title: Lack of supervision after residential cardiac rehabilitation increases cardiovascular risk factors.
abstract: BACKGROUND
  Cardiovascular rehabilitation (CR) is an important component of care for patients with cardiovascular disease (CVD) and has been well documented and promoted by various health organizations and position statements worldwide.
  
  
  OBJECTIVE
  The purpose of this study was to investigate whether patients readmitted to CR on average 16 months after their previous discharge, maintained the reduction in CVD risk factors, maintained or improved functional capacity, occurrence of adverse cardiovascular events, and possible modifications in prescribed medications.
  
  
  METHODS
  Five hundred and seventy patients (60+/-10 years) underwent cycle ergometry and blood sampling at the beginning, the end of 21+/-2 days of the previous CR, and again at readmission to CR. The CR consisted of cycling for 17+/-4 min at frequency of six times a week and daily walking for 45 min at 60-70% of the maximal individual heart rate.
  
  
  RESULTS
  Blood total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and body mass index decreased significantly during CR. Resting blood pressure, maximal performance (watts), maximal oxygen uptake, and heart rate recovery improved significantly in 1 min (P<0.001). At readmission, all traditional CVD risk factors increased significantly, although medication was unchanged and angiotensin-converting enzyme inhibitors were partly replaced by angiotensin II receptor antagonists. Exercise performance remained unchanged.
  
  
  CONCLUSIONS
  At readmission, we observed an increase in CVD risk factors, although, physical fitness remained stable. Thus, failure of lifestyle modification after CR indicates the cause for concern. Reinforcement of home setting sessions of CR patients or other strategies to enhance long-term compliance to lifestyle changes could reduce the observed attrition in CR benefits.
authors.affiliation: Center for Cardiovascular Rehabilitation, Bad Schallerbach, Austria. robert.berent@aon.at
authors.forename: Robert
authors.initials: R
authors.lastname: Berent
authors.forename: Serge P
authors.initials: SP
authors.lastname: von Duvillard
authors.forename: Johann
authors.initials: J
authors.lastname: Auer
authors.forename: Helmut
authors.initials: H
authors.lastname: Sinzinger
authors.forename: Peter
authors.initials: P
authors.lastname: Schmid
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D000072038:Cardiac Rehabilitation; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration; D010101:Oxygen Consumption; D010349:Patient Compliance; D010359:Patient Readmission; D010809:Physical Fitness; D020127:Recovery of Function; D012112:Residential Facilities; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002317:Cardiovascular Agents; D008055:Lipids