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Original research article
Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a randomised controlled trial
  1. Gabriela Suellen da Silva Chaves1,
  2. Gabriela Lima de Melo Ghisi2,3,
  3. Sherry L Grace2,3,
  4. Paul Oh2,
  5. Antonio L Ribeiro4,
  6. Raquel R Britto1
  1. 1 Physical Therapy Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
  2. 2 Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
  3. 3 School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
  4. 4 Hospital das Clínicas, Division of Cardiology and Cardiovascular Surgery, and School of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
  1. Correspondence to Dr Raquel R Britto, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil; r3britto{at}


Objective Despite the growing epidemic of cardiovascular diseases in middle-income countries, there is insufficient evidence about cardiac rehabilitation (CR) in these countries. Thus, the effects of comprehensive CR on functional capacity and risk factors were investigated in Brazil, to test the hypothesis that it results in better outcomes than exercise-only or no CR.

Methods Single-blinded, randomised controlled trial with three parallel arms: comprehensive CR (exercise+education) versus exercise-only CR versus wait-list control. Eligible coronary patients were randomised in blocks of four with 1:1:1 concealed allocation. Participants randomised to exercise-only CR received 36 exercise classes; comprehensive CR group also received 24 educational sessions. The primary outcome was incremental shuttle walk test (ISWT) distance; secondary outcomes were cardiovascular risk factors. All outcomes were assessed at baseline and 6 months later. Analysis of covariance was performed on the basis of intention-to-treat (ITT) and per-protocol.

Results 115 (88.5%) patients were randomised; 93 (80.9%) were retained. There were improvements in ISWT distance from pretest to post-test with comprehensive (from 358.4±132.6 to 464.8±121.6 m; mean change=106.4; p<0.001) and exercise-only (from 391.5±118.8 to 488.1±106.3 m; mean change=96.5, p<0.001) CR, with significantly greater functional capacity with comprehensive CR versus control (ITT: mean difference=75.6±30.7 m, 95% CI 1.4 to 150.2). There were also reductions in systolic blood pressure with comprehensive CR (ITT: reduction of 6.2±17.8 mm Hg, p=0.04). There were no significant differences for other outcomes.

Conclusion Results showed clinically significant improvements in functional capacity and blood pressure with CR, and significantly greater functional capacity with comprehensive CR compared with usual care.

Trial registration number NCT02575976; Results.

  • coronary artery disease
  • cardiac rehabilitation
  • cardiac risk factors and prevention

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  • Contributors GSdaSC, GLdeMG, SLG and RRB: substantial contributions to the conception or design of the work; the acquisition, analysis and interpretation of data for the work. PO and ALR: substantial contributions to the conception and interpretation of data for the work.

  • Funding Professor RRB was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq#305786/2014-8), Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG#PPM-00869-15 and BCS00290-16) and Coordination for the Improvement of Higher Education Personnel (CAPES). Dr ALR was supported in part by CNPq (Bolsa de produtividade em pesquisa, 310679/2016-8) and by FAPEMIG (Programa Pesquisador Mineiro, PPM-00428-17). Professor SLG was supported by a York University Faculty Association sabbatical fellowship and Social Science and Humanities Research Council research opportunity grant.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the research ethics committees at Universidade Federal de Minas Gerais (UFMG), in Belo Horizonte, Brazil (#898.235) and York University, in Toronto, Canada (#e2015-172).

  • Provenance and peer review Not commissioned; externally peer reviewed.