Is shorter duration cardiac rehabilitation including progressive resistance training more effective than standard-care cardiac rehabilitation?

This study will compare the efficacy of a modified twice per week for six weeks cardiac rehabilitation program (intervention) with a standard-care once per for twelve weeks cardiac rehabilitation program (control treatment) on outcomes of physical and cardiac function. The intervention is described here. Brief Name: Modified Shorter Duration Combined Training Cardiac Rehabilitation. Procedures and Number of Times: Participants in the intervention group will complete a cardiac rehabilitation program involving two sessions per week for six weeks. One session each week will involve one-hour of exercise including a 10-minute warm-up, 25 minutes of resistance training, 15 minutes of aerobic training and a 10-minute cool-down. The resistance training will involve a combination of the following exercises depending on the participant's medical treatment: leg extension/squat/sit-to-stand, chest press, shoulder press, upright row, leg curl, calf raise, hip extension, hip flexion, cable fly and latissimus dorsi pull-down. Participants will complete five of the aforementioned resistance training exercises initially for two sets of up to 10 repetitions at 60% of their predicted one-repetition maximum with two minute rest periods between sets. The prescription will be progressed via increases in repetitions per set and then intensity. The second session each week will be according to current cardiac rehabilitation practice, except participants will complete three resistance training exercises for 15 minutes in place of a dedicated walk. Cardiac disease related education will be provided to each participant according to standard care cardiac rehabilitation. Topics include heart disease and interventions/procedures, identifying and modifying risk factors, exercise and heart disease, self-management, medications, nutrition, emergency care, managing emotional responses to cardiac events, behaviour change, and community support services and cardiopulmonary resuscitation. Participants will attend one one-hour education session per week for six weeks. Given that standard care cardiac rehabilitation includes twelve education sessions, participants unable to attend a particular education session will be given a video-recorded copy of missed talks/discussions (where applicable) and/or physical hard-copies of applicable educational materials. Participants will be given advice to continue exercise at the conclusion of their cardiac rehabilitation program. Materials: Aerobic exercise will be completed as a training circuit (as per standard-care cardiac rehabilitation) using a combination of treadmills, bicycle ergometers, hand pedals, small hand weights, steps, and exercise balls as well as walking outside. In the intervention group, resistance training will be completed using cable machine weights, dumbbells and an exercise bench. Individual components of exercise prescription (frequency, intensity (load), duration, type) during cardiac rehabilitation will be recorded. Pulse oximeters will be used to monitor heart rate and oxygen saturation while the Borg 6-20 Rate of Perceived Exertion Scale will be used to evaluate the participant's rate of perceived exertion. Participants will have access to educational material via a combination of group talks/discussions, video-recorded talks/discussions and physical hard-copies of educational materials. Who: Cardiac rehabilitation sessions will be delivered by a combination of an Accredited Exercise Physiologist, experienced Cardiac Rehabilitation Coordinators/Nurses, Physiotherapists and Allied Health Assistants. Different education sessions will be provided by a Cardiac Rehabilitation Coordinator/Nurse, a Cardiac Rehabilitation Physiotherapist, an occupational therapist, a pharmacist, a dietitian, a paramedic, a social worker and Heartbeat volunteers. Mode of Delivery: The exercise sessions will be delivered face-to-face predominantly in a group setting. A rolling recruitment will be employed, therefore between 1-15 study participants are expected to be completing cardiac rehabilitation in any given session. Location: The intervention will be delivered in the outpatient cardiac rehabilitation clinic of a publicly funded hospital. Adherence: Adherence will be monitored by the Cardiac Rehabilitation Coordinators/Nurses, Physiotherapists and Accredited Exercise Physiologist involved with the study. The exercise sheets used in the study will be dated for every session that a participant attends cardiac rehabilitation, which will then be used to monitor attendance and compliance with the exercise prescription.