Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial.
BACKGROUND
participation in centre-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality but participation rates among the elderly are low. Establishing alternative programmes is important, and home-based CR is the predominant alternative. However, no studies have investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up.


METHODS
randomised clinical trial comparing home-based CR with comprehensive centre-based CR among patients ≥ 65 years with coronary heart disease.


RESULTS
seventy-five patients participated. There were no significant differences in exercise capacity after the intervention between home and centre-based CR. Adjusted mean differences of peak VO₂ = 0.9 ml/kg/min (95% CI -0.7, 2.4) and of 6 min walk test = -18.7 m (95% CI -56.4, 18.9). In addition, no differences were found in the secondary outcomes of systolic blood pressure (-0.6 mmHg, 95% CI -11.3, 10.0), LDL cholesterol (0.3 mmol/l, 95% CI -0.04, 0.7), HDL cholesterol (0.2 mmol/l, 95% CI -0.01, 0.3), body composition, proportion of smokers and health-related quality of life. A group of patients who did not have an effect of either programmes were characterised by higher age, living alone and having COPD. At 12 months of follow-up, both groups had a significant decline in exercise capacity.


CONCLUSIONS
home-based CR is as effective as centre-based CR in improving exercise capacity, risk factor control and health-related quality of life. However, a group of patients did not improve regardless of the type of intervention. Continued follow-up is essential in order to maintain the gained improvements.
Oerkild
Bodil
B
Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark. oerkild@dadlnet.dk
Frederiksen
Marianne
M
Hansen
Jorgen Fischer
JF
Simonsen
Lene
L
Skovgaard
Lene Theil
LT
Prescott
Eva
E
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000534:rehabilitation*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012047:Rehabilitation Centers; D016896:Treatment Outcome
D002784:Cholesterol