Cardiac rehabilitation designed for patients with obesity: OPTICARE XL RCT results on health-related quality of life and psychosocial well-being

Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis

BACKGROUND

The aim of this systematic review with meta-analysis was to assess the effectiveness of non-immersive virtual reality (niVR) active videogames in patients who underwent cardiac rehabilitation (CR).

METHODS

A systematic review with meta-analysis, according to the PRISMA guidelines and previously registered in PROSPERO (CRD42023485240), was performed through a literature search in PubMed (Medline), SCOPUS, WOS, and PEDro since inception to 21 November 2023. We included randomized controlled trials (RCTs) that assessed the effectiveness of an niVR intervention, in comparison with conventional CR and usual care, on aerobic capacity and cardiovascular endurance (physical function), anxiety, depression, and quality of life (QoL). The risk of bias in individual studies was assessed using the Cochrane risk of bias tool. Effect size was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model.

RESULTS

Nine RCT that met the inclusion criteria were included in the meta-analysis. The meta-analysis showed a moderate-to-large effect favoring niVR active videogames included in CR in increasing aerobic capacity and cardiovascular endurance (SMD = 0.74; 95% CI 0.11 to 1.37; p = 0.021) and reducing anxiety (SMD = -0.66; 95% CI -1.13 to -0.2; p = 0.006). Only 4.8% of patients reported adverse events while performing niVR active videogames.

CONCLUSIONS

Inclusion of niVR active videogames in CR programs is more effective than conventional CR in improving aerobic capacity and cardiovascular endurance and in reducing anxiety.

Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial

Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.

Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior, and Physical Fitness: The OPTICARE XL Randomized Controlled Trial

OBJECTIVE

Previously published results of the OPTICARE XL open label randomized controlled trial showed no added value of OPTICARE XL CR, a dedicated cardiac rehabilitation (CR) program for patients with obesity, with respect to health-related quality of life (primary outcome). This clinical trial studied the effects of OPTICARE XL CR on several secondary outcomes, which included body weight, physical activity, sedentary behavior, and physical fitness.

METHODS

Patients with coronary artery disease or atrial fibrillation and body mass index ≥ 30 were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). OPTICARE XL CR was a 1-year group intervention, specifically designed for patients with obesity that included aerobic and strength exercise, behavioral coaching, and an aftercare program. Standard CR consisted of a 6- to 12-week group aerobic exercise program, supplemented with cardiovascular lifestyle education. Study end points included body weight, physical activity, sedentary behavior (accelerometer), and physical fitness (6-Minute Walk Test and handgrip strength), which were evaluated 6 months after the end of CR (primary endpoint) and 3 months after the start of CR.

RESULTS

Six months after completion of either program, improvements in body weight, physical activity, sedentary behavior, and physical fitness were similar between the groups. Three months after CR start, patients randomized to OPTICARE XL CR showed greater weight loss (mean change = -3.6 vs -1.8 kg) and a larger improvement in physical activity (+880 vs +481 steps per day) than patients randomized to standard CR.

CONCLUSION

Patients allocated to OPTICARE XL CR lost significantly more body weight and showed promising results with respect to physical activity 3 months after the start of CR; however, these short-term results were not expanded or sustained in the longer term.

IMPACT

Patients with obesity do not benefit from standard CR programs. The new OPTICARE XL CR program showed its effects in the short term on weight loss and physical activity, and, therefore, redesign of the aftercare phase is recommended.