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

Abstract

ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.ParticipantsSixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.Outcome measuresThe primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.ResultsThe mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05).ConclusionPatients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.

The impact of different forms of exercise on circulating endothelial progenitor cells in cardiovascular and metabolic disease

“…Another possible confounder is the (often not reported) training fidelity. In other words, it is assumed (but not monitored) that participants follow the training instructions they have received, in terms of frequency, duration and intensity of exercise, for the duration of the study (Ibeggazene et al 2020 ).…”

The National ReferAll Database: An Open Dataset of Exercise Referral Schemes Across the UK

“…It also undermines the strategic implementation of schemes, whether private or public sector, as there appears to be differences in how ‘exercise’ or ‘physical activity’ is conceptualized [ 7 ]. Evidence from cardiac rehabilitation programmes suggests that many participants do not meet the intended intensity of effort for exercise prescription [ 42 , 43 ]. This could help explain the lackluster results observed here for ERS.…”

Exercise-Based Cardiac Rehabilitation: Is a Little Encouragement Enough?

“…In light of these questions, there has been a contemporary move to substantiate the efficacy of CR based on reduced hospital readmissions, health care costs, and quality of life. 2 Given that a number of reviews, letters to editors, post hoc trials, and audit-data analyses have raised the question of exercise program dose fidelity, 6,7 the aim of the current study was to investigate the influence of exercise fidelity on measures of CRF (incremental shuttle-walk test and heart rate walking speed index [HRWSI]) when patients were actively encouraged to achieve intensities >50% heart rate reserve (HRR).…”