Jan. 29, 2005 Although three months are often prescribed for cardiac rehabilitation, it takes nine months for patients to reach peak improvement, say researchers from the University of Toronto.
The study, published in the December issue of the Journal of Cardiopulmonary Rehabilitation, found a 52-week rehabilitation program that combined supervised and unsupervised exercise sessions was effective in improving both physical and mental health, with the peak occurring at 38 weeks (nine months).
"To receive the optimal benefits in physical fitness and quality of life, patients should attend cardiac rehabilitation programs which last for at least six, and up to nine months," says Dr. Terence Kavanagh, a professor in U of T's Faculty of Physical Education and Health and the Faculty of Medicine. Increased program length also gives health care professionals a longer period to help patients make heart-healthy lifestyle changes that lower the risk of future cardiac events, such as quitting smoking or switching to a low-fat diet.
In the study, 623 male patients with coronary heart disease were randomized to one of two programs. The first used weekly supervised exercise sessions over 52 weeks, while the second used weekly supervised sessions for 26 weeks followed by one supervised session per month for the remaining 26 weeks. Patients were kept on their drug therapies and had nutritional interventions as well as being prescribed a walking or walk-jog (where appropriate) program.
Dr. Larry Hamm, an adjunct professor in U of T's Faculty of Physical Education and Health and program director of cardiac rehabilitation at National Rehabilitation Hospital, Washington, D.C., says that Ontario and most of Canada already have programs that extend sessions beyond 12 weeks. "They would need very minor modifications to achieve these optimal benefits."
However, American programs typically employ supervised sessions three times a week for 12 weeks, a regime that is determined in large part by insurance company rules and regulations, Hamm says. While the number of supervised sessions used in U.S. programs is similar to that used in the study, the length of the program is considerably less, at three versus nine months. "We hope this data may increase the willingness on the part of insurance companies to consider paying for programs that use an extended period of time and possibly some unsupervised exercise sessions," he says.
According to Kavanagh, one of the primary arguments against prolonging the time for outpatient rehabilitation services has been cost. "Our study has shown that the costs associated with the modified 38-week program are comparable with programs that use 36 sessions in a shorter period," calling into question the practice of terminating outpatient programs at 12 weeks.
The researchers also found that in the later period of the study, from 26 to 52 weeks, there was little difference in response between the format that used weekly supervised sessions and the format which decreased the supervised sessions from weekly to monthly after 26 weeks. Kavanagh says this shows that more money can be saved by introducing a progressive tapering of supervision.
"Our results justify the approach first taken by the Toronto Rehabilitation Centre in 1968, and which has made it one of the largest, best-known and most effective cardiac rehabilitation programs in North America," says Kavanagh.
This study was supported by a research grant from the Canadian Cardiac Rehabilitation Foundation and was undertaken at the Toronto Rehabilitation Institute, formerly the Toronto Rehabilitation Centre.
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