Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial.
OBJECTIVE
To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD).


METHODS
Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34-74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage.


RESULTS
Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR.


CONCLUSIONS
CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings.
Fitchet
A
A
Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK. alan.fitchet@talk21.com
Doherty
P J
PJ
Bundy
C
C
Bell
W
W
Fitzpatrick
A P
AP
Garratt
C J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D017147:Defibrillators, Implantable; D003863:Depression / Q000209:etiology; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology