A randomized controlled trial of an eight-week cardiac rehabilitation home verse hospital exercise programme for post coronary cardiac bypass patients

Abstract Background The prevalence and morbidity and mortality rates of coronary heart disease (CHD) continue to increase towards epidemic proportions in the Kingdom of Saudi Arabia (KSA). Despite the advances in Cardiac surgery, currently there are no established out-patient phase program of Cardiac Rehabilitation (CR) for CHD participants in KSA. Aim of the study To evaluate the effectiveness of a home-based CR (Home CR) program using individualized exercise (Physiotools-R) and out-patient phase of CR (Hospital CR) program compared to standard care of home instructions on physical function, physiological and psychological status, body composition and the quality of life of the CHD participants post Coronary Artery Bypass Graft (CABG) surgery. Methods 73 participants post-CABG surgery were randomly assigned to one of three groups: Hospital CR group (n=25), Home CR group (n=24) and Control group (n=24). Outcome measures include Incremental Shuttle Walk Test (ISWT), Metabolic Equivalent Tasks (METs), Psychosocial outcomes and body composition were recorded at baseline, eight weeks of CR intervention, and after four weeks of observation follow up. Intervention: Hospital CR program comprised of group based Aerobic Circuit Training, home based structured individualized exercise program. Each programme had 2 hours’ sessions, 3 times a week for 8 weeks, followed by four weeks of observation follow-up. The control group followed standard care comprised usual advice on post-operation precautions. Results Post intervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures Conclusion Home-based CR is as effective as hospital-based CR at improving exercise capacity in patients following CABG surgery. Home-based CR appears to be more effective at maintaining these improvements with no further input in the longer term.