S Nichols1, C Taylor2, T Goodman3, R Page4, A Kallvikbacka-Bennett5, F Nation6, A L Clark7, S T Birkett8, S Carroll9, L Ingle10. 1. Centre for Sports and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield S10 2BP, United Kingdom. Electronic address: s.j.nichols@shu.ac.uk. 2. Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom. Electronic address: claire@hewison.net. 3. City Health Care Partnership CIC, East Riding Community Hospital, Swinemoore Lane, Beverley HU17 0FA, United Kingdom. Electronic address: toni.goodman@nhs.net. 4. Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom. Electronic address: r.page@hull.ac.uk. 5. Academic Cardiology Castle Hill Hospital, Hull and East Yorkshire Hospitals, Castle Road, Cottingham HU16 5JQ, United Kingdom. Electronic address: Anna.Bennett@hey.nhs.uk. 6. Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom. Electronic address: f.nation@hull.ac.uk. 7. Academic Cardiology Castle Hill Hospital, Hull and East Yorkshire Hospitals, Castle Road, Cottingham HU16 5JQ, United Kingdom. Electronic address: A.L.Clark@hull.ac.uk. 8. School of Sport and Health Sciences, University of Central Lancashire, Preston, PR1 2HE, United Kingdom. Electronic address: SBirkett4@uclan.ac.uk. 9. Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom. Electronic address: s.carroll@hull.ac.uk. 10. Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom. Electronic address: l.ingle@hull.ac.uk.
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 12 months. 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 physiological outcomes.
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 12 months. 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 physiological outcomes.
Authors: Grace Dibben; James Faulkner; Neil Oldridge; Karen Rees; David R Thompson; Ann-Dorthe Zwisler; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2021-11-06
Authors: Kasara A Little; Joshua R Smith; Jose R Medina-Inojosa; Audry S Chacin Suarez; Jenna L Taylor; Shane M Hammer; Karen M Fischer; Amanda R Bonikowske; Ray W Squires; Randal J Thomas; Thomas P Olson Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2022-09-02
Authors: Gabbi Frith; Kathryn Carver; Sarah Curry; Alan Darby; Anna Sydes; Stephen Symonds; Katrina Wilson; Gordon McGregor; Kevin Auton; Simon Nichols Journal: BMC Health Serv Res Date: 2021-12-24 Impact factor: 2.655