Community-based Cardiac Rehabilitation Program Research Articles

Co-Designing a Community-Based Cardiac Rehabilitation Program for Chinese Migrants in Australia: A Mixed Method Study

Co-Designing a Community-Based Cardiac Rehabilitation Program for Chinese Migrants in Australia: A Mixed Method Study

Cardiovascular risk factor profile in patients admitted to a community-based cardiac rehabilitation program after one year: what risk factors are not being controlled?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) is a multidisciplinary intervention designed to reduce cardiovascular (CV) risk, encourage healthy behaviors, reduce physical impairment, and promote an active lifestyle. After completing a phase II CR program, it is important to maintain long-term CV risk factor control. However, many patients do not achieve or maintain lifestyle and risk factor targets on a long-term basis. Therefore, it is of interest to understand which risk factors are not reaching the targets to better understand and personalize long-term community-based CR programs. Purpose To characterize the modifiable CV risk factors profile in coronary artery disease (CAD) patients admitted to a community-based phase III CR program, including lipid profile, overweight/obesity, physical activity (PA) and sedentary behaviour (SB), at the beginning and after completing the first year of the CR program. Methods This retrospective cohort study included CAD patients that attended for 1-year a community-based phase III CR program. At the beginning (M0) and after one year (M1) of the CR program, all patients performed a risk profile assessment including: Lipid profile [total cholesterol (total-c), high density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL)], body mass index (BMI), PA and SB. BMI was assessed with the patient's weight in kilograms divided by the square of height in meters and lipid profile values were obtained from blood testing. PA and SB were objectively measured by using an accelerometer. All participants attended supervised exercise sessions, 3x week, 60 mins, including aerobic and resistance exercises, 3 educational sessions and a nutritional counseling consultation per year. Results In the sample of 159 patients at baseline (81.8% male, mean age 61±10 years, BMI: 28.3±4.3 kg/m²), overweight and obesity proved to be the most prevalent risk factor (80.7%), followed by uncontrolled LDL levels (74.8%). After a 1-year intervention (n=48, 90% male, mean age 62±10 years), LDL levels were kept above the targets (M0: 73.3±28.9 mg/dL and M1: 68.6±19.6 mg/dL, p=0.186), BMI did not change (M0: 27.5±3.9 kg/m² and M1: 27.8±4.0 kg/m², p=0.168) and SB remained high (M0: 11.50±2.90 hours/day and M1: 11.58 ± 2.71 hours/day, p=0.908). Although, moderate to vigorous PA (MVPA) decreased (M0: 343±195 mins/week and M1: 293±164 mins/week, p<0.001), participants were still on target, between 150 to 300 mins MVPA week. Conclusion Our findings show that after a 1-year of a phase III CR program intervention CVD patients maintained MVPA recommended levels, but did not reach body composition, lipid profile, and SB targets. Future strategies should be implemented in long-term CR programs to better control LDL, body composition and SB.

Loneliness predicts physical and mental health-related quality of life over 9months among patients with coronary heart disease.

This study investigated whether loneliness would predict physical and mental health-related quality of life (HRQoL) over 9months and examined whether medical adherence would mediate their associations in patients with coronary heart disease (CHD). The overall design is a three-wave longitudinal study. A sample of 255 outpatients with CHD was recruited from a community-based cardiac rehabilitation programme. Participants, with a mean age of 63 years, completed measures assessing loneliness, depression and physical and mental HRQoL at baseline. Medical adherence was assessed at 3months, and physical and mental HRQoL were reassessed at 9months. A total of 88% of participants reported moderate or high loneliness. Baseline loneliness predicted physical and mental HRQoL at 9months after adjusting for baseline physical and mental HRQoL, respectively. The effects remained significant when depression was also adjusted. Medical adherence at 3months partially mediated the associations of baseline loneliness with 9-month physical and mental HRQoL. Findings underline the necessity of assessing loneliness for CHD patients to promote long-term medical adherence and further improve physical and mental HRQoL.

REAL-WORLD OUTCOMES & HEALTH CARE COSTS OF REGION-WIDE COMMUNITY-BASED CARDIAC REHABILITATION

REAL-WORLD OUTCOMES & HEALTH CARE COSTS OF REGION-WIDE COMMUNITY-BASED CARDIAC REHABILITATION

Evaluation of Current Resources Available for Community-Based Cardiac Rehabilitation in Korea: A Nationwide Survey Study.

BackgroundIn Korea, the actual distribution of cardiac rehabilitation (CR) to the clinical field is insufficient due to the many barriers for cardiovascular patients to participate in CR. Community-based CR is a useful alternative to overcome these obstacles. Through a nationwide survey, we investigated the possibility of regional medical and public health management institutes which can be in charge of community-based CR in Korea.MethodsThe questionnaires on recognition of CR and current available resources in health-related institutions were developed with reference to the CR evaluation tools of York University and the International Council of Cardiovascular Prevention and Rehabilitation. The questionnaires were sent to regional public and private medical institutions and public health management institutions.ResultsIn total, 2,267 questionnaires were sent to 1,186 institutions. There were 241 and 242 responses from 173 and 179 regional private and public medical institutions, respectively. And a total of 244 responses were gathered from 180 public health management institutions. Although many institutions were equipped with the necessary facilities for exercise training, there were few patient-monitoring systems during exercise. Most institutions were aware of the need for CR, but were burdened with the cost of establishing personnel and facilities to operate CR.ConclusionMost regional medical, and public health management institutions in Korea are unprepared for the implementation of community-based CR programs. To encourage the utilization of such, there should be efforts to establish a national consensus.

What am I doing here? Enablers and barriers to community-based cardiac rehabilitation attendance: a qualitative study utilising a behavioural science approach

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Community Engaged Scholars Programme (CES-P), PPI Ignite, National University of Ireland, Galway Background Despite the well-established benefits of cardiovascular prevention and rehabilitation, programme uptake rates remain suboptimal. Delivering cardiac rehabilitation (CR) in the community offers an alternative model of care that may help address the challenges that exist around uptake and accessibility of CR. Yet in comparison to traditional hospital based CR programmes less is known about the enablers and barriers that may be unique to attending community based CR programmes. Purpose This study aimed to identify enablers and barriers to attending and completing a community-based CR programme from the patient perspective. Methods Individuals who were referred to a 12 week, interdisciplinary, multi-component community-based CR programme were invited to take part in semi-structured interviews. Reasons for attending or not attending the programme and for completing or not completing the full programme were discussed. Purposeful sampling was used to obtain variation in age, gender, and level of engagement with the programme. Interviews were transcribed verbatim and analysed using framework analysis guided by the Capability Opportunity Motivation (COM B) Model and the Theoretical Domains Framework, to explore initial attendance and programme completion. Results Data saturation was achieved with sixteen participants. The majority of the identified barriers and enablers were common to both initial programme attendance and completion of programme. Having the social opportunity to receive support from peers, family members and staff was seen as an important enabler. While ease of access to a programme based in the community enabled attendance and completion, for some, distance to the cardiac rehabilitation centre was a barrier. Further barriers related to capability issues regarding poor physical health, time, work commitments and travel. Key motivational enablers included, beliefs around consequences, improved health status, knowledge, goals, intentions and personality. Identity was an important determinant of attendance as participants discussed their understanding of "what am I doing here?" Some participants identified themselves as the type of person who would benefit from the programme and others did not. For example, some felt the programme would suit those who needed motivation to enhance their health and some felt the programme was more or less suited to people of different ages and fitness levels. Conclusion The results suggest that interventions to enhance attendance at community-based CR need to address multiple factors related to capability, opportunity and motivation. While there is no one model of cardiovascular prevention and rehabilitation that will meet the needs of all patients, patients should be offered community based programmes as part of a choice of options that fit their needs and personal preferences.

Identifying the active ingredients of cardiac rehabilitation: A behaviour change technique and qualitative analysis.

Despite evidence that cardiac rehabilitation (CR) can be effective, the active ingredients or behaviour change techniques (BCTs) constituting effective CR remain unclear. There is also a lack of research surrounding patient and facilitator perceptions of active ingredients. This study sought to identify the active ingredients of a community-based CR programme and explore patient and facilitator perceptions of the active ingredients. A multimethod design conducted in two stages, a BCT coding stage and a qualitative stage. The BCT coding stage involved the observation and audio recording of ten sessions from a community-based CR programme and the collection of programme materials. Data were coded using the BCT Taxonomy version 1 (Ann Behav Med, 46, 2013, 81). During the qualitative stage, six focus groups were carried out separately with patients (n=16) and facilitators (n=4). Qualitative data were analysed using an inductive thematic analysis. The BCT coding phase identified 34 BCTs, many of which were highlighted by patients and facilitators. Patients and facilitators felt the group effort, motivation provided by facilitators, individualized care, knowledge gained, acceptance, and fear reduction enabled change. The majority of BCTs identified in the qualitative stage were also identified in the BCT coding stage, excluding a component related to self-acceptance. Facilitators felt the programme was limited by duration and inadequate psychological support. The study provides a comprehensive overview of objectively coded BCTs and perceived active ingredients of CR. The findings can be used to inform future refinement and improvement of CR.

Community-Based Cardiac Rehabilitation Conducted in a Public Health Center in South Korea: A Preliminary Study.

Objective To evaluate the safety and effectiveness of the community-based cardiac rehabilitation (CBCR) program that we had developed.MethodsIndividuals aged >40 years with cardiovascular disease or its risk factors who were residing in a rural area were recruited as study subjects. The CBCR program, which consisted of 10 education sessions and 20 weeks of customized exercises (twice a week), was conducted in a public health center for 22 weeks. Comprehensive outcomes including body weight, blood glucose level, and 6-minute walk distance (6MWD) were measured at baseline, 11th week, and completion. Furthermore, the outcomes of young-old (65–74 years) and old-old (≥75 years) female subjects were compared.ResultsOf 31 subjects, 21 completed the program (completion rate, 67.7%). No adverse events were observed, and none of the subjects discontinued the exercise program because of chest pain, dyspnea, and increased blood pressure. Body weight and blood glucose level were significantly decreased, and 6MWD was significantly increased following program implementation (p<0.05). Both young-old and old-old women exhibited an improvement in blood glucose level and 6MWD test (p<0.05).ConclusionWe reported the results of the first attempted CBCR in South Korea that was implemented without adverse events during the entire program. Improved aerobic exercise ability and reduced risk factors in all participants were observed. These improvements were also achieved by older adults aged ≥75 years.

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure.

Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

Evaluation of a Community Based Cardiac Rehabilitation Programme

The transition from hospital-based (phase II) to community-based (phase III) cardiac rehabilitation (CR) is an important step in the long-term maintenance of positive health behaviour change. PURPOSE: To evaluate the effect of participation in a phase III, community-based CR (CBCR) programme on selected fitness indices in comparison to a control group that received usual care advice and to explore participant experiences and perceived benefits in transitioning from hospital-based phase II CR to CBCR. METHODS: Following completion of phase-II CR, 95 individuals were referred to a 10-week CBCR exercise programme (intervention). A total of 22 (73% male) participants were unable to attend CBCR classes and were assigned to the control group. The remaining 73 (67% male) were assigned to the CBCR exercise program. Aerobic fitness (6MWT), functional upper (hand grip) and lower (timed sit to stand) limb strength, flexibility (sit and reach test) and body composition (waist & hip girth and BMI) were measured pre and post the intervention. All participants from the intervention group were invited to attend a focus group on completion and a thematic analysis was conducted. RESULTS: A total of 51 participants (69% male) completed the 10-week program (70% compliance). There was a significant improvement (p<0.05) in the timed sit to stand (26.5±7.21 v 21.4±5.65sec), 6MWT (505±66.6 v 534±71.9m),) and waist circumference (100.9±13.09 v 98.5±13.37cm) in the intervention group. There was no significant change in any of the fitness indices in the control group. The focus groups were attended by 20 participants (60% male). The main themes identified included the strong sense of need for CBCR programmes and the reassurance provided by the link between the hospital and community provider. Physical, psychological and social benefits were described including moving from fear to confidence in their ability to exercise. CONCLUSION: Participation in a 10-week CBCR programme resulted in improved lower limb strength, aerobic fitness and waist circumference with maintenance of all other measured fitness components. Participants self-reported an increased ability and motivation to undertake exercise. This study provides an important insight into the experience and benefits, both perceived and actual, in the early transition to CBCR.

Nature of Community-based Cardiac Rehabilitation in New Zealand

Community-based cardiac rehabilitation (CR) is recommended as a potentially more accessible delivery model for patients, and it could be more cost-effective. No data are available on the nature of community-based CR. This study described the nature of community-based CR in New Zealand (NZ), and compared it with other high-income countries (HICs). Secondary analysis of a global, cross-sectional survey of CR programmes was undertaken. National CR societies or champions facilitated administration of the survey to each programme in their country, via REDCap. Data from NZ CR programmes were compared with the 31 other HICs providing CR (data collected in 28). Responses were received from 27 (62.7%) CR programmes in NZ, and 619 (43.1%) in other HICs. NZ was significantly more likely to offer community-based CR (n = 11, 40.7% vs. other HICs n = 75, 11.6%, p < 0.001). Programmes were primarily overseen by nurses (n = 3, 30.0%) and exercise physiologists (n = 2, 20.0%), serving a median of 40.0% (10.0–70.0%) of total CR programme patients/year. NZ programmes run for a median of 8.0 weeks (Q25–75 = 7.0–12.0), with 10.0 (9.5–13.0) patients/session, attending 12.0 (3.5–12.0) sessions/month. NZ community-based programmes predominantly served moderate (n = 9, 90.0%) and low (n = 4, 40%) cardiac risk patients. NZ CR patients were most often offered community-based programmes based on their choice (n = 10, 70.0%) and distance to main CR centre (n = 4, 40.0%); this did not differ from other HICs (n = 53, 74.6% & n = 33, 46.5%). NZ is a global leader in community-based CR. Availability, quality, safety, efficacy and cost-effectiveness of community-based CR should be considered, in NZ and beyond.

Patient preferences for types of community-based cardiac rehabilitation programme

IntroductionCardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours...

Feasibility of an exercise intervention for fatigued breast cancer patients at a community-based cardiac rehabilitation program.

PurposeExercise is beneficial to quality of life after cancer treatment, yet few cancer survivors meet exercise guidelines. Our study sought to determine the feasibility of an oncology rehabilitation exercise program embedded within a cardiac rehabilitation program.MethodsPatients who rated their fatigue >4/10 after completion of adjuvant chemotherapy for breast cancer were screened for eligibility and the outcomes were assessed (Piper Fatigue Scale, Functional Assessment of Cancer Therapy-Breast [FACT-B], Edmonton Symptom Assessment System, body composition, stress test, and physical activity measurement [accelerometer]). Participants received individualized exercise prescription. Following the 16-week program, repeat assessment plus patient acceptance and satisfaction survey was completed. The primary end point was the composite of accrual rate >25%, program adherence >80%, and mean compliance with accelerometer use >80%.ResultsTwenty of 24 screened patients consented to the study and completed the baseline assessment. Adherence was 30.3%. Mean accelerometer use was 3.88/7 days (78%). Fatigue at baseline was rated at 4.82/10, and at 3.59 (p = 0.09) after the intervention. Overall well-being (FACT-B) score changed from 92.7 to 98.3 (p = 0.05). There were no significant changes in body composition (except for bone mineral content), aerobic exercise capacity, or activity patterns.ConclusionAlthough the primary outcome was not met, our study indicates that an oncology exercise rehabilitation program can be incorporated into an existing cardiac rehabilitation program. Based on feedback received, we propose that in order to achieve exercise goals, frequent, encouraging, and tailored feedback and group sessions to foster a sense of community may additionally be needed to strengthen adherence to a prescribed exercise program.

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases.

Background:Cardiac rehabilitation (CR) programmes have been shown to improve patient outcomes, but vary widely in their components. The impact of Singapore’s CR programme on clinical outcomes is currently not known.Objective:To evaluate the effects of a community-based CR programme on important clinical parameters in patients with cardiovascular disease in Singapore.Method:A retrospective cohort study was conducted. Cardiovascular patients who had completed a hospital-based CR programme were included. Patients who continued with community-based CR (n = 94) during the period of 2009-2013 were compared with patients who received regular care (n = 157). Changes in clinical and physical examination parameters between baseline and one-year post follow-up were analyzed. Within-group differences were compared using the paired t-test, while multivariate linear regression was used to compare the changes in the various parameters between the intervention and control groups. The primary outcome measure was low density lipoprotein (LDL) levels.Results:Patients in the intervention group had significant lowering of LDL (2.5 to 2.2 mmol/L, p<0.01), while the control group’s LDL increased (2.2 to 2.4 mmol/L, p<0.01). The intervention group had greater improvements in LDL (-0.3 vs. +0.2 mmol/L, p<0.01), triglycerides (-0.1 vs. +0.1 mmol/L, p=0.01), total cholesterol (-0.3 vs. +0.3 mmol/L, p<0.01), fasting blood glucose (-0.5 vs. +0.3 mmol/L, p<0.01), systolic blood pressure (-3.2 vs. +5 mmHg, p<0.01) and diastolic blood pressure (-2.6 vs. +2.8 mmHg, p<0.01).Conclusion:The community-based CR programme in Singapore is associated with improvements in several cardiovascular clinical parameters and may be of benefit to cardiovascular patients.

Cardiac patients show high interest in technology enabled cardiovascular rehabilitation.

BackgroundCardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR.MethodsA technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations.ResultsOf 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = −0.16; p = 0.005).ConclusionsCVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0329-9) contains supplementary material, which is available to authorized users.

Community-based Cardiac Rehabilitation Led By Ceps Improves Physical And Mental Health Of Phase 2 Patients

Post-event phase 2 cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of life (QoL) while reducing depression and anxiety. Unfortunately many patients decline hospital-based CR because it is inconvenient to attend the facility. Community-based programs have been developed to increase CR program accessibility however; these programs often lack adequately-trained staff and it remains unclear how effective they are. PURPOSE: This study sought to examine the effectiveness of a community-based cardiac rehabilitation exercise program lead by clinical exercise physiologists on CRF, self-reported QoL, depression and anxiety in adults with CVD. METHODS: Participants (n=43; 86% male) with CVD (63.4 ± 9.6 yrs) were referred to a community-based CR program located in Auckland, NZ. All participants underwent baseline and follow-up assessment which included a ramped ECG monitored maximal exercise test with gas analysis, a QoL (Short Form-36), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants completed 3 weekly sessions of aerobic (40-70% VO2R), resistance (1-2 sets; 12-15 reps at 40-80% 1RM) and flexibility exercise, totalling approximately 60 minutes/session. Significantly different (p<.05) pre- vs. post-program values were identified by dependent t-tests. Data are the mean ± SD. RESULTS: Participants attended 83.3% ± 16% of total prescribed sessions. Post-program CRF significantly increased (27.5 ± 7.3 to 30.4 ± 7.4 ml.kg-1.min-1) despite no significant increase in HRpeak (149.5 ± 19.8 to 148.5 ± 21.9 bpm) and respiratory exchange ratio (1.01 ± 0.1 to 1.01 ± 0.1) during maximal exercise testing. SF36 component scores for physical (44.2 ± 10.6 to 51.1 ± 7.3) and mental health (47.2 ± 13.3 to 52.9 ± 6.9) increased while the HADs anxiety (4.2 ± 3.2 to 3.5 ± 2.9) and depression (2.9 ± 3.0 to 1.4 ± 1.4) scores were significantly lower post-program. No deaths or medical events occurred during maximal exercise testing or during regular exercise programming. CONCLUSIONS: Twelve weeks of community-based exercise cardiac rehabilitation led by clinical exercise physiologists is safe and effective for increasing CRF, and QoL while reducing depression and anxiety in phase 2 CR patients.

Heart Wellness Programme: a pilot community-based cardiac rehabilitation programme in a multiethnic society.

Community-based exercise programmes have been shown to be effective in the Western world. However, there is a dearth of literature on their effectiveness in Asia. This pilot study aims to assess the effectiveness of the Asian community-based Health Wellness Programme (HWP) in Singapore. The HWP provides community cardiac rehabilitation services. A retrospective database analysis was conducted on cardiac rehabilitation patients who had completed the one-year wellness programme from 2010 to 2011. Patients were included in the programme if they had an underlying cardiac disease such as ischaemic heart disease and were deemed as stable by their cardiologist. Patients with New York Heart Association Class III or IV heart failure were excluded from this programme. Sociodemographic, anthropometric, clinical and laboratory data was recorded. Changes between the baseline and final measurements were analysed. Complete data from a total of 136 patients was analysed. Improvements were noted in body fat percentage (change [Δ] -1.3%, p < 0.01), distance walked (Δ 9.7 m, p = 0.01), total cholesterol (Δ -7.8 mg/dL, p = 0.03), low-density lipoprotein (Δ -7.8 mg/dL, p = 0.03) and triglyceride (Δ -17.8 mg/dL, p < 0.01). The low-to-moderate intensity HWP seems to be effective in a multiethnic community setting. To confirm the quality and effectiveness of such a programme in secondary cardiovascular prevention, more evidence from prospective controlled trials with suitable controls is needed.

Feeling Supported and Abandoned

In 2010, the Healthy Heart (HH) community-based cardiac rehabilitation program was offered at Latrobe Community Health Service in rural Victoria, Australia. The 8-week program, based on National Heart Foundation guidelines, consisted of exercise sessions; health education on diet, stress, and smoking cessation; and behavioral change strategies. Participants were also informed about local community exercise opportunities. A program evaluation was conducted in 2011 to assess whether the content of the program was meeting the needs of participants and to identify what suggestions they had for improvement. Eighteen patients had completed the HH program in 2010. Eight of these participants, 7 men and 1 woman, volunteered to take part in a focus group. Conventional content analysis was used to identify and group the common themes that emerged from the focus group discussions. Three themes were identified that reflected the participant experiences of attending the HH program. The first, "recovering confidence," described participant responses to the content of the sessions. The second, "putting it into practice," referred to their comments about taking responsibility for making lifestyle changes. The third, "feeling abandoned," emerged from the reported difficulty participants expressed about maintaining motivation for change after program completion. Participants rated the HH program as very successful by objective measures. However, they reported struggling to maintain self-management strategies postprogram. There is clearly a need to develop strategies that support cardiac rehabilitation participants over the longer-term.

Effects of Community-Based Cardiac Rehabilitation on Body Composition and Physical Function in Individuals with Stable Coronary Artery Disease: 1.6-Year Followup

Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR). Design. Thirty-four individuals (69.7 ± 8.2 years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance. Results. Participants attended 38.5 ± 30.3% sessions during 1.6 ± 0.2 year followup. A significant increase in 30-second chair stands (17.0 ± 4.7 to 19.6 ± 6.4, P < 0.001), body weight (75.8 ± 11.1 to 77.2 ± 12.1 kg, P = 0.001), and body fat (27.0 ± 9.5 to 29.1 ± 9.6%, P < 0.001) and a decline in handgrip strength (36.4 ± 9.4 to 33.0 ± 10.6 kg·f, P < 0.001) and muscle mass (40.8 ± 5.6 to 39.3 ± 5.8%, P < 0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes. Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.

Meta-Analysis of the Effect of Cardiac Rehabilitation Interventions on Depression Outcomes in Adults 64 Years of Age and Older

Heart disease is a major cause of hospitalization and is associated with greater impairment than arthritis, diabetes mellitus, or lung disease. Depression is prevalent and a serious co-morbidity in heart disease with negative consequences including higher levels of chronic physical illness, decreased psychological well-being, and increased health care costs. The objective of the study was to examine with meta-analysis the impact of community-based cardiac rehabilitation (CR) treatment on depression outcomes in older adults. Randomized controlled trials comparing patients (≥64 years old) receiving CR to cardiac controls were considered. Meta-analyses were based on 18 studies that met inclusion criteria, comprising 1,926 treatment participants and 1,901 controls. Effect sizes (ESs) ranged from -0.39 (in favor of control group) to 1.09 (in favor of treatment group). Mean weighted ES was 0.28, and 11 studies showed positive ESs. Meta-analysis suggests that most CR programs delivered in the home can significantly mitigate depression symptoms. Tailored interventions combined with psychosocial interventions are likely to be more effective in decreasing depression in older adults with heart disease than usual care.