Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a randomised controlled trial

Abstract

ObjectiveDespite 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.MethodsSingle-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.Results115 (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.ConclusionResults 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 numberNCT02575976; Results.

Effectiveness of an Education Intervention Among Cardiac Rehabilitation Patients in Canada: A Multi-Site Study

“…The education intervention tested in this study was translated to English and French, as well as put in plain language and designed on the basis of patients' needs and feedback, which aligns to the recommendations listed in the literature, [37][38][39] and can be broadly used in different socioeconomic settings, including a low-and middle-income one as reported previously. 19,20 According to the American Medical Association, "health literacy entails more than a patient being able to read written instructions; it requires the ability to comprehend and apply the information ascertained." 40 This is an important measure in studies assessing the effectiveness of education intervention, and although our intervention was not able to statistically improve this outcome, it contributed to the scarce literature on this topic.…”

“…The education intervention tested in this study was translated to English and French, as well as put in plain language and designed on the basis of patients’ needs and feedback, which aligns to the recommendations listed in the literature, 37 , 38 , 39 and can be broadly used in different socioeconomic settings, including a low- and middle-income one as reported previously. 19 , 20…”

“…Our research group has developed and pilot tested an evidence- and theoretically based comprehensive education intervention 17 that incorporates the use of manuals, patient-oriented didactics, online tools, and a small-group format. 18 This intervention has been tested in a low- and middle-income setting and was shown to improve clinical outcomes, 19 change healthy behaviours, 20 increase disease-related knowledge, 20 and decrease morbidity, 21 with maintenance of gains 1 year after CR. Accordingly, the objective of this study was to assess the effectiveness of an education intervention in improving knowledge and health behaviours among CR patients in 3 sites in Canada.…”

Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study

“…In most Latin American countries however, patient education is not often delivered, and definitely not in a standardized way where it is [ 13 ]. This is despite our recent randomized controlled trial demonstrating it can be delivered in this region, and is effective [ 14 ].…”

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

“…We observed large improvements in ISWT distance (+193±14 m), a surrogate measure of exercise capacity, following participation in CR. This increase by far exceeds the minimally clinically meaningful difference of 70 m 40 and is almost double the improvement seen in a recent RCT in a middle-income country 41 despite using one-third of the total number of sessions. This unexpectedly large improvement in ISWT performance likely reflects familiarisation 42 with the test plus an increase in exercise tolerance and/or effort.…”