The Effects of Exercise in a Coronary Rehabilitation Programme Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease Exercise-based cardiac rehabilitation increases daily physical activity of patients following myocardial infarction: subanalysis of two randomised controlled trials. Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence Influence of a Cardiac Rehabilitation Program on the cardiovascular, psychological, and social functioning of cardiac patients A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. Cardiac rehabilitation after myocardial infarction. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study) The effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome 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 LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol A Behavior Change Intervention for Women in Cardiac Rehabilitation A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. A controlled trial of community based coronary rehabilitation. Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
Twenty-two male and female patients who had recently suffered a myocardial infa rct ion were r and omly assigned to a treatment group who participated in a 10-week exercise-based cardiac rehabilitation programme or a routine care group who did not participate in the rehabilitation programme .  Physiological and psychological function were assessed before the programme started and after it finished . Results indicated that the treatment group did not improve physiological functioning more than the control group but they did evidence statistically significant improved psychological functioning . This investigation appears to be the first attempt to assess the potential benefits of an exercise-based cardiac rehabilitation programme in Glasgow and supports the suggestion that exercise-based cardiac rehabilitation has psychological benefits Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of OBJECTIVE To assess the effects of an exercise-based cardiac rehabilitation programme on daily physical activity levels of patients following myocardial infa rct ion . DESIGN Sub analysis of two r and omised , prospect i ve controlled trials . SETTING Outpatient clinic of a secondary hospital . PARTICIPANTS Fifty consecutive patients r and omised to the exercise group { n=25 ; 23 males ; mean age 54 [ st and ard deviation ( SD ) 9 ] years } or the control group [ n=25 ; 20 males ; mean age 58 ( SD 9 ) years ] . INTERVENTIONS The exercise group participated in an 8-week aerobic exercise programme plus usual medical care and follow-up . The control group received usual medical care and follow-up . MAIN OUTCOME MEASURES The primary outcome measure was change in time spent undertaking moderate-to-vigorous physical activity per day , assessed by accelerometer over 7 consecutive days . Secondary outcome measures were cardiorespiratory fitness , body mass , and resting blood pressure and heart rate . RESULTS Moderate-to-vigorous physical activity levels increased significantly in the exercise group [ 43.2 ( SD 36.3 ) to 53.5 ( SD 31.9 ) minutes/day , P=0.030 ] , and remained unchanged in the control group [ 40.8 ( SD 26.2 ) to 36.8 ( SD 26.5 ) minutes/day , P=0.241 ] from baseline to the end of the programme . Cardiorespiratory fitness increased significantly in the exercise group ( mean difference 2.8 ; 95 % of the difference 1.3 to 4.4ml/kg/minute , P=0.001 ) after the 8-week programme . CONCLUSIONS In patients under optimal medication following myocardial infa rct ion , participation in an 8-week exercise-based cardiac rehabilitation programme was found to improve physical activity levels consistent with health-related benefits . Future studies are needed to determine whether the increase in physical activity is maintained in the long term 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 Twenty-eight male cardiac patients who had either experienced myocardial infa rct ion or undergone coronary bypass surgery were assigned to a treatment condition and participated in a 3-month , exercise-based Cardiac Rehabilitation Program , whereas 20 other cardiac patients were assigned to a routine-care condition and did not participate in the rehabilitation program .  Cardiovascular , psychological , and psychosocial functioning were assessed before treatment or routine care was begun , after 3 months of treatment or routine care , and 4 months later . Results indicated that patients in the treatment condition evidence d reliably more efficient cardiovascular functioning ( resting heart rate , resting diastolic blood pressure , treadmill exercise performance , exercise heart rate , exercise systolic blood pressure ) , better underst and ing of heart disease , better underst and ing of and reported compliance with treatment recommendations , more positive self-perceptions ( health , body concept , self-concept , progress toward goals ) , and better psychosocial functioning ( e.g. , decreased employmentrelated stress , more active use and enjoyment of leisure time , more physical and sexual activity ) .  Chronic patients benefited as much from the treatment as did acute patients , and the beneficial effects for all treated patients were evident not only just after rehabilitation , but also 4 months later . This investigation appears to be the first such test of effects of this type of treatment , and the results have wide generalizability and applicability OBJECTIVE The goal of this study was to compare the effectiveness of home-based , transtelephonically monitored cardiac rehabilitation with  st and ard , on-site , supervised cardiac rehabilitation . BACKGROUND Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity , decrease cardiovascular symptoms , improve psychosocial status , and decrease total and cardiovascular mortality rates in patients with coronary heart disease . Because of multiple factors , national overall participation is only at 15 % of eligible patients . METHODS Effects of a 3-month home-based , transtelephonically monitored rehabilitation program ( n = 83 patients ) with simultaneous voice and electrocardiographic transmission to a central ly located nurse coordinator were compared with effects of a st and ard on-site rehabilitation program ( n = 50 patients ) . The study design was a multicenter , controlled trial . Primary outcome variables were peak aerobic capacity and quality of life , as measured by the Health Status Question naire . RESULTS Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site ( 18 % vs 23 % ) . Quality of life domains of physical functioning , social functioning , physical role limitations , emotional role limitations , bodily pain , and energy/fatigue improved similarly in both groups . There were no circulatory arrests or other major exercise-related medical events in either group . A total of 3100 hours of home exercise were transtelephonically monitored . CONCLUSIONS Patients with coronary heart disease can effectively participate in home-based , monitored cardiac rehabilitation , with exercise and quality of life improvements comparable to those demonstrated at on-site programs Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment Objectives 1 . To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases ( myocardial infa rct ion , acute coronary syndrome , percutaneous transluminal coronary angioplasty and coronary artery bypass grafting ) . 2 . To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group , in comparison with similar changes in the conventional care group . Design R and omized , controlled , parallel-group design ( intervention/conventional care ) . Setting Akershus County , southeast of Oslo City , Norway . Participants 500 patients , men and women , aged 40 - 85 years , who have sustained at least one of the above-mentioned cardiovascular diseases . Interventions 8 weeks of supervised , structured physical training of three periods of 20 min per week , targeting a heart rate of 60 - 70 % of the individual 's maximum ; home-based physical exercise training with the same basic schedule as in the supervised period ; quantification of patients ' compliance with the exercise programme by the use of wristwatches , information stored in the watch memory being retrieved once a month during the 3-year follow-up period ; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control Background : Acute coronary syndrome is one of the major cardiovascular diseases that leads to a significant amount of morbidity . The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome . Material s and Methods : This was a clinical trial study conducted on 50 patients with acute coronary syndrome admitted to the coronary care units of Shohada Hospital in Isfahan in 2013 - 2014 . The participants were r and omly assigned to control ( n = 25 ) and study ( n = 25 ) groups . The study group received cardiac rehabilitation in phase 1 and 2 . Phase 1 was conducted in a hospital in Isfahan province that had no cardiac rehabilitation center but had minimal cardiac rehabilitation equipments . Phase 2 was conducted at home by follow-up through telephone and referring the patients to the hospital . The control group received usual cardiac rehabilitation . The data were collected via a demographic question naire and SF-36 quality of life question nre before and 1 month after intervention by the research er . Data were analyzed by independent sample s t-test . Results : In the study group , the mean scores in all domains of quality of life increased significantly after intervention ( P < 0.05 ) . In the control group , the mean scores of quality of life were not significantly different before and after intervention ( P > 0.05 ) . A significant difference was found between the study and control groups in all domains of quality of life except for general health and social function ( P < 0.05 ) in favor of the study group . Conclusions : The results of this study showed that cardiac rehabilitation program could lead to improving the quality of life in the patients with acute coronary syndrome 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 Background Due to improved treatments and ageing population , many countries now report increasing prevalence in rates of ischemic heart disease and heart failure . Cardiac rehabilitation has potential to reduce morbidity and mortality , but not all patients complete . In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program . The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called ‘ learning and coping ’ to that of st and ard care . Further , this paper aims to describe the theoretical basis and details of this intervention . Methods / design Open parallel r and omised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure . Patients are allocated to either the intervention group with learning and coping strategies incorporated into st and ard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program . Learning and coping consists of two individual clarifying interviews , participation of experienced patients as educators together with health professionals and theory based , situated and inductive teaching . Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units . In both groups , cardiac rehabilitation consists of training three times a week and education once a week over eight weeks . The primary outcomes are adherence to cardiac rehabilitation , morbidity and mortality , while secondary outcomes are quality of life ( SF-12 , Health education impact question naire and Major Depression Inventory ) and lifestyle and risk factors ( Body Mass Index , waist circumference , blood pressure , exercise work capacity , lipid profile and DXA-scan ) . Data collection occurs four times ; at baseline , at immediate completion of cardiac rehabilitation , and at three months and three years after the finished program . Discussion It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality . By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation . Trial registration Identifier NCT01668394 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 There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care Two hundred patients who had suffered an acute myocardial infa rct ion 4 - 6 weeks before entered a r and omised controlled trial of  exercise treatment  at a community sports centre supervised by a general practitioner . Eighty one per cent of the treatment group continued to exercise until they returned to work and 73 % completed three months ' exercise . There were no serious complications of the exercise course . The prevalence of angina pectoris fell by 10 % in the treatment group but rose by 60 % in the control group . The perceived energy level rose by significantly more in the treatment group than in the controls . The rise in predicted maximum oxygen uptake was significantly greater in the treatment group than in the control group as was the reduction in the double product ( a reflection of myocardial workload ) at peak exercise . Coronary rehabilitation in the community can be both safe and effective We have design ed a new 4-week hospitalized phase II cardiac rehabilitation program . The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infa rct ion ( MI ) improves after participation in our program . Twenty-nine patients ( 27 males , two females ) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed . All patients enrolled in this study had received coronary interventions . The rehabilitation consisted of exercise training , education and counseling . We evaluated the physical and psychological status of the patients before and just after the program , and at a 6-month follow up . The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold , frequency of exercise , and serum concentrations of triglyceride , total cholesterol , high-density lipoprotein-cholesterol , and low-density lipoprotein-cholesterol . The psychological status was assessed by the Spielberger state-trait anxiety inventory question naire ( STAI ) and the self-rating question naire for depression ( SRQ-D ) .  Thirty-four patients ( 27 men , seven women ) with MI who did not participate in our rehabilitation program  served as a control group . After participation in our rehabilitation program , exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation . These parameters had improved significantly 6 months after rehabilitation . The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program . Regular physical activity was continued even 6 months after the completion of the program . Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI . This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities 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
Conclusions Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease .
While our analysis was constrained by the quality of included trials and missing information about intervention components , there appears to be little differential effect of variations in exercise intervention , particularly on mortality outcomes .
Background While the clinical benefits of exercise-based cardiac rehabilitation are well established , there is extensive variation in the interventions used within these trials .
It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes .
This study aims to systematic ally examine the relationship between individual components of the exercise intervention in cardiac rehabilitation ( such as intensity and frequency ) and clinical outcomes for people with coronary heart disease .