Design, implementation and evaluation of a reduced cardiac rehabilitation program

Background: Cardiac rehabilitation remains under-utilized and novel modes of cardiac rehabilitation delivery are needed to address this concern. Purpose: To compare a reduced cardiac rehabilitation program (rCRP) with the standard program (sCRP) in regards to change in exercise capacity and ischemic heart disease risk factors, at program completion and at one-year follow-up. Methods: This was a randomized controlled non-inferiority trial. Secondary prevention patients at low and moderate risk were randomized to either the sCRP (n=60) or to the rCRP (n=61). While the sCRP entailed 32 on-site exercise sessions, the rCRP consisted of 10 sessions throughout the four-month program duration. Mixed model analyses of variance were used to test for non-inferiority of the rCRP and repeated measured ANOVA to assess within-group comparisons. Results: Baseline data were similar between groups. The rCRP was non-inferior to the sCRP group in regards to exercise capacity at four and 16 months (group estimate=5.25, 95% CI 15.51-26.00 seconds, p=0.62). Exercise capacity improved at program completion for the sCRP and rCRP groups; 524 ± 168 to 630 ± 150 seconds and 565 ± 183 to 655 ± 196 seconds, p< 0.01, respectively, and remained higher than baseline at 16 months; 524 ± 168 to 604 ± 172 seconds and 565 ± 183 to 640 ± 192 seconds, p< 0.01, respectively. The rCRP was non-inferior in regards to HDL-C, triglycerides, TC/HDL-C ratio, fasting glucose, blood pressure, body mass index, waist circumference and waist to hip ratio changes. The rCRP had a higher attendance rate than the sCRP group (97.3 ± 62.6 % vs 70.5 ± 22.0 %, p=0.002) and was non-inferior in terms of self-reported physical activity (group estimate=1.02, 95% CI 0.86-1.21, p=0.8105). These improvements were maintained at one-year follow-up. Conclusion: While it utilized less hospital resources, rCRP was “not worse” than the sCRP in terms of exercise capacity and ischemic heart disease risk factor changes as well as program adherence for low and moderate risk patients. Further research is needed to assess if the rCRP helps overcome current CRP utilization barriers.