Abstract
ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome Measure(s)Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.
Highlights
The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in extraordinary worldwide public health orders of social distancing and self-isolation
In Austria, the first COVID-19 lockdown was initiated in mid-March 2020, with closure of all outpatient cardiac rehabilitation (CR) centres and restriction of inpatient rehabilitation to patients with urgent medical indications only (Beiglböck et al, 2020; Desson et al, 2020)
We recruited participants from a cohort of CR patients who had regularly attended weekly group-based exercise training at the University Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria, until the COVID-19-related lockdown came into force in mid-March 2020
Summary
The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in extraordinary worldwide public health orders of social distancing and self-isolation This has led to widespread disruption of centre-based cardiac rehabilitation (CR) programmes and other social opportunities for cardiovascular disease (CVD) patients to engage in heart-healthy exercise. Heart-healthy exercise, in this context, refers to the medically recommended amount and intensity of regular physical activity (PA) to achieve a positive effect in the secondary prevention of CVD. This includes leisure activities and activities of daily living (e.g., walking, hiking, gardening) as well as targeted endurance and strength training (Niebauer et al, 2013; Schwaab et al, 2021). In July 2020, Austrian outpatient CR centres re-opened under strict hygiene regulations, enabling a gradual return to group-based training for CVD patients
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