Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice

Abstract

IntroductionExercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia.DesignCross-sectional survey.MethodsAustralian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics.Results297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1–2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (<6%) made use of technology, such as mobile phones or the internet, to deliver or support exercise training.ConclusionsWhile advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients.

A Review of Cardiac Rehabilitation Delivery Around the World

“…The first aimed to describe the status of CR in Australia 50 . Findings indicated that the mean exercise session duration was 55 minutes.…”

“…Also interestingly, in some regions physiotherapists were a main part of the team (n=17 of 21 papers reporting staff composition, e.g., Australia, England, Scotland, Northern Ireland, Wales, Denmark, Italy, Portugal, Spain, Mexico, Bahrain, Egypt, Qatar, UAE and Canada; e.g., 24,61,66,92 ), whereas in others, exercise specialists were more common (i.e., exercise physiologists, kinesiologists; n=7 of 21 papers reporting staff composition; North America, China and the Middle East; e.g., 24,93 ). Whether this is a function of availability of training programs and hence staff to hire, reimbursement policies in the healthcare system, costs to programs, or other factors is unknown, as is the impact for patient outcomes (although there is no basis on which to assume different outcomes would be observed).…”

Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care

“…Phase II usually involves patients attending a hospital-based programme as an outpatient, weekly or twice weekly over a 6- to 12-week period,9,27 although flexible modes of service delivery have been used to cater for the requirements of a broader range of patients (see Such modes have included centre or home-based services, as well as telephone, mobile and internet-based services 3. Phase II programmes provide initial physical, psychological, and social assessments to facilitate return to everyday function, and education regarding cardiovascular disease risk factors, and exercise and lifestyle changes that may have long-term cardioprotective effects 3…”

Pacing and perceived exertion in endurance performance in exercise therapy and health sports

“…In fact, in routine health care, intensity is often regulated by perceived exertion. In Australia, 80% of cardiac rehabilitation centers use the Borg-RPE, and only 19% use heart rate or the results of an exercise performance stress test (Abell, Glasziou, Briffa, & Hoffmann, 2016).…”