A secondary analysis of data from the OPTICARE randomized controlled trial investigating the effects of extended cardiac rehabilitation on functional capacity, fatigue, and participation in society

Abstract

Objective: In this secondary analysis of data from the OPTICARE trial, we compared the effects of two behavioral interventions integrated into cardiac rehabilitation to standard rehabilitation with regard to functional capacity, fatigue, and participation in society. Design: This is a randomized controlled trial. Setting: This study was conducted in a cardiac rehabilitation setting. Subjects: A total of 740 patients with acute coronary syndrome were recruited for this study. Interventions: Patients were randomized to (1) three months of standard rehabilitation; (2) cardiac rehabilitation plus nine months after-care with face-to-face group lifestyle counseling; or (3) cardiac rehabilitation plus nine months after-care with individual lifestyle telephone counseling. Main measures: Functional capacity (6-minute walk test), fatigue (Fatigue Severity Scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) were measured at randomization, 3, 12, and 18 months. Results: Additional face-to-face sessions resulted at 12 months in 12.49 m more on the 6-minute walk test compared to standard rehabilitation ( P = .041). This difference was no longer present at 18 months. Prevalence of fatigue decreased from 30.2% at baseline to 11.9% at 18 months compared to an improvement from 37.3% to 24.9% after standard rehabilitation (between-group difference: odds ratio = 0.47; P = .010). The additional improvements in functional capacity seemed to be mediated by increases in daily physical activity. No mediating effects were found for fatigue. No additional improvements were seen for participation in society. Additional telephonic sessions did not result in additional intervention effects. Conclusion: Extending cardiac rehabilitation with a face-to-face behavioral intervention resulted in additional long-term improvements in fatigue and small improvements in functional capacity up to 12 months. A telephonic behavioral intervention provided no additional benefits.

Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge

“…The minimally clinically important difference of 25 m was exceeded at 1 mo (26 m) but not at 3 mo (22 m) 33. There have been mixed findings regarding the improvement of functional exercise capacity following CR 49,50. However, based on our findings in activity and participation and other functions, our participants were generally successful in maintaining their PA level, participation, independence, and mental health.…”

“…33 There have been mixed findings regarding the improvement of functional exercise capacity following CR. 49,50 However, based on our findings in activity and participation and other functions, our participants were generally successful in maintaining their PA level, participation, independence, and mental health. Particularly, the high level of light-intensity PA and MVPA for 9 mo post-CR may well explain this improved functional exercise capacity in our participants.…”

The scientific basis for secondary prevention of coronary artery disease: recent contributions from the Netherlands

“…Compared with standard cardiac rehabilitation, adding face-to-face physical activity counselling resulted in additional improvement in daily step counts [16]. Furthermore, the face-to-face counselling resulted in an improved maintenance of physical fitness up to 12 months and in long-term reductions in fatigue [17]. The extra counselling sessions did not confer additional benefits with respect to blood pressure, cholesterol, or smoking.…”

Management of Long COVID—The CoviMouv' Pilot Study: Importance of Adapted Physical Activity for Prolonged Symptoms Following SARS-CoV2 Infection

“…There is currently no specific treatment for "acute" asthenia that has progressed for <4 months. However, a program combining exercise and therapeutic patient education has already shown significant benefits for combatting recent or semi recent fatigue following a cardiovascular event (Staniute et al, 2014;Van Geffen et al, 2015;Ter Hoeve et al, 2019) and even during cancer treatment (Van Vulpen et al, 2016;Zhang et al, 2018;Gheyasi et al, 2019). Exercise is also strongly recommended in chronic fatigue syndrome (Clark and White, 2005) and in fibromyalgia, where exercise is the only "strong for" therapybased recommendation (Macfarlane et al, 2017).…”