Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

NICHOLS, Simon, TAYLOR, C., GOODMAN, T., PAGE, R., KALLVIKBACKA-BENNETT, A., NATION, F., CLARK, A.L., BIRKETT, S.T., CARROLL, S. and INGLE, L. (2020). Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study. International Journal of Cardiology, 305, 25-34.

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Link to published version:: https://doi.org/10.1016/j.ijcard.2020.01.044
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    Abstract

    Background Recent evidence suggests that routine exercise-based cardiac rehabilitation (CR) may not lead to a substantial increase in estimated peak oxygen uptake (V̇O2peak). This could reduce the potential benefits of CR and explain why CR no longer improves patient survival in recent studies. We aimed to determine whether routine exercise-based CR increases V̇O2peak using gold-standard maximal cardiopulmonary exercise testing (CPET), and to quantify the exercise training stimulus which might be insufficient in patients undertaking CR. Methods We studied the effects of a routine, twice weekly, exercise-based CR programme for eight weeks (intervention group) compared with abstention from supervised exercise training (control group) in patients with coronary heart disease. The primary outcome was V̇O2peak measured using CPET. We also measured changes in body composition using dual X-ray absorptiometry, carotid intima-media thickness, hs-CRP and N-terminal pro B-type natriuretic peptide at baseline, 10 weeks and one year. We also calculated the Calibre 5-year all-cause mortality risk score. Results Seventy patients (age 63.1 SD10.0 years; BMI 29.2 SD4.0 kg·m−2; 86% male) were recruited (n = 48 intervention; n = 22 controls). The mean aerobic exercise training duration was 23 min per training session, and the mean exercise training intensity was 45.9% of heart rate reserve. V̇O2peak was 23·3 ml·kg-1·min−1 at baseline, and there were no changes in V̇O2peak between groups at any time point. The intervention had no effect on any of the secondary endpoints. Conclusion Routine CR does not lead to an increase in V̇O2peak and is unlikely to improve long-term outcomes.

    Item Type: Article
    Additional Information: ** Article version: AM ** From Elsevier via Jisc Publications Router ** Licence for AM version of this article starting on 21-01-2020: http://creativecommons.org/licenses/by-nc-nd/4.0/ **Journal IDs: issn 01675273 **History: issue date 22-01-2020; accepted 20-01-2020
    Identification Number: https://doi.org/10.1016/j.ijcard.2020.01.044
    Page Range: 25-34
    SWORD Depositor: Colin Knott
    Depositing User: Colin Knott
    Date Deposited: 27 Jan 2020 11:21
    Last Modified: 10 Mar 2020 10:30
    URI: http://shura.shu.ac.uk/id/eprint/25732

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