Can low risk cardiac patients be 'fast tracked' to Phase IV community exercise schemes for cardiac rehabilitation? A randomised controlled trial

Abstract

Background: A prospective single blinded randomised controlled trial within a university hospital NHS Trust was undertaken to determine if fast tracking low risk cardiac rehabilitation patients, under the supervision of an exercise instructor, is superior in the medium term to conventional service delivery.

Methods: 100 low risk cardiac rehabilitation patients were randomised to either a conventional Phase III hospital group or to a fast-tracked group in a community scheme led by an exercise instructor. Both groups undertook once weekly supervised exercise sessions for the duration of six weeks. Both groups were also encouraged to continue with Phase IV and were reassessed at six months. The primary outcome measure was Incremental Shuttle Walking Test (ISWT) distance. Secondary health related quality of life measures were also analysed.

Results: ISWT distance statistically significantly increased over time (f=26.80, p<0.001) for both groups. No between group differences were observed (f=0.03, p=0.87). All domains of the MacNew quality of life questionnaire and five domains of the Short Form 36 showed statistical mean score improvements over time (p<0.05). Continued attendance at Phase IV at six months was statistically significantly higher in the fast track group (p=0.04). At six months all attendees of Phase IV had a clinically and statistically significant mean improvement in ISWT distance in comparison to non-attendees (mean difference 40.38 m, 95%CI 4.20 to 76.57, p=0.03).

Conclusions: The fast track service model of cardiac rehabilitation is effective and offers the additional benefit of greater medium term adherence to exercise.