Hospital-based Exercise Training Research Articles

Home- and hospital-based exercise training programme after Fontan surgery.

Exercise training has been shown to increase exercise capacity in survivors of Fontan surgery. The geographic distribution of the Fontan population has been a barrier to hospital-based exercise training programmes. The objective of this study was to establish whether a home exercise training programme could achieve similar improvements to a hospital programme. Adolescents with a Fontan circulation aged 12-19 years were prospectively recruited in a hospital or home exercise training programme. Patients underwent cardiopulmonary exercise testing and completed the Paediatric Quality of Life Inventory at initial assessment and after completion of an 8-week programme. Both groups performed two 1-hour training sessions per week. Patients in the home training programme had their first session in the hospital, and then progressed independently with one phone consult per week and one home visit by a physiotherapist. In total, 17 patients, with a mean age of 15±3 years, completed the training programme (six hospital). Characteristics and baseline performance of patients were similar in both groups. Oxygen consumption at anaerobic threshold increased from 19.3±3.8 to 21.6±6.0 ml/kg/minute (p=0.02) and peak oxygen pulse increased from 8.8±2.5 to 9.5±2.7 ml/beat (p=0.049). Total quality of life scale improved from 68 to 74% (p=0.01) and psychosocial health improved from 67 to 74% (p=0.02). No patient experienced training-related complications. Exercise training is beneficial and most likely safe after Fontan, resulting in improved exercise capacity and self-reported quality of life. Home exercise training programmes are probably as effective as hospital programmes. Home exercise training programmes should be integrated in the follow-up care of patients undergoing Fontan surgery.

Comparison of Supervised Hospital-based versus Educated Home-based Exercise Training in Korean Heart Failure Patients.

Background and ObjectivesAlthough many clinical trials have shown that exercise training (ET) improves functional capacity and clinical outcomes in heart failure (HF) patients, data comparing supervised hospital-based and educated home-based ET in HF patients is lacking.Subjects and MethodsThis was a single-center, non-randomized, prospective study of 82 HF patients with reduced ejection fraction (≤40%) who completed ET. The hospital-based group (n=30) underwent supervised ET at 60% of peak oxygen consumption (VO2), while a physiotherapist-educated group (n=52) exercised at home without monitoring. The 2 groups were compared before and after the 3-month ET program with respect to functional capacity, quality of life (QOL), and cardiac events (all-cause mortality or hospitalization with worsening HF).ResultsAfter ET, peak VO2 increased in the hospital-based group (19.4±4.4 to 21.4±4.3 mL/min/kg, p=0.006) and remained unchanged in the home-based group (18.9±4.6 to 18.4±4.6 mL/min/kg, p=0.660). The change in peak VO2 after ET was greater in the hospital-based group compared to the home-based group by 2.5 mL/min/kg (p=0.014). QOL improved in the hospital-based group (43.1±18.0 to 28.1±21.6, p=0.003). During one year of follow-up, a comparison of the 2 groups did not reveal a statistical difference in cardiac events (hazard ratio, 0.66; 95% confidence interval, 0.2–2.8; p=0.570).ConclusionHospital-based ET was beneficial for HF patients, improving functional capacity and QOL. However, no significant advantages were observed in terms of a composite endpoint compared to home-based ET. Further investigations are required to address the effects and roles of the 2 ET programs for HF patients.

Abstract 18497: Hospital-based Exercise Training Program Post Coronary Artery Bypass Graft Surgery: Impact of Once and Twice Daily Exercise Program on Cardiac Autonomic Modulation

Introduction: Coronary artery bypass surgery (CABG) patients with postoperative decreased cardiac autonomic modulation (CAM) have a higher mortality rate and although cardiovascular rehabilitation and exercises have substantial benefits in CAM, there is a paucity of information about its effects considering a possible "dose-dependent” autonomic adaptation in a hospital-based exercise program. The aim was to evaluate the impact of once daily versus twice daily dosing regimens of hospital-based exercise training on CAM in post CABG patients. Hypothesis: We hypothesized that there is a dose-dependent exercise adaptation on CAM and greater benefit to twice daily exercise group. Methods: Thirty-seven patients post-CABG were divided into: GEX1 (n = 12) and GEX2 (n = 11), composed of patients who underwent exercises one and two daily sessions, respectively; and of a control group (CG, n = 14) who received usual care (respiratory therapy). GEX patients initiated the exercises on post-operative day 1 (PO1), following a whole progressive program until discharge. CAM was assessed by indices of heart rate variability (HRV) analyzed from heart rate and R-R intervals signals recording at rest during 10 minutes on PO1 (baseline) and discharge time. Results: At the time of discharge after the hospital rehabilitation conclusion, GEX2 presented higher values of rMSSD index, representative of parasympathetic modulation, and also higher values of RRtri, TINN and STDRR indices, representative of overall variability of RRi compared to GC, respectively (rMSSD: 7.5±1.9 vs 5.2±1.8 ms; RRtri: 3.2±1.4 vs 2.0±0.7ms; TINN: 46.0±30.5 vs 25.7±11.0 ms and STDRR: 10.0±6.3 vs 5.4±3.3 ms), while GEX1 presented only higher values of rMSSD compared to CG (rMSSD: 7.8±2.5 vs 5.2±1.8 ms). However, no differences were observed between groups on HRV baseline and at discharge time between groups GEX1 and GEX2. Conclusion: Our results suggested that twice daily hospital-based exercise program stimulated more favorably the cardiac autonomic nervous system adaptations in patients post-CABG. Although a daily exercise session promotes beneficial adaptations, two sessions should be encouraged to additional benefits in the cardiac autonomic modulation FAPESP 2015/2015 / 16730-3.

Home- versus hospital-based exercise training in heart failure: an economic analysis

Home- versus hospital-based exercise training in heart failure: an economic analysis

Effects of home versus hospital-based exercise training in chronic heart failure

Many researchers have demonstrated that supervised hospital-based training yields improvements in exercise capacity and quality of life (QoL) for heart failure (HF) sufferers [ 1 Davies E.J. Moxham T. Rees K. et al. Exercise Based Rehabilitation for Heart Failure (Review). in: Cochrane Database of Systematic Reviews. John Wiley, Chichester2010 Google Scholar ]. Though comparatively under-researched, home-training does not involve a potentially tiring return journey to hospital, and can be undertaken whenever the individual feels best able to exercise, therefore may offer a more pragmatic exercise option for this frail group [ 2 Chien C. Lee C. Wu Y. Chen T. Wu Y. Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review. Aust J Physiother. 2008; 54: 87-93 Google Scholar , 3 Hwang R. Marwick T. Efficacy of home-based exercise programmes for people with chronic heart failure: a meta-analysis. Eur J Cardiovasc Prev Rehabil. 2009; 16: 527-535 Google Scholar ]. Three previous non-controlled trials have compared effects of home and hospital-based exercise training in HF [ 4 Daskapan A. Arikan H. Caglar N. Tunali N. Ataman S. Comparison of supervised exercise training and home-based exercise training in chronic heart failure. Saudi Med J. 2005; 26: 842-847 Google Scholar , 5 Karapolat H. Demir E. Bozkaya Y.T. et al. Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters. Clin Res Cardiol. 2009; 98: 635-642 Google Scholar , 6 Piotrowicz E. Baranowski R. Bilinska M. et al. A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life and adherence. Eur J Heart Fail. 2010; 12: 164-171 Google Scholar ]. Two [ 5 Karapolat H. Demir E. Bozkaya Y.T. et al. Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters. Clin Res Cardiol. 2009; 98: 635-642 Google Scholar , 6 Piotrowicz E. Baranowski R. Bilinska M. et al. A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life and adherence. Eur J Heart Fail. 2010; 12: 164-171 Google Scholar ] found significant improvements in exercise capacity and QoL of up to 10% with both types of training, whilst the other [ 4 Daskapan A. Arikan H. Caglar N. Tunali N. Ataman S. Comparison of supervised exercise training and home-based exercise training in chronic heart failure. Saudi Med J. 2005; 26: 842-847 Google Scholar ] found that only hospital-training significantly improved exercise capacity (by 19%). To date, this is the only trial to compare effects of home versus hospital-based aerobic exercise training versus control upon exercise capacity and QoL in HF.

Impact of a rehabilitation program on muscular strength and endurance in peripheral arterial occlusive disease patients

Rehabilitation care and physical exercise are known to constitute an effective treatment for chronic peripheral arterial occlusive disease (PAOD) at the intermittent claudication (IC) stage. Improvements in functional capacities and quality of life have been reported in the literature. We decided to assess the effects of hospital-based exercise training on muscle strength and endurance for the ankle plantar and dorsal flexors in this pathology. Patients and methods This prospective study included 31 subjects with chronic peripheral arterial occlusive disease (PAOD) and IC who followed a 4-week rehabilitation program featuring walking sessions, selective muscle strengthening, general physical exercise and therapeutic patient education. An isokinetic assessment of ankle plantar and dorsal flexors strength was conducted on the first and last days of the program. We also studied the concentric contractions at the angular velocity of 30°/s and 120°/s for muscle strength and at 180°/s for muscle fatigue. We also measured the walking distance for each patient. Results Walking distance improved by 246%. At baseline, the isokinetic assessment revealed severe muscle weakness (mainly of the plantar flexors). The only isokinetic parameter that improved during the rehabilitation program was the peak torque for plantar flexors at 120°/s. Conclusion All patients presented with severe weakness and fatigability of the ankle plantar and dorsal flexors. Our program dramatically improved walking distance but not muscle strength and endurance.

Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery

ObjectiveTo compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during cardiac rehabilitation (CR) on exercise capacity and habitual physical activity.DesignSix-year follow-up of patients who participated in a...

A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level

In heart failure, reduced physical activity level can adversely affect physical and psychosocial functioning. No previous heart failure research has compared effects of home and hospital-based exercise training upon physical activity level, or has objectively assessed their long-term effects upon physical activity. This study used an activPAL™ monitor to examine immediate and long-term effects of home and hospital-based aerobic exercise training upon physical activity level. Randomized controlled trial. Sixty patients with heart failure (mean age 66 years; NYHA class II/III; 51 male/9 female) were randomized to home training, hospital training or control. Both programmes consisted of aerobic circuit training, undertaken twice a week for one hour, for eight weeks. All participants wore the activPAL™ at baseline, and after eight weeks, for one week. Six months after cessation of training, a subgroup of participants from the home and hospital training groups (n = 10 from each group) wore the activPAL™ for a further week. Hospital-based training significantly increased steps taken per day during 'extra long' (P = 0.04) and 'long' (P = 0.01) walks. Neither programme had any immediate effect upon physical activity level otherwise. Though daily upright duration for the home group significantly improved six months after cessation of training (P = 0.02), generally physical activity level was maintained in the long term for both training groups. Hospital-based training enabled participants to walk for longer periods. It is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period.

Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters

To compare the effects of home-based and hospital-based exercise programs on exercise capacity, quality of life, psychological symptoms, and hemodynamic parameters in heart failure (HF) patients. Seventy-four patients were randomized into either a hospital-based exercise (Group 1) or a home-based exercise (Group 2) group. Prior to and after the 8-week rehabilitation program, the two groups were compared with respect to their functional capacity [maximal oxygen uptake (pVO(2)) and 6-min walk test (6MWT)], quality of life (Medical Outcomes Study and the 36-item Short Form Survey, SF-36), psychological symptoms [Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory], and hemodynamic parameters [(left ventricular diastolic diameter in diastole, left ventricular diameter in systole, mitral early diastolic peak flow velocity (E)/late diastolic peak flow velocity (A), mitral E/mitral early peak velocity (E (m)), tei index, right ventricular systolic peak velocity (S (m)), tricuspid annular plane systolic excursion, systolic pulmonary arterial pressure (SPAP), and left and right ventricular ejection fraction (LVEF and RVEF)]. After the exercise programs, significant improvement was observed in pVO(2), 6MWT and subscales of physical function, general health, and vitality of SF 36, as well as BDI and LVEF in both groups (P < 0.05). A comparison of the two exercise groups revealed no significant differences between them regarding the analyzed variables (P > 0.05). Both the hospital-based and home-based exercise groups improved significantly in functional capacity, quality of life, depression symptoms, and LVEF. Based on these results, we believe that physicians can recommend home-based exercise under strict supervision for stable HF patients. However, additional research should be conducted in this area.

Intermittent Claudication: Clinical Effectiveness of Endovascular Revascularization versus Supervised Hospital-based Exercise Training—Randomized Controlled Trial

To compare clinical success, functional capacity, and quality of life during 12 months after revascularization or supervised exercise training in patients with intermittent claudication. This study had institutional review board approval, and all patients gave written informed consent. Between September 2002 and September 2005, 151 consecutive patients who presented with symptoms of intermittent claudication were randomly assigned to undergo either endovascular revascularization (angioplasty-first approach) (n = 76) or hospital-based supervised exercise (n = 75). The outcome measures were clinical success, functional capacity, and quality of life after 6 and 12 months. Clinical success was defined as improvement in at least one category in the Rutherford scale above the pretreatment level. Significance of differences between the groups was assessed with the unpaired t test, chi(2) test, or Mann-Whitney U test. To adjust outcomes for imbalances of baseline values, multivariable regression analysis was performed. Immediately after the start of treatment, patients who underwent revascularization improved more than patients who performed exercise in terms of clinical success (adjusted odds ratio [OR], 39; 99% confidence interval [CI]: 11, 131; P < .001), but this advantage was lost after 6 (adjusted OR, 0.9; 99% CI: 0.3, 2.3; P = .70) and 12 (adjusted OR, 1.1; 99% CI: 0.5, 2.8; P = .73) months. After revascularization, fewer patients showed signs of ipsilateral symptoms at 6 months compared with patients in the exercise group (adjusted OR, 0.4; 99% CI: 0.2, 0.9; P < .001), but no significant differences were demonstrated at 12 months. After both treatments, functional capacity and quality of life scores increased after 6 and 12 months, but no significant differences between the groups were demonstrated. After 6 and 12 months, patients with intermittent claudication benefited equally from either endovascular revascularization or supervised exercise. Improvement was, however, more immediate after revascularization.

Cost-effectiveness of endovascular revascularization compared to supervised hospital-based exercise training in patients with intermittent claudication: A randomized controlled trial

Cost-effectiveness of endovascular revascularization compared to supervised hospital-based exercise training in patients with intermittent claudication: A randomized controlled trial

Cost-effectiveness of endovascular revascularization compared to supervised hospital-based exercise training in patients with intermittent claudication: A randomized controlled trial

The optimal first-line treatment for intermittent claudication is currently unclear. To compare the cost-effectiveness of endovascular revascularization vs supervised hospital-based exercise in patients with intermittent claudication during a 12-month follow-up period. Randomized controlled trial with patient recruitment between September 2002-September 2006 and a 12-month follow-up per patient. A large community hospital. Patients with symptoms of intermittent claudication due to an iliac or femoro-popliteal arterial lesion (293) who fulfilled the inclusion criteria (151) were recruited. Excluded were, for example, patients with lesions unsuitable for revascularization (iliac or femoropopliteal TASC-type D and some TASC type-B/C. Participants were randomly assigned to endovascular revascularization (76 patients) or supervised hospital-based exercise (75 patients). Mean improvement of health-related quality-of-life and functional capacity over a 12-month period, cumulative 12-month costs, and incremental costs per quality-adjusted life year (QALY) were assessed from the societal perspective. In the endovascular revascularization group, 73% (55 patients) had iliac disease vs 27% (20 patients) femoral disease. Stents were used in 46/71 iliac lesions (34 patients) and in 20/40 femoral lesions (16 patients). In the supervised hospital-based exercise group, 68% (51 patients) had iliac disease vs 32% (24 patients) with femoral disease. There was a non-significant difference in the adjusted 6- and 12-month EuroQol, rating scale, and SF36-physical functioning values between the treatment groups. The gain in total mean QALYs accumulated during 12 months, adjusted for baseline values, was not statistically different between the groups (mean difference revascularization versus exercise 0.01; 99% CI -0.05, 0.07; P = .73). The total mean cumulative costs per patient was significantly higher in the revascularization group (mean difference euro2318; 99% CI 2130 euros, 2506 euros; P < .001) and the incremental cost per QALY was 231 800 euro/QALY adjusted for the baseline variables. One-way sensitivity analysis demonstrated improved effectiveness after revascularization (mean difference 0.03; CI 0.02, 0.05; P < .001), making the incremental costs 75 208 euro/QALY. In conclusion, there was no significant difference in effectiveness between endovascular revascularization compared to supervised hospital-based exercise during 12-months follow-up, any gains with endovascular revascularization found were non-significant, and endovascular revascularization costs more than the generally accepted threshold willingness-to-pay value, which favors exercise.

Long-term effects of cardiac rehabilitation on end-exercise heart rate recovery after myocardial infarction

Heart rate recovery (HRR) is a marker of vagal tone that is a powerful predictor of mortality in patients with coronary artery disease. This study aims at evaluating the effects of long-term exercise training on HRR after acute myocardial infarction (AMI), in order to clarify whether prolonged exercise training could maintain a long-term improvement of HRR. Forty-four patients after AMI were enrolled in a 3-month hospital-based exercise training programme. At the end, patients were subdivided into two groups: group A (n=22), patients discharged with a specific home-based exercise training programme and instructions for improving leisure-time physical activity; group B (n=22), patients discharged with generic instructions to maintain physical activity. All patients underwent a cardiopulmonary exercise test before, at the end of 3 months exercise training and at 6 months follow-up. At the end of the hospital-based exercise training programme we observed an increase in peak oxygen consumption [VO2peak; from 13.9+/-3.6 to 18+/-2.7 ml/kg per min (A) and from 14.1+/-3.9 to 17.9+/-2.1 ml/kg per min (B), P<0.001] and in HRR [from 17.1+/-1.8 to 23.4+/-1.4 beats/min (A), and from 18.8+/-2.1 to 24.3+/-1.9 beats/min (B), P<0.001]. At 6 months' follow-up we observed a further improvement in VO2peak (from 18.0+/-2.7 to 20.3+/-2.7 ml/kg per min, P<0.001) and in HRR (from 23.4+/-1.4 to 27.8+/-2.1 beats/min, P<0.001) in group A, but a significant decrease in VO2peak and in HRR in group B (P<0.001). Long-term exercise training is useful for maintaining or improving the beneficial results of the standard 3-month exercise training programme on cardiovascular capacity and HRR. This observation may bear beneficial prognostic effects on patients after AMI.

Myocardial Oxygen Consumption Index in Patients with Coronary Artery Disease

One hundred and thirty-six men with coronary artery disease were randomly assigned to a hospital-based or home-based exercise program of 3 sessions per week. A treadmill test was carried out with the modified Naughton protocol. After 3 months, 125 patients (92%) with a mean age of 55 +/- 11 years had completed the study. Maximum workload achieved increased by 65% [(12.40 +/- 1.32 vs. 7.50 +/- 0.85 metabolic equivalent units (METs)] in the hospital-based group, and by 17% (8.86 +/- 0.9 vs. 7.56 +/- 0.78 METs) in the home-based group ( p = 0.0001). The heart rate-blood pressure product, an index of myocardial oxygen consumption, decreased at rest by 19% in the hospital-based group but was unchanged in the home-based group ( p = 0.0001). The heart rate-blood pressure product at 5 and 7 METs activity level decreased 28% and 26%, respectively, in the hospital-based group vs. 8% and 2% in the home-based group ( p = 0.0001). It was concluded that hospital-based exercise training in patients with coronary artery disease improves functional capacity and decreases the myocardial oxygen consumption index at rest and during exercise.

Home-based versus hospital-based exercise programs in patients with coronary artery disease: Effects on coronary vasomotion

Background In a randomized study, we recently documented that a vigorous, hospital-based exercise training (ET) program improves coronary endothelial function in coronary artery disease. The aim of this consecutive study was to assess whether a home-based exercise program with reduced average training duration can sustain previously achieved effects on coronary endothelial function. Methods Nineteen patients with coronary endothelial dysfunction documented by acetylcholine-induced vasoconstriction were randomly assigned to a training group (n = 10) or a control group (n = 9). After 4 weeks of inhospital training (60 min of bicycle ergometry per day), all training patients were enrolled in a 5-month home-based program of 20 minutes' ergometry training per day and 1 group training session per week. At baseline, after 4 weeks and 6 months, endothelium-mediated vasodilation was assessed by quantitative coronary angiography after intracoronary infusions of acetylcholine. Average peak velocity (APV) was measured with a Doppler wire. Coronary blood flow (CBF) was calculated by multiplying vascular cross-sectional area and APV. Results CBF increased in response to 7.2 μg/min acetylcholine, from 27% ± 11% at the beginning of the study to 110% ± 24% after 4 weeks ( P < .01 vs control group). After 6 months, the increase in CBF was lower versus inhospital training (67% ± 18%, P < .05 vs 4 weeks). Changes in APV between 1 and 6 months correlated with daily training durations ( r = 0.65, P = .03). Conclusions Home-based ET sustained part of the effects of hospital-based ET on endothelium-dependent vasodilation in coronary artery disease. However, acetylcholine-induced increases in CBF were lower after home-based ET, suggesting a relation between daily training duration and improvement of coronary vasomotion. (Am Heart J 2003;145:e3.)

Randomized Trial of a Hospital-Based Exercise Training Program After Acute Myocardial Infarction: Cardiac Autonomic Effects

Objectives. This study sought to determine whether a moderate intensity supervised exercise training program, performed immediately after an uncomplicated acute myocardial infarction, improves recovery in cardiac autonomic function compared with standard advice about activity at home.Background. Exercise training has beneficial effects on cardiac autonomic function and may improve prognosis after acute myocardial infarction.Methods. Thirty-nine male and 10 female patients, mean (±SE) age 57 ± 1 years, with an uncomplicated acute myocardial infarction were randomized to either a 6-week moderate intensity supervised hospital-based exercise training program (exercise group) or to an unsupervised low intensity home walking program (control group). Outcome measures included changes in baroreflex sensitivity (phenylephrine bolus method) and heart rate variability (24-h Holter monitoring) and the endurance time at 85% of peak oxygen consumption.Results. At baseline, there were no significant differences in left ventricular ejection fraction (57 ± 2% vs. 53 ± 2%), frequency of anterior infarction (27% vs. 18%) and peak creatine kinase (1,256 ± 170 vs. 1,599 ± 295 IU) between the exercise and control groups. Baroreflex sensitivity (10.5 ± 1.0 vs. 8.4 ± 1.2 ms/mm Hg) and time domain measures of heart rate variability were also similar. After completion of the program, the exercise group exercised for a median of 15 min (interquartile range 12 to 25) at a workload of 104 ± 7 W compared with 7 min (interquartile range 3.5 to 12) at a workload of 89 ± 8 W in the control group (p < 0.01). There were significant (p < 0.001) improvements in baroreflex sensitivity and heart rate variability for the 49 patients combined but no differences between the exercise and control groups. Baroreflex sensitivity improved by 3.4 ± 1.0 and 1.7 ± 1.0 ms/mm Hg and the standard deviation of 24-h RR intervals by 36 ± 6 and 40 ± 10 ms, respectively (p > 0.1).Conclusions. A hospital-based exercise training program increased endurance capacity but did not improve recovery of cardiovascular autonomic function after uncomplicated acute myocardial infarction.(J Am Coll Cardiol 1997;29:1263–8)