Cardiac Surgery, Coronary Artery Bypass Graft CABG, Stent, Valve Replacement
Conditions
Keywords
Physical Therapy, Cardiopulmonary Rehabilitation, Cardiac Surgery, Exercise, Heart Rate, Objective Outcome Assessments
Brief summary
Determine if the standard of care at a cardiac rehabilitation center using what the investigators term to be hybrid model on the exercise component of cardiac rehabilitation is associated with improved adherence and outcomes. Discuss the hybrid model in comparison to traditional cardiac rehabilitation and layout a template on how to incorporate this hybrid model. Discuss factors that may lead to poor adherence and attendance to cardiac rehabilitation.
Detailed description
Purpose: The aim of this prospective cohort study was to determine the effectiveness of an individualized physical therapist (PT) driven hybrid model of the exercise component of cardiac rehabilitation (CR) that uses a novel intensity-recovery progression protocol (IRPP) and cardiac testing template (CTT) to assess achieved heart rate intensity (AHRI%), heart rate recovery (HRR%), and intensity-recovery total (IR%) as indicators to guide treatment. Methods: Assessment of a subjective questionnaire, vital signs, treadmill 6-minute walk (6MW), 1-minute sit-to-stand (1STS), 1-minute step (1ST), and 1-minute agility square tests (1AST) were assessed on 100 participants during the 36-visit program. The hybrid model was led by a PT, was longer in duration, added high intensity interval training (HIIT) to continuous aerobic exercise training (CAET) and resistance training, and used a 1:1 treatment ratio. Treatment intensity and progression were measured based on clinical decision making through the IRPP and CTT.
Interventions
OTHERExercise Component Of Cardiac Rehabilitation (Hybrid Model) Intensity Recovery Progression Protocol (IRPP)
Data collected on participants who completed the intensity recovery progression protocol program
Sponsors
Good Shepherd Integrated Healthcare Systems
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Underwent cardiac surgery (CABG, PCI with stent placement, and valve replacement) * Surgery was within the previous 365 days * Could independently ambulate into the facility.
Exclusion criteria
* Implantable cardioverter defibrillator (ICD) * Pacemaker (PPM) * Heart Transplant * Left ventricular assist device (LVAD) * All other cardiac procedures not listed within inclusion criteria * Diagnosed a-fib * Participants who attended cardiac rehabilitation before
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Six Minute Walk Test | Six Minutes | Treadmill Six Minute Walk Test |
| Timed Sit To Stand Test | One Minute | A standardized test measuring how many times an individual can stand from a standardized seated position in one minute using hand support to push off. |
| Timed Step Test | One Minute | A test measuring how many repetitions an individual can go up and down a standardized step while using bilateral arm support on a rail. |
| Timed Agility Square Test | One Minute | Using agility ladder square to go in and out of designated two boxes |
| Achieved Target Heart Rate (AHRI%) | One minute | Heart rate achieved during outcome measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). Participants expected to attend the program at a frequency of 2x a week for 36 total visits. |
| Heart Rate Recovery (HRR%) | One minute | Heart rate observed one minute after outcome measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). |
| Intensity Recovery Total Score (IR%) | One minute | The total of the AHRI + HRR during objective measurements (six minute walk test, timed sit to stand test, timed step test, timed agility square test). Completed every 5 visits from date of initiation up to 1 year after initiation or until visit 36 achieved (whichever comes first). |
| Subjective Questionnaire | From date of initiation of study up to 1 year after initiation. Collected on Visit 1, Visit 15, Visit 30 for each participant, who were expected to attend the program at a frequency of 2x a week for 36 total sessions. | Three questions (where higher scores denote better outcomes) Question 1: Rate your endurance (using a visual analog scale from 0-100% marked every 10%)? Question 2: Estimate how many stairs you could go up using arm support before you would have to take a break? Question 3: Estimate how many hours of exercise you completed in the previous 7 days? |
Countries
United States
Outcome results
None listed