Abstract
BackgroundRecent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies.DesignObservational study.MethodsWe evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated.ResultsThirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570).ConclusionThe key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.
Highlights
In 2016, an updated Cochrane review, [1] synthesising 63 international studies, concluded that compared to no exercise control, exercise-based cardiac rehabilitation (CR) reduced the risk of subsequent cardiovascular mortality, but not total mortality
We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in cardiorespiratory fitness (CRF) reported in previous studies
Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and session rating of perceived exertion (sRPE)]
Summary
In 2016, an updated Cochrane review, [1] synthesising 63 international studies, concluded that compared to no exercise control, exercise-based cardiac rehabilitation (CR) reduced the risk of subsequent cardiovascular mortality, but not total mortality. Powell and colleagues [3] conducted a systematic review and meta-analysis to determine the effectiveness of exercise-based CR in terms of all-cause mortality, cardiovascular mortality, and hospital admissions from the year 2000 onwards, which include only trials which use a modern approach to medical management. They included 22 studies including 4,834 patients (mean age 59.5 years, 78.4% male). We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies
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