Patients Waiting for Elective Coronary Artery Bypass Graft Surgery
Conditions
Keywords
Preoperative care, Exercise therapy, Cardiac surgery
Brief summary
Low levels of physical fitness increase the risk of death in patients with cardiovascular disease. Although cardiac rehabilitation programs improve the health of patients after heart surgery, most patients are not referred until after surgery. Therefore, the purpose of this study was to determine if an exercise pre-habilitation (i.e., Prehab) program before heart surgery would improve the health of patients before surgery and whether these improvements would be maintained after surgery. The investigators hypothesized that Prehab would promote the health of patients before heart surgery, and these improvements would be maintained three months post-operatively, as compared to patients who received standard care.
Detailed description
This was a single-centre, parallel randomized controlled trial conducted in Canada to determine the feasibility and efficacy of an exercise and education pre-habilitation (i.e., Prehab) program before elective coronary artery bypass graft surgery (CABG). We recruited 17 patients who were scheduled to undergo elective CABG surgery from February 2011-May 2012. Enrolled patients were assessed at baseline, one week pre-operatively, and three months post-operatively.
Interventions
BEHAVIORALPrehab
Sponsors
St. Boniface Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* On elective waitlist for coronary artery bypass graft surgery with a minimum anticipated wait time of 4-6 weeks or more * No history of unstable angina * Canadian Cardiovascular Society score of less than 4 * No history of myocardial infarction within the past 7 days * Ejection fraction greater than 30% * No history of dementia or psychiatric problems * No self-reported dizziness or confusion * Able to read, speak, and understand English * Previously sedentary (reporting accumulating less than 45 minutes of moderate intensity physical activity per day on at least three days per week over the last three months) * No previous participation in cardiac rehabilitation * Lives in Winnipeg, Manitoba, Canada or has easy access to the Reh-Fit Centre (local medical fitness facility)
Exclusion criteria
* If patients cannot attend Prehab due to geographical limitations * If patients cannot participate due to physical limitations * Diagnosis of exercise-induced arrhythmia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in 6-minute walking distance | Baseline; 1 week pre-operatively; 3 months post-operatively | Assessed using the 6-minute walking test. Output is distance. Change from baseline 6-minute walking distance was assessed at each follow-up time point. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in objectively measured physical activity | Baseline; 1 week pre-operatively; 3 months post-operatively | Measured by accelerometry. Output is minutes of moderate-vigorous as well as total physical activity per week. Change from baseline physical activity was assessed at each follow-up time point. |
| Change in quality of life | Baseline; 1 week pre-operatively; 3 months post-operatively | Self-reported using the Short Form-36 questionnaire. Output is a summary score across eight dimensions: General health, Physical functioning, Role limitations due to physical health, Role limitations due to emotional problems, Energy/fatigue, Pain, Emotional well-being, and Social functioning. Change from baseline quality of life measures was assessed at each follow-up time point. |
| Change in 5-meter gait speed | Baseline; 1 week pre-operatively; 3 months post-operatively | Assessed using the 5-meter gait speed test. Output is seconds. Change from baseline 5-meter gait speed was assessed at each follow-up time point. |
| Change in exercise self-efficacy | Baseline; 1 week pre-operatively; 3 months post-operatively | Assessed by the Cardiac Exercise Self-efficacy Index. Output was a numerical score. Change from baseline exercise self-efficacy was assessed at each follow-up time point. |
| Change in cardiac anxiety | Baseline; 1 week pre-operatively; 3 months post-operatively | Assessed by the Cardiac Anxiety Questionnaire. Outputs were numerical scores across four dimensions: Fear, Avoidance, Heart-Focused Attention, and Total Score. Change from baseline cardiac anxiety was assessed at each follow-up time point. |
| Change in depressive symptoms | Baseline; 1 week pre-operatively; 3 months post-operatively | Assessed using the Patient Health Questionnaire-9. Output was a numerical and categorical score. Change from baseline depressive symptoms was assessed at each follow-up time point. |
Countries
Canada
Outcome results
None listed