Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients? The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease Cardiac rehabilitation services in England and Wales: a national survey. [The influence of the outpatient cardiologic rehabilitation on the physical fitness at patients after a STEMI]. Cardiac rehabilitation after myocardial infarction. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study How important are individual counselling, expectancy beliefs and autonomy for the maintenance of exercise after cardiac rehabilitation? The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements? Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial A Behavior Change Intervention for Women in Cardiac Rehabilitation Individualized vs. group exercise in improving quality of life and physical activity in patients with cardiac disease and low exercise capacity: results from the DOPPELHERZ trial Rehabilitation outcomes following percutaneous coronary interventions (PCI). Aerobic exercise-based cardiac rehabilitation in Chinese patients with coronary heart disease: study protocol for a pilot randomized controlled trial Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. 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An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study) Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design Cardiac Rehabilitation vs. Home Exercise After Coronary Artery Bypass Graft Surgery: A Comparison of Heart Rate Recovery LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) – the study protocol of a randomised, controlled trial Promoting Self-efficacy and Outcome Expectations to Enable Adherence to Resistance Training After Cardiac Rehabilitation [The impact of comprehensive cardiac rehabilitation in patients up to 55 years old after acute myocardial infarction treated with primary coronary intervention]. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population. Effects of a Community-Based, Post-Rehabilitation Exercise Program in COPD: Protocol for a Randomized Controlled Trial With Embedded Process Evaluation Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial Benefits and weaknesses of a cardiac rehabilitation programme. Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial E-Rehabilitation – an Internet and mobile phone based tailored intervention to enhance self-management of Cardiovascular Disease: study protocol for a randomized controlled trial An education booklet to aid cardiac patients' recovery at home. Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic review HEART: heart exercise and remote technologies: A randomized controlled trial study protocol Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial. Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Effect of a cardiac rehabilitation program on left ventricular diastolic function and its relationship to exercise capacity in patients with coronary heart disease: experience from a randomized, controlled study. The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. [A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem]. A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial Usefulness of the 6-minute walk test and the 200-metre fast walk test to individualize high intensity interval and continuous exercise training in coronary artery disease patients after acute coronary syndrome: a pilot controlled clinical study Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial A six-month exercise intervention in subclinical diabetic heart disease: effects on exercise capacity, autonomic and myocardial function. Effects of a CHANGE intervention to increase exercise maintenance following cardiac events Telerehabilitation versus traditional centre-based pulmonary rehabilitation for people with chronic respiratory disease: protocol for a randomised controlled trial Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol Endurance exercise training in older patients with heart failure: results from a randomized, controlled, single-blind trial.
Background Heart failure is a common and costly condition , particularly in the elderly . A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes . Potentially , cardiac rehabilitation models can also improve outcomes . Aim To assess the impact of a nurse-coordinated multidisciplinary , cardiac rehabilitation program to decrease hospitalizations , increase functional capacity , and meet the needs of patients with heart failure . Method In a r and omized control trial , a total of 105 patients were recruited to the study . Patients in the intervention group received an individualized , multidisciplinary 12-week cardiac rehabilitation program , including an individualized exercise component tailored to functional ability and social circumstances . The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner . This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs . Results During the study period , patients in the intervention group were less likely to have been admitted to hospital for any cause ( 44 vs. 69 % , P = 0.01 ) or after a major acute coronary event ( 24 vs. 55 % , P = 0.001 ) . Participants in the intervention group were more likely to be alive at 12 months , ( 93 vs. 79 % ; P = 0.03 ) ( odds ratio = 3.85 ; 95 % confidence interval = 1.0314.42 ; P = 0.0042 ) . Quality of life scores improved at 3 months compared with baseline ( intervention t = 4.37 , P [ 0.0001 ; control t= 3.52 , P [ 0.01 ) . Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group ( t = 3.40 ; P = 0.01 ) . Conclusion This study shows that a multidisciplinary heart failure cardiac rehabilitation program , including an individualized exercise component , coordinated by a specialist heart failure nurse can substantially reduce both all-cause and cardiovascular readmission rates , improve functional status at 3 months and exercise tolerance Background Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease . Despite the benefits associated with regular exercise , adherence with supervised exercise-based cardiac rehabilitation remains low . Increasingly powerful mobile technologies , such as smartphones and wireless physiological sensors , may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease . This study compares the effectiveness of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( REMOTE ) to st and ard supervised exercise-based cardiac rehabilitation in New Zeal and adults with a diagnosis of coronary heart disease . Methods / Design A two-arm , parallel , non-inferiority , r and omised controlled trial will be conducted at two sites in New Zeal and . One hundred and sixty two participants will be r and omised at a 1:1 ratio to receive a 12-week program of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( intervention ) , or an 8 - 12 program of st and ard supervised exercise-based cardiac rehabilitation (control).The primary outcome is post-treatment maximal oxygen uptake ( V̇O2max ) . Secondary outcomes include cardiovascular risk factors ( blood lipid and glucose concentrations , blood pressure , anthropometry ) , self-efficacy , intentions and motivation to be active , objective ly measured physical activity , self-reported leisure time exercise and health-related quality of life . Cost information will also be collected to compare the two modes of delivery . All outcomes are assessed at baseline , post-treatment , and 6 months , except for V̇O2max , blood lipid and glucose concentrations , which are assessed at baseline and post-treatment only . Discussion This novel study will compare the effectiveness of technology-supported exercise-based cardiac rehabilitation to a traditional supervised approach . If the REMOTE program proves to be as effective as traditional cardiac rehabilitation , it has potential to augment current practice by increasing access for those who can not utilise existing services . Trial registration Australian New Zeal and Clinical Trials Registry Study ID number : ACTRN12614000843651 . Registered 7 August Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of We sent a short postal question naire to 244 centres in Engl and and Wales that admitted patients with cardiac conditions . In total , 199 ( 81 % ) of the centres cl aim ed to provide a  cardiac rehabilitation service .  Of these , 25 were r and omly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services . Most ( 18 ( 72 % ) ) of the centres had commenced their rehabilitation programme within the previous 5 years , usually at the instigation of interested staff . Patient entry to cardiac rehabilitation programmes was restricted ; women ( who represented only 15 % of attenders ) , elderly people ( excluded in 10 ( 40 % ) centres ) , and those with more complex problems , such as angina or heart failure , were under-represented . The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision . Most ( 22 ( 88 % ) ) programmes were hospital out-patient based , one ( 4 % ) was hospital in-patient based , one ( 4 % ) was community-based and one ( 4 % ) was home-based . The staffing and funding of programmes was variable , with 7 ( 28 % ) having no identified funding . There are wide variations in the re sources currently available for the rehabilitation of patients with coronary heart disease . There is a need for clearer direction of these services , in particular to determine minimum service provision . Guidelines are necessary to give a framework for this relatively new and rapidly exp and ing service UNLABELLED Myocardial infraction , sudden cardiac death next is one of the most serious clinical demonstrations of ischaemic heart diseases . It is characterized by an irreversible destruction ( necrosis ) of a part of cardiac muscle , caused by severe narrowing or blood clot ( thrombosis ) in the lumen of coronary arteries . The long-term , systematic and individually selected program of the physical rehabilitation has a beneficial effect to the improvement in the physical fitness at patients , after an myocardial infa rct ion . The aim of this work was to examine the influence of the outpatient , cardiological rehabilitation on the physical fitness and the normalization of the arterial pressure at patients after STEMI , treated with methods of invasive cardiology , and determining effects of the rehabilitation . MATERIAL AND METHODS The study included 108 patients ( 93 men and 15 women ) . An average age of patients was 53 . Examined patients were divided into 2 groups : rehabilitated ( 55 people ) and control ( 53 people ) . The program of the cardiologic rehabilitation included 24 forty-minute training sessions , for 2 - 3 times during the week . Every training session spread through 10 minutes of the general keep-fit exercise ( warm-up ) , 24 minutes of the ride on cycloergometer ( intervallic training ) with submaximal load adjusted individually for every patient , under the constant electrocardiographic scrutiny of the action of the heart , and 6 minutes of respiratory exercises . The criterion of intensity of a physical effort was determined on the basis of a Bruce test according to on the level of the 70 % of the maximum limit of the heart rate . The rehabilitation lasted about 3 months . RESULTS Obtained findings show that the outpatient , cardiologic rehabilitation has a beneficial effect for the improvement in the physical fitness and the decrease in value of the rest arterial pressure at patients after STEMI . Examinations show the increase of the maximum load ( max MET 'S ) and longer duration of the exercise test . CONCLUSIONS Above findings confirm the effectiveness of the cardiological rehabilitation , although they are not spectacular . Perhaps if they increase the frequency and intensity and number of training sessions , the results would be more significant Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment Background Physical training has beneficial effects on exercise capacity , quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation . However , cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period . Home-based training has the potential to increase cardiac rehabilitation uptake , and was shown to be safe and effective in improving short-term exercise capacity . Long-term effects on physical fitness and activity , however , are disappointing . Therefore , we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home . In this way , we aim to improve self-management skills like self-efficacy and action planning for independent exercise and , consequently , improve long-term effectiveness with respect to physical fitness and physical activity . In addition , we aim to compare costs of this strategy with centre-based cardiac rehabilitation . Methods / design This r and omized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular , 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention . The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment . Participants are instructed to train at 70 - 85 % of their maximal heart rate for 45–60 minutes , twice a week . Patients receive individual coaching by telephone once a week , based on measured heart rate data that are shared through the internet . Primary endpoints are physical fitness and physical activity , assessed at baseline , after 12 weeks and after one year . Physical fitness is expressed as peak oxygen uptake , assessed by symptom limited exercise testing with gas exchange analysis ; physical activity is expressed as physical activity energy expenditure , assessed by tri-axial accelerometry and heart rate measurements . Secondary endpoints are training adherence , quality of life , patient satisfaction and cost-effectiveness . Discussion This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance . This strategy is in line with the trend to shift non-complex healthcare services towards patients ’ home environments . Trial registration Dutch Trial Register : NTR3780 . Clinical trials.gov register : Aims : We examined whether autonomy supportive and self-efficacy enhancing individual lifestyle counselling was associated with improved maintenance of exercise and physical capacity compared with group based counselling . We also tested whether self-efficacy beliefs and autonomous motivation was associated with improved maintenance of exercise over time . Methods : R and omised controlled trial and longitudinal study of predictor variables . One hundred and seventy six ( 38 female ) patients mainly with coronary heart disease were r and omized to either have st and ard group based rehabilitation or to additionally receive the intervention . Patients were recruited from a 4-week cardiac rehabilitation programme  with two years follow-up at Krokeide Centre in Bergen , Norway . Results : We found no statistically significant between-group differences . The groups showed an overall improvement of their self-evaluated physical capacity during the two years of the study , corresponding 7 % change of score ( p<0.001 ) . The composite exercise score improved 6 % during follow-up ( p<0.001 ) . Intensity of exercise activities improved 17 % from inclusion to 24 months ' follow-up ( p<0.001 ) . Self-efficacy for increased exercise , general expectancy and autonomous motivation were significant predictors of increased exercise and physical capacity . Controlled motivation hampered physical capacity improvement . Conclusions : Among this self-selected and motivated group of rehabilitation patients we found no additional effect of adding individual counselling to group-based interventions . Based on longitudinal documentation this cardiac rehabilitation programme improves long-term maintenance of exercise and physical capacity and this maintenance is related to autonomous motivation , general expectancy and self-efficacy Objective : To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft ( CABG ) surgery . Design : Thirty subjects who received CABG surgery were r and omly assigned to enter or not enter a cardiac rehabilitation exercise programme ( cardiac rehabilitation n=15 ; control group n=15 ) . Setting : Outpatient cardiac rehabilitation centre in a national medical hospital . Interventions : Patients assigned to the cardiac rehabilitation group received 36 sessions of the exercise programme , three times a week , with the intensity design ed to achieve an individual 60 - 85 % peak heart rate in cardiopulmonary exercise test . Patients assigned to the control group did not get further advice about a specific exercise programme . Main outcome measures : Resting heart rate and recovery of heart rate over 1 min after a peak exercise test at discharge and three months later were collected . The heart rates were analysed with computer-recorded electrocardiogram . Results : At follow-up , the 15 patients in the cardiac rehabilitation group had a significantly lower resting heart rate ( 77.469± 9.49 versus 92.319± 10.18 bpm ; p B± 0.001 ) and a significantly higher recovery of heart rate over 1 min ( 16.389± 6.32 versus 11.389± 4.81 bpm ; p ± 0.03 ) compared with the control group . There were also significant reductions in resting heart rates  ( cardiac rehabilitation p ± 0.001 ; control p=0.05 ) and improvements in recovery on heart rate over 1 min  ( cardiac rehabilitation p ± 0.001 ; control p= 0.001 ) compared with baseline measurements in both the cardiac rehabilitation and control groups . Conclusion : Cardiac rehabilitation had a positive effect on the improvement of recovery on heart rate over 1 min in patients with coronary artery disease who received CABG surgery Background It is unclear how much of the reduction in cardiac mortality in coronary heart disease ( CHD ) patients with exercise training  is the result of direct effects on the heart and coronary vasculature , or to indirect effects , via primary risk factors . Objective The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature . Methods The IMPACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta- analysis of cardiac rehabilitation r and omized , controlled trials . Patients were receiving rehabilitation following an acute myocardial infa rct ion , angina pectoris or revascularization . Outcomes considered were primary risk factors ( total cholesterol , systolic blood pressure and smoking behaviour ) and cardiac mortality . Results Nineteen exercise-only cardiac rehabilitation trials ( including 2984 patients ) were identified . Across these trials , exercise training reduced pooled cardiac mortality by 28 % ( relative risk , 0.72 , 95 % confidence interval 0.55–0.95 ) , with 30 fewer deaths than in the control group . Applying the CHD model , approximately 17 ( 58 % ) of these 30 fewer deaths were attributable to reductions in major cardiovascular risk factors : 7.1 deaths ( minimum estimate 6.2 , maximum estimate 9.5 ) attributable to an 18 % reduction in smoking prevalence ; 5.9 deaths ( minimum −0.6 , maximum 12.6 ) to a 0.11 mmol/l reduction in cholesterol , and 4.4 deaths ( −1.0 minimum , 6.7 maximum ) to a 2.0 mmHg reduction in systolic blood pressure . Conclusions Approximately half of the 28 % reduction in cardiac mortality achieved with exercise-based cardiac rehabilitation may be attributed to reductions in major risk factors , particularly smoking . Eur J Cardiovasc Prev Rehabil 13:369–374 © 2006 The European Society of Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes Abstract Purpose : Important goals of cardiac rehabilitation maintenance programs ( CMP ) are to increase leisure time physical activity ( LTPA ) and improve health-related quality of life ( HRQoL ) . Elderly patients with cardiac disease and low exercise capacity are simultaneously the most severely affected and have the most to gain from exercise-based rehabilitation . Individualized combined exercise ( ICE ) may be an effective modality to achieve these goals . We compared six months of ICE to CMP in their effects on LTPA and HRQoL. Methods : Sixty patients ( 70 ± 9 years , 39 % female ) with cardiac disease and low exercise capacity ( < 6 MET ) were r and omly allocated to six months of once-weekly ICE or CMP . The patients in ICE performed moderate endurance and resistance exercise on machines , based on intensities from individual peak exercise testing . Patients in CMP performed weekly sessions of calisthenics , flexibility , coordination and relaxation activities . LTPA and HRQoL were assessed with accelerometry and question naires at baseline and six months . Results : Sixty patients completed the trial . ICE  increased vigorous PA ( ICE : Δ + 12 MET-min/d , CMP : Δ –5 MET-min/d , p = .02 ) and steps per day ( ICE : + 1586 steps/d , CMP : –838 steps/d , p < .01 ) compared to CMP after six months . ICE significantly improved in several components of HRQoL ( vitality , emotional health , social health , positive and negative affect ( all p < .05 ) compared to CMP . Conclusions : ICE result ed in significant improvements in physical activity levels and health related quality of life in moderate to high-risk patients compared to CMP . Implication s for rehabilitation Relatively low volumes and intensities of exercise may lead to substantial improvements in both physical activity levels and health-related quality of life Exercise modes in cardiac rehabilitation maintenance programs should not be limited to calisthenics and large group-based exercise Supplemental resistance exercise may improve health-related quality of life and increase physical activity levels in patients with low exercise capacity Moderate to high-risk elderly patients also benefit from individualized endurance-resistance This prospect i ve study evaluated the effect of an individualized , comprehensive , home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors , psychological well-being , functional capacity , and work resumption in 99 post-percutaneous coronary interventions ( PCI ) patients r and omized to control ( st and ard care plus telephone follow-up  , n=49 ) or intervention ( individualized , comprehensive , home-based cardiac rehabilitation , n=50 ) groups . Data were collected at time 1 ( T(1 ) ) during hospital admission , time 2 ( T(2 ) ) approximately 2 months post-PCI , and time 3 ( T(3 ) ) approximately 12 months post-PCI . Results suggest that the allocation to an individualized , comprehensive , home-based cardiac rehabilitation program provided more advantageous outcomes . At both follow-ups , the intervention group showed within-group improvement in serum cholesterol levels ( P<0.02 ; P<0.01 ) and exercise participation ( P<0.001 ; P<0.001 ) with differences in exercise participation favoring the intervention group ( P<0.01 ) at T(2 ) . Repeated measures ANOVA showed significant improvements over time in body mass index ( BMI ) ( P<0.01 ) , psychological well-being ( P<0.001 ) , and functional capacity ( P<0.001 ) for both groups . More patients in the intervention group had returned to work at T(2 ) ( P<0.001 ) and did so more quickly ( P<0.01 ) . These findings suggest that an individualized , comprehensive , home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI Background Cardiovascular disease is the leading cause of morbidity and mortality in the world , including China . Cardiac rehabilitation ( CR ) has been demonstrated to be beneficial in reducing cardiovascular mortality , myocardial infa rct ion , and cerebrovascular events . This pilot study seeks to assess the feasibility of aerobic-exercise-based CR in Chinese patients with coronary heart disease ( CHD ) and outcomes of aerobic metabolism capacity and molecular biomarkers . Methods / design This study is a single-center , pilot , r and omized , controlled study that is currently being carried out at a regional hospital in Shanghai . Forty patients with CHD who underwent percutaneous coronary intervention will be r and omly allocated into either the intervention group or control group . Participants in the intervention group will undergo 8 weeks of aerobic exercise with targeted intensity and participants in the control group will undergo 8 weeks of leisure exercise . The primary measurement is the feasibility of the trial ; the secondary measurement is the capacity of aerobic metabolism and the exploratory measurement includes additional molecular biomarkers underlying cardiovascular function . Discussion This is the first prospect i ve r and omized and controlled clinical study in China that assesses the parameters of aerobic metabolism and comprehensively screens for substantial blood biomarkers to reveal the molecular mechanisms underlying changes in cardiovascular function after aerobic exercise with targeted intensity in participants with CHD . The success of this study will contribute to guide the design of future CR studies in patients with CHD in China . Trial registration Chinese Clinical Trial Registry , ChiCTR-IPR-17010556 . Registered on 1 June 2016 OBJECTIVE To estimate the incremental effects on cost and quality of life of  cardiac rehabilitation after an acute coronary syndrome . DESIGN Open r and omised controlled trial with 1 year 's follow-up . Analysis was on an intention-to-treat basis . SETTING Two tertiary hospitals in Sydney . INTERVENTION 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor . PARTICIPANTS 113 patients aged 41 - 75 years who were self-caring and literate in English . Patients with uncompensated heart failure , uncontrolled arrhythmias , severe and symptomatic aortic stenosis or physical impairment were excluded . MAIN OUTCOME MEASURES Costs ( hospitalisations , medication use , outpatient visits , investigations , and personal expenses ) ; and measures of quality of life . Incremental cost per quality -adjusted life year ( QALY ) saved at 1 year ( this estimate combines within- study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality ) . Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival , 3 years of treatment effect on survival and variations in utility . RESULTS The estimated incremental cost per QALY saved for  rehabilitation  relative to st and ard care was 42,535 US dollars when modelling included the reported treatment effect on survival . This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included . The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective . CONCLUSIONS The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome . The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee Dear Editor , Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults.[1][2 ] Today , inflammation is regarded as the key pathogenic mechanism in both initiation and progression of atherosclerosis.[3]Inflammatory markers such as high sensitive C-reactive protein ( CRP ) have been used to identify patients at higher risk for coronary events . The prognostic value of CRP has been established for patients with acute coronary syndrome , stable coronary artery diseases[4 ] and in apparently healthy people.[5][6 ] Comprehensive cardiac rehabilitation is probably the most effective approach for cardiovascular reduction and long-term care of cardiac patients as well as subjects with multiple coronary risk factors.[7][8 ] Secondary prevention , through cardiac rehabilitation program is now regarded as an essential component of contemporary management of patients with various presentations of coronary disease.[9 ] There are some evidence s that protective effects of cardiac rehabilitation may in part be related to lowering of inflammation . The goal of this prospect i ve study was to assess the effect of cardiac rehabilitation on high sensitive CRP as a marker of increased risk of coronary artery disease . The subjects were r and omly selected from patients with recent anterior wall myocardial infa rct ion referring to Alzahra Cardiac Rehabilitation Center in Shiraz from May to December 2007 . Inclusion criteria were males and females aged 30 - 75 years with anterior wall MI in past 1 month . Patients were divided into two groups . Group A consisted of 30 participants who received cardiac rehabilitation  and group B consisting of 26 participants which did not receive any cardiac rehabilitation program .  CRP levels were assessed before starting the program and eight weeks later . We used CRP Quantitative Diagnostic Kit for serum and plasma-Photometry technique . The data were analyzed by Wilcoxon Signed Rank and Mann-Whitney tests . The cardiac rehabilitation program included 8 weeks of exercise training , education and behavior modification therapy 3 times per week . The exercise training included arm and leg ergometry and treadmills . Behavioral modifications were smoking cessation , healthy nutrition , hypertension control , etc . The average age of patients was 62.7 years old . At enrollment , 66 % ( n=20 ) of participants in cardiac rehabilitation ( group A ) had CRP levels in the intermediate and high-risk range of > 1 mg/dl and after completion of cardiac rehabilitation only 27 % ( n= 5 ) of patients had elevated CRP levels ( P=0.0009 ) . In the group B , 73 % ( n=19 ) of participants had CRP levels > 1 mg/dl and after eight weeks , 53 % ( n=14 ) of them had CRP levels > 1 mg/dl ( p=0.50 ) . A higher CRP level was observed in patients 65 years , but both age groups demonstrated significant improvements in CRP postcardiac rehabilitation . This study showed a significant decrease in CRP levels in patients with cardiac disease after participation in cardiac rehabilitation program .  The findings showed that cardiac rehabilitation decreased vascular inflammation accompanying improvement in risk factors . Regardless of gender , there was a significant decrease in CPR at the completion of cardiac rehabilitation . The decrease in inflammation along with previously described benefits of cardiac rehabilitation supports the recommendations of American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation that participation in cardiac rehabilitation should be a part of comprehensive care of cardiac patients . The findings in our study had two important clinical implication s. First , the potential independent effect of cardiac rehabilitation in lowering CRP levels was demonstrated which is independent from weight in our study . The non-pharmacologic mechanism for this observation may be due to dietary modifications , weight management and exercise components of the program . Secondly , the decrease in vascular inflammation associated with cardiac rehabilitation is evident regardless of gender , age and metabolic syndrome Background High-intensity interval training ( HIT ) as exercise therapy is gradually implemented in cardiac rehabilitation as the cardiovascular benefits from exercise is intensity dependent . However , in previous studies , HIT has been performed with strict supervision . The aim of the study was to assess the feasibility and effectiveness of different modes of HIT in cardiac rehabilitation . Design a r and omized clinical study . Methods Ninety participants with coronary artery disease ( 80 men/10 women , mean age 57 ± 8 years ) were r and omly assigned to one of three exercise modes : group exercise ( GE ) , treadmill exercise ( TE ) , or home-based exercise ( HE ) . HIT was performed twice a week for 12 weeks with an exercise intensity of 85–95 % of peak heart rate . The primary outcome measure was change in peak oxygen uptake ( peak VO2 ) . Results Eighty-three participants ( 92 % ) completed the intervention without any severe adverse events . Peak VO2 increased from 34.7 ± 7.3 to 39.0 ± 8.0 ml/kg/min , 32.7 ± 6.5 to 36.0 ± 6.2 ml/kg/min , and 34.4 ± 4.8 to 37.2 ± 5.2 ml/kg/min in TE , GE , and HE , respectively . Mean group difference for TE vs. HE was 1.6 ml/kg/min ( 95 % confidence interval , CI , 0.7 to 3.1 , p = 0.02 ) , TE vs. GE 1.1 ml/kg/min ( 95 % CI−0.5 to 2.5 , p = 0.27 ) , and GE vs. HE 0.6 ml/kg/min ( 95 % CI −1.0 to 2.1 , p = 1 ) . However , on-treatment analysis showed no significant difference between groups . Conclusion HIT was efficiently performed in three setting s of cardiac rehabilitation , with respect to target exercise intensity , exercise attendance , and increase in peak VO2 . Exercise mode was not essential for exercise capacity PURPOSE Despite the documented benefits of participating in rehabilitation programs , access to cardiac rehabilitation is limited for a large number of people with coronary artery disease ( CAD ) . There is potential to increase participation in exercise training if home-based exercise were a viable option . METHODS We conducted a retrospective data base review of 1,042 patients who took part in exercise rehabilitation following coronary artery bypass graft surgery ( CABGS ) between 1992 and 1998 . Of these , 713 patients took part in supervised exercise , and 329 were in an unsupervised , home-based group .  All exercise protocol s were based upon American College of Sports Medicine guidelines , and patients in both groups received exercise prescriptions that were similar in intensity , frequency , and duration . RESULTS There were no differences between groups at baseline . Following 6 months of exercise training , there were substantial improvements in peak VO2 , peak workload , and peak MET levels in both the supervised and unsupervised groups ( P < 0.0001 ) . Patients in the supervised group had significant improvements in both LDL and HDL-cholesterol , whereas the home-based group showed improvement in HDL-cholesterol only . When analyzed by sex , men performed better than women for all measures of exercise capacity ; however , women in both groups showed approximate 20 % improvements ( P < 0.05 ) in exercise capacity as well as improvements in HDL-cholesterol . CONCLUSION Stable post CABGS patients who receive a detailed exercise prescription to follow at home do as well as those in supervised rehabilitation Background Poor health-related quality of life ( HRQL ) has been shown to be predictive of adverse outcomes in cardiac patients . As women with coronary heart disease have been shown to have lower HRQL than men with coronary heart disease , women are at greater risk of a poor clinical outcome . This study tested the effect of a 12-week home walking intervention after completion of  outpatient cardiac rehabilitation ( OCR )  on HRQL and maintenance of physical activity among women . Design Multicenter two-group r and omized trial . Methods After completion of OCR , participants were r and omly allocated to the intervention or usual care groups . The outcomes were HRQL ( assessed using the MacNew Heart Disease HRQL instrument ) and self-reported physical activity ( assessed using the Stages of Change model of exercise behavior ) at 3 , 6 , and 12 months after OCR . Results Seventy-two women were r and omized to the intervention and 81 to usual care . Attrition was greater in the treatment group ( 13 vs. 1 % ) . HRQL scores increased relative to the base level in both arms and were significantly higher in the intervention group at 6 months , but not at 3 or 12 months . Maintenance of physical activity declined over time in both groups , however , this decline was significantly reduced among women in the intervention group . Conclusion HRQL improved in both groups , but seemed to increase earlier among women in the intervention group . As maintenance of physical activity was higher among women in the intervention group , this minimal intervention could be used to facilitate women 's progression from supervised to independent exercise Background : Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health . However , left ventricular ejection fraction ( LVEF ) is clinical ly used as a predictor of long-term prognosis in coronary artery disease ( CAD ) patients , there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF . Objective : To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients . Patients and Methods : In a single blinded , r and omized controlled trial , post-coronary event CAD patients from the age group of 35 - 75 years , surgically ( Coronary artery bypass graft or percutaneous coronary angioplasty ) or conservatively treated , were recruited from Golsar Hospital , Iran . Exclusion criteria were high-risk group ( AACVPR-99 ) patients and contraindications to exercise testing and training . Forty-two patients were r and omized either into Study or Control . The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based ( CExs ) or Home-based ( HExs ) according to the ACSM-2005 guidelines . The control group only received the usual cardiac care without any exercise training .  LVEF was measured before and after 12 weeks of exercise training for all three groups . Differences between and within groups were analyzed using the general linear model , two-way repeated measures at alfa=0.05 . Results : Mean age of the subjects was 60.5 ± 8.9 years . There was a significant increase in LVEF in the study ( 46.9 ± 5.9 to 61.5 ± 5.3 ) group compared with the control ( 47.9 ± 7.0 to 47.6 ± 6.9 ) group ( P=0.001 ) . There was no significant difference in changes in LVEF between the HExs and CExs groups ( P=1.0 ) . Conclusion : A 12-week early ( within 1 month post-discharge ) structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients BACKGROUND participation in centre-based cardiac rehabilitation ( CR ) is known to reduce morbidity and mortality but participation rates among the elderly are low . Establishing alternative programmes is important , and home-based CR is the predominant alternative . However , no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up . METHODS r and omised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease . RESULTS seventy-five patients participated . There were no significant differences in exercise capacity after the intervention between home and centre-based CR . Adjusted mean differences of peak VO₂ = 0.9 ml/kg/min ( 95 % CI -0.7 , 2.4 ) and of 6 min walk test = -18.7 m ( 95 % CI -56.4 , 18.9 ) . In addition , no differences were found in the secondary outcomes of systolic blood pressure ( -0.6 mmHg , 95 % CI -11.3 , 10.0 ) , LDL cholesterol ( 0.3 mmol/l , 95 % CI -0.04 , 0.7 ) , HDL cholesterol ( 0.2 mmol/l , 95 % CI -0.01 , 0.3 ) , body composition , proportion of smokers and health-related quality of life . A group of patients who did not have an effect of either programmes were characterised by higher age , living alone and having COPD . At 12 months of follow-up , both groups had a significant decline in exercise capacity . CONCLUSIONS home-based CR is as  effective as centre-based CR  in improving exercise capacity , risk factor control and health-related quality of life . However , a group of patients did not improve regardless of the type of intervention . Continued follow-up is essential in order to maintain the gained improvements PURPOSE Cardiac rehabilitation is an integral component of comprehensive care for patients with coronary heart disease . Although the typical programmatic delivery of outpatient cardiac rehabilitation services often involves 36 sessions over 12 weeks , that format is based more on historical practice than on outcome data . This study aim ed to determine the point at which during 52 weeks of outpatient cardiac rehabilitation , patients achieved peak values for selected outcomes , and whether the number of supervised exercise sessions had any effect on these outcomes . METHODS In this study , 623 male patients with coronary heart disease admitted to an outpatient cardiac rehabilitation program were r and omized to one of two 52-week program formats . One format ( CR1 ) used one supervised exercise session per week over 52 weeks , and the second format ( CR2 ) used weekly supervised sessions for 26 weeks followed by one supervised session per month for the remaining 26 weeks . Both formats used four unsupervised , documented exercise sessions per week . Selected clinical , physiologic , and psychological variables were measured at baseline , then at 4 , 12 , 26 , 38 , and 52 weeks . The program costs for both the CR1 and CR2 formats were calculated from known expenses . RESULTS Because there were no significant intercohort differences between CR1 and CR2 and no significant interaction ( time x group ) , data from the two cohorts were pooled for statistical analysis . Peak oxygen intake ( VO(2peak ) ) significantly increased by 4.4 mL/kg per minute at 38 weeks , and the greatest percentage of patients ( 30.1 % ) also achieved their highest VO(2peak ) at this time . The largest gain in Medical Outcomes Survey Short Form 36 role physical scores was from baseline to 38 weeks ( 52.4 versus 85.2 ) , and the highest percentage of patients ( 72 % ) with role physical scores in the excellent category occurred at 38 weeks . Clinical depression at baseline ( Beck Depression Inventory score > 10 ) had no significant effect on the dropout rate or the gain in VO(2peak ) with exercise training . Program costs for these alternative formats of service were similar to the cost for a st and ard program format of 36 sessions . CONCLUSIONS Patients achieved their highest functional capacity after 38 weeks of outpatient cardiac rehabilitation using a program format of only 29 to 38 supervised exercise sessions . The results of this study show that an outpatient cardiac rehabilitation program combining supervised with unsupervised exercise sessions and continuing for 38 weeks results in the greatest improvement in these selected outcomes Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease . However , their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies . We developed a mobile health system design ed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring , guidance , motivational feedback , and educational content . Methods Our multi-disciplinary approach is based on mapping “ desired behaviours ” into specific system ’s specifications , borrowing concepts from Fogg ’s Persuasive Systems Design principles . A r and omised controlled trial was conducted to compare  mobile-based rehabilitation ( 55 patients ) versus st and ard care ( 63 patients ) . Results Some technical issues related to connectivity , usability and exercise sessions interrupted by safety algorithms affected the trial . For those who completed the rehabilitation ( 19 of 55 ) , results show high levels of both user acceptance and perceived usefulness . Adherence in terms of started exercise sessions was high , but not in terms of total time of performed exercise or drop-outs . Educational level about heart-related health improved more in the intervention group than the control . Exercise habits at 6 months follow-up also improved , although without statistical significance . Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits , but further studies would be needed to confirm these indications Objectives 1 . To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases ( myocardial infa rct ion , acute coronary syndrome , percutaneous transluminal coronary angioplasty and coronary artery bypass grafting ) . 2 . To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group , in comparison with similar changes in the conventional care group . Design R and omized , controlled , parallel-group design ( intervention/conventional care ) . Setting Akershus County , southeast of Oslo City , Norway . Participants 500 patients , men and women , aged 40 - 85 years , who have sustained at least one of the above-mentioned cardiovascular diseases . Interventions 8 weeks of supervised , structured physical training of three periods of 20 min per week , targeting a heart rate of 60 - 70 % of the individual 's maximum ; home-based physical exercise training with the same basic schedule as in the supervised period ; quantification of patients ' compliance with the exercise programme by the use of wristwatches , information stored in the watch memory being retrieved once a month during the 3-year follow-up period ; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Background : Regular physical activity has been consistently related to improvements in health- related quality of life ( HRQL ) in older adults . Nevertheless , systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse . Purpose : The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program ( GMCB ) to a traditional cardiac rehabilitation program ( CRP ) with regard to changes in HRQL in a community-dwelling sample of older adults . Methods : This r and omized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms . Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 ( SF-36 ) from the Medical Outcomes Study . Results : Mixed-model analyses yielded significant Baseline × Gender × Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36 . Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment . Conclusions : Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment , gender , and initial mental health status . Results are discussed in terms of the implication s for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL Background The Lung Cancer Exercise Training Study ( LUNGEVITY ) is a r and omized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness ( VO2peak ) , patient-reported outcomes , and the organ components that govern VO2peak in post-operative non-small cell lung cancer ( NSCLC ) patients . Methods / Design Using a single-center , r and omized design , 160 subjects ( 40 patients / study arm ) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center ( DUMC ) will be potentially eligible for this trial . Following baseline assessment s , eligible participants will be r and omly assigned to one of four conditions : ( 1 ) aerobic training alone , ( 2 ) resistance training alone , ( 3 ) the combination of aerobic and resistance training , or ( 4 ) attention-control ( progressive stretching ) . The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70 % of the individually determined VO2peak for aerobic training and an intensity between 60 and 80 % of one-repetition maximum for resistance training , for 30 - 45 minutes/session . Progressive stretching will be matched to the exercise groups in terms of program length ( i.e. , 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 30 - 45 mins/session ) . The primary study endpoint is VO2peak . Secondary endpoints include : patient-reported outcomes ( PROs ) ( e.g. , quality of life , fatigue , depression , etc . ) and organ components of the oxygen cascade ( i.e. , pulmonary function , cardiac function , skeletal muscle function ) . All endpoints will be assessed at baseline and postintervention ( 16 weeks ) . Sub studies will include genetic studies regarding individual responses to an exercise stimulus , theoretical determinants of exercise adherence , examination of the psychological mediators of the exercise - PRO relationship , and exercise-induced changes in gene expression . Discussion VO2peak is becoming increasingly recognized as an outcome of major importance in NSCLC . LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect . Overall , this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum . Trial Registration Wu S-K , Lin Y-W , Chen C-L , Tsai S-W : Cardiac rehabilitation vs. home exercise after coronary artery bypass graft surgery : a comparison of heart rate recovery . Am J Phys Med Rehabil 2006;85:711–717 . Objective : The autonomic dysfunction is known to adversely affect clinical outcome in patients with cardiovascular disease , and exercise training has been shown to modify the sympathovagal control of heart rate . The purpose s of this study were to investigate the effect of cardiac rehabilitation on heart rate recovery in patients who received coronary artery bypass grafting ( CABG )  and compare the effect with that of a home-based exercise program . Design : Fifty-four male patients having undergone CABG were r and omly assigned to a cardiac rehabilitation exercise program ( n = 18 ) , a home-based exercise program ( n = 18 ) , and a control group ( n = 18 ) for 12 wks to evaluate the differences in heart rate recovery among groups . Results : Patients in the cardiac rehabilitation group had significant increases in heart rate recovery ( 19.1 ± 6.2 vs. 14.0 ± 5.4 beats/min , P = 0.022 ) compared with those in the control group . There were no significant differences in heart rate recovery between cardiac rehabilitation and home-based exercise groups ( 16.2 ± 4.8 beats/min ) or between home-based exercise and control groups . All three groups had significantly improved heart rate recovery compared with their baseline data ( P < 0.001 , < 0.001 , and 0.007 ) . Conclusion : Our results point out that a cardiac rehabilitation exercise program has a positive effect on heart rate recovery in patients having undergone CABG and is consistent with the autonomic improvement . Although the home-based exercise group did not reveal statistical significance s over those in the control group , it had comparable efficacy to that demonstrated in the cardiac rehabilitation group Background Due to improved treatments and ageing population , many countries now report increasing prevalence in rates of ischemic heart disease and heart failure . Cardiac rehabilitation has potential to reduce morbidity and mortality , but not all patients complete . In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program . The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called ‘ learning and coping ’ to that of st and ard care . Further , this paper aims to describe the theoretical basis and details of this intervention . Methods / design Open parallel r and omised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure . Patients are allocated to either the intervention group with learning and coping strategies incorporated into st and ard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program . Learning and coping consists of two individual clarifying interviews , participation of experienced patients as educators together with health professionals and theory based , situated and inductive teaching . Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units . In both groups , cardiac rehabilitation consists of training three times a week and education once a week over eight weeks . The primary outcomes are adherence to cardiac rehabilitation , morbidity and mortality , while secondary outcomes are quality of life ( SF-12 , Health education impact question naire and Major Depression Inventory ) and lifestyle and risk factors ( Body Mass Index , waist circumference , blood pressure , exercise work capacity , lipid profile and DXA-scan ) . Data collection occurs four times ; at baseline , at immediate completion of cardiac rehabilitation , and at three months and three years after the finished program . Discussion It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality . By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation . Trial registration Identifier NCT01668394 Background To help patients with coronary artery disease ( CAD ) benefit from the positive health effects attained by exercise-based cardiac rehabilitation ( CR ) , adherence to these programmes according to international guidelines is important . Strategies to increase adherence to exercise-based CR are mainly an unexplored area . The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy , containing goal - setting , self-monitoring and feedback , with the aim of improving rehabilitation outcomes for exercise-based CR , compared with usual care . Methods This is a r and omised , controlled trial . A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden . Patients are r and omised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy , in addition to usual care for 4 months . Outcome assessment at baseline , 4 and 12 months includes submaximal aerobic capacity ( primary outcome ) , exercise adherence , muscle endurance , level of physical activity , biomarkers , anxiety and depression , health-related quality of life , patient enablement and self-efficacy ( secondary outcomes ) . Discussion This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes . The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.Trial registration The study include all items from the World Health Organization Trial Registration Data Set . Trial registration number : NCT02895451 , 2016 - 08 - 16 , retrospectively registered Background and Objective : Resistance training offers clinical and functional benefits to cardiac patients , yet exercise adherence after cardiac rehabilitation ( CR ) is problematic . This study examined effects of an intervention targeting self-efficacy , outcome expectations , and adherence to upper-body resistance exercise after CR . Participants and Methods : Cardiac patients ( N = 40 ) were r and omly allocated to receive either st and ard exercise recommendations ( wait-list control ) or an intervention involving a theory-based instructional manual and Thera-B and resistive b and s for upper-body resistance exercise .  Self-efficacy and outcome expectations were assessed at baseline and 4 weeks later . Participation in resistance exercise was measured at 4 weeks postbaseline and at 3-month follow-up . Results and Conclusions : The intervention group reported higher levels of self-efficacy , outcome expectations , and resistance exercise volume compared with the control group at the 4-week follow-up . Adherence differences were sustained at 3-month follow-up , with some support that self-efficacy for adhering to resistance training mediated the effects of the intervention on follow-up exercise training frequency . Findings support the use of a theory-based motivational manual and Thera-B and resistive b and s to increase self-efficacy and outcome expectations for , and adherence to , resistance training after CR UNLABELLED The aim of our study was to evaluate the impact of comprehensive 3-phases cardiac rehabilitation in patients aged up to 55 years after acute myocardial infa rct ion treated with primary coronary intervention ( PCI ) of the infa rct ion related artery on the cardiovascular status , modification of coronary risk factors , psychological and physical status and exercise tolerance . METHODS Out of 106 consecutive patients aged up to 55 years with acute myocardial infa rct ion ( AMI ) with ST-segment elevation , treated with primary coronary intervention ( PCI ) of the infa rct ion related artery 71 patients entered the study and were r and omized either to the Study Group ( GB ) or to the Control Group ( GK ) . 31 patients of GB underwent 3-phases cardiac rehabilitation program and 40 patients of GK did not participate in phase III of the program . At phase I of the rehabilitation and 6 months after myocardial infa rct ion physical examination , echocardiography and treadmill exercise test were performed . RESULTS At 6-months follow-up chest pain and symptoms of heart failure were significantly less common ( p < 0.001 ) and a tendency for fewer new cardiac events and re-PCI was noted in GB . Self-evaluated , significantly greater improvement in the emotional and physical status as well as in physical activity ( p < 0.001 ) was achieved in GB . In GB better exercise tolerance on treadmill exercise test , greater improvement in left ventricular ejection fraction ( p < 0.05 ) and contractile index ( p < 0.05 ) on echocardiography were observed . The effects of the secondary prevention in terms of smoking cessation and obesity were not satisfactory in both groups . CONCLUSION 3-phases comprehensive cardiac rehabilitation in patients with AMI treated with PCI of the infa rct ion related artery improves recovery at 6-month follow-up . It has a favorable impact on the anginal and heart failure symptoms , cardiac risk factors ( especially physical activity , restrictive diet ) , psychological and physical status . It contributes towards maintaining a further event-free period . It improves selected cardiovascular parameters such as exercise tolerance , segmental and global left ventricular function BACKGROUND Current guidelines broadly recommend comprehensive cardiac rehabilitation ( CR ) , although evidence for this is still limited . It is not known whether evidence from before 1995 is still valid . STUDY DESIGN The DANish Cardiac ReHABilitation ( DANREHAB ) trial was design ed as a central ly r and omized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure , ischemic heart disease , or high risk for ischemic heart disease . A combined primary outcome measure included total mortality , myocardial infa rct ion , or readmissions due to heart disease based on linkage to public registries . The CR was an individually tailored , multidisciplinary program ( 6 weeks of intensive CR and 12 months of follow-up ) including patient education , exercise training , dietary counseling , smoking cessation , psychosocial support , risk factor management , and clinical assessment . STUDY POPULATION Of 5060 discharged patients , 1614 ( 32 % ) were eligible for the trial and 770 patients were r and omized ( 47 % of those eligible ) . Participants were younger ( P < .001 ) and had less comorbidity than non participants ( P < .03 ) . CONCLUSION Our trial shows that a large-scale , central ly r and omized clinical trial on comprehensive CR can be conducted among a broadly defined patient group , but reaching the stipulated number of 1800 patients was difficult . Although the study included relatively many women and older people , elderly patients and patients with high comorbidity were underrepresented , which may influence the external validity Background : Chronic obstructive pulmonary disease ( COPD ) is a leading cause of death across the world and will become increasingly common with an aging population . Pulmonary rehabilitation ( PR ) is an evidence -based , nonpharmacological intervention for individuals with COPD , targeting the secondary impairments of the disease . Although the benefits of participation in PR are well established , improvements in exercise tolerance and health status typically deteriorate following discharge . Challenges with long-term adherence to recommended exercise regimens are thought to explain much of this decline . Therefore , we developed a community-based exercise maintenance program for patients with COPD following discharge from PR . Objectives This manuscript ( 1 ) outlines the intervention , ( 2 ) describes how its effectiveness is being evaluated in a pragmatic r and omized controlled trial , and ( 3 ) summarizes the embedded process evaluation aim ing to underst and key barriers and facilitators for implementation in new environments . Methods Participating centers refer eligible individuals with COPD following discharge from their local PR program . Consenting patients are assigned to a year-long community exercise program or usual care using block r and omization and stratifying for supplemental oxygen use . Patients in the intervention arm are asked to attend an exercise session at least twice per week at their local community facility where their progress is supervised by a case manager . Each exercise session includes a component of aerobic exercise , and activities design ed to optimize balance , flexibility , and strength . All study participants will have access to routine follow-up appointments with their respiratory physician , and additional health care providers as part of their usual care . Assessment s will be completed at baseline ( post-PR ) , 6 , and 12 months , and include measures of functional exercise capacity , quality of life , self-efficacy , and health care usage . Intervention effectiveness will be assessed by comparing functional exercise capacity between intervention and control groups . A mixed- methods process evaluation will be conducted to better underst and intervention implementation , guided by Normalization Process Theory and the Consoli date d Framework for Implementation Research . Results Based on results from our pilot work , we anticipate a maintenance of exercise capacity and improved health-related quality of life in the intervention group , compared with a decline in exercise capacity in the usual care group . Discussion Findings from this study will improve our underst and ing of the effectiveness of community-based exercise programs for maintaining benefits following PR in patients with COPD and provide information on how best to implement them . If effective , the intervention represents an opportunity to transition patients from institutionally-based rehabilitative management to community-based care . The results of the process evaluation will contribute to the science of translating evidence -based programs into regular practice BACKGROUND Cardiac rehabilitation is widely recognized as a medical management procedure that reduces mortality , but the cardiovascular safety of exercise training has not been clearly established . Published data are retrospective or out date d , as patient management has substantially progressed in recent years . The aim of this prospect i ve registry was to determine the current complication rate during exercise performed in the course of cardiac rehabilitation . METHODS This study was conducted by the Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology . During a 1-year period , 65 cardiac rehabilitation centers reported that serious events had occurred during or 1 hour after an exercise stress test or a training session .  Severe cardiovascular events were vali date d by a scientific committee . RESULTS A total of 25,420 patients ( 78 % men ; mean age , 61.3 years ) were included in the study . Initial indications for cardiac rehabilitation were post-cardiac surgery ( coronary bypass , 34.3 % ; valvular surgery , 18.4 % ) ; recent percutaneous coronary intervention ( 21.6 % ) ; and other coronary ( 13.2 % ) and noncoronary ( 12.5 % ) conditions . The study population underwent 42,419 exercise stress tests and 743,471 patient-hours of exercise training . Twenty severe cardiac events were reported : 5 were related to exercise testing and 15 were related to exercise training . The event rate was 1 per 8484 exercise stress tests and 1 per 49,565 patient-hours of exercise training ; the cardiac arrest rate was 1.3 per million patient-hours of exercise . Neither fatal complications nor emergency defibrillations were reported . CONCLUSION The frequency of major cardiovascular complications during  supervised exercise training in France is quite low A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a st and ard evidence -based rehabilitation protocol . Eleven r and omized , controlled trials ( level 1 and 2 ) evaluating the effect of exercise in the treatment of impingement were identified . Data regarding demographics , methodology , and outcomes of pain , range of motion , strength , and function were recorded . Individual components of each rehabilitation program were catalogued . Effectiveness was determined by statistical and clinical significance . Although many articles had method ologic concerns , the data demonstrate that exercise has statistically and clinical ly significant effects on pain reduction and improving function , but not on range of motion or strength .  Manual therapy augments the effects of exercise  , yet supervised exercise was not different than home exercise programs . Information regarding specific components of the exercise programs was synthesized into a gold st and ard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement Background Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . Methods / Design This r and omised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be r and omly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . Discussion This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .Trial registration Clinical Trials.gov : NCT01423227 The British Heart Foundation and the Chest , Heart and Stroke Association have allocated funds to develop cardiac rehabilitation programmes . We have recently completed and now evaluate an exercise-based rehabilitation course reinforced with advice about return to normal activity for 110 patients who had suffered acute myocardial infa rct ion . Patients admitted to the Plymouth cardiac care unit were r and omised into groups : a control group to receive st and ard hospital care , and a rehabilitation group who , in addition , received an exercise programme reinforced with advice . Patients were assessed at entry to the study and at intervals thereafter . Assessment was by question naire and objective tests consisting of a 12-minute walking test and weekly outpatient pedometry . In the rehabilitation group patients were able to walk further and faster , return to work earlier , undertake more housework , and resume normal sexual activity ; they were less short of breath and did not experience more angina . However , the rehabilitation course brought little benefit to the patients ' perception of well-being and their anxiety about health or their outlook on life .  Exercise and advice are important components of a rehabilitation programme , but more attention needs to be given to the psychological aspects of recovery from a heart attack Background Despite the cardiovascular etiology of stroke , exercise and risk factor modification programs akin to cardiac rehabilitation ( CR ) are not available . This study aim ed to establish the feasibility of adapting a CR model for individuals with mild to moderate stroke disability . A secondary objective was to determine the program 's effects on aerobic and walking capacity , and stroke risk factors . Methods A repeated measures design was used with a 3-month baseline period and 6-month adapted CR intervention  ( n = 43 , mean ± SD age 65 ± 12 years , 30 ± 28 months post stroke ) . Feasibility was determined by the number of participants who completed the study , occurrence of adverse events and frequency , duration and intensity of exercise performed . To determine effectiveness of the program , outcomes measured included aerobic capacity ( VO2peak , ventilatory threshold ) , 6-Minute Walk Test ( 6MWT ) distance , and risk factors . Descriptive statistics characterized the classes attended and number and intensity of exercise sessions . Paired t-tests , one-factor repeated measures analyses of variance contrasts and chi-square analyses were used to compare changes over time . Results Two participants withdrew during the baseline period . Of the remaining 41 participants who commenced the program , 38 ( 93 % ) completed all aspects . No serious adverse effects occurred . Post-intervention , VO2peak improved relative to the stable baseline period ( P = 0.046 ) and the increase in ventilatory threshold approached significance ( P = 0.062 ) . Conclusions CR is feasible after stroke and may be adapted to accommo date for those with a range of post-stroke disability . It is effective in increasing aerobic capacity . CR may be an untapped opportunity for stroke survivors to access programs of exercise and risk factor modification to lower future event risk . Trial registration Clinical Trials.gov registration number : Background Cardiac rehabilitation is very important for the recovery and the secondary prevention of cardiovascular disease , and one of its main strategies is to increase the level of physical activity . Internet and mobile phone based interventions have been successfully used to help people to achieve this . One of the components that are related to the efficacy of these interventions is tailoring of content to the individual . This trial is study ing the effect of a longitudinally tailored Internet and mobile phone based intervention that is based on models of health behaviour , on the level of physical activity and the adherence to the intervention , as an extension of a face-to-face cardiac rehabilitation stay . Methods / Design A parallel group , cluster r and omized controlled trial . The study population is adult participants of a cardiac rehabilitation programme in Norway with home Internet access and mobile phone , who in monthly clusters are r and omized to the control or the intervention condition . Participants have access to a website with information regarding cardiac rehabilitation , an online discussion forum and an online activity calendar . Those r and omized to the intervention condition , receive in addition tailored content based on models of health behaviour , through the website and mobile text messages . The objective is to assess the effect of the intervention on maintenance of self-management behaviours after the rehabilitation stay . Main outcome is the level of physical activity one month , three months and one year after the end of the cardiac rehabilitation programme . The r and omization of clusters is based on a true r and om number online service , and participants , investigators and outcome assessor are blinded to the condition of the clusters . Discussion The study suggests a theory-based intervention that combines models of health behaviour in an innovative way , in order to tailor the delivered content . The users have been actively involved in its design , and because of the use of Open- Source software , the intervention can easily and at low-cost be reproduced and exp and ed by others . Challenges are the recruitment in the elderly population and the possible underrepresentation of women in the study sample . Funding by Northern Norway Regional Health Authority . Trial registration Trial registry http://www . clinical trials.gov : NCT01223170 BACKGROUND Hospital and home-based cardiac rehabilitation programmes improve the health outcomes of cardiac patients . Both types of programmes include patient education as a core component . However , many patients do not attend cardiac rehabilitation programmes for a variety of reasons . In Singapore , where cardiac rehabilitation is comparatively uncommon , patient education is usually delivered face-to-face by healthcare professionals because educational material s design ed specifically for cardiac patients recovering at home are not available . AIM This paper describes the development of a patient education booklet design ed to aid recovery at home after a myocardial infa rct ion in Singapore . METHODS The conception and development of this evidence -based Heart Recovery Education Booklet was based on patient need and current clinical guidelines pertaining to cardiac rehabilitation and planned in consultation with specialists such as cardiologists , psychiatrists and physiotherapists . RESULTS The booklet is a patient re source to aid recovery at home after an myocardial infa rct ion . It is interactive , based on identified need and aims to guide and assist the patient in performing their usual activities of daily living and adhering to treatment regimens , including exercise . CONCLUSION This booklet is a re source for patients with myocardial infa rct ion and healthcare professionals and its effectiveness in improving health-related quality of life , psychological status and coronary risk profile is to be tested in a r and omized controlled trial . IMPLICATION S FOR NURSING AND HEALTH POLICY Policy makers in health and nursing must find ways of developing and implementing cardiac rehabilitation programmes that aid recovery from myocardial infa rct ion . This education booklet offers one way to do this Background The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established . Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low . Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors . Objectives The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease . Search strategy A literature search was performed using the following data bases MEDLINE ( 1966‐2006 ) , CINAHL ( 1982‐2006 ) , EMBASE ( 1980‐current ) and up to the Cochrane Controlled Trials Register ( Issue 2 , 2006 of Cochrane Library ) . In addition , the reference lists of relevant trials and conference proceedings were also scrutinised . Company representatives , experts and investigators were contacted to elicit further information . Selection criteria All r and omised and quasi‐r and omised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review . Data collection and analysis Eligibility of the trials for inclusion in the review , details of eligible trials and the method ological quality of the trials were assessed independently by two review ers . Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals . Where synthesis was inappropriate , trials were considered separately . Main results Seventeen trials involving a total of 4725 participants were included in the final review : three trials compared the effects of brief structured interventions  on diet modification ; seven on smoking cessation ; and seven on multiple risk factors . Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification . Although there was a tendency for more participants in the intervention arm to lose weight at the 12‐week follow up and achieve target cholesterol levels at the 6‐month follow up , these results were not statistically significant . Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary  modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention . However , no difference in fish , fruit and vegetable intake between the groups was evident . Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation . There was no difference in the smoking cessation rates at the 3‐ and 6‐week follow up , however , there was evidence of a benefit of brief structured interventions  for smoking cessation at the 3‐ , 6‐ and 12‐month follow up . In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups . In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake , weight loss and consequently on reduction in the body mass index , smoking cessation and physical activity among the participants . The findings concerning the effect on blood pressure , blood glucose levels and the lipid profile , however , remain inconclusive . Conclusions There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease . This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease . Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Cardiac rehabilitation ( CR ) is aim ed at improving health behaviors to slow or reverse the progression of CVD disease . Exercise is a central element of CR . Technologies such as mobile phones and the Internet ( mHealth ) offer potential to overcome many of the psychological , physical , and geographical barriers that have been associated with lack of participation in exercise-based CR . We aim to trial the effectiveness of a mobile phone delivered exercise-based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD . This paper outlines the rationale and methods of the trial . Methods A single-blinded parallel two-arm r and omized controlled trial is being conducted . A total of 170 people will be r and omized at 1:1 ratio either to receive a  mHealth CR program  or usual care .  Participants are identified by CR nurses from two metropolitan hospitals in Auckl and , New Zeal and through outpatient clinics and existing data bases . Consenting participants are contacted to attend a baseline assessment . The intervention consists of a theory-based , personalized , automated package of text and video message components via participants ' mobile phones and the Internet to increase exercise behavior , delivered over six months . The control group will continue with usual CR . Data collection occurs at baseline and 24 weeks ( post-intervention ) . The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks . Secondary outcomes include post-intervention measures on self-reported physical activity ( IPAQ ) , cardiovascular risk factors ( systolic blood pressure , weight , and waist to hip ratio ) , health related quality of life ( SF-36 ) , and cost-effectiveness . Discussion This manuscript presents the protocol for a r and omized controlled trial of a mHealth exercise-based CR program . Results of this trial will provide much needed information about physical and psychological well-being , and cost-effectiveness of an automated telecommunication intervention . If effective , this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally ( and internationally ) in a very short time , enhancing the translational aspect of this research . It also has potential to extend to comprehensive CR ( nutrition advice , smoking cessation , medication adherence).Trial Registration Objective : To determine the short- and long-term effects of an intensive , concentrated rehabilitation programme in patients with chronic heart failure . Design : R and omized controlled trial , with one-month and six-year evaluations . Setting : Residential rehabilitation centre in Switzerl and . Subjects : Fifty patients with chronic heart failure , r and omized to exercise or control groups . Interventions : A rehabilitation programme lasting one month , including educational sessions , a low-fat diet , and 2 hours of individually prescribed exercise daily . Main measures : Exercise test responses , health outcomes and physical activity patterns . Results : Peak Vo2 increased 21.4 % in the exercise group during the rehabilitation programme ( P<0.05 ) , whereas peak Vo2 did not change among controls . After the six-year follow-up period , peak Vo2 was only slightly higher than that at baseline in the trained group ( 7 % , NS ) , while peak Vo2 among controls was unchanged . During long-term follow-up , 9 and 12 patients died in the exercise and control groups , respectively ( P = 0.63 ) . At six years , physical activity patterns tended to be higher in the exercise group ; the mean energy expenditure values over the last year were 2704 ± 1970 and 2085 ± 1522 kcal/week during recreational activities for the exercise and control groups , respectively . However , both groups were more active compared to energy expenditure prior to their cardiac event ( P<0.001 ) . Conclusions : Six years after participation in a residential rehabilitation programme , patients with chronic heart failure had slightly better outcomes than control subjects , maintained exercise capacity and engaged in activities that exceed the minimal amount recommended by guidelines for cardiovascular health Objective To compare home-based cardiac rehabilitation ( CR ) with usual care ( control group with no rehabilitation ) in elderly patients who declined participation in centre-based CR . Design R and omised clinical trial with 12 months follow-up and mortality data after 5.5 years ( mean follow-up 4½ years ) . Setting Rehabilitation unit , Department of Cardiology , Copenhagen , Denmark . Participants Elderly patients ≥65 years with coronary heart disease . Intervention A physiotherapist made home visits in order to develop an individualised exercise programme that could be performed at home and surrounding outdoor area . Risk factor intervention , medical adjustment , physical and psychological assessment s were offered at baseline and after 3 , 6 and 12 months . Main outcome measurements The primary outcome was 6 min walk test ( 6MWT ) . Secondary outcomes were blood pressure , body composition , cholesterol profile , cessation of smoking , health-related quality of life ( HRQoL ) , anxiety and depression . Results 40 patients participated . The study population was characterised by high age ( median age 77 years , range 65–92 years ) and high level of comorbidity . Patients receiving home-based CR had a significant increase in the primary outcome 6MWT of 33.5 m ( 95 % CI : 6.2 to 60.8 , p=0.02 ) at 3 months , whereas the usual care group did not significantly improve , but with no significant differences between the groups . At 12 months follow-up , there was a decline in 6MWT in both groups ; −55.2 m ( 95 % CI : 18.7 to 91.7 , p<0.01 ) in the home group and −52.1 m ( 95 % CI : −3.0 to 107.1 , p=0.06 ) in the usual care group . There were no significant differences in blood pressure , body composition , cholesterol profile , cessation of smoking or HRQoL after 3 , 6 and 12 months follow-up . Conclusions Participation in home-based CR improved exercise capacity among elderly patients with coronary heart disease , but there was no significant difference between the home intervention and the control group . In addition , no significant difference was found in the secondary outcomes . When intervention ceased , the initial increase in exercise capacity was rapidly lost Background : Short hospital stays for patients with acute coronary syndromes ( ACSs ) reduce the opportunity for risk factor intervention during admission . After discharge , cardiac rehabilitation can decrease the recurrence of coronary events by up to 25 % . However , it remains underused . Objectives : The aim of this study was to determine whether a nursing intervention focused on individual ACS patients ’ perceptions of their disease and treatment would increase rehabilitation enrollment after discharge . Method : A total of 242 ACS patients admitted to a specialized tertiary cardiac center were r and omized to either the intervention or  usual care  ( n = 121 in both groups ) . The intervention included one nurse – patient meeting before discharge with 2 additional contacts over the 10 days after discharge ( mean duration = 40 minutes per contact ) . The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge . Secondary outcomes included illness perceptions ; family support ; anxiety level ; medication adherence ; and cardiac risk factors including lack of exercise , smoking , body mass index , and diet . Results : The sample was composed of a majority of male , married workers who experienced a myocardial infa rct ion or unstable angina without severe complications . The mean hospital stay in both groups was 3.6 days . There was a significantly higher rate of rehabilitation enrollment in the intervention group ( 45 % ) than in the control group ( 24 % ; p = .001 ) . For the secondary outcomes , only the personal control dimension of illness perceptions was improved significantly with the intervention . Discussion : Progressive , individualized interventions by nurses result ed in greater rehabilitation enrollment , thereby potentially improving long-term outcome BACKGROUND Despite proven benefits of cardiac rehabilitation ( CR ) , adherence to CR remains suboptimal . This trial aim ed to assess the impact of the patient education ' Learning and Coping Strategies ' ( LC ) on patient adherence to an eight-week CR program . METHODS 825 patients with ischaemic heart disease or heart failure were open label r and omised to either the LC arm ( LC plus CR ) or the control arm ( CR alone ) across three hospital units in Denmark . Both arms received same amount of training and education hours . LC consisted of individual clarifying interviews , participation of experienced patients as co-educators , situational , reflective and inductive teaching . The control arm received structured deductive teaching . The primary outcomes were patient adherence to at least 75 % of the exercise training or education sessions . We tested for subgroup effects on the primary outcomes using interaction terms . The primary outcomes were compared across arms using logistic regression . RESULTS More patients in the LC arm adhered to at least 75 % of the exercise training sessions than control ( 80 % versus 73 % , adjusted odds ratio (OR):1.48 ; 95 % CI:1.07 to 2.05 , P=0.018 ) and 75 % of education sessions ( 79 % versus 70 % , adjusted OR:1.61 , 1.17 to 2.22 , P=0.003 ) . Some evidence of larger effects of LC on adherence was seen for patients with heart failure , low education and household income . CONCLUSIONS Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education . Patients with heart failure , low levels of education and household income appear to benefit most from this adherence promoting intervention . TRIAL REGISTRATION www . clinical trials.gov identifier NCT01668394 OBJECTIVE To assess the effects of phase I cardiac rehabilitation intervention on anxiety of patients hospitalized for coronary artery bypass graft ( CABG ) surgery . DESIGN Prospect i ve , quasi-experimental , r and om assignment , repeated measurements . SETTING The Veterans General Hospital Taipei , Taiwan , Republic of China . PATIENTS Seventy patients were r and omly assigned to ( 1 ) the phase I cardiac rehabilitation intervention ( experimental ) group and ( 2 ) the nonintervention ( comparison ) group . Ultimately , 60 subjects were included in the data analyses . OUTCOME MEASURES Psychological status was evaluated by the state of anxiety scores on the State-Trait Anxiety Inventory . Anxiety scores were measured 3 times : ( 1 ) after admission , before the patient underwent CABG surgery ; ( 2 ) the day before the patient underwent CABG surgery ; and ( 3 ) the day of discharge from the hospital . INTERVENTION Individual instruction in progressive exercises and daily activities according to the phase I cardiac rehabilitation program ( Chinese manual ) were used during hospitalization . RESULTS Data analysis was performed with use of generalized estimating equations ( GEE ) to assess the between- and within-group variations . The mean anxiety for all subjects before undergoing CABG surgery was 42.6 . The mean anxiety on the day before undergoing CABG surgery was 33.7 in the experimental group and 49.8 in the comparison group ; there were statistical differences , with a P < .05 level of significance between these 2 groups . The mean anxiety on the day of discharge in the experimental group was 28.6 and in the comparison group was 38.4 ; there were statistical differences , with a P < .05 level of significance between these 2 groups . CONCLUSIONS These results have been supported by similar studies . This finding suggests that application of phase I cardiac rehabilitation intervention can reduce the anxiety level during hospitalization of patients undergoing CABG surgery BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge BACKGROUND A cardiac rehabilitation and prevention program ( CRPP ) is a recognized nonpharmacological modality in the management of coronary heart disease ( CHD ) . However , the effect of a CRPP on systolic function of the heart is controversial , and no data exists on diastolic function in CHD . A r and omized , controlled study was conducted to address these issues . METHODS Patients ( n = 269 ) with recent acute myocardial infa rct ion ( n = 193 ) or after percutaneous coronary intervention ( PCI ) ( n = 76 ) were r and omized to either CRPP ( 2-hour twice-weekly exercise program for 8 weeks ) or conventional therapy ( control group ) . Serial treadmill exercise testing and at-rest echocardiography were performed during phases 1 ( baseline ) , 2 ( post-exercise training ) , and 3 ( 8-month follow up ) . RESULTS The prevalence of left ventricular ( LV ) abnormal relaxation pattern ( ARP ) of diastolic dysfunction was increased in the control group only in phase 3 ( 65 % vs 88 % , chi2 = 7.6 , P < .01 ) . Significant improvement of individual LV diastolic parameters towards less severe delayed relaxation was also observed in the CRPP group , especially in those with recent acute myocardial infa rct ion or ARP . The gain in exercise capacity was faster and more substantial in the CRPP than the control group ( P < .001 for phase 2 , P < .05 for phase 3 ) , and was significantly correlated with LV diastolic indices in those with ARP . Exercise training had neutral effects on LV systolic function and rate-pressure product . CONCLUSIONS In patients with CHD , CRPP prevented the progression of resting LV diastolic dysfunction , without affecting systolic function . In those with ARP , the improvement of diastolic function predicted the gain in exercise capacity AIMS To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity , psychological well-being and quality of life in patients with coronary heart disease . BACKGROUND Cardiac rehabilitation ( CR ) in short term improves exercise capacity and quality of life in patients with cardiac disease . However , the long-term benefits of CR are inconclusive . DESIGN A prospect i ve CR programme with repeated measures follow-up over 12 months . METHODS A six-week outpatient cardiac rehabilitation programme  was conducted including 147 patients with coronary heart disease . Patients completed the  physical activity energy expenditure ( seven-day recall activity ) , MacNew Heart Disease Health-Related Quality of Life ( MacNew ) and Hospital Anxiety and Depression scale ( HADs ) at baseline , six weeks , six and 12 months . RESULTS One hundred and five ( 71 % ) patients ( 76 male ) mean age of 61.8 ( SD 9.7 ) completed the four-measurement points . Analysis of variance revealed that total energy expenditure ( F ( 2 , 231 ) = 131 , p < 0.001 ) , HADs ( F ( 2 , 237 ) = 19.3 , p < 0.001 ) , depression score ( F ( 2 , 235 ) = 21.06 , p < 0.001 ) , anxiety score ( F ( 2,237 ) = 17.02 , p < 0.001 ) and MacNew ( F ( 2 , 197 ) = 77.02 , p < 0.001 ) were all statistically significant over time . Bonferroni pairwise follow-up confirmed significant positive differences ( p < 0.05 ) between baseline values and all subsequent measures over time . Depression was independently explained in 22 % of the variance in quality of life at 6 or 12 months . The energy expenditure was significantly higher for men compared to women ( F ( 1 , 103 ) = 31 , p < 0.001 ) . CONCLUSION A six-week cardiac rehabilitation programme is beneficial in improving quality of life , physical activity status , anxiety and depression . These benefits were maintained at 12 months . Elevated levels of depression were associated with impaired quality of life . RELEVANCE TO CLINICAL PRACTICE All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme . Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes AIM To analyze the impact of a home exercise training ( ET ) program on quality of life , motor activity ( MA ) , dietary habit , functional and biochemical parameters , and clinical course of the disease in patients who have experienced acute coronary syndrome ( ACS ) and /or endovascular coronary intervention ( ECI ) . SUBJECTS AND METHOD The trial included 100 patients after ECL who were r and omized into 2 groups : those who had gone through Patient School ( PS ) and received a 6-week course of controlled ET ( a study group ( Group S ) ) and those who had gone through PS only ( a control group ( Group C ) . The patients of both groups were recommended a home ET program and , according to its implementation , they formed 2 subgroups : Subgroup A ( home ET+ ) comprising 51 patients who had trained themselves at home ) and Subgroup B ( home ET- ) consisting of 46 patients who had not . The follow-up lasted 1 year . Quality of life , risk factors , lifestyle and clinical parameters were assessed . RESULTS As time elapsed , the patients ' motivation to perform home ET ;  and , accordingly , the proportion of those who had trained themselves decreased in Group S to 67 and 61 % and in Group C to 39 and 40 % after 6 and 12 months , respectively . Among the reasons for refusal to perform home ET , disease was reported by only 5.6 % of the patients ( by all from Group C ) . The comprehensive physical rehabilitation program ( RP ) ( controlled ET in combination with home ET ) produced the best effect in raising the level of daily MA , exercise performance with a 21.3-fold increase in cardiac performance ( p < 0.05 ) and a 14.3-fold decrease in heart rate increment in response to exercises . Group C patients who had refused the home ET program , as compared to those in the same group who had trained themselves at home , showed the worst daily MA levels , none body mass index reduction , and a rise in the low-density lipoprotein cholesterol ( by 20.3 % ; p < 0.05 ) and in the number of angina attacks ( by 1.9 times ; p < 0.05 ) . CONCLUSION RP in the early-stage , which encompasses an educational program ( PS ) , a short-term course of controlled ET and home ET used in patients with ACS , including in those after ECI , has clear clinical benefits . The participation of patients with coronary heart disease ( CHD ) in the home ET programs increases their motivation and , hence , the proportion of those who participate in therapeutic and rehabilitation measures . Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services Objective : To study the effects of three individualized exercise training prescriptions using either a percentage of maximal heart rate ( HR ) , maximal 6-minute walk test ( 6MWT ) HR , or maximal 200-metre fast walk test ( 200-mFWT ) HR , on walking performance and exercise capacity in coronary artery disease ( CAD ) patients . Design : Controlled clinical study . Participants : Twenty-seven out patients enrolled in a rehabilitation programme after an acute coronary syndrome . Setting : Cardiac rehabilitation unit . Interventions : Three groups : ( A ) : moderate intensity continuous exercise ( MICE ) at 70 % of the maximal HR of the grade d maximal exercise test ( n = 10 ) ; ( B ) : MICE at the maximal 6MWT HR ( n = 8) ; ( C ) : high intensity interval training ( HIIT ) based on the 6MWT and the 200-mFWT maximal HR ( n = 9 ) . Group B and C performed walk tests every 2 weeks , to readjust training HR ( THR ) if needed . Measures : 6MWT and 200-mFWT performances , peak VO2 and peak power ( Pmax ) . Results : 6MWT and 200-mFWT performances improved significantly and similarly in all groups ( P < 0.05 ) . Peak VO2 improved significantly in all groups ( P < 0.05 ) , this improvement being higher in group C ( HIIT ) versus A ( P < 0.05 ) . Group B was closer to the recommended THR during exercise sessions compared to group A. Conclusion : This pilot study showed that using the 6MWT and 200-mFWT HR to individualize MICE or HIIT prescription is feasible in CAD patients , and could lead them closer to THR objective , to similar improvements in walking performance , and greater peak VO2 increase for HIIT . Future r and omised studies should investigate long-term effects of programmes prescribed from walk tests HR , especially for HIIT modality Background Heart valve diseases are common with an estimated prevalence of 2.5 % in the Western world . The number is rising due to an ageing population . Once symptomatic , heart valve diseases are potentially lethal , and heavily influence daily living and quality of life . Surgical treatment , either valve replacement or repair , remains the treatment of choice . However , post surgery , the transition to daily living may become a physical , mental and social challenge . We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery . Methods A r and omised clinical trial , CopenHeartVR , aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery . The trial will r and omly allocate 210 patients , 1:1 intervention to control group , using central r and omisation , and blinded outcome assessment and statistical analyses . The intervention consists of 12 weeks of physical exercise , and a psycho-educational intervention comprising five consultations . Primary outcome is peak oxygen uptake ( VO2 peak ) measured by cardiopulmonary exercise testing with ventilatory gas analysis . Secondary outcome is self-assessed mental health measured by the st and ardised question naire Short Form 36 . Also , long-term healthcare utilisation and mortality as well as biochemistry , echocardiography and cost-benefit will be assessed . A mixed- method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study . Discussion The study is approved by the local regional Research Ethics Committee ( H-1 - 2011 - 157 ) , and the Danish Data Protection Agency ( j.nr . 2007 - 58 - 0015).Trial registration Clinical Trials.gov ( http://NCT01558765 ) OBJECTIVE Autonomic dysfunction may contribute to the etiology and exercise intolerance of sub clinical diabetic heart disease . This study sought the efficacy of exercise training for improvement of peak oxygen uptake ( VO₂(peak ) ) and cardiac autonomic function in type 2 diabetic patients with non-ischemic sub clinical left-ventricular ( LV ) dysfunction . MATERIAL S/ METHODS Forty-nine type 2 diabetic patients with early diastolic tissue Doppler velocity > 1 st and ard deviation below the age-based mean entered an exercise intervention ( n=24 ) or usual care ( n=25 ) for 6-months ( controlled , pre-/post- design ) . Co- primary endpoints were treadmill VO₂(peak ) and 5-min heart-rate variability ( by the coefficient of variation of normal RR intervals [ CVNN ] ) . Autonomic function was additionally assessed by resting heart-rate ( for sympathovagal balance estimation ) , baroreflex sensitivity , cardiac reflexes , and exercise/recovery heart-rate profiles . Echocardiography was performed for LV function ( systolic/diastolic tissue velocities , myocardial deformation ) and myocardial fibrosis ( calibrated integrated backscatter ) . RESULTS VO₂(peak ) increased by 11 % during the exercise intervention ( p=0.001 vs. -1 % in controls ) , but CVNN did not change ( p=0.23 ) . Reduction of resting heart-rate in the intervention group ( p<0.05 ) was associated with an improvement in the secondary endpoint of heart-rate variability total spectral power ( p<0.05 ) . However , baroreflex sensitivity , cardiac reflexes , and exercise/recovery heart-rate profiles showed no significant benefit . No effects on LV function were observed despite favorable reduction of calibrated integrated backscatter in the intervention group ( p<0.05 ) . CONCLUSIONS The exercise intolerance of sub clinical diabetic heart disease was amenable to improvement by exercise training . Despite a reduction in resting heart-rate and potential attenuation of myocardial fibrosis , no other cardiac autonomic or LV functional adaptations were detected Background : Despite participation in a cardiac rehabilitation program , there is a downward trajectory of exercise participation during the year following a cardiac event . Purpose : The purpose of this study was to test the effectiveness of CHANGE ( Change Habits by Applying New Goals and Experiences ) , a lifestyle modification program design edto increase exercise maintenance in the year following a cardiac rehabilitation program . The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement , problem-solving skills , and relapse prevention strategies to address exercise maintenance problems . Method : Participants ( N = 250 ) were r and omly assigned to the CHANGE intervention ( supplemental to usual care ) or a usual-care-only group . Exercise  was measured using portable wristwatch heart rate monitors worn during exercise for 1 year . Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups . Results : Participants in the usual-care group were 76 % more likely than those in the  CHANGE group to stop exercising during the year following a cardiac rehabilitation program ( hazard ratio = 1.76 , 95 % confidence interval = 1.08–2.86 , p = .02 ) when adjusting for the significant covariates race , gender , comorbidity , muscle and joint pain , and baseline motivation . Most participants , however , had less than recommended levels of exercise amount and intensity . Conclusions : Counseling interventions that use contemporary behavior change strategies , such as theCHANGEintervention , can reduce the number of individuals who do not exercise following cardiac events Background Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease . However , fewer than 5 % of eligible individuals receive pulmonary rehabilitation on an annual basis , largely due to limited availability of services and difficulties associated with travel and transport . The Rehabilitation Exercise At Home ( REAcH ) study is an assessor-blinded , multi-centre , r and omised controlled equivalence trial design ed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease . Methods Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training , either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet . Supervised exercise training sessions will include 30 min of aerobic exercise ( cycle and /or walking training ) . Individualised education and self-management training will be delivered . All participants will be prescribed a home exercise program of walking and strengthening activities . Outcomes will be assessed by a blinded assessor at baseline , after completion of the intervention , and 12-months post intervention . The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Question naire – dyspnea domain ( CRQ-D ) . Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance , endurance cycle time during a constant work rate test , physical activity and quality of life . Adherence to pulmonary rehabilitation between the two models will be compared . A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation . Discussion Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes . This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation . If efficacious and cost-effective , the proposed telerehabilitation model is design ed to be rapidly deployed into clinical practice .Trial registration Clinical trial registered with the Australian and New Zeal and Clinical Trials Register at ( ACTRN12616000360415 ) . Registered 21 March 2016 OBJECTIVES The health benefits of high-intensity interval training in cardiac rehabilitation warrant further research . We compared the effectiveness of low-volume high-intensity interval training vs continuous aerobic exercise training in chronic heart failure . DESIGN / SETTING S Unblinded , two arm parallel design with r and om assignment to exercise interventions in out-patient hospital rehabilitation gym . METHODS Patients with signs of chronic heart failure and ejection fraction < 45 % , ( mean age : 59.1 years ( st and ard deviation ( SD ) 8.6 ) ; 3 women ) completed 6 months of exercise using continuous aerobic exercise training ( n = 9 ) or high-intensity interval training ( n = 8) . Cardiorespiratory fitness was determined during cycle ergometry using respiratory gas exchange analysis .  Functional capacity was assessed via sit-to-st and and gait speed . Quality of life was assessed using the MOS Short-Form 36 and Minnesota living with heart failure question naires . Cardiac autonomic regulation was assessed using Heart Rate Variability . RESULTS Analysis of Covariance revealed significant time effects but no group × time interactions for exercise and functional capacity outcomes . Peak oxygen uptake ( VO2peak ) improved by a mean of 14.9 % ( SD 16.3 % ) from baseline and by 22 % ( SD 28.3 ) at ventilatory threshold in both groups . Sit-to-st and ( 11.9 ( SD 11 % ) ) and gait speed ( 16.0 ( SD 19 % ) ) improved similarly in both groups . No changes in quality of life or heart rate variability were noted . Training adaptations in high-intensity interval training were achieved despite a significantly reduced time commitment and total work volume compared to continuous aerobic exercise training . CONCLUSION Low-volume high-intensity interval training is a feasible and well tolerated training modality in cardiac rehabilitation setting s , but is not more effective than continuous aerobic exercise training Introduction Atrial fibrillation affects almost 2 % of the population in the Western world . To preserve sinus rhythm , ablation is undertaken in symptomatic patients . Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physically active due to fear of triggering fibrillation . Small trials indicate that exercise training has a positive effect on exercise capacity and mental health , and both patients with recurrent atrial fibrillation and in sinus rhythm may benefit from rehabilitation in managing life after ablation . No r and omised trials have been published on cardiac rehabilitation for atrial fibrillation patients treated with ablation that includes exercise and psychoeducational components . Aim To test the effects of an integrated cardiac rehabilitation programme versus treatment as usual for patients with atrial fibrillation treated with ablation . Methods and analysis design The trial is a multicentre parallel arm design with 1:1 r and omisation to the intervention and control group with blinded outcome assessment . 210 patients treated for atrial fibrillation with radiofrequency ablation will be included . The intervention consists of a rehabilitation programme including four psychoeducative consultations with a specially trained nurse and 12 weeks of individualised exercise training , plus the st and ard medical follow-up . Patients in the control group will receive the st and ard medical follow-up . The primary outcome measure is exercise capacity measured by the VO2 peak . The secondary outcome measure is self-rated mental health measured by the Short Form 36 question naire . Postintervention , qualitative interviews will be conducted in 10 % of the intervention group . Ethics and dissemination The protocol is approved by the regional research ethics committee ( number H-1 - 2011 - 135 ) , the Danish Data Protection Agency ( reg . nr . 2007 - 58 - 0015 ) and follows the latest version of the Declaration of Helsinki . The results will be published in peer- review ed journals and may possibly impact on rehabilitation guidelines . Trial registration Clinical trials.gov identifier : NCT01523145 OBJECTIVES To test the hypothesis that exercise training ( ET ) improves exercise capacity and other clinical outcomes in older persons with heart failure with reduced ejection fraction ( HfrEF ) . DESIGN R and omized , controlled , single-blind trial . SETTING Outpatient cardiac rehabilitation program . PARTICIPANTS Fifty-nine patients aged 60 and older with HFrEF recruited from hospital records and referring physicians were r and omly assigned to a 16-week supervised ET program ( n=30 ) or an attention-control , nonexercise , usual care control group ( n=29 ) . INTERVENTION Sixteen-week supervised ET program of endurance exercise ( walking and stationary cycling ) three times per week for 30 to 40 minutes at moderate intensity regulated according to heart rate and perceived exertion . MEASUREMENTS Individuals blinded to group assignment assessed four domains pivotal to HFrEF pathophysiology : exercise performance , left ventricular ( LV ) function , neuroendocrine activation , and health-related quality of life ( QOL ) . RESULTS At follow-up , the ET group had significantly greater exercise time and workload than the control group , but there were no significant differences between the groups for the primary outcomes : peak exercise oxygen consumption ( VO(2 ) peak ) , ventilatory anaerobic threshold ( VAT ) , 6-minute walk distance , QOL , LV volumes , EF , or diastolic filling . Other than serum aldosterone , there were no significant differences after ET in other neuroendocrine measurements . Despite a lack of a group " training " effect , a subset ( 26 % ) of individuals increased VO(2 ) peak by 10 % or more and improved other clinical variables as well . CONCLUSION In older patients with HFrEF , ET failed to produce consistent benefits in any of the four pivotal domains of HF that were examined , although the heterogeneous response of older patients with HFrEF to ET requires further investigation to better determine which patients with HFrEF will respond favorably to ET
Conclusions Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease .
While our analysis was constrained by the quality of included trials and missing information about intervention components , there appears to be little differential effect of variations in exercise intervention , particularly on mortality outcomes .
Background While the clinical benefits of exercise-based cardiac rehabilitation are well established , there is extensive variation in the interventions used within these trials .
It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes .
This study aims to systematic ally examine the relationship between individual components of the exercise intervention in cardiac rehabilitation ( such as intensity and frequency ) and clinical outcomes for people with coronary heart disease .