Peak oxygen uptake after cardiac rehabilitation: a randomized controlled trial of a 12-month maintenance program versus usual care

Erik Madssen; Ingerid Arbo; Ingrid Granøien; Liv Walderhaug; Trine Moholdt

doi:10.1371/journal.pone.0107924

Peak oxygen uptake after cardiac rehabilitation: a randomized controlled trial of a 12-month maintenance program versus usual care

PLoS One. 2014 Sep 23;9(9):e107924. doi: 10.1371/journal.pone.0107924. eCollection 2014.

Authors

Erik Madssen¹, Ingerid Arbo², Ingrid Granøien³, Liv Walderhaug³, Trine Moholdt⁴

Affiliations

¹ K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pulmonary Medicine, St. Olavs Hospital, Trondheim, Norway.
² K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
³ Ålesund Hospital, Ålesund, Norway.
⁴ K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Women's Clinic, St. Olavs Hospital, Trondheim, Norway.

Abstract

Background: Exercise capacity is a strong predictor of survival in patients with coronary artery disease (CAD). Exercise capacity improves after cardiac rehabilitation exercise training, but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program. There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients. We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care.

Materials and methods: Two-centre, open, parallel randomized controlled trial with 12 months follow-up comparing usual care to a maintenance program. The maintenance program consisted of one monthly supervised high intensity interval training session, a written exercise program and exercise diary, and a maximum exercise test every third month during follow-up. Forty-nine patients (15 women) on optimal medical treatment were included following discharge from cardiac rehabilitation. The primary endpoint was change in peak oxygen uptake at follow-up; secondary endpoints were physical activity level, quality of life and blood markers of cardiovascular risk.

Results: There was no change in peak oxygen uptake from baseline to follow-up in either group (intervention group 27.9 (±4.7) to 28.8 (±5.6) mL·kg (-1) min (-1), control group 32.0 (±6.2) to 32.8 (±5.8) mL·kg (-1) min (-1), with no between-group difference, p = 0.22). Quality of life and blood biomarkers remained essentially unchanged, and both self-reported and measured physical activity levels were similar between groups after 12 months.

Conclusions: A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake in CAD patients after discharge from cardiac rehabilitation compared to usual care. This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group.

Trial registration: ClinicalTrials.gov NCT01246570.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Coronary Artery Disease / physiopathology*
Coronary Artery Disease / rehabilitation
Exercise Test / methods*
Exercise Therapy / methods*
Female
Humans
Male
Middle Aged
Oxygen Consumption*
Quality of Life
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01246570

Grants and funding

Authors were supported by funds from the Liaison Committee for Central Norway Regional Health Authority and the Norwegian University of Science and Technology, Funds for Medical Research at St. Olavs University Hospital, and the Norwegian Fund for Post-Graduate Training in Physiotherapy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.