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The Impact of Reduced Cardiac Rehabilitation on Maximal Treadmill Exercise Time: A RANDOMIZED CONTROLLED TRIAL

Farias-Godoy, Alejandra, MD, PhD; Chan, Sammy, MD; Claydon, Victoria, E., PhD; Ignaszewski, Andrew, MD; Mendell, Joanna, MPH; Park, Julie, E., MMath; Singer, Joel, PhD; Lear, Scott, A., PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: January 2018 - Volume 38 - Issue 1 - p 24–30
doi: 10.1097/HCR.0000000000000269
Cardiac Rehabilitation

Purpose: Cardiac rehabilitation programs (CRPs) remain underutilized partly because of access barriers. We therefore evaluated a CRP with fewer center-based sessions (rCRP) compared with standard CRP (sCRP) with respect to changes in exercise capacity and cardiac risk factors.

Methods: In this randomized controlled noninferiority trial, primary and secondary prevention patients at low and moderate risk were randomized to an sCRP (n = 60) or an rCRP (n = 61). Over 4 months, sCRP and rCRP participants attended 32 and 10 on-site cardiac rehabilitation sessions, respectively. The primary outcome was the difference in the change in exercise capacity from baseline at 4 and 16 months between the groups measured in seconds from a maximal treadmill exercise test. Noninferiority of the rCRP was tested with mixed-effects model analysis with a cut point of 60 seconds for the upper value of the group estimate.

Results: Attendance was higher for the rCRP group (97% ± 63% vs 71% ± 22%, P = .002). Over 16 months, exercise test time increased for the sCRP (524 ± 168 to 604 ± 172 seconds, P < .01) and the rCRP (565 ± 183 to 640 ± 192 seconds, P < .01). The rCRP was not inferior to the sCRP regarding changes in treadmill time (48.47 seconds, P = .454). The rCRP was not inferior to the sCRP regarding metabolic and anthropometric risk factors.

Conclusion: Our findings suggest that, for a selected group of low-/moderate-risk patients, the number of center-based CRP exercise sessions can be decreased while maintaining reduced cardiovascular risk factors.

In this randomized controlled noninferiority study, we evaluated a reduced cardiac rehabilitation program (CRP) using one-third of centerbased exercise sessions (rCRP) compared with standard CRP (sCRP). rCRP was not inferior to sCRP regarding changes in exercise capacity and metabolic and anthropometric risk factors. rCRP has the potential to reduce CRP access barriers.

Department of Biomedical Physiology and Kinesiology (Drs Farias-Godoy, Claydon, and Lear) and Faculty of Health Sciences (Ms Mendell and Dr Lear), Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Healthy Heart Program, St Paul's Hospital, Vancouver, British Columbia, Canada (Drs Chan, Ignaszewski, Singer, and Lear); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Ms Park and Dr Singer).

Correspondence: Scott A. Lear, PhD, Healthy Heart Program, St Paul's Hospital, 180-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada (

All authors have read and approved the article.

The authors declare no conflicts of interest.

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