Exercise-based rehabilitation for coronary heart disease

Jolliffe, Judith; Rees, Karen; Taylor, R. S.; Thompson, David R.; Oldridge, Neil; Ebrahim, Shah

doi:10.1002/14651858.cd001800

Cited by 664 publications

(577 citation statements)

References 71 publications

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“…In one metaanalysis of CHD patients, total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels were significantly decreased in patients in the comprehensive CR intervention, but not the ET-only group. 94 Another meta-analysis based on this population demonstrated reductions in total cholesterol and triglycerides, without improvements in LDL-C and HDL-C levels. 87 Moreover, systolic but not diastolic BP was significantly reduced following CR.…”

Section: Impact Of Cr On the Cvd Risk Factor Profilementioning

confidence: 84%

“…These demonstrated a similar reduction in mortality rates associated with CR, as high as 13%-27% for all-cause mortality 2,87,94,95 and 26%-36% for CVD mortality. 2,87,94,95 Due to recent developments in interventional and surgical revascularization procedures, and advances in medical therapies for CHD, including high intensity statins and dual anti-platelet therapy, some have questioned whether or not the beneficial effects of CR continue to persist in contemporary CVD patients. Several systematic reviews and meta-analyses have been conducted to address this query.…”

Section: Impact Of Cr On Mortalitymentioning

confidence: 99%

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Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Kachur

Chongthammakun

Lavie

et al. 2017

Progress in Cardiovascular Diseases

128

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Section: Impact Of Cr On the Cvd Risk Factor Profilementioning

confidence: 84%

Section: Impact Of Cr On Mortalitymentioning

confidence: 99%

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Kachur

Chongthammakun

Lavie

et al. 2017

Progress in Cardiovascular Diseases

128

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“…In this trial, we used a ramp‐up phase to gradually increase physical activity goals (15% increase per week) and personalized these goals using the patient's baseline step count. This approach mirrors that of cardiac rehabilitation programs 5, 7. Future studies could directly compare immediate versus gradually increasing step goals and evaluate different trajectories for step‐goal increases.…”

Section: Discussionmentioning

confidence: 98%

“…Regular physical activity reduces the risk of cardiovascular events among patients with IHD 1, 3. For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9. However, the majority of eligible patients do not participate in a cardiac rehabilitation program 8, 10, 11.…”

mentioning

confidence: 99%

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Chokshi

Adusumalli

Small

et al. 2018

JAHA

124

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BackgroundRegular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.Methods and ResultsACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8‐week maintenance incentive phase) and an 8‐week follow‐up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks. In the ramp‐up incentive phase, daily step goals increased weekly by 15% from baseline with a maximum of 10 000 steps and then remained fixed. Each week, $14 was allocated to a virtual account; $2 could be lost per day for not achieving step goals. The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Ischemic heart disease patients had a mean (SD) age of 60 (11) years and 70% were male. Compared with control, patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp‐up (1388 versus 385; adjusted difference, 1061 [95% confidence interval, 386–1736]; P<0.01), maintenance (1501 versus 264; adjusted difference, 1368 [95% confidence interval, 571–2164]; P<0.001), and follow‐up (1066 versus 92; adjusted difference, 1154 [95% confidence interval, 282–2027]; P<0.01).ConclusionsLoss‐framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16‐week intervention, and effects were sustained during the 8‐week follow‐up.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02531022.

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“…Meta‐analyses suggested that CR participation can reduce all‐cause mortality by 15% to 28% for patients with MI4, 37, 38, 39 and 45% to 47% for patients with percutaneous coronary intervention 40. The effect was estimated to be comparable to improvements associated with aspirin, β‐blocker, angiotensin‐converting enzyme inhibitor, statin, and anticoagulant therapy 5, 41, 42, 43.…”

Section: Discussionmentioning

confidence: 99%

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

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BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival.Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral.Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.

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Exercise-based rehabilitation for coronary heart disease

Cited by 664 publications

References 71 publications

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

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