Cardiac Rehabilitation Population Research Articles

Validity of the Active Australia Survey in an Australian cardiac rehabilitation population

ObjectivesTo examine the long-term validity of the Active Australia Survey in a cardiac rehabilitation population using accelerometry as the reference measure. DesignCohort validation study. MethodsCardiac rehabilitation participants with coronary heart disease were recruited to a prospective cohort study. Over 7-days, 61 participants wore an ActiGraph ActiSleep accelerometer (1-second epoch, 10-minute bout) and completed the self-administered Active Australia Survey at baseline, 6-weeks, 6 and 12-months. Total daily moderate-to-vigorous physical activity from both methods was compared using Bland-Altman plots and Spearman rank-order correlations. ResultsParticipants tended to over-report moderate-to-vigorous physical activity, with more active participants more likely to over-report moderate-to-vigorous physical activity. There was a good level of agreement between the accelerometer 1-second epochs and Active Australia Survey at all time points (mean bias (ratio) 1.04, 1.16, 1.14, and 1.06, respectively), with weak-moderate correlations (ρ = 0.3-0.48). Conversely, there was a poor level of agreement between the accelerometer 10-minute bouts and Active Australia Survey at all time points (mean bias (ratio) 6.78, 9.09, 6.35, and 5.68, respectively), with weak-moderate correlations (ρ = 0.3-0.52). Agreement between the two measures did not improve over time for both 1-second and 10-minute bout accelerometry data. ConclusionsThe Active Australia Survey may be an acceptable self-report measure of moderate-to-vigorous physical activity in cardiac rehabilitation attendees when capturing any time spent in moderate-to-vigorous physical activity. The Active Australia Survey may be useful to routinely monitor physical activity levels over-time in Australian cardiac rehabilitation programs at both individual and group levels. Trial registrationTrial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx.

Lipid profile analyses of patients with and without type-2 diabetes in a cardiac rehabilitation population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Type 2 diabetes mellitus (T2DM) can double your risk of coronary artery disease (CAD). SGLT2 inhibitors reduce all-cause mortality for patients with T2DM and CAD, targeting metabolic syndrome components like HbA1c, blood pressure and weight. Lipid profiles are intrinsically linked to obesity however the secondary effects of SGLT2 inhibitors remain unclear, with studies showing a rise in HDLc and LDLc with these medications. Propose To compare the effect of cardiac rehabilitation and guideline directed statin therapy on lipid panels of those with diabetes to those without, and to conduct a sub-analysis on SGLT2 inhibited patients to assess for increased HDLc and LDLc. Methods We retrospectively reviewed our cardiac rehab records. Data was collected on sequential patients over age 18 who completed cardiac rehab, until 90 diabetics and 90 non-diabetics were identified. Statistical analyses performed using SPSS v.26. Results Diabetics had significantly lower total cholesterol, HDL and LDL prior to commencing rehab (Table 1). Diabetics also showed less reduction in total cholesterol and LDL than non-diabetics. Groups had similar follow-up time and anti-lipid therapy. N = 12 (13.3%) diabetics were on SGLT2 inhibitors. This group showed the greatest mean increase of HDL and lowest mean decrease of LDL levels, however, did start with the lowest initial lipid levels. Conclusions Diabetics had lower LDL and HDL prior to rehab, which may have led to reduced change in their profiles compared to non-diabetics. Interestingly however, patients on SGLT2 inhibitors showed a trend towards least reduction in mean LDL and the greatest increase in mean HDL compared to other diabetics. Table 1 Category(Lipids in mmol/L) Non-Diabetics, n = 90 (Mean ± SD) Diabetics, n = 90 (Mean ± SD) p-value SGLT2 cohort, n = 12 (Mean ± SD) Age (Years) 66.1 ± 8.73 67.73 ± 8.88 0.21 66.41 ± 7.8 Max. statin (%) 92.2% 90% 0.16 100% Pre-Total Chol. 4.21 ± 1.29 3.57 ± 0.9 <0.01* 3.36 ± 0.62 Pre-Triglyceride 1.6 ± 0.85 1.87 ± 1.02 0.054 1.63 ± 0.6 Pre-HDL 1.33 ± 0.48 1.12±.029 <0.001* 1.03 ± 0.22 Pre-LDL 2.14 ± 1.03 1.68 ± 0.93 0.002* 1.60 ± 0.57 Change- Total Chol. -0.75 ± 1.13 -0.26 ± 0.09 0.9 -0.09 ± 0.45 Change-HDL -0.01 ± 0.42 +0.03 ± 0.19 0.33 +0.19 ± 0.13 Change- LDL -0.61 ± 0.96 -0.28 ± 0.75 0.01* -0.24 ± 0.63 Lipids rechecked (months) 8.4 ± 0.25 7.9 ± 0.26 0.14 8.25 ± 2.26 Pre-intervention lipid profiles, followed by change in levels over time. *Denotes significance.

Determinants of achieving the minimum clinically important difference for the Incremental Shuttle Walk Test in a cardiac rehabilitation population

Abstract The primary aim of this study was to identify the determinants of achieving the minimum clinically important difference (MCID) for the Incremental Shuttle Walk Test (ISWT) in the CR population. The secondary aim was to examine whether achieving MCID in ISWT at the end of the CR programme is associated with the likelihood of patients meeting the physical activity recommendation or whether it is associated with the patients' self-reported physical fitness (Dartmouth COOP tool) at the end of the CR programmme. Method Routine clinical data related to patients who undertook ISWT as a pre- and post-CR functional capacity assessment were taken from National Audit of Cardiac Rehabilitation (NACR) during the 2013 to 2016 and retrospectively analysed. A sub-analysis was conducted to address the secondary aim. Logistic regression approaches, taking account of potential confounders were constructed. Results For the main study, data from 9,786 patients (mean age of 63.9±10.7), 77.5% of whom were male, were analysed. Sixteen determinants for achieving the MCID for ISWT in CR patients were identified. A sub-analysis was also conducted on 7,950 to address the secondary aim. Patients who achieved the MCID were 30% more likely to meet the physical activity recommendation and 60% more likely to rate themselves positively on the self-reported physical fitness Dartmouth COOP scale. Funding Acknowledgement Type of funding source: None

An Exploration of the needs of a Cardiac Rehabilitation Population using a Subjective Quality-of-Life Measure

Context: The aim of this study was to profile a cardiac rehabilitation population in the West of Ireland and establish Subjective Quality of Life (SQoL), using The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), a validated subjective QoL measure. Bothersome symptoms (SB) and Symptom Interference in SQoL (SBIQoL) were also assessed using a using a modified SEIQoL-DW. Objectives: QoL is a difficult concept to define, therefore the medical profession often premise QoL on health and illness. The focus of this study was to explore the QoL needs of a cardiac population, with a view to informing the development of a newly formed cardiac rehabilitation support group. The SEIQoL-DW was developed to overcome the limitations of quantitative questionnaires, as it is based on the individual’s personal view of life and its quality. Methods: SQoL, symptoms and SBIQoL, of 22 individuals, who had suffered a cardiac event were explored. SEIQoL-DW is a semi-structured interview, enabling the individual to convert their perspectives into scientific values. QoL areas of importance to patients are called ‘cues’. A modified SEIQoL-DW was used to assess SB and SBIQoL. Data were analysed using both quantitative analysis and qualitative descriptive analysis. Findings: Participants highlighted a range of QoL cues; findings from this study showed that 45% of participants did not rate ‘health’ in the first five QoL cues. A significant number of participants experienced symptoms; a medium negative correlation was found between symptom interference and QoL, rho = -0.353, with high levels of symptom interference associated with low levels of QoL. Conclusions: The range of QoL cues and bothersome symptoms identified in this study had implications for the development of the group, with participants eager to participate and talk candidly about their needs. SEIQoL-DW proved to be an acceptable, reliable and valid technique for measuring both individual QoL, SB and SBIQoL, taking greater consideration of individual perspectives compared with traditional measurement approaches. The significance of nominated symptoms and SBIQoL warrants further attention, especially if these symptoms are reversible.

Validity of the Past-day Adults' Sedentary Time Questionnaire in a Cardiac Rehabilitation Population.

Self-report measures of sedentary behavior are easier to use in a clinical setting; yet, no self-report measures of sedentary behavior appear to be validated in cardiac rehabilitation over time. The aim of this study was to assess the validity of the Past-day Adults' Sedentary Time (PAST) questionnaire in a cardiac rehabilitation population over 12 mo. Seventy-two cardiac rehabilitation participants were recruited to a prospective cohort study. Participants wore an ActiGraph ActiSleep accelerometer (sedentary time <100 counts/min) for 7 consecutive days and completed the self-administered PAST questionnaire at baseline, 6 wk, and 6 and 12 mo. Total daily sedentary time from both methods were compared using Bland-Altman plots and Spearman rank-order correlations. Agreement between the 2 measures of sedentary time improved over 12 mo. At 6 and 12 mo, there was a good level of agreement between measures (mean difference between accelerometer and PAST 57 and -0.7 min, respectively), although the dispersion of the differences was wide (95% limits of agreement -428 to 541 and -500 to 498 min, respectively). There were weak correlations between the PAST questionnaire and average accelerometer measured sedentary time at all time points (α = -0.249 to 0.188). Following repeated assessments, the PAST questionnaire may be useful to determine sedentary time in cardiac rehabilitation participants at a group level, with participants appearing to more accurately recall their time spent in sedentary behavior. Further research is indicated to assess the validity of sedentary behavior questionnaires in cardiac rehabilitation, with a combination of objective and self-reported measures currently recommended.

Quantifying the Occurrence of Shoulder Pain after Cardiac Surgery in a Cardiac Rehabilitation Population.

Purpose: The aim of this study was to identify the occurrence of shoulder pain after cardiac surgery among cardiac rehabilitation participants (CRPs) and its interaction with cardiac rehabilitation (CR). Method: This was a cross-sectional questionnaire-based study of open-heart surgery patients conducted at the midpoint of a 6-month CR programme. We measured the proportion of patients experiencing shoulder pain, onset, location, impact on rehabilitation, and pain and disability using the Shoulder Pain and Disability Index. Results: Of 70 (76% men) CRPs, 47% (33) reported shoulder pain post-surgery, with most (91%; 29 of 32) remaining symptomatic at the time of questionnaire completion, 14.6 (SD 37.9) months post-surgery. Disability and pain scores were 4.2 (SD 2.8) and 5.7 (SD 2.5), respectively (maximum score 10). Of people with shoulder pain participating in resistance training (RT; 19), 8 (42%) reported it was beneficial for shoulder pain; 7 (37%), no effect or unknown; and 4 (21%), some aggravation. Modifications to RT by programme staff were reported by 47% (8) of participants. Of those with shoulder pain, 10 (31%) reported some benefit; 20 (63%), no effect or unknown; and 2 (6%), aggravation from aerobic training. Conclusions: Almost half of the CRPs who had undergone open-heart surgery reported moderately severe and disabling shoulder pain that persisted for at least 14.6 (SD 37.9) months. Almost half the RT participants were prescribed exercise modifications with few negative effects. Shoulder pain is a significant issue after surgery, and appropriate screening is recommended for safe CR participation.

Green space and mental health symptoms in a cardiac rehabilitation population

The association between mental health symptoms and the quantity of green space surrounding the homes of people who recently experienced a cardiovascular event were examined while also assessing pla...

The Prevalence of Anxiety and Depression in a Cardiac Rehabilitation Population and its Impact on Adherence: A Cohort Study

The Prevalence of Anxiety and Depression in a Cardiac Rehabilitation Population and its Impact on Adherence: A Cohort Study

Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: Systematic review with meta-synthesis of quantitative and qualitative data.

Background Mobile technologies are innovative, scalable approaches to reducing risk of cardiovascular disease but evidence related to effectiveness and acceptability remains limited. We aimed to explore the effectiveness, acceptability and usefulness of mobile applications (apps) for cardiovascular disease self-management and risk factor control. Design Systematic review with meta-synthesis of quantitative and qualitative data. Methods Comprehensive search of multiple databases (Medline, Embase, CINAHL, SCOPUS and Cochrane CENTRAL) and grey literature. Studies were included if the intervention was primarily an app aimed at improving at least two lifestyle behaviours in adults with cardiovascular disease. Meta-synthesis of quantitative and qualitative data was performed to review and evaluate findings. Results Ten studies of varying designs including 607 patients from five countries were included. Interventions targeted hypertension, heart failure, stroke and cardiac rehabilitation populations. Factors that improved among app users were rehospitalisation rates, disease-specific knowledge, quality of life, psychosocial well-being, blood pressure, body mass index, waist circumference, cholesterol and exercise capacity. Improved physical activity, medication adherence and smoking cessation were also characteristic of app users. Appealing app features included tracking healthy behaviours, self-monitoring, disease education and personalised, customisable content. Small samples, short duration and selection bias were noted limitations across some studies, as was the relatively low overall scientific quality of evidence. Conclusions Multiple behaviours and cardiovascular disease risk factors appear modifiable in the shorter term with use of mobile apps. Evidence for effectiveness requires larger, controlled studies of longer duration, with emphasis on process evaluation data to better understand important system- and patient-level characteristics.

Is the 10 m incremental shuttle walk test a useful test of exercise capacity for patients referred to cardiac rehabilitation?

Field exercise tests are a feasible alternative to the symptom-limited exercise test for measuring exercise capacity in patients attending cardiac rehabilitation. To evaluate the criterion validity of the 10 m incremental shuttle walk test (ISWT) as a useful tool for measurement of exercise capacity for patients eligible for cardiac rehabilitation. Fifteen patients eligible for cardiac rehabilitation completed a treadmill symptom-limited exercise test and two ISWTs with the order of testing randomised. Associations between the symptom-limited exercise test and the ISWT were explored and the ability of the ISWT to predict symptom-limited exercise test duration estimated. There was a moderate to high association ( r2 ⩾0.72) between ISWT duration and distance, and symptom-limited exercise test duration; and a moderate association between ISWT peak heart rate and end of test oxygen saturation and these outcomes on the symptom-limited exercise test (0.47⩽ r2 ⩽0.67). However, prediction of symptom-limited exercise test duration based on the ISWT produced wide 95% confidence intervals, for example, ranging from 9.1 to 16.3 minutes for an individual who completes the ISWT. Order of testing did not affect the results and the association between the ISWT and symptom-limited exercise test was similar for both the first (ISWT 1) and second test (ISWT 2) ISWT. The results provide support for the ISWT as a convenient field test of exercise capacity in a cardiac rehabilitation population, but not as a surrogate to predict symptom-limited exercise test duration for individuals. A single ISWT may provide as good an estimate of exercise capacity as repeating the test.

Evaluation of determinants of walking fitness in patients attending cardiac rehabilitation

AimThis study aims to investigate the ability of patients’ baseline characteristics to predict the distance walked during the incremental shuttle walk test (ISWT) in the cardiac rehabilitation (CR) population and...

Relationship between employment and mental health outcomes following Cardiac Rehabilitation: an observational analysis from the National Audit of Cardiac Rehabilitation

BackgroundEmployment status has been shown to impact mental health state and intervention outcomes, yet still to be studied in a Cardiac Rehabilitation (CR) population. This observational study investigated the relationship between employment status and mental health outcomes following Cardiac Rehabilitation (CR). MethodsAll patients with an eligible cardiovascular incident entered into the National Audit of Cardiac Rehabilitation (NACR) 1 January 2013–31st December 2015. Logistic regression comparing the association between employment status and normal mental health categories. ResultsA total of 24,242 CR patients with completed post CR assessments were included and had representative age and gender distribution (mean 65years, 73.2% male). At baseline the unemployed status had a lower proportion of patients in normal healthy categories than other groups (T-test and chi-squared p=<0.05). The regression analyses revealed no significant association between retired and employed groups and outcome. There was significant association between unemployed patients and all mental health outcomes except anxiety; all p values<0.05 and odds ratios between 0.525 and 0.772 showing less likelihood of achieving the normal healthy category. ConclusionsThis is the first UK study, using routinely collected data, to investigate in coronary heart disease patients the impact of employment status on outcomes. The findings were that when weighted for baseline differences, unemployed patients mostly had poorer outcomes. Teams involved in CR delivery should take particular care when interpreting mental health baseline measures when setting CR goals, especially in relation to unemployed patients, and efforts should be made in providing more patient tailored interventions.

The Association Between Insomnia Symptoms and Mood Changes During Exercise Among Patients Enrolled in Cardiac Rehabilitation.

Insomnia symptoms (ie, difficulty falling asleep, difficulty staying asleep, and early awakenings) are common among patients with cardiovascular disease and may interfere with the beneficial impact of exercise on mood state. This study investigated the association of insomnia symptom severity with mood disturbance and with changes in mood state during exercise in a cardiac rehabilitation (CR) population. Insomnia symptom severity was measured using the Insomnia Severity Index upon admission to a 12-week CR program (n = 57). The Physical Activity Affect Scale was administered before and during a single bout of moderate intensity exercise to measure changes in mood state. Indices of mood disturbance included depressive symptoms (Hospital Anxiety and Depression Scale) and pre-exercise mood state (Physical Activity Affect Scale). Greater severity of insomnia symptoms was associated with less pleasant mood overall (r = -0.45, P < .001), including less tranquility (r = -0.37, P = .005), lower positive affect (r = -0.39, P = .003), and worse fatigue (r = 0.36, P = .005); greater insomnia symptom severity also predicted greater improvements during exercise in both overall mood state (b = 0.26, standard error = 0.10, P = .009) and tranquility (b = 0.09, standard error = 0.04, P = .04), following statistical adjustment for demographic variables and pre-exercise mood state. Although CR patients reporting insomnia symptoms tend to experience daytime mood disturbance, they may benefit from mood-elevating properties of exercise. Future research is needed to help optimize mood during exercise, which may have implications for improving psychological distress and CR adherence.

The 10 m incremental shuttle walk test is a highly reliable field exercise test for patients referred to cardiac rehabilitation: a retest reliability study

ObjectivesTo determine the retest reliability of the 10m incremental shuttle walk test (ISWT) in a mixed cardiac rehabilitation population. DesignParticipants completed two 10m ISWTs in a single session in a repeated measures study. Ten participants completed a third 10m ISWT as part of a pilot study. SettingHospital physiotherapy department. Participants62 adults aged a mean of 68 years (SD 10) referred to a cardiac rehabilitation program. Main outcome measuresRetest reliability of the 10m ISWT expressed as relative reliability and measurement error. Relative reliability was expressed in a ratio in the form of an intraclass correlation coefficient (ICC) and measurement error in the form of the standard error of measurement (SEM) and 95% confidence intervals for the group and individual. ResultsThere was a high level of relative reliability over the two walks with an ICC of .99. The SEMagreement was 17m, and a change of at least 23m for the group and 54m for the individual would be required to be 95% confident of exceeding measurement error. ConclusionsThe 10m ISWT demonstrated good retest reliability and is sufficiently reliable to be applied in practice in this population without the use of a practice test.

Development of the Health Incentive Program Questionnaire (HIP-Q) in a cardiac rehabilitation population.

The purpose of this study was to develop a questionnaire to facilitate the design of acceptable financial health incentive programs. A multiphase psychometric questionnaire development method was used. Theoretical and literature reviews and three focus groups generated a pool of content areas and items. New items were developed to ensure adequate content coverage. Field testing was conducted with a convenience sample of cardiac rehabilitation (CR) patients (n = 59) to establish face and construct validity (p = 0.021) and reliability (intraclass coefficients = 0.42–0.87). The final questionnaire is comprised of 23 items. This questionnaire builds on previous attempts to explore acceptability by sampling a wider range of instrumental and affective attitudes and by measuring the effect of program features on the likelihood of incentive program participation. Future research is now needed to examine whether tailoring incentives to preferences assessed by the questionnaire improves uptake and effectiveness.

HeartHealth: A Cardiovascular Disease Home-based Rehabilitation System

Abstract The increasing pressure on medical institutions around the world requires health care professionals to be prescribing home- based exercise rehabilitation treatments to empower patients to self-monitor their rehabilitation journey. Home-based exercise rehabilitation has shown to be highly effective in treating conditions such as Cardiovascular Disease (CVD). However, adherence to home-based exercise rehabilitation remains low. Possible causes for this are that patients are not monitored, they cannot be con- fident that they are performing the exercise correctly or accurately and they receive no feedback. This paper proposes HeartHealth, a novel patient-centric gamified exercise rehabilitation platform that can help address the issue of adherence to these programmes. The key functionality is the ability to record the patient movements and compare them against the exercises that have been pre- scribed in order to return feedback to the patient and to the health care professional, as well. In order to synthesize a compact fully operational system able to work in real life scenarios, tools and services from FI-PPP projects, FIWARE 1 and FI-STAR 2, were exploited and a new FI-STAR component, Motion Evaluation Specific Enabler (SE), was designed and developed. The HeartHealth system brings together real-time cloud-based motion evaluation coupled with accurate low-cost motion capture, a personalised ex- ercise rehabilitation programme and an intuitive and fun serious game interface, designed specifically with a Cardiac Rehabilitation population in mind.

Intertester Reliability of the Talk Test in a Cardiac Rehabilitation Population

The validity of the Talk Test (TT) is well documented, but the reliability of the test is not clear. The aim of this study was to assess the absolute and relative intertester reliability of the TT in cardiac patients. Cardiac patients (n = 64) who had completed an exercise rehabilitation program were consecutively included in the study. Patients performed a submaximal ramp cycle ergometer test with the TT as intensity indicator. Every patient was tested twice on the same day by 2 different physiotherapists with a break of maximum 45 minutes between tests. Physiotherapists were randomized to tests. Workload in watts at the first negative stage of the TT was registered as the test result. Patients and physiotherapists were blinded to test results of the first test. Absolute reliability of the TT was assessed with Bland-Altman plot, standard error of measurement, and minimal detectable change. Relative reliability was assessed using the intraclass correlation coefficient (ICC). Mean difference in peak workload between test and retest was 0.8 W (95% CI: -4.8 to 3.3). Limit of agreement was estimated to be +31/-32 W. Standard error of measurement was 11 W (95% CI: 10-14), and minimal detectable change was 32 W. The ICC was 0.85 (95% CI: 0.78 to 0.91). Although the ICC was acceptable, we found a weak absolute intertester reliability of the TT and that the test is an insufficient measure to monitor exercise intensity and safety of cardiac patients when 2 or more physiotherapists may be administering the TT.

Vigorous Exercise Mimics Remote Ischemic Preconditioning and Provides Benefit in Cardiac Rehabilitation Patients

Remote ischemic preconditioning (rIPC) has been shown to reduce the extent of myocardial infarction during an ischemic event as well as prior to a planned cardiac intervention. Vigorous exercise has been shown to have similar cardiovascular benefits to remote ischemic preconditioning in healthy individuals. Despite this effect, many individuals who exercise regularly present with cardiovascular disease. Those individuals who participate in cardiac rehabilitation programs provide a unique opportunity to determine whether the effects of vigorous exercise prior to a cardiac event result in improved outcomes. This investigation analyzed a cardiac rehabilitation database and compared individuals with the highest and the lowest exercise capacity as determined by their peak oxygen consumption on a cardiopulmonary exercise testing (CPX) test prior to initiating a cardiac rehabilitation program to compare baseline characteristics and outcomes. Group 1 (VigEx) includes individuals with higher peak VO2 (mean peak VO2 33 and METS 9) and Group 2 (LowEx) includes those with lower peak VO2 (mean peak VO2 11 and METS 3). 72% of the subjects in VigEx had a preserved ejection fraction (EF) but only 50% of subjects in LowEx. None of the subjects in VigEx had severely reduced EF, while 28% of LowEx had an EF < 30%. In conclusion, individuals with cardiovascular disease who participate in vigorous exercise prior to their cardiac event have improved EF and may obtain a protective benefit similar to rIPC. Also, given the safety of vigorous exercise in the cardiac rehabilitation population and its similar effects to rIPC, cardiac rehabilitation programs should promote vigorous exercise in capable individuals.

An Investigation of the Benefits of Stress Management Within a Cardiac Rehabilitation Population

Research describing whether stress management can improve clinical outcomes for patients in cardiac rehabilitation (CR) has yielded equivocal findings. The present investigation retrospectively examined the incremental impact of exercise and stress management (n = 188), relative to exercise only (n = 1389), on psychosocial and physical health outcomes following a 12-week CR program. Participation in stress management and exercise was associated with greater reductions in waist circumference and systolic blood pressure, relative to exercise alone, for patients with baseline clinical elevations on these measures. The stress management group had more depressive symptoms (as measured by the Hospital Anxiety and Depression Scale; t[1] = 3.81, P < .001) and lower physical quality of life (as measured by the 12-Item Short Form Health Survey Physical Component; t[1] = 3.00, P = .003) than the exercise-only group at baseline, but there were no differences between the groups at 12 weeks in terms of depressive symptoms (t[1] = 1.74, P = .082) or physical quality of life (t[1] = 1.56, P = .120). These findings suggest that stress management may offer additional benefits in selected patients over and above exercise in CR.

Repeated Six-Minute Walk Tests for Outcome Measurement and Exercise Prescription in Outpatient Cardiac Rehabilitation: A Longitudinal Study

Bellet RN, Francis RL, Jacob JS, Healy KM, Bartlett HJ, Adams L, Morris NR. Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Objective To determine whether repeated 6-minute walk tests (6MWTs) are required for outcome measurement and exercise prescription in a typical cardiac rehabilitation (CR) population. Design Prospective longitudinal observational study. Setting Outpatient community health center. Participants Sixty-one of 154 consecutive patients. Intervention 6MWTs (N=2) were conducted at 3 assessment points: at CR start, postcompletion, and 6-months postcompletion. Main Outcome Measure 6MWT distance (6MWD). Results Mean 6MWD for the first (6MWT1) and second (6MWT2) 6MWTs at the 3 assessment points were 507±85 (522±84), 532±86 (560±87), and 549±99 (575±107)m. Repeated 6MWDs strongly correlated at each assessment point, with intraclass correlation coefficients of .96 (95% confidence interval [CI], 0.93–.98), .97 (95% CI, .92–.98), and .94 (95% CI, .89–.97), respectively. Relative increases in mean 6MWD from 6MWT1 to 6MWT2 at each assessment point were 3%, 5%, and 5%, respectively ( P<.001 in each case). Differences in walking speed derived from 6MWD1 and 6MWD2 did not translate into differences in exercise prescription. Conclusions The difference between 6MWD1 and 6MWD2 was consistent regardless of previous exposure to 6MWTs. A single 6MWT was as effective as 2 repeated 6MWTs for outcome measurement and exercise prescription. We therefore recommend that when 6MWDs are used for CR outcome measurement, either a single 6MWT be used or the number of 6MWTs performed be consistent at all assessment points.