A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level

Cowie, Aynsley; Thow, Morag; Granat, Malcolm; Mitchell, Sarah

doi:10.1177/1741826710389389

Cited by 53 publications

(39 citation statements)

References 18 publications

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“…Subsequently, a combination of rehabilitation in a Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) facility and home training for up to 3 years (n=72), in which BP during exercise was not monitored and exercise intensity was higher than ours, had no influence on AAA expansion rate . Precisely regulating the BPs of patients with AAA during home‐based exercise is difficult, and home‐based exercise is sometimes less effective than supervised exercise . For patients with AAA, BP during exercise should be monitored carefully, under supervision, and exercise programs should be carefully modified to avoid excessive BP elevation during exercise.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Nakayama

Morita

Nagayama

et al. 2018

JAHA

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BackgroundVirtually no reports on the effects of exercise in patients with a small abdominal aortic aneurysm (AAA) exist.Methods and ResultsWe conducted a retrospective cohort study on 1515 patients with a small AAA before surgery at 2 high‐volume hospitals in Tokyo, Japan, from April 2004 to September 2015. A carefully modified cardiac rehabilitation program without excessive blood pressure elevation during exercise was prescribed to 50 patients with an AAA. Using propensity score matching, mortality and clinical outcomes, including AAA expansion rate, were compared between 2 groups: rehabilitation group and nonrehabilitation group. The background characteristics of the rehabilitation group (n=49) and the nonrehabilitation group (n=163) were almost identical. The risk for AAA repair was much lower in the rehabilitation group after matching (before matching: hazard ratio, 0.43; 95% confidence interval, 0.25–0.72; P=0.001; and after matching: hazard ratio, 0.19; 95% confidence interval, 0.07–0.50; P<0.001). AAA expansion rate was slower in the rehabilitation group (before matching: rehabilitation versus nonrehabilitation group, 2.3±3.7 versus 3.8±3.4 mm/y [P=0.008]; after matching: rehabilitation versus nonrehabilitation group, 2.1±3.0 versus 4.5±4.0 mm/y [P<0.001]). Elevation of blood pressure during exercise was positively correlated with AAA expansion rate after the rehabilitation program (r=0.569, P<0.001).ConclusionsCardiac rehabilitation protects against the expansion of small AAAs and mitigates the risk associated with AAA repair, possibly because of the decreased elevation of blood pressure during exercise.Clinical Trial RegistrationURL: upload.umin.ac.jp. Unique identifier: UMIN000028237.

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Section: Discussionmentioning

confidence: 99%

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Nakayama

Morita

Nagayama

et al. 2018

JAHA

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“…In the HF-ACTION trial, for the most part the exercise program was performed at home, and this in part may explain the small increase in functional capacity as compared with control patients. In the present investigation, the dropout rate was 3% on average in the T group and 5% in the NT group (15)(16)(17)(18)(19). Because of its social networking, the coronary club may represent an efficient model to follow for a large segment of CHF patients to participate in a long-term cardiac rehabilitation program.…”

Section: Discussionmentioning

confidence: 86%

10-Year Exercise Training in Chronic Heart Failure

Belardinelli¹,

Georgiou

Cianci³

et al. 2012

Journal of the American College of Cardiology

254

197

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“…In addition, personal barriers such as reluctance to participate in group-based therapy and individual training preferences that deviate from what is offered in centre-based CR can limit participation rates. 8,9 Second, the long-term effectiveness of CR is low. 10 Although it is well established that low physical activity levels (i.e.…”

Section: Introductionmentioning

confidence: 99%

Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study

Kraal

Marle

Abu‐Hanna

et al. 2017

Eur J Prev Cardiolog

202

305

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AimAlthough cardiac rehabilitation improves physical fitness after a cardiac event, many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time. Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness.Methods and resultsWe randomised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training. Although training adherence was similar between groups, satisfaction was higher in the home-based group (p = 0.02). Physical fitness improved at discharge (p < 0.01) and at one-year follow-up (p < 0.01) in both groups, without differences between groups (home-based p = 0.31 and centre-based p = 0.87). Physical activity levels did not change during the one-year study period (centre-based p = 0.38, home-based p = 0.80). Healthcare costs were statistically non-significantly lower in the home-based group (€437 per patient, 95% confidence interval –562 to 1436, p = 0.39). From a societal perspective, a statistically non-significant difference of €3160 per patient in favour of the home-based group was found (95% confidence interval –460 to 6780, p = 0.09) and the probability that it was more cost-effective varied between 97% and 75% (willingness-to-pay of €0 and €100,000 per quality-adjusted life-years, respectively).ConclusionWe found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness, physical activity level or health-related quality of life. However, home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training. We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation.

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A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level

Abstract: Hospital-based training enabled participants to walk for longer periods. It is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period.

Cited by 53 publications

References 18 publications

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

10-Year Exercise Training in Chronic Heart Failure

Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study

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