title: A controlled trial of hospital versus home-based exercise in cardiac patients.
abstract: BACKGROUND
  Large numbers of patients who stand to benefit from the exercise training component of cardiac rehabilitation are not being served due to access issues. Home-based exercise training may be a potentially useful alternative to training in institutional environments.
  
  
  OBJECTIVE
  The purpose of this study was to examine the benefit of 6 months of hospital-based exercise training versus 6 months of monitored, home-based exercise training with respect to physical, quality of life, and social support outcomes in patients after coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Randomized controlled trial of "direct-to-home" (Home; = 120) versus "direct-to-hospital" (Hosp; = 122) exercise training, 35-49 d post CABG surgery. The primary outcome was peak exercise capacity, measured by peak oxygen consumption (VO(2)) on a symptom-limited cycle ergometer exercise test. Secondary outcomes were health-related quality of life (measured by the SF-36) and social support (measured by the ISEL). Measurements were taken at baseline and after 3 and 6 months of exercise training.
  
  
  RESULTS
  The study groups had similar demographic and health profiles at baseline. Peak VO(2) improved significantly in both groups after 6 months of exercise training; 36% in the Hosp group (1,222.1 +/- 269.0 mL x min(-1) to 1,497.2 +/- 594.3 mL x min(-1); < 0.0001) and 31% in the Home group (1,260.3 +/- 306.5 mL x min(-1) to 1,433.4 +/- 589.7 mL x min(-1); < 0.05). The Home group reported greater total social support than the Hosp group at 3 (36.2 +/- 4.5 vs 34.0 +/- 6.7; < 0.0001) and 6 months (36.0 +/- 4.9 vs 34.6 +/- 6.4; = 0.05). The Home group demonstrated a greater improvement in health-related quality of life (physical) by 6 months in comparison to the Hosp patients (51.2 +/- 6.4 vs 48.6 +/- 7.1; = 0.004).
  
  
  CONCLUSIONS
  This study suggests that low-risk CABG surgery patients may be served as well or better with a monitored, home-based exercise program than with an institution-based program.
authors.affiliation: McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada. arthurh@mcmaster.ca
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kodis
authors.forename: Robert
authors.initials: R
authors.lastname: McKelvie
mesh_terms: D003327:Coronary Disease / Q000534:rehabilitation* / Q000628:therapy; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010814:Physical Therapy Department, Hospital; D015397:Program Evaluation; D011788:Quality of Life; D013689:Telephone