Home-based exercise with telemonitoring guidance in patients with coronary artery disease; Does it improve long-term physical fitness?

Avila, Andrea, Claes, Jomme, Buys, Roselien, Goetschalckx, Katcha, Azzawi, May ORCID: https://orcid.org/0000-0001-6238-9777, Vanhees, Luc and Cornellissen, Veronique (2019) Home-based exercise with telemonitoring guidance in patients with coronary artery disease; Does it improve long-term physical fitness? European Journal of Preventive Cardiology, 27 (4). pp. 367-377. ISSN 2047-4873

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Abstract

Background: Exercise and physical activity are an essential part of contemporary coronary artery disease (CAD) management. However, evidence shows that patients experience clear difficulties in maintaining a physically active lifestyle following completion of a structured and supervised phase II exercise-based CR program. Home-based (HB) interventions have been shown to enhance a patient’s self-efficacy and might facilitate the lifelong uptake of a physically active lifestyle. Yet, data on the long-term effectiveness of HB exercise training on physical activity (PA) and exercise capacity (EC) are scarce. Objective: The main purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of the implementation of a short HB phase III exercise program with telemonitoring guidance to a prolonged center-based (CB) phase III program in patients with CAD. Primary outcome measure was exercise capacity. Secondary outcome measures included physical activity behaviour, cardiovascular risk profile and health related quality of life. Methods: Ninety CAD patients were randomized to three months of HB (=30), CB (=30) or a control group (CG) (=30) on a 1:1:1 basis after completion of their phase II ambulatory CR program. Outcome measures were assessed at discharge of the phase II program and after one year. Results: Eighty patients (91%, 72 men and mean age 62.6 years old) completed the one-year follow-up measurements. Exercise capacity (VO2P), cardiovascular risk factors and health related quality of life were preserved in all three groups (p-time >0.05 for all), irrespective of the intervention (p-interaction >0.05 for all). 85 % of patients met the international guidelines for PA (p-time < 0.05). No interaction effect was found for PA (steps, amount of active time, and amount of sedentary time) over the one-year period after discharge of a phase II program. Conclusion: Although exercise capacity remained stable over time, our HB exercise intervention did not result in higher levels of fitness or PA at one year of FU compared to the other two interventions.