Community-based Cardiac Rehabilitation Research Articles

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.

Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial.

BackgroundExercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence.ObjectiveThe aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform.MethodsA convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform.ResultsParticipant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022.ConclusionsThis pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform.International Registered Report Identifier (IRRID)PRR1-10.2196/31855

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.

Enhancing the appeal of cardiac rehabilitation for women: development and pilot testing of a women-only yoga cardiac rehabilitation programme.

Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme; WYCRP); (ii) to investigate programme acceptability; and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive; qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76%; P = 0.40), CR completion, and continuation were (95% vs. 56%; P = 0.02, and 72% vs. 12%; P < 0.001, respectively). This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.

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.

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds,...

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.

Community-based Cardiac Rehabilitation Improved Adherence to Medication, Quality of Life and Rehospitalization Among Stable Coronary Artery Patients: A Cohort Study

Background : Community-based cardiac rehabilitation interventions have been known as an important aspect of secondary prevention. However, no data are available regarding the benefit of this program in Indonesian coronary artery disease (CAD) patients treated with optimal medication. Objectives : To assess the benefit of community-based cardiac rehabilitation on patient adherence to the drugs, quality of life (QoL) and MACE, in stable CAD. Methods : An observational prospective cohort study recruited the Malang community of cardiovascular care (MC3) members as an intervention group and Aisyah Islamic hospital patients in Malang, Indonesia, as a control, for a year follow up. Member of MC3 has regular aerobic exercise, education regarding the disease, the importance of the drugs, and its side effect in addition to standard education given in outpatient clinic setting as the control group members. A validated MMS-8, QOL (SF-36), and SAQ questionnaire were used to assess adherence to the drugs, QoL, and MACE of participants. Results: A total of 73 interventions and 73 control patients were enrolled for the study. Our findings showed that intervention patients were 2.04-fold associated with having a better physical function and 3.85-fold better compliance than control patients. The hospitalization rate also significantly lower in members of the intervention group (MC3). However, no significant difference observed among the two groups. Moreover, in the subgroup analysis, it shows that the intervention group who had participated for 2 years had the highest value of MMS-8 compared to the other groups with p &lt; 0.005. Conclusion: Our study reveals that community based cardiac rehabilitation intervention have better adherence to medication and quality of life than patients control, and also could reduce rehospitalization in stable CAD patients.

Extended Cardiac Rehabilitation Does Not Improve Exercise Adherence More Than Usual Care

PURPOSE: Exercise adherence is in general poor after cardiac rehabilitation (CR). In Norway, standard exercise-based CR typically offers 12 weeks of hospital-based supervised exercise at moderate or high intensity. The use of high-intensity interval training (HIT) in CR expands; however, it is still unclear how HIT affects exercise adherence. The purpose of this study was to assess the effect of an extended community-based or home-based CR program on long-term exercise adherence. METHODS: Between August 2014 and June 2017, 161 persons (27 women, age 62.3 (8.7) /134 men, age 60.1 (8.9)) were recruited. All had completed an HIT-based CR at St. Olav`s Hospital in Trondheim, Norway. They were randomized in a 1:1:1 ratio to an extended supervised community-based CR (ExCR) , a home-based CR (HCR) or a control group (CG). The extended CRs (ExCR and HCR) consisted of one HIT session and two additional sessions a week for eight weeks. The ExCR got a follow-up session every third month until one year after inclusion. The CG received usual care (standard advice for exercise and life style). Measurements were performed at baseline (T1), at 1 year (T2) and 2 years (T3) after inclusion. Primary outcome was peak oxygen uptake (VO2peak) at 2 years. Secondary outcome was achievement of current guidelines in regard of physical activity (PA) at moderate (MPA) and vigorous (VPA) intensity, measured with accelerometer. Data are analyzed with mixed linear model. RESULTS: Out of 161 participants, 144 (89%) completed the 2 year follow-up. VO2peak (ml/kg/min) was not significantly different between groups (p=0.777) at T1 (33.1 (7.7), 33.6 (8.5), 34.0 (7.2)), T2 (33.1 (7.9), 33.1 (8.4), 33.9 (7.4)) or T3 (30.9 (7.5), 32.2 (8.6) and 32.0 (7.3) for ExCR, HCR and CG, respectively). The decrease in VO2peak over time was significant from T2 to T3 (p=0.024). Daily average of minutes in MPA and VPA were not significantly different between groups (p=0.441 and p=0.557 respectively) at any time. There was a significant reduction from T1 to T2 in both MPA (107 (61) min to 100 (59) min, p=0.043) and VPA (14 (19) min to 11 (18) min, p=0.007). CONCLUSIONS: Extended cardiac rehabilitation did not enhance exercise adherence compared to usual care after a HIT-based CR program. Despite a decrease in VO2peak over two years, the amount of physical activity met the current guidelines.

Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China.

BackgroundThe level of physical activity (PA) among patients with coronary heart disease (CHD) living in Chinese communities who do not participate in cardiac rehabilitation programs and the factors contributing to patient maintenance of PA are unclear.ObjectiveThis cross-sectional study, guided by the Transtheoretical Model, evaluated (1) the maintenance of PA in Chinese patients with CHD 12 months after hospital discharge and (2) the demographic, clinical, and psychological characteristics associated with maintenance of PA.MethodsA total of 1162 patients completed 6 questionnaires at 12 months posthospitalization to assess their maintenance of PA, stage of change, symptoms of depression and anxiety, and health-related quality of life and sleep.ResultsOnly 40% of patients with CHD maintained regular PA 12 months after hospital discharge. Walking was their primary PA. Thirty-seven percent of patients reported no intention of having regular PA. Male sex (odds ratio [OR], 1.69), awareness of PA's cardiac benefit (OR, 4.12), a history of regular PA before the cardiac event (OR, 6.08), history of chronic disease (OR, 1.43), mild depressive symptoms (OR, 1.40), moderate and severe depressive symptoms (OR, 0.41), smoking (OR, 0.54), and years of CHD (OR, 0.96) were related to maintenance of regular PA. Patients with CHD who maintained regular PA had better quality of life and sleep (P < .001) and fewer unplanned clinic visits (P = .001) and cardiac cause readmissions (P = .012) and reported fewer declines in PA capacity (P < .001).ConclusionsWalking is the most common form of PA 12 months posthospitalization among patients with CHD in China. Patient education and counseling about the cardiac benefits of PA, taking into account stage of change, are important considerations to improve maintenance of PA.

Community-Based Cardiac Rehabilitation To Improves Medication Adherence in Stable Coronary Artery Disease

Cardiovascular disease contributes to 48% of deaths in the world. A cohort study at the Harapan Kita National Heart Center and 5 Indonesia hospitals in 2006 showed that the death rate due to heart disease in hospitals was around 6-12%. Rehospitalization rate reached 29% and the all-out expense of INA-CBG claimed for inpatient was Rp 42.4 trillion. The major problem causing rehospitalization was poor compliance to medication in coronary artery disease (CAD) patients. Education to improve compliance has been known not only reduced rehospitalization rate but also improve quality of life. In these review the author discussed the efficacy of community based cardiac rehabilitation for rehospitalisation reduction dan quality of life improvement.

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.

Chronic Adaptations On The Oxygen Uptake Kinetics In Trained Older Adults With Coronary Artery Disease

Previous studies have reported that slower VO2 kinetics typically observed in healthy older individuals can be prevented by long-term endurance training interventions. However, the chronic adaptations on the VO2 kinetics and muscle deoxygenation ([HHb]) kinetics response in trained older adults with coronary artery disease (CAD) remains unknown. PURPOSE: to compare VO2 and [HHb] kinetics response in moderate exercise in older adults with CAD and a control group (CG) of healthy active age- and gender-matched individuals. Both groups did at least 6 months the following exercise training (ET) prescription, 3 d.wk-1 x 60-min: 30 min at 60-70% heart rate reserve + 2 x 8-12 repetitions in 6 major muscle groups. METHODS: thirty-two male participants (age: 63.5 ± 8.3 years; n= 17 CAD and n=15 CG) completed the following assessments: 1) incremental symptom-limited cycling cardiopulmonary exercise test; 2) square-wave transitions from rest to moderate-intensity exercise. Pulmonary VO2 was collected breath-by-breath and [HHb] data of the vastus lateralis was determined by near-infrared spectroscopy. The parameters of the VO2 and [HHb] kinetics were determined using a monoexponential model. Differences between groups was assessed with the independent-samples t-test. RESULTS: Peak oxygen consumption and peak work load were lower in CAD compared to CG (CAD: 23.2 ± 6.2, CG: 30.4 ± 7.5 ml/kg/min, p<0.05; and CAD: 158 ± 47, CG: 193 ± 50 W, p<0.05). For the square-wave transition, VO2 amplitude was significantly lower in CAD patients than CG group (10.1 ± 2.9 vs 13.1 ± 3.8 ml/kg/min, p<0.05). In contrast, VO2 baseline, time constant of the primary phase, gain and mean response time were not significant (p>0.05). The effective deoxy-[Hb+Mb] was not statistically different between groups (p>0.05). CONCLUSIONS: Long term ET in CAD participants had lower measured VO2peak and work load compared to age- and gender matched. However, both pulmonary and muscular oxygen kinetics were not slower in older adults with CAD compared to their training-matched counterparts. These findings support the importance on the referral of elderly patients to community-based cardiac rehabilitation ET program to maintain their submaximal pulmonary and muscle [HHb] kinetics to continue their ability to perform daily activities.

EFFICACY OF A TECHNOLOGY-ENABLED, HOME-BASED CARDIAC REHABILITATION PROGRAM

Despite strong evidence for cardiac rehabilitation (CR) in secondary prevention of CVD, uptake rates are poor and long-term adherence rates are low. Home-based, technology enabled, CR has been advocated as an alternative mode of delivery for community-based CR. PATHway (Physical Activity Towards

Importance of Completing Hybrid Cardiac Rehabilitation for Long-Term Outcomes: A Real-World Evaluation.

Community-based hybrid cardiac rehabilitation (CR) programs offer a viable alternative to conventional centre-based CR, however their long-term benefits are unknown. We conducted a secondary analysis of the CR Participation Study conducted in London, Ontario, between 2003 and 2006. CR eligible patients hospitalized for a major cardiac event, who resided within 60 min, were referred to a hybrid CR program; 381 of 544 (64%) referred patients initiated CR; an additional 1,498 CR eligible patients were not referred due to distance. For the present study, CR participants were matched using propensity scores to CR eligible non-participants who resided beyond 60 min, yielding 214 matched pairs. Subjects were followed for a mean (standard deviation, SD) of 8.56 (3.38) years for the outcomes of mortality or re-hospitalization for a major cardiac event. Hybrid CR participation was associated with a non-significant 16% lower event rate (Hazard Ratio [HR]: 0.84, 95% CI: 0.59–1.17). When restricting to pairs where CR participants achieved a greater than 0.5 metabolic equivalent exercise capacity increase (123 pairs), CR completion was associated with a 51% lower event rate (HR: 0.49, 95% CI: 0.29–0.81). Successful completion of a community-based hybrid CR program may be associated with decreased long-term mortality or recurrent cardiac events.

Physical activity, physical function and quality of life in community-based maintenance cardiac rehabilitation

Objective: This study compared physical activity (PA), physical function and quality of life in elderly individuals with coronary artery disease (CAD) and their non-CAD peers participating in community-based, maintenance cardiac rehabilitation (CR). Design: Cross-sectional study. Setting: Community-based maintenance CR programme. Methods: A total of 39 individuals (71.8% women; age 70.5 ± 5.5 years; 13 CAD, 26 non-CAD) wore an accelerometer for 7 days and completed anthropometry, chair stands, handgrip strength, a Short Physical Performance Battery, a PA questionnaire (IPAQ- SF), a quality of life questionnaire (SF-36), a 10-m shuttle walk test and two 6-minute walk tests. Results: Compared with the non-CAD group, the CAD group accumulated more objectively measured moderate-to-vigorous PA per week (329.7 ± 233.3 vs 160.6 ± 149.5 minutes, p = .013), achieved PA guidelines on more days per week (3.8 ± 2.2 vs 2.1 ± 2.6 days/week, p = .042), had a lower proportion of body fat (27.5 ± 8.4% vs 36.5 ± 8.7%, p = .004) and a higher proportion of muscle mass (72.5 ± 8.4% vs 63.0 ± 9.8%, p = .022). Physical function and quality of life were not different between the groups. Conclusion: Elderly CAD patients participating in community-based maintenance CR performed more PA and had more favourable body composition but similar physical function and quality of life compared with their non-CAD peers. Long-term participation in community-based maintenance CR may promote PA in elderly CAD patients and help maintain physical function and quality of life at a level similar to that of their non-CAD peers. However, due to a small sample size, these findings should be interpreted with caution and examined in future larger studies.