Fast-track equivalent to traditional cardiac rehabilitation? Pilot study outcome

Abstract

The exercise dose required to achieve benefits from cardiac rehabilitation (CR) is unknown and benefits may be independent of exercise supervision frequency. This randomized pilot study examined equivalence in two CR models, hypothesizing ≤10% difference between models. Subjects undertook 6 weeks of supervised low-/moderate-intensity exercise training. Fast-track (n = 25) included once-weekly exercise sessions and a one-off 7 h education session. Traditional (n = 36) included twice-weekly exercise and education sessions. Six-Minute Walk Test distance (6MWD), Timed Up and Go test time (TUGTT), Depression, Anxiety and Stress Scale (DASS-21) score and secondary outcomes were assessed pre-CR, post-CR and 6 months post-CR. Attendance was 100%, 79% and 82%, respectively. Missing data were imputed using last-observation-carried-forward methodology. Although intention-to-treat analysis found minimal between-group differences [7 m, p = 0.76 (6MWD); 0.27 s, p = 0.35 (TUGTT); and 14.6, p = 0.09 (DASS-21)] and similar proportions of subjects achieved a minimal clinically important difference and predicted values for 6MWD and TUGTT post-CR, the effect size was greater for fast-track subjects. A > 10% difference was noted for several secondary outcomes, mostly in favour of the traditional CR model. In conclusion, this pilot study identifies appropriate methodology to assess equivalence in CR models and suggests that one supervised exercise session may be as effective as two sessions for common outcome measurements.

Keywords:

• Anxiety
• cardiovascular disease
• coronary artery disease
• DASS-21
• depression
• exercise therapy
• outcome assessment (healthcare)
• patient dropouts
• randomized controlled trial
• Six-Minute Walk Test
• Timed Up and Go test

Acknowledgements

We wish to thank Tracey Ward BPhty and Kylie Neighbour BPhty, who provided research assistance in conducting assessments and data collection for the study; Thomas Selwood RN, who coordinated the patient appointments and provided patient management during the exercise sessions; and Nicole Sabapathy BPhty, for her assistance checking the accuracy of the RCT data transcription.

Disclosure statement

The authors report no conflicts of interest.

Funding information

This work was supported by the Queensland Health Community Rehabilitation Workforce Project, Community Rehabilitation Research Scheme 2007 approved on 24 June 2007; and the Queensland Health Allied Health Postgraduate Scholarship 2012, approved on 21 December 2011.