Sherry L Grace1, Liz Midence2, Paul Oh3, Stephanie Brister3, Caroline Chessex3, Donna E Stewart3, Heather M Arthur4. 1. York University, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada. Electronic address: sgrace@yorku.ca. 2. York University, Toronto, Ontario, Canada. 3. University Health Network, Toronto, Ontario, Canada. 4. Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
Abstract
OBJECTIVE: To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR). PATIENTS AND METHODS: Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013. Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario, Canada. Consenting participants completed a preprogram survey, and clinical data were extracted from charts. Participants were referred to CR at 1 of 3 sites. After intake assessment, including a graded exercise stress test, eligible patients were randomized to supervised mixed-sex, supervised women-only, or home-based CR. Six months later, CR adherence and exit assessment data were ascertained. RESULTS: Of the 264 consenting patients, 169 (64.0%) were eligible and randomized. Twenty-seven (16.0%) did not attend, and 43 (25.4%) attended a different model. Program adherence was moderate overall (54.46%±35.14%). Analysis of variance revealed no significant differences based on per-protocol analysis (P=.63), but as-treated, home-based participants attended significantly more than did women-only participants (P<.05). Overall, there was a significant increase in functional capacity preprogram to postprogram (P<.001). Although there were no significant differences in functional capacity by model at CR exit based on per-protocol analysis, there was a significant difference on an as-treated basis, which sustained adjustment. Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs (P<.05). CONCLUSION: Offering women alternative program models may not promote greater CR adherence or functional capacity; however, replication is warranted. Other proven strategies such as action planning and self-monitoring should be applied. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01019135.
RCT Entities:
OBJECTIVE: To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR). PATIENTS AND METHODS: Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013. Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario, Canada. Consenting participants completed a preprogram survey, and clinical data were extracted from charts. Participants were referred to CR at 1 of 3 sites. After intake assessment, including a graded exercise stress test, eligible patients were randomized to supervised mixed-sex, supervised women-only, or home-based CR. Six months later, CR adherence and exit assessment data were ascertained. RESULTS: Of the 264 consenting patients, 169 (64.0%) were eligible and randomized. Twenty-seven (16.0%) did not attend, and 43 (25.4%) attended a different model. Program adherence was moderate overall (54.46%±35.14%). Analysis of variance revealed no significant differences based on per-protocol analysis (P=.63), but as-treated, home-based participants attended significantly more than did women-only participants (P<.05). Overall, there was a significant increase in functional capacity preprogram to postprogram (P<.001). Although there were no significant differences in functional capacity by model at CR exit based on per-protocol analysis, there was a significant difference on an as-treated basis, which sustained adjustment. Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs (P<.05). CONCLUSION: Offering women alternative program models may not promote greater CR adherence or functional capacity; however, replication is warranted. Other proven strategies such as action planning and self-monitoring should be applied. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01019135.
Authors: Marta Supervía; Jose R Medina-Inojosa; Colin Yeung; Francisco Lopez-Jimenez; Ray W Squires; Carmen M Pérez-Terzic; LaPrincess C Brewer; Shawn E Leth; Randal J Thomas Journal: Mayo Clin Proc Date: 2017-03-13 Impact factor: 7.616
Authors: Randal J Thomas; Alexis L Beatty; Theresa M Beckie; LaPrincess C Brewer; Todd M Brown; Daniel E Forman; Barry A Franklin; Steven J Keteyian; Dalane W Kitzman; Judith G Regensteiner; Bonnie K Sanderson; Mary A Whooley Journal: J Cardiopulm Rehabil Prev Date: 2019-07 Impact factor: 2.081
Authors: Keith C Ferdinand; Fortunato Fred Senatore; Helene Clayton-Jeter; Dennis R Cryer; John C Lewin; Samar A Nasser; Mona Fiuzat; Robert M Califf Journal: J Am Coll Cardiol Date: 2017-01-31 Impact factor: 24.094
Authors: Randal J Thomas; Alexis L Beatty; Theresa M Beckie; LaPrincess C Brewer; Todd M Brown; Daniel E Forman; Barry A Franklin; Steven J Keteyian; Dalane W Kitzman; Judith G Regensteiner; Bonnie K Sanderson; Mary A Whooley Journal: J Am Coll Cardiol Date: 2019-05-13 Impact factor: 24.094
Authors: Lindsey Anderson; Georgina A Sharp; Rebecca J Norton; Hasnain Dalal; Sarah G Dean; Kate Jolly; Aynsley Cowie; Anna Zawada; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2017-06-30