Comparative Effectiveness of Cardiac Rehabilitation on Functional Capacity and Physical Activity Duration among Post-Revascularization Patients in a Tertiary Care Setting in Pakistan

Abstract INTRODUCTION Cardiovascular disease remains a leading cause of global morbidity and mortality, with revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention being commonly performed interventions. Despite these procedures, patients frequently experience diminished functional capacity and quality of life. Cardiac rehabilitation (CR) is a proven strategy for improving post-surgical outcomes, yet participation remains notably low in low-resource settings such as Pakistan. METHODS This comparative study enrolled 501 post-revascularization patients at a tertiary cardiac care center in Karachi, Pakistan between January 2020 and December 2022. Participants were categorized into attenders (n = 250) who completed ≥ 15 structured CR sessions within 8 weeks, and non-attenders (n = 251) who attended fewer sessions. Exercise capacity was measured using peak metabolic equivalents, while exercise duration was assessed as moderate-to-vigorous physical activity in minutes per week. Assessments were conducted at baseline, 8-week follow-up, and one-year follow-up. Non-parametric statistical tests including Wilcoxon signed-rank and Mann-Whitney U tests were employed for analysis. RESULTS Both groups demonstrated improvements in peak metabolic equivalents and moderate-to-vigorous physical activity from baseline to follow-up. However, CR attenders showed significantly greater median improvements in peak metabolic equivalents (1.41 vs 0.76, p < 0.001) and moderate-to-vigorous physical activity (175.0 vs 35.0 minutes/week, p < 0.001) compared to non-attenders. Baseline characteristics including age, gender, and blood pressure were comparable between groups. CONCLUSION Structured CR significantly enhances exercise capacity and physical activity duration in post-revascularization patients, with attenders demonstrating substantially greater improvements than non-attenders. These findings underscore the vital role of organized CR in optimizing recovery outcomes in low-resource settings and support the expansion of such programs in Pakistan.