Evaluating Exercise Progression in an Australian Cardiac Rehabilitation Program: Should Cardiac Intervention, Age, or Physical Capacity Be Considered?

Kym Joanne Price,Amanda Clare Benson,Brett Ashley Gordon,Stephen Richard Bird

doi:10.3390/ijerph18115826

Abstract

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

Highlights

Cardiovascular disease (CVD) is a leading cause of morbidity worldwide, with major economic and personal implications due to increased health care costs and the loss of patient and carer productivity [1]
The aims of this study were to investigate the frequency and volume of exercise progression over the course of an outpatient cardiac rehabilitation program in Australia, and whether the exercise progression is different between cardiovascular intervention received, age or initial physical capacity category
The final mean aerobic exercise prescription for all patients was similar to that reported previously for this population in the United States, Japan, and New Zealand [19,20,21], but the progression of exercise throughout cardiac rehabilitation allowed for a maximum contribution of approximately 30% to the exercise dose of 500 to 1000 metabolic equivalents (METs)·min per week recommended by the American Association of Cardiovascular and Pulmonary Rehabilitation, by the end of the rehabilitation program

Summary

Introduction

Cardiovascular disease (CVD) is a leading cause of morbidity worldwide, with major economic and personal implications due to increased health care costs and the loss of patient and carer productivity [1]. Cardiac rehabilitation is a cost-effective intervention that reduces cardiovascular morbidity, repeat hospital admissions and mortality, and facilitates individuals with CVD to recover and attain their optimal functional capacity via improvements in aerobic fitness and muscular strength [2]. Functional assessments are not re-evaluated at the end of the program and individuals are discharged after completing the set number of sessions rather than after achieving any objectively measured outcome [4]. It remains uncertain if patients have attained their full potential before ‘graduating’ from the cardiac rehabilitation program. Potential consequences of this include patients functioning at a sub-optimal level in their activities of daily living and personal

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