Optimizing Cardiac Rehabilitation

It is known that cardiac rehabilitation (CR) successfully improves health (e.g. blood pressure and lipid profile), quality of life, and risk of mortality. In part 1 of this thesis we focused on changes in objectively measured moderate-to-vigorous intensity physical activity (MVPA), sedentary behaviour, fatigue and participation in society during cardiac rehabilitation (CR) in patients with coronary heart disease. Our results showed small improvements in MVPA and time spent in sedentary behaviour. However, by the end of CR, patients still spent relatively little time in physical activity and a long time sedentary. More substantial improvements were found for fatigue and participation in society. However, the prevalence of severely fatigued patients and the proportion of patients that experienced restrictions and dissatisfaction in their participation in society remained high 1 year after CR.
In part 2 we focused on the added value of two novel behavioural lifestyle interventions on top of standard CR. A total of 914 patients with an acute coronary syndrome were randomized to: 1) 3 months of standard CR (CR-only); 2) 3 months of standard CR with three pedometer-based, face-to-face physical activity group counseling sessions followed by 9 months of aftercare with three general lifestyle, face-to-face group counseling sessions (CR+F); or 3) 3 months of standard CR, followed by 9 months of aftercare with five to six general lifestyle, telephonic counseling sessions (CR+T).
Compared to standard CR, adding three pedometer-based physical activity counselling sessions (initial phase CR+F) improved daily step count with an additional 500 steps/day. Furthermore, time spent in prolonged MVPA periods (>10min, which is suggested for health benefits) increased. There were no changes in total MVPA time or sedentary behaviour. At completion of the CR+F aftercare program, improvements in step count partly diminished. However, the additional improvements in prolonged MVPA were maintained. Furthermore, the CR+F intervention was successful in sustaining aerobic capacity gains up to 12 months and reaching long-term improvements in fatigue. No additional benefits were found for the CR+T intervention. Both novel intervention did not improve participation in society.
Based on the results, we recommend that face-to-face physical activity group counselling sessions including objective feedback (CR+F) be added to standard CR, although aftercare optimization is needed.