Effectiveness of additional resistance and balance training and telephone support program in exercise-based cardiac rehabilitation on quality of life and physical activity: Randomized control trial

Abstract

Objectives To evaluate 20 days and 3 months follow-up effectiveness of cardiac rehabilitation (CR) enhanced by resistance/balance training and telephone-support program compared to usual CR care in improving quality of life, clinical course and physical activity behavior. Design Single-centre randomized controlled trial. Setting Inpatient CR clinic Subjects 116 (76.1 ± 6.7 years, 50% male) patients 14.5 ± 5.9 days after valve surgery/intervention were randomized to intervention group (IG, n = 60) or control group (CG, n = 56). Intervention Additional resistance/balance training (3 days/week) during phase-II CR and telephone-support program during 3-month follow-up. CG patients were provided with usual CR care. Main measures Short Form 36 Health Survey scales, European Quality of Life 5 Dimensions 3 Level Version QoL index, visual analog scale, clinical course, and physical activity behavior assessed with standardized questionnaires. Results IG reported statistically significant higher mental component score (48.5 ± 6.91 vs. 40.3 ± 11.21 at the baseline, 50.8 ± 9.76 vs. 42.6 ± 9.82 after 20 days, 49.4 ± 8.45 vs. 40.5 ± 8.9 after 12 weeks follow up), general health (48.6 ± 3.17 vs. 45.0 ± 2.95 at the baseline, 53.6 ± 3.02 vs. 43.8 ± 2.55 after 20 days, 53.2 ± 3.11 vs. 44.2 ± 3.07 after 12 weeks) and role limitations due to emotional problems (48.5 ± 15.2 vs. 27.7 ± 11.5 at the baseline, 72.7 ± 12.6 vs. 30.5 ± 11.2 after 20 days, 66.6 ± 14.2 vs. 36.1 ± 11.2 after 12 weeks) in all three assessments ( p < 0.05). CG patients had more documented hospital admissions (4 (8%) vs 10 (25%), p = 0.027), atrial fibrillation paroxysms (3 (6.0%) vs. 10 (35.0%), p = 0.011) and blood pressure swings (13 (26%) vs. 20 (50%), p = 0.019). IG patients chose more different physical activities (1.7 ± 0.7 vs. 1.25 ± 0.63, p = 0.002), spent more time being physical active every day (195.6 ± 78.6 vs. 157.29 ± 78.8, p = 0.002) Conclusions The addition of resistance/balance exercises and telephone-support program 12 weeks after to the CR could linked to higher physical activity levels and fewer clinical complications but did not lead to a significant improvement in quality of life.

Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease

“…In addition, these studies are mostly small and with a great heterogeneity in terms of patient characteristics and interventions offered. Nevertheless, the results are promising and show that RT is feasible, safe, and effective 52,67,69,74,80,81. More high-quality studies are warranted in these patient cohorts.…”

“…Interestingly, a significant difference in frailty levels in favor of the intervention was reported at 3-mo follow-up. This could be a result of higher levels of physical activity after CR since members of the intervention group spent significantly more time in daily physical activity during follow-up than control 74,81…”

“…Nevertheless, the results are promising and show that RT is feasible, safe, and effective. 52,67,69,74,80,81 More high-quality studies are warranted in these patient cohorts.…”

“…79 In a small RCT including patients with transcatheter aortic valve implantation, 8-wk combined AT and RT led to an increase in exercise capacity and muscle strength compared with the control group. 80 In a second RCT, 74,81 the effects of additional RT and balance training during CR in elderly patients after valve surgery or intervention compared with usual care CR were evaluated. The results revealed improvements in exercise capacity, mobility, SPPB, 5-m walk test, leg strength, QoL, and frailty levels in both groups with no difference between groups.…”

“…This could be a result of higher levels of physical activity after CR since members of the intervention group spent significantly more time in daily physical activity during follow-up than control. 74,81 The results of the few available studies are promising and show that RT is feasible and can help achieve the intended effects on mobility and frailty. High-quality studies, however, are urgently needed to close the gaps in evidence about RT in VHD patients.…”