Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial In-class Active Video Game Supplementation and Adherence to Cardiac Rehabilitation Results of the Sedentary Intervention Trial in Cardiac Rehabilitation (SIT-CR Study): A pilot randomized controlled trial. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery Using the CHANGE intervention to enhance long-term exercise. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program. The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. Cardiac rehabilitation is associated with lasting improvements in cognitive function in older adults with heart failure. Effects of two behavioral cardiac rehabilitation interventions on physical activity: A randomized controlled trial. Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial. Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence HEART: heart exercise and remote technologies: A randomized controlled trial study protocol
BACKGROUND participation in centre-based cardiac rehabilitation ( CR ) is known to reduce morbidity and mortality but participation rates among the elderly are low . Establishing alternative programmes is important , and home-based CR is the predominant alternative . However , no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up . METHODS r and omised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease . RESULTS seventy-five patients participated . There were no significant differences in exercise capacity after the intervention between home and centre-based CR . Adjusted mean differences of peak VO₂ = 0.9 ml/kg/min ( 95 % CI -0.7 , 2.4 ) and of 6 min walk test = -18.7 m ( 95 % CI -56.4 , 18.9 ) . In addition , no differences were found in the secondary outcomes of systolic blood pressure ( -0.6 mmHg , 95 % CI -11.3 , 10.0 ) , LDL cholesterol ( 0.3 mmol/l , 95 % CI -0.04 , 0.7 ) , HDL cholesterol ( 0.2 mmol/l , 95 % CI -0.01 , 0.3 ) , body composition , proportion of smokers and health-related quality of life . A group of patients who did not have an effect of either programmes were characterised by higher age , living alone and having COPD . At 12 months of follow-up , both groups had a significant decline in exercise capacity . CONCLUSIONS home-based CR is as  effective as centre-based CR  in improving exercise capacity , risk factor control and health-related quality of life . However , a group of patients did not improve regardless of the type of intervention . Continued follow-up is essential in order to maintain the gained improvements Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention Objective To compare home-based cardiac rehabilitation ( CR ) with usual care ( control group with no rehabilitation ) in elderly patients who declined participation in centre-based CR . Design R and omised clinical trial with 12 months follow-up and mortality data after 5.5 years ( mean follow-up 4½ years ) . Setting Rehabilitation unit , Department of Cardiology , Copenhagen , Denmark . Participants Elderly patients ≥65 years with coronary heart disease . Intervention A physiotherapist made home visits in order to develop an individualised exercise programme that could be performed at home and surrounding outdoor area . Risk factor intervention , medical adjustment , physical and psychological assessment s were offered at baseline and after 3 , 6 and 12 months . Main outcome measurements The primary outcome was 6 min walk test ( 6MWT ) . Secondary outcomes were blood pressure , body composition , cholesterol profile , cessation of smoking , health-related quality of life ( HRQoL ) , anxiety and depression . Results 40 patients participated . The study population was characterised by high age ( median age 77 years , range 65–92 years ) and high level of comorbidity . Patients receiving home-based CR had a significant increase in the primary outcome 6MWT of 33.5 m ( 95 % CI : 6.2 to 60.8 , p=0.02 ) at 3 months , whereas the usual care group did not significantly improve , but with no significant differences between the groups . At 12 months follow-up , there was a decline in 6MWT in both groups ; −55.2 m ( 95 % CI : 18.7 to 91.7 , p<0.01 ) in the home group and −52.1 m ( 95 % CI : −3.0 to 107.1 , p=0.06 ) in the usual care group . There were no significant differences in blood pressure , body composition , cholesterol profile , cessation of smoking or HRQoL after 3 , 6 and 12 months follow-up . Conclusions Participation in home-based CR improved exercise capacity among elderly patients with coronary heart disease , but there was no significant difference between the home intervention and the control group . In addition , no significant difference was found in the secondary outcomes . When intervention ceased , the initial increase in exercise capacity was rapidly lost Purpose : The application of active video games ( AVGs ) during cardiac rehabilitation ( CR ) sessions could potentially facilitate patient adherence . The feasibility , safety , and efficacy of in-class AVG supplementation as an alternative to conventional phase 2 programs were investigated . Methods : A pilot , evaluator-blinded , intention-to-treat , r and omized controlled trial recruited 32 low-moderate risk CR participants and allocated them to conventional or AVG-supplemented exercise . Both groups experienced equal exercise loads for 6 weeks . Patients were assessed at baseline , end of the program , and after an 8-week followup . Adherence and safety-related outcomes were the primary endpoints . Secondary outcomes included change in exercise capacity , daily physical activity ( PA ) , energy expenditure ( EE ) , and psychometric profiling . Results : Patients ( males 81 % ; 60 ± 10 years ) presented with typical cardiovascular risk factors and similar baseline characteristics . Participants did not perceive an increased risk of injury and were more interactive . At the end of the program , there was a lower tendency for dropping out ( 6 % vs 19 % , P > .05 ) , a significant improvement in PA ( 322 vs 247 arbitrary acceleration units/min , P = .047 ) and related EE per body weight ( 13 vs 11 kcal/kg/d , P = .04 ) among AVG participants compared with controls . No significant differences between groups for adverse medical events , exercise capacity , affect toward exercise , anxiety , depression , or quality -of-life changes were reported . Conclusions : The additional use of AVGs during CR sessions is feasible , safe , and significantly improved daily PA and EE . A dropout reduction trend among its users , which needs to be confirmed in a larger trial , raises awareness to AVG supplementation as a promising strategy to increase CR adherence BACKGROUND Sedentary time ( ST ) is negatively associated with cardiometabolic health and fitness . Traditional cardiac rehabilitation ( CR ) programming may not significantly reduce ST . The objectives of the study were to assess the feasibility and practicality of activPAL devices for measuring ST in CR , and whether prompting cues to interrupt sedentary behaviour can decrease ST and improve clinical outcomes . METHODS An 8-week , two-arm pilot r and omized controlled trial allocated coronary artery disease patients to either a control ( usual care CR ) or intervention ( CR + sedentary prompts from an activPAL3-VT ) group . Primary outcomes included : recruitment ; acceptability ; completion ; and , adherence rates . Secondary outcomes included changes in : ST ; physical activity ( PA ) ; cardiometabolic health ; psychosocial health ; and , fitness . RESULTS Forty participants ( 16 females ; 19 intervention ; 62 ± 10 years ) were r and omized . Outcome data were available for 95 % of participants . All but one participant completed the full intervention . Most ( 73 % ) intervention participants felt the prompts had somewhat changed their sedentary behaviour . At baseline , participants spent 47 % of their day sedentary . No significant group differences in changes for any of the ST , PA or fitness outcomes were observed . The mean group difference for post-intervention ST ( controlling for baseline ) was 30.3 min/day ( 95 % CI : -51.7 , 112.2 ) in favour of the intervention . The intervention group reported significantly better physical health and had a lower ratio of total cholesterol-to-high density lipoprotein when compared to controls . CONCLUSIONS It is feasible to use activPAL devices to measure ST in a CR setting . Further studies are needed to assess the effectiveness of multi-component sedentary behaviour interventions Objective To 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 . Design Six-year follow-up of patients who participated in a r and omised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery . Setting Outpatient CR centre in Central -South Ontario , Canada . Participants 196 Patients who participated in the original r and omised controlled trial and who attended an evaluation 1 year after CR . Interventions 6 months of home or hospital-based exercise training during CR . Main outcome measures Peak oxygen uptake ( peak Vo2 ) , Physical Activity Scale in the Elderly ( PASE ) to assess habitual activity , semi-structured interviews to assess vital status , demographic and descriptive information . Results Of the 196 eligible patients , 144 ( 75.5 % ; 74 Hospital , 70 Home ) were available for participation . Patients were predominantly male ( n=120 ; 83.3 % ) aged 70±9.5 years .  Clinical and sociodemographic outcomes were similar in both groups . While exercise performance declined over time , there were significant between-group differences in peak Vo2 ( 1506±418 ml/min vs 1393±341 ml/min ; p=0.017 ) and PASE scores ( 166.7±90.2 vs 139.7±66.5 ; p=0.001 ) at 6-year follow-up in favour of the home group . Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR . Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo2 and persistent physical activity compared with traditional hospital-based CR Although Phase II Cardiac Rehabilitation ( CR ) is effective at reconditioning people following cardiac events , it has had limited effectiveness in assisting participants to maintain the long-term exercise necessary for secondary prevention of cardiovascular events . This article describes a promising new intervention , CHANGE ( Change Habits by Applying New Goals and Experiences ) , design ed to enhance individuals ' problem solving , self-efficacy , and relapse prevention skills regarding long-term exercise . Five small-group ,  nurse-led sessions  are used to provide the intervention during the last three weeks of the formal CR program , and at one and two months following CR . Pilot data indicate that the CHANGE intervention has a positive effect on number and length of exercise sessions , number of minutes exercised , and time spent in target heart rate ( HR ) zone as measured by wristwatch HR monitors for three months following CR . The CHANGE intervention was found to be acceptable to clients and feasible to clinicians Background Home-based exercise training in cardiac rehabilitation ( CR ) has the potential to improve CR uptake , decrease costs and increase self-management skills . The FIT@Home study evaluates home-based CR with telemonitoring guidance using coaching interventions including strategies for behavioural changes with the aim to maintain adherence to a healthy lifestyle and to improve long-term effects . In this interim analysis we provide short-term results on exercise capacity , quality of life and training adherence of the first 50 patients included in the FIT@Home study . Design The study design was a r and omised controlled trial . Methods Low to moderate risk CR patients were r and omised to a 12-week home-based training ( HT ) programme or a 12-week centre-based training ( CT ) programme .  In both groups , training was performed at 70–85 % of maximal heart rate ( HRmax ) for 45–60 min , 2–3 times per week . The HT group received three supervised training sessions , before commencing training with a heart rate monitor in their home environment . These patients received individual coaching by telephone weekly , based on training data uploaded on the Internet . The CT programme was performed under the direct supervision of a physical therapist . Exercise capacity and health-related quality of life were assessed at baseline and at 12 weeks . Results CT ( n = 25 ) and HT ( n = 25 ) both showed a significant improvement in peak oxygen uptake ( peak VO2 ) ( 10 % and 14 % respectively ) and quality of life after 12 weeks of training , without significant between-group differences . The average training intensity of the HT group was 73.3 ± 3.5 % of HRmax . Training adherence was similar between groups . Conclusion This analysis shows that HT with telemonitoring guidance has similar short-term effects on exercise capacity and quality of life as CT in CR patients Background Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease . Despite the benefits associated with regular exercise , adherence with supervised exercise-based cardiac rehabilitation remains low . Increasingly powerful mobile technologies , such as smartphones and wireless physiological sensors , may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease . This study compares the effectiveness of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( REMOTE ) to st and ard supervised exercise-based cardiac rehabilitation in New Zeal and adults with a diagnosis of coronary heart disease . Methods / Design A two-arm , parallel , non-inferiority , r and omised controlled trial will be conducted at two sites in New Zeal and . One hundred and sixty two participants will be r and omised at a 1:1 ratio to receive a 12-week program of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( intervention ) , or an 8 - 12 program of st and ard supervised exercise-based cardiac rehabilitation (control).The primary outcome is post-treatment maximal oxygen uptake ( V̇O2max ) . Secondary outcomes include cardiovascular risk factors ( blood lipid and glucose concentrations , blood pressure , anthropometry ) , self-efficacy , intentions and motivation to be active , objective ly measured physical activity , self-reported leisure time exercise and health-related quality of life . Cost information will also be collected to compare the two modes of delivery . All outcomes are assessed at baseline , post-treatment , and 6 months , except for V̇O2max , blood lipid and glucose concentrations , which are assessed at baseline and post-treatment only . Discussion This novel study will compare the effectiveness of technology-supported exercise-based cardiac rehabilitation to a traditional supervised approach . If the REMOTE program proves to be as effective as traditional cardiac rehabilitation , it has potential to augment current practice by increasing access for those who can not utilise existing services . Trial registration Australian New Zeal and Clinical Trials Registry Study ID number : ACTRN12614000843651 . Registered 7 August OBJECTIVE To assess the efficacy of a strategy , based on telephone support oriented by accelerometer measurements , on the adherence to physical activity ( PA ) recommendations in cardiac patients not achieving PA recommendations . DESIGN Prospect i ve and r and omized study . SETTING A cardiac rehabilitation program ( CRP ) at a clinic . PARTICIPANTS Stable , noncompliant cardiac ( coronary artery disease , heart failure , post-cardiovascular surgery ) patients ( weekly moderate-intensity PA < 150 min ) were r and omly assigned to an intervention group ( n=19 ) or a control group ( n=10 ) . INTERVENTIONS The intervention group wore an accelerometer for 8 weeks . Every 15 days , feedback and support were provided by telephone . The control group wore the accelerometer during the 8th week of the intervention only . MAIN OUTCOME MEASURES Active energy expenditure ( EE ) ( in kilocalories ) and the time spent doing light , moderate , or intense PA ( minutes per week ) . RESULTS In the intervention group , the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week ( P=.002 ) , with 36.8 % of the sample achieving the target amount of moderate-intensity PA . During the 8th week , the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group , respectively ( P=.004 ) . CONCLUSIONS Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients . This intervention could be implemented after a CRP as an inexpensive , modern , and easy-to-use strategy AIMS To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity , psychological well-being and quality of life in patients with coronary heart disease . BACKGROUND Cardiac rehabilitation ( CR ) in short term improves exercise capacity and quality of life in patients with cardiac disease . However , the long-term benefits of CR are inconclusive . DESIGN A prospect i ve CR programme with repeated measures follow-up over 12 months . METHODS A six-week outpatient cardiac rehabilitation programme  was conducted including 147 patients with coronary heart disease . Patients completed the  physical activity energy expenditure ( seven-day recall activity ) , MacNew Heart Disease Health-Related Quality of Life ( MacNew ) and Hospital Anxiety and Depression scale ( HADs ) at baseline , six weeks , six and 12 months . RESULTS One hundred and five ( 71 % ) patients ( 76 male ) mean age of 61.8 ( SD 9.7 ) completed the four-measurement points . Analysis of variance revealed that total energy expenditure ( F ( 2 , 231 ) = 131 , p < 0.001 ) , HADs ( F ( 2 , 237 ) = 19.3 , p < 0.001 ) , depression score ( F ( 2 , 235 ) = 21.06 , p < 0.001 ) , anxiety score ( F ( 2,237 ) = 17.02 , p < 0.001 ) and MacNew ( F ( 2 , 197 ) = 77.02 , p < 0.001 ) were all statistically significant over time . Bonferroni pairwise follow-up confirmed significant positive differences ( p < 0.05 ) between baseline values and all subsequent measures over time . Depression was independently explained in 22 % of the variance in quality of life at 6 or 12 months . The energy expenditure was significantly higher for men compared to women ( F ( 1 , 103 ) = 31 , p < 0.001 ) . CONCLUSION A six-week cardiac rehabilitation programme is beneficial in improving quality of life , physical activity status , anxiety and depression . These benefits were maintained at 12 months . Elevated levels of depression were associated with impaired quality of life . RELEVANCE TO CLINICAL PRACTICE All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme . Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes OBJECTIVE Heart failure ( HF ) is a known risk factor for cognitive impairment .  Cardiac rehabilitation ( CR ) may attenuate poor neurocognitive outcomes in HF via improved physical fitness -- a significant promoter of cognitive function . However , no study has examined the possible acute and lasting benefits of CR on cognitive function in persons with HF . METHODS AND RESULTS Fifty-two patients with HF completed a 12-week Phase II CR program .  All participants were administered neuropsychological testing  and completed a brief physical fitness assessment  at baseline , completion of CR ( i.e. 12 weeks ) , and 12-month follow-up . Repeated measures analyses showed a significant time effect for both attention/executive function and memory ( P < 0.05 ) . Attention/executive function performance increased from baseline to 12 weeks and these gains remained up to 12 months ; memory was unchanged from baseline to 12 weeks , but then improved between the 12-week and 12-month time points . Physical fitness improved from baseline to 12 weeks and these benefits were maintained 12 months later . Changes in physical fitness and cognitive function over time did not reach a statistically significant association , though poorer physical fitness was associated with decreased cognitive performance at the baseline and 12-month time points . CONCLUSIONS CR is associated with both acute and lasting cognitive benefits in patients with HF . Prospect i ve studies with extended follow-ups are needed to clarify the mechanisms that underpin cognitive improvements following CR ( e.g. , improved cerebral perfusion ) and whether CR can ultimately reduce risk for cognitive decline and conditions like Alzheimer 's disease in HF BACKGROUND St and ard cardiac rehabilitation ( CR ) is insufficient to help patients achieve an active lifestyle . The effects of two advanced and extended behavioral CR interventions on physical activity ( PA ) and sedentary behavior ( SB ) were assessed . METHODS In total , 731 patients with ACS were r and omized to 1 ) 3months of st and ard CR ( CR-only ) ; 2 ) 3months of st and ard CR with three pedometer-based , face-to-face PA group counseling sessions followed by 9months of aftercare with three general lifestyle , face-to-face group counseling sessions ( CR+F ) ;  or 3 )  3months of st and ard CR , followed by 9months of aftercare with five to six general lifestyle , telephonic counseling sessions ( CR+T ) . An accelerometer recorded PA and SB  at r and omization , 3months , 12months , and 18months . RESULTS The CR+F group did not improve their moderate-to-vigorous intensity PA ( MVPA ) or SB time compared to CR-only ( between-group difference=0.24 % MVPA , P=0.349 ; and 0.39 % SB , P=0.529 ) . However , step count ( between-group difference=513 steps/day , P=0.021 ) and time in prolonged MVPA ( OR=2.14 , P=0.054 ) improved at 3months as compared to CR-only . The improvement in prolonged MVPA was maintained at 18months ( OR=1.91 , P=0.033 ) . The CR+T group did not improve PA or SB compared to CR-only . CONCLUSIONS Adding three pedometer-based , face-to-face group PA counseling sessions to st and ard CR increased daily step count and time in prolonged MVPA . The latter persisted at 18months . A telephonic after-care program did not improve PA or SB . Although after-care should be optimized to improve long-term adherence , face-to-face group counseling with objective PA feedback should be added to st and ard CR Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based OBJECTIVE To compare program adherence and functional capacity between women referred to supervised mixed-sex , supervised women-only , or home-based cardiac rehabilitation ( CR ) .  PATIENTS AND METHODS Cardiac Rehabilitation for Heart Event Recovery ( CR4HER ) was a single-blind , 3 parallel-arm , pragmatic r and omized controlled trial . The study took place between November 1 , 2009 , and July 31 , 2013 . Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario , Canada . Consenting participants completed a preprogram survey , and clinical data were extracted from charts . Participants were referred to CR at 1 of 3 sites . After intake assessment , including a grade d exercise stress test , eligible patients were r and omized to supervised mixed-sex , supervised women-only , or home-based CR . Six months later , CR adherence and exit assessment data were ascertained . RESULTS Of the 264 consenting patients , 169 ( 64.0 % ) were eligible and r and omized . Twenty-seven ( 16.0 % ) did not attend , and 43 ( 25.4 % ) attended a different model . Program adherence was moderate overall ( 54.46%±35.14 % ) . Analysis of variance revealed no significant differences based on per- protocol analysis ( P=.63 ) , but as-treated , home-based participants attended significantly more than did women-only participants ( P<.05 ) . Overall , there was a significant increase in functional capacity preprogram to postprogram ( P<.001 ) . Although there were no significant differences in functional capacity by model at CR exit based on per- protocol analysis , there was a significant difference on an as-treated basis , which sustained adjustment . Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs ( P<.05 ) . CONCLUSION Offering women alternative program models may not promote greater CR adherence or functional capacity ; however , replication is warranted . Other proven strategies such as action planning and self-monitoring should be applied . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01019135 Background Methods to ensure sustained benefits of cardiac rehabilitation need to be explored . The aim was to assess the effect of a home-based intervention ( INT ) on exercise adherence and risk factors after cardiac rehabilitation . Design Prospect i ve r and omized study . Methods We evaluated patients who were followed for 1 year after either inpatient ( ICR ) or outpatient cardiac rehabilitation ( OCR ) by assessment of exercise capacity , physical activity , risk factors and quality of life  , both at the completion of rehabilitation , and after 1 year . Patients were r and omized to either be instructed how to use a diary of physical activities complemented by quarterly group meetings ( INT ) or to receive st and ard treatment ( usual care ) . Results Two hundred and sixty-one patients gave consent to be reevaluated after 1 year . Of these patients 33 were lost to follow-up ( two deaths ) ; thus 228 patients had complete 1-year follow-up data ( 195 male and 33 female , 91 % with coronary artery disease ) . At 1-year follow-up significantly more patients of the INT group than of the control group adhered to regular physical activity ( 73 vs. 40 % , P < 0.0001 ) . Moreover , INT patients showed a better evolution of body mass index and lipid values . In a stepwise multiple regression analysis the following variables showed a significant impact on regular physical activity at follow-up : study INT [ odds ratio ( OR ) : 4.19 , P < 0.0001 ] , previous cardiac surgery ( OR : 2.50 , P = 0.008 ) , BMI at baseline ( OR : 0.89 , P = 0.018 ) and quality of life at baseline ( OR : 1.58 , P = 0.041 ) . Conclusion Sustained benefits of cardiac rehabilitation can be documented 1 year after both inpatient and outpatient programmes . Self-monitoring of physical activity greatly increased long-term adherence to regular exercise , which in turn was associated with greater improvements of risk factors and quality of life Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Cardiac rehabilitation ( CR ) is aim ed at improving health behaviors to slow or reverse the progression of CVD disease . Exercise is a central element of CR . Technologies such as mobile phones and the Internet ( mHealth ) offer potential to overcome many of the psychological , physical , and geographical barriers that have been associated with lack of participation in exercise-based CR . We aim to trial the effectiveness of a mobile phone delivered exercise-based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD . This paper outlines the rationale and methods of the trial . Methods A single-blinded parallel two-arm r and omized controlled trial is being conducted . A total of 170 people will be r and omized at 1:1 ratio either to receive a  mHealth CR program  or usual care .  Participants are identified by CR nurses from two metropolitan hospitals in Auckl and , New Zeal and through outpatient clinics and existing data bases . Consenting participants are contacted to attend a baseline assessment . The intervention consists of a theory-based , personalized , automated package of text and video message components via participants ' mobile phones and the Internet to increase exercise behavior , delivered over six months . The control group will continue with usual CR . Data collection occurs at baseline and 24 weeks ( post-intervention ) . The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks . Secondary outcomes include post-intervention measures on self-reported physical activity ( IPAQ ) , cardiovascular risk factors ( systolic blood pressure , weight , and waist to hip ratio ) , health related quality of life ( SF-36 ) , and cost-effectiveness . Discussion This manuscript presents the protocol for a r and omized controlled trial of a mHealth exercise-based CR program . Results of this trial will provide much needed information about physical and psychological well-being , and cost-effectiveness of an automated telecommunication intervention . If effective , this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally ( and internationally ) in a very short time , enhancing the translational aspect of this research . It also has potential to extend to comprehensive CR ( nutrition advice , smoking cessation , medication adherence).Trial Registration
Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC .
Background Exercise-based cardiovascular rehabilitation ( CR ) improves exercise capacity ( EC ) , lowers cardiovascular risk profile and increases physical functioning in the short term .
However , uptake of and adherence to a physically active lifestyle in the long run remain problematic .
Home-based ( HB ) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity ( PA ) .
The current systematic review and meta- analysis aim ed to compare the longer-term effects of HB exercise programmes with usual care ( UC ) or centre-based ( CB ) CR in patients referred for CR .