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 randomised 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 randomised 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.
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Funding This research was supported in part by the Heart and Stroke Foundation of Ontario (grant # T4004). KMS was funded by a Canadian Graduate Scholarship from the Canadian Institutes of Health Research, the Margaret McWilliams Fellow of the Canadian Federation of University Women and a doctoral research award from the Canadian Association of Cardiac Rehabilitation. HMA holds the Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research. The study investigators were independent of the sponsors. The sponsors played no role in the design, analysis/interpretation or dissemination of the study findings.
Competing interests KMS, RSM, KET and HMA have no relationships that might have an interest in the submitted work in the previous 3 years. KMS was the first author of the previous 1-year follow-up of home versus hospital-based exercise training during CR after CABG; she was also a co-author of the original RCT. HMA was the first author of the original RCT of home versus hospital-based exercise training during CR after CABG and a co-author of the 1-year follow-up study. RSM was a co-author on both the RCT and 1-year follow-up studies related to the present work.
Ethics approval This study was conducted with the approval of the Joint Research Ethics Board of McMaster University and the Hamilton Health Sciences, Hamilton, Ontario, Canada. The study complied with the Declaration of Helsinki and was approved by the joint institutional review board of McMaster University and the HHS (Protocol #05-034).
Provenance and peer review Not commissioned; externally peer reviewed.
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