Extended cardiac rehabilitation improves aerobic capacity and fatigue: A randomized controlled trial

Introduction/Background: To investigate the effects of two behavioral lifestyle interventions integrated into cardiac rehabilitation on aerobic capacity, fatigue, and participation in society and to explore mediating effects of physical activity. Material and method: In the OPTICARE trial, 914 patients with acute coronary syndrome were randomized to (1) 3 months of standard cardiac rehabilitation (CR-only); (2) CR-only with additional face-to-face physical activity group counseling sessions plus 9 months of after-care with general lifestyle group counseling (CR + F); or (3) CR-only plus 9 months of after-care with individual, general lifestyle telephone counseling sessions (CR + T). Aerobic capacity (6-minute walk test), fatigue (FSS), and participation in society (USER-P) were measured at randomization, 3 months, 12 months, and 18 months. Results: Generalized estimating equation analysis revealed favorable intervention effects for CR + F (compared to CR-only) in aerobic capacity up to 12 months (B = 12.49 m; 95% CI 0.53–24.46; P =.041) and in prevalence of fatigue until at least 18 months (OR = 0.47; 95% CI = 0.26-0.84; P =.010). No additional improvements were seen for participation in society. No intervention effects were found for CR + T. Additional analysis showed that improvements in aerobic capacity in CR + F were mediated by improvements in physical activity. No mediating effects were found for improvements in fatigue. Conclusion: Extending cardiac rehabilitation with a face-to-face behavioral group intervention was successful in sustaining aerobic capacity gains for up to 12 months and for reaching long-term goals for improvements in fatigue. The benefits in aerobic capacity seem to be mediated by improvements in daily physical activity. A telephonic behavioral intervention provided no additional benefits.

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