title: Rural cardiac rehabilitation: a 20-year success story.
abstract: BACKGROUND
  Data are lacking on long-term participation in a clinically supervised cardiac rehabilitation program in a rural setting. We sought to determine whether there were sustained improvements in physiologic measures and discover what restorative and deteriorative processes took place over time.
  
  
  METHODS
  We retrospectively analyzed the records of patients who were enrolled for a least 1 year in the Healthy Hearts Cardiac Rehabilitation Program. Data from stress tests were tracked for up to 18 years to determine whether there were any sustained improvements and what factors were associated with restorative and deteriorative processes.
  
  
  RESULTS
  We analyzed data from 85 participants. The mean age of the participants was 72 years, and the mean length of participation was 8 years. Duration of stress testing significantly (p < 0.01) increased by a mean of 15% from the first year to the second year, with a corresponding increase in estimated metabolic equivalent of task (MET) level (Cohen d = 0.82). The increase in duration was sustained into the ninth year, with an overall increase of 35% compared with the first year of testing. After the ninth year, the duration and estimated MET levels declined.
  
  
  CONCLUSIONS
  Participants in the cardiac rehabilitation program demonstrated improved duration of stress testing, and stable rate-pressure product, blood pressure and resting heart rate during long-term participation in the program.
authors.affiliation: Rehabilitation Sciences, Western University, London, Ont.
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Gillin
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Ont.
authors.forename: Alan
authors.initials: A
authors.lastname: Salmoni
authors.affiliation: School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Grant M
authors.initials: GM
authors.lastname: Dawson
authors.affiliation: Western University, London, Ont.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dawson
authors.affiliation: School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Majed
authors.initials: M
authors.lastname: Fiaani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D019035:Rural Health Services; D013997:Time Factors; D016896:Treatment Outcome