Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial

INTRODUCTION AND OBJECTIVES

Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years.

METHODS

We conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years.

RESULTS

Seventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL.

CONCLUSIONS

Patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.

A retrospective observational study of face-to-face versus hybrid phase II cardiac rehabilitation program during COVID-19 pandemic

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): With the support of: Col.legi de Fisioterapeutes de Catalunya [R02/2018] Health Department of Generalitat de Catalunya. Instrumental action of intensification of nursing professionals (SLT017/20/000098)

Introduction

Cardiac rehabilitation (CR) is a class I level A recommendation. The COVID-19 pandemic forced us to halt face-to-face patient physical exercise programs during the lockdown. Due to it, it was necessary to redesign the cardiac rehabilitation program (CRP) modality to achieve the goals of CR.

Purpose

To assess the impact of the COVID-19 pandemic in the functional capacity of cardiac patients who finished phase II CRP and to determine the impact of the CRP modality performed during COVID-19 period.

Methods

We conducted a retrospective observational study with patients admitted to our CRP from October 2019 to June 2021. Eligible patients were diagnosed with myocardial infarction, unstable angina or chronic coronary syndrome, without cognitive deficit, with Barthel index >60 and providing signed informed consent. Patients attended to face-to-face CRP (pre-COVID-19) receiving supervised exercise training centre-based program consisting of 3 hours a week (spread over 3 alternate days) of supervised exercise training for 10 weeks. After COVID-19 lockdown (post-COVID-19), we designed a new hybrid model of CRP. It consisted in attending the supervised training centre-based sessions to ensure the correct learning of the physical exercise routine. Patients continued this practice for their own under telemonitoring by video call once a week. Face-to-face and hybrid models were offered according to the needs of participants. All patients performed an exercise stress test before and at the end of phase II (3 months).

Results

Ninety-one patients were included, 49 during pre-COVID-19 and 42 during post-COVID-19. Related to baseline characteristics, no statistically significant differences were observed between groups. Considering functional capacity, metabolic equivalent (MET) improved 0.8 (SD 1.7) and 1.3 (SD 1.6) (p=0.186) at 3 months in the pre- and post-COVID-19 period respectively. Related to the minutes of exercise, the increase was 0.8 (SD 1.6) and 1.3 (SD 1.6) (p=0.108) respectively. In the post-COVID-19 period, 18 patients took part in face-to-face model and 24 in hybrid version. In regard to baseline characteristics, patients in the hybrid model were younger than face-to-face version, 56.4 vs 61.1 years (p=0.096) and the low level of risk of CRP was higher in the hybrid model, 50.0% vs 16.7%; (p=0.239). Related to functional capacity, patients in the hybrid version had better baseline conditions, 8.0 (SD 2.3) vs 6.3 (SD 1.6) MET (p=0.011) and 8.2 (SD 2.3) vs 6.3 (SD 2.0) minutes (p=0.007). However, the improvements observed at 3 months were lower in the hybrid model, 0.9 (SD 1.6) vs 1.8 (SD 1.4) MET (p=0.072) and 0.9 (SD 1.5) vs 1.9 (SD 1.5) minutes (p=0.028).

Conclusions

COVID-19 pandemic did not affect the gains in functional capacity in phase II CRP. In the post-COVID-19 period, patients in both models increased their physical condition and the differences observed in the improvement were possibly due to the baseline risk level of CRP.

Effects of COVID-19 lockdown on physical activity in coronary patients on a phase III cardiac rehabilitation program

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): College of Physiotherapists of Catalonia

Introduction

At the start of the COVID-19 pandemic, all over Europe imposed population lockdowns. In our country, the government approved a nationwide confinement from March 14 to April 12, which restricted the movement of people to a very specific schedule. The lockdown was then relaxed, but remained in place until June 7. Cardiac rehabilitation (CR) is a class I level A recommendation with clinical benefits that are now well documented. The COVID-19 lockdown made it particularly difficult to achieve the goals of CR, that is, the maintenance of physical exercise and the control of cardiovascular risk factors (CVRF) in cardiac patients. Little is known about its effects on phase III of CR program (CRP).

Purpose

To assess the effect of the COVID-19 pandemic lockdown on physical activity and on the adherence to a cardio-healthy lifestyle in post-acute coronary syndrome (ACS) patients.

Methods

A nested cross-sectional substudy of all patients included in a randomised clinical trial before the lockdown by means of a telephone survey during the month of May. We are conducting a randomized clinical trial to assess the efficacy of a phase III CRP, based on counselling in the maintenance of physical exercise (time of physical exercise per week) and on reinforcing the control of CVRF for patients with ACS, once the hospital-supervised physical exercise program of a phase II CRP had been completed.

Results

Thirty-two patients were included. Mean age was 60.3 (SD 10.1) and 81.3% were men. Related to baseline, no statistically significant differences were observed between groups. One patient (3.1%) had symptoms of COVID-19. The lockdown altered the dynamics of physical exercise in 21 patients (65.6%), 20 of whom (95.2%) reported taking fewer minutes of exercise per week. After the end of the lockdown period and outdoor physical exercise was allowed once again, 11 patients (55.0%) in the control group and 9 patients (75.0%) in the intervention group found it easy to restart physical exercise. With regard to nutrition, most patients (78.1%) followed the recommendations to eat a Mediterranean diet. Five (15.6%) modified their alcohol consumption, and three smokers (33.3%) modified their tobacco consumption. When asked about their mood during the lockdown, 22 (68.8%) reported feeling well. Finally, 96.9% of patients adhered to medical treatment.

Conclusions

The lockdown reduced the level of physical activity but more intervention group patients resumed recommended physical activity. The COVID-19 pandemic is likely to result in care disruptions of varying degrees in the near future. To counteract the damaging effects of giving up physical exercise, health professionals should stay in contact with patients to motivate them to take physical exercise and encourage them to perform indoor exercise-based personalized programs to keep up the amount of exercise they take each week.