Abstract

BackgroundExercise capacity is a strong predictor of survival in patients with coronary artery disease (CAD). Exercise capacity improves after cardiac rehabilitation exercise training, but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program. There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients. We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care.Materials and MethodsTwo-centre, open, parallel randomized controlled trial with 12 months follow-up comparing usual care to a maintenance program. The maintenance program consisted of one monthly supervised high intensity interval training session, a written exercise program and exercise diary, and a maximum exercise test every third month during follow-up. Forty-nine patients (15 women) on optimal medical treatment were included following discharge from cardiac rehabilitation. The primary endpoint was change in peak oxygen uptake at follow-up; secondary endpoints were physical activity level, quality of life and blood markers of cardiovascular risk.ResultsThere was no change in peak oxygen uptake from baseline to follow-up in either group (intervention group 27.9 (±4.7) to 28.8 (±5.6) mL·kg (-1) min (−1), control group 32.0 (±6.2) to 32.8 (±5.8) mL·kg (−1) min (−1), with no between-group difference, p = 0.22). Quality of life and blood biomarkers remained essentially unchanged, and both self-reported and measured physical activity levels were similar between groups after 12 months.ConclusionsA maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake in CAD patients after discharge from cardiac rehabilitation compared to usual care. This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group.Trial RegistrationClinicalTrials.gov NCT01246570

Highlights

  • Exercise-based rehabilitation in patients with coronary artery disease (CAD) reduces mortality [1,2,3,4], and cardiorespiratory fitness is a strong, independent predictor of both cardiac- and allcause mortality in patients with CAD [5,6]

  • There was no change in peak oxygen uptake from baseline to follow-up in either group (intervention group 27.9 (64.7) to 28.8 (65.6) mL?kg (-1) min (21), control group 32.0 (66.2) to 32.8 (65.8) mL?kg (21) min (21), with no betweengroup difference, p = 0.22)

  • A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake in CAD patients after discharge from cardiac rehabilitation compared to usual care

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Summary

Introduction

Exercise-based rehabilitation in patients with coronary artery disease (CAD) reduces mortality [1,2,3,4], and cardiorespiratory fitness is a strong, independent predictor of both cardiac- and allcause mortality in patients with CAD [5,6]. Peak oxygen uptake (VO2peak) has been found to decline at six months, and more so at 30 months, after discharge from cardiac rehabilitation in patients with CAD [7]. There is a need for studies to assess interventions that may help patients adhere to regular and effective exercise training after ending a formalized cardiac rehabilitation exercise program [8]. Exercise capacity is a strong predictor of survival in patients with coronary artery disease (CAD). Exercise capacity improves after cardiac rehabilitation exercise training, but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program. We assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care

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