The aim of this study was to investigate the effectiveness of a novel bespoke 4-pillar (4P) approach to cardiac rehabilitation compared to current practice.
272 patients (mean age = 57 years; 225 males and 47 female) were recruited to a novel 4-pillar outpatient method of cardiac rehabilitation. The structure of the programme consisted of 1-2-1 resistance training (RT), independent cardiovascular training (CV), nutrition guidance and step tracking. Subjects attended the clinic twice per week for 1-hour resistance exercise, the sessions consisted of a squat, push (e.g. chest press) and pull (e.g. low row) movement performed over three sets of 90s to technical overload. Alongside the clinic sessions, the subjects were instructed to perform a 55-minute steady state cardiovascular exercise session (30 minutes at 50% DVT1-VT2, plus 15-minute warm up and 10-minute cool down). The subjects were also asked to track their nutritional intake using a food diary and step count. The subjects received feedback each time they attended the clinic on their exercise performance, nutrition score (aiming for 80% positive choices) and step count (aiming for >10,000 steps per day). The subjects were assessed pre-intervention and post-intervention after 12 weeks of the programme. Each programme was delivered bespoke to the individual’s goals, clinical history and baseline function based on the initial assessment. During assessment, recordings of cardiorespiratory health, metabolic health and body composition were taken. At 12-weeks the outcomes were compared to the BHF National Audit of Cardiac Rehabilitation 2019 (NACR). A team of clinical exercise specialists led each session overviewed by a Physiotherapist and Nurse.
Results: 97.0% of patients completed the programme compared to 77.0% completion for NACR. 100.0% completed their follow up assessment compared to 68.6% in the NACR. The current study programme lasted 84 days vs. 76 days in the NACR. On the 4P programme the average adherence to the programme was 1.61 RT sessions per week, 1.75 CV sessions per week, 64.77% food diary score and 10359 steps per week. Following assessment, there was a larger increase in percentage of patients with body mass index (BMI) <30 (4P = +3.6%, NACR = 0.2%), normal Hospital Anxiety and Depression score (HADs; 4P = +14.4%, NACR = +6.1%) and blood pressure below 140/90 mmHg (4P = +15.1%, NACR = +1.2%) compared to the NACR outcomes. However, the current study showed a smaller change in percentage of patients with total cholesterol <4.00 mmol/L (4P = +7.3%, NACR = +29.3%).
Conclusion(s): The current study shows that a bespoke 4-pillar approach to cardiovascular exercise is both feasible and effective. The outcomes were generally better than those of the national average with strong adherence to the programme. Further research is needed to elucidate the independent effects of each of the pillars and cost analysis is required to determine how this model could be scalable within the public and private health sector.
Cost and savings
This is one of the first studies to incorporate a multi-modality model of cardiovascular exercise using outpatient appointments, independent exercise and holistic lifestyle prescription. This creates a template for service development
Top three learning points
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