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Traditional Versus Hybrid Outpatient Cardiac Rehabilitation


Gabelhouse, Jacqueline MSc; Eves, Neil PhD; Grace, Sherry L. PhD; Reid, R. Colin PhD; Caperchione, Cristina M. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: July 2018 - Volume 38 - Issue 4 - p 231–238
doi: 10.1097/HCR.0000000000000253
Cardiac Rehabilitation

Purpose: Due to the suboptimal uptake of cardiac rehabilitation (CR), alternative models have been proposed. This study compared the effectiveness of a traditional supervised program in a medical setting versus a hybrid CR model, where patients transition to unsupervised programming.

Methods: This was a prospective, 2-arm, nonrandomized study. Health-related quality of life (HRQoL), functional capacity, physical activity, diet, smoking, blood pressure, lipids, blood glucose, anthropometrics, and depressive symptoms were assessed before and after the 8-week program models. Program adherence and completion were also recorded. Both models offered outpatient supervised exercise sessions, group health education classes, and a resource manual. The hybrid model involved a blend of supervised and unsupervised, independent home-based exercise, and followup phone calls.

Results: One hundred twenty-five cardiac patients consented to the study, of whom 72 (57.6%) and 53 chose the traditional and hybrid programs, respectively. One hundred ten (traditional: n = 62, 86.1%; hybrid: n = 48, 92.3%; P > .05) participants completed their program. Significant improvements were observed for both models over time in HRQoL (P < .001), physical activity (P < .001), and diet (P < .001). Significant reductions in smoking (P = .043), systolic blood pressure (P < .001), total cholesterol (P < .001), low-density lipoprotein (P < .001), waist circumference (P < .001), and depressive symptoms (P < .001) were also observed. There were no significant differences pre- and postprograms between models for any outcome.

Conclusions: Hybrid CR was not significantly different from the traditional model in terms of HRQoL, functional capacity, heart health behaviors, and risk factors, with no differences in completion rates.

Hybrid cardiac rehabilitation, where patients transition from supervised to home exercise, may overcome barriers to program use. Results of this quasi-experimental study indicated patients participating in a hybrid or traditional model improved health-related quality of life and cardiovascular risk factors. No differences between models or completion rates were observed.

School of Health and Exercise Sciences (Mrs Gabelhouse and Drs Eves, Reid, and Caperchione), Centre for Heart, Lung and Vascular Health (Drs Eves and Caperchione), and Institute for Healthy Living and Chronic Disease Prevention (Dr Caperchione), University of British Columbia, Kelowna, Canada; and School of Kinesiology and Health Science, York University, and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada (Dr Grace).

Correspondence: Jacqueline Gabelhouse, MSc, UBC Okanagan Campus, ART360 (Arts Bldg), 1147 Research Rd, Kelowna, BC V1V 1V7, Canada (

The authors declare no conflicts of interest.

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