconds, our criterion for non-inferiority. We used mixed model ANOVA to test for non-inferiority of the rCRP, and repeated measures ANOVA to assess within-group comparisons.
Results: Attendance was higher in the rCRP than the sCRP group (97.3 ± 62.6 % vs 70.5 ± 22.0 %, p=0.002). Compared to baseline, exercise capacity improved at program completion for both groups: 524 ± 168 seconds to 630 ± 150 seconds for sCRP and 565 ± 183 seconds to 655 ± 196 seconds for rCRP and remained higher than baseline at 16 months (p< 0.01 for within group changes). The rCRP was non-inferior to the sCRP group in regards to exercise capacity change after 16 months (mean difference between groups=5.25 seconds 95% CI: -15.51-26.00).The rCRP was also non-inferior in regards to HDL-C, triglycerides, TC/HDL-C ratio, fasting glucose, blood pressure and anthropometry measures based on pre-study criteria. There were no differences in adverse events between groups.
Conclusion: Our reduced CRP that used a third of the exercise sessions than a standard CRP, illicited changes in exercise capacity and risk factors that were no different from the sCRP. The rCRP has the potential to reduce access barriers of travel and potentially increase capacity without increasing resource use or compromising patient care.
- © 2013 by American Heart Association, Inc.