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Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation

  • Joseph J Carlson
    Correspondence
    Address for reprints: Joseph J. Carlson, PhD, RD, Stanford University School of Medicine, Stanford Center for Research in Disease Prevention, 730 Welch Road, Suite 234, Palo Alto, California 94304-1583
    Affiliations
    Stanford University School of Medicine, Stanford Center for Research in Disease Prevention, Palo Alto, California, USA

    Spectrum Health East (Formerly Blodgett Memorial Medical Center), Department of Preventive Cardiology and Rehabilitation, Grand Rapids, Michigan, USA
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  • Jeffrey A Johnson
    Affiliations
    Spectrum Health East (Formerly Blodgett Memorial Medical Center), Department of Preventive Cardiology and Rehabilitation, Grand Rapids, Michigan, USA
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  • Barry A Franklin
    Affiliations
    William Beaumont Hospital, Division of Cardiology (Cardiac Rehabilitation), Royal Oak, Michigan, USA
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  • Ronald L VanderLaan
    Affiliations
    Spectrum Health East (Formerly Blodgett Memorial Medical Center), Department of Preventive Cardiology and Rehabilitation, Grand Rapids, Michigan, USA
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      Abstract

      Common concerns with the traditional protocol (TP) for cardiac rehabilitation include suboptimal program participation, poor facilitation of independent exercise, the use of costly continuous electrocardiographic (ECG) monitoring, and lack of insurance reimbursement. To address these concerns, a reduced cost-modified protocol (MP) was developed to promote independent exercise. Eighty low- to moderate-risk cardiac patients were randomized to a TP (n = 42) or a MP (n = 38) and were compared over 6 months on program participation, exercise adherence, cardiovascular outcomes, and program costs. During month 1, patients followed identical regimens, including 3 ECG-monitored exercise sessions/week, with encouragement to achieve ≥5 thirty-minute sessions/week. In week 5, the TP continued with a facility-based regimen including 3 exercise sessions/week for 6 months and used ECG monitoring the initial 3 months. The MP discontinued ECG monitoring in week 5 and were gradually weaned to an off-site exercise regimen that was complemented with educational support meetings and telephone follow-up. Compared with TP patients, MP patients had higher rates of off-site exercise over 6 months (p = 0.05), and total exercise (on site + off site) during the final 3 months (p = 0.03). Also, MP patients were less likely to drop out (p = 0.05). Both protocols promoted comparable improvements in maximal oxygen uptake (p <0.05), blood lipids (p <0.001), and hemodynamic measurements (p <0.002). The MP cost $738 less/patient than the TP and required 30% less staff (full-time equivalents). These results suggest that a reduced cost MP was as effective as an established TP in improving physiologic outcomes while demonstrating higher rates of exercise adherence and program participation. Thus, the MP or a similar protocol has applicability to hospitals with large capitated or managed care populations to provide cost-effective cardiovascular risk reduction to patients.
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