An Exploration of the Impact of the “Open Gym” Scheduling Model of Cardiovascular Rehabilitation on Completion, Attendance, and Health Outcomes

Whited, Matthew C.; Ellis, Jordan M.; Freeman, John Taylor; Corson, Ansley Taylor; Greenway, Stacey; Busch, Andrew M.; Whited, Amanda; Sears, Samuel F.

doi:10.1097/hcr.0000000000000312

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…Another relatively simple action that can be taken is providing an open gym option (eg, 4-hr attendance window) to individuals who face inconsistencies with transportation, work schedules, family responsibilities, or other reasons that contribute to irregular availability. It is important to note that a retrospective analysis comparing attendance and completion rates between standard scheduling (eg, set exercise times) and the open gym model found no significant differences 50. Because this study was retrospective, future studies will need to randomize ECR-eligible patients with attendance barriers to either model and determine whether one promotes greater attendance.…”

Section: Early Outpatient Cardiac Rehabilitationmentioning

confidence: 95%

“…It is important to note that a retrospective analysis comparing attendance and completion rates between standard scheduling (eg, set exercise times) and the open gym model found no significant differences. 50 Because this study was retrospective, future studies will need to randomize ECR-eligible patients with attendance barriers to either model and determine whether one promotes greater attendance. Until objective data are available, programs are recommended to have internal discussions about the number of patients who have difficulty committing to a consistent exercise time and whether they would benefit from an open gym model.…”

Section: Contemporary Strategies To Increase Enrollment and Adherencementioning

confidence: 99%

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Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs

Ozemek

Squires

2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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S ince recognizing the benefits of exercise training 1 and establishing early outpatient cardiac rehabilitation (ECR, commonly referred to as phase II CR) programs for a number of cardiac conditions (eg, myocardial infarction [MI], coronary angioplasty or stent, coronary artery bypass graft, stable angina, heart failure with an ejection fraction ≤35%, heart transplant, valve repair, or replacement), a consistently growing body of evidence has highlighted numerous health-related benefits associated with ECR participation. 2,3 These studies have similarly reported reduced hospitalization rates, recurrence of events, mortality risk, improved physical and physiologic function, and perhaps most meaningful to patients, quality of life. The convincing body of data has fostered recognition within the clinical field of the value of ECR in the continuum of managing individuals with cardiovascular disease (CVD), and as a result, ECR has received the highest levels of evidence-based recommendation from both national and international organizations. [4][5][6] Collectively, one would assume that widespread enrollment among qualifying patients would occur. Unfortunately, this has historically not been the case. 7 Maintenance cardiac rehabilitation (MCR, commonly referred to as phase III/IV CR) has been utilized to assist patients who have completed ECR to continue in the lifelong process of CVD management. The MCR components may include all of the secondary prevention practices including exercise training, adherence with cardioprotective medications, periodic appointments with health care providers, healthy nutrition, and CVD risk factor management. 8,9 Although there have been comparatively fewer studies reporting MCR enrollment and adherence rates, it is clear from the available data that rates are also suboptimal. 10 Despite the continued challenges of CR enrollment and adherence, many organization-led initiatives have provided strategies to promote increases in CR participation while reports of innovative and effective institutional efforts offer a road map to nullifying common barriers that limit CR utilization. This review highlights current data on enrollment and adherence to ECR and MCR, discusses evidence-based programmatic strategies to support CR utilization, and offers areas needing further exploration and consideration. EARLY OUTPATIENT CARDIAC REHABILITATIONA large proportion of patients with diagnoses that make them eligible for ECR receive insurance coverage through Medicare. 11,12 This has presented investigators with an opportunity to routinely survey administrative data to identify trends in ECR enrollment across the country. The most recent examination of Medicare fee-for-service beneficiaries (≥65 yr) enrolling in ≥1 ECR session, between 2016 and 2017, found that little progress in increasing national enrollment rates was made since previous large-scale analyses (Figure 1), 7,13,14 with only a quarter of qualifying patients participating in ECR. 15 A greater proportion of MI patients undergoing percutaneous...

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Section: Early Outpatient Cardiac Rehabilitationmentioning

confidence: 95%

Section: Contemporary Strategies To Increase Enrollment and Adherencementioning

confidence: 99%

Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs

Ozemek

Squires

2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…This report could help programs considering one model over another. 10 There were no differences observed between the number of CR sessions patients attended (traditional = 22, open gym = 20) and the proportion of patients completing CR (64 and 65%, respectively) between the two models. However, in the case of key clinical outcome measures representing cardiorespiratory fitness (CRF), both the 6-min walk distance (traditional +82.1 ± 57.5 m, open gym +57.2 ± 59.8 m) and peak metabolic equivalents of task (METs) (traditional +1.5 ± 1.4 vs open gym +1.0 ± 1.4 METs) improved to a greater extent in the traditional model of scheduling CR sessions.…”

Section: Adherencementioning

confidence: 78%

“…However, many, if not all, CR programs deliver service in group settings with multiple patients to one practitioner and offer exercise sessions either at set times or in an “open gym” model, which allows patients to arrive within a large time block (eg, 4-hr window). Whited et al10 provided an assessment of patient attendance and clinical outcomes in response to traditional CR scheduling and the open gym concept. This report could help programs considering one model over another 10.…”

Section: Enrollment and Adherence In Cr Programsmentioning

confidence: 99%

Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations

Ozemek

Lavie

Kaminsky

2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.

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“…The CVPR center that participated in the study follows an “Open Gym” scheduling model (see Whited et al, 2019 for a detailed description of this scheduling model). Patients are advised to attend CVPR three times per week, at the time of their choosing.…”

Section: Methodsmentioning

confidence: 99%

Mobile assessment of experiential avoidance, mood, stress, and attendance in cardiopulmonary rehabilitation.

Ellis¹,

Midgette²,

Capiaghi³

et al. 2022

Health Psychology

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Objectives: This study utilized mobile ecological momentary assessment (EMA) to examine the dynamic relationships among experiential avoidance (EA), mood, and cardiopulmonary rehabilitation (CVPR) attendance. Method: Participants (n = 47; 40.4% female; 80.1% White; 85.1% Cardiac, 14.9% Pulmonary) were recruited from CVPR during their first 2 weeks of the program. They completed daily EMA prompts to assess momentary mood and EA for 2 weeks using a smartphone device. Multilevel modeling (MLM) was employed to investigate the impact of EA and mood on next-week attendance and the within-person within-prompt correlates, antecedents, and consequences of EA. Results: Greater EA and negative mood significantly predicted worse next-week CVPR attendance rates. Within the same EMA prompt individuals with higher EA also reported greater negative affect and perceived stress, while individuals with lower EA reported greater positive mood. In addition, lagged analyses showed that EA was negatively related to next-day positive mood scores. Conclusions: EA appears to be an important targetable mechanism negatively related to CVPR program attendance and mood in CVPR patients. The present study builds upon previous research supporting EA as a dynamic and fluid emotion-regulation process, suggesting EA’s impact on mood and behavior may be best understood through repeated real-time measurement methodology.

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An Exploration of the Impact of the “Open Gym” Scheduling Model of Cardiovascular Rehabilitation on Completion, Attendance, and Health Outcomes

Cited by 4 publications

References 6 publications

Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs

Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs

Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations

Mobile assessment of experiential avoidance, mood, stress, and attendance in cardiopulmonary rehabilitation.

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