title: Ecologically optimizing exercise maintenance in men and women post-cardiac rehabilitation: Protocol for a randomized controlled trial of efficacy with economics (ECO-PCR).
abstract: Exercise-based cardiac rehabilitation (CR) participation results in increased cardio-metabolic fitness, which is associated with reduced mortality. However, many graduates fail to maintain exercise post-program. ECO-PCR investigates the efficacy and cost-effectiveness of a social ecologically-based intervention to increase long-term exercise maintenance following the completion of CR.
  
  
  
  A three-site, 2-group, parallel randomized controlled trial is underway. 412 male and 192 female (N=604) supervised CR participants are being recruited just before CR graduation. Participants are randomized (1:1 concealed allocation) to intervention or usual care. A 50-week exercise facilitator intervention has been designed to assist CR graduates in the transition from structured, supervised exercise to self-managed home- or community-based (e.g., Heart Wise Exercise programs) exercise. The intervention consists of 8 telephone contacts over the 50week period: 3 individual and 5 group. Assessments occur at CR graduation, and 26, 52 and 78weeks post-randomization. The primary outcome is change in minutes of accelerometer-measured moderate to vigorous-intensity physical activity (MVPA) from CR graduation to 52weeks post-randomization. Secondary measures include exercise capacity, quality of life, and cardiovascular risk factors. Analyses will be undertaken based on intention-to-treat. For the primary outcome, an analysis of variance will be computed to test the change in minutes of MVPA in each group between CR graduation and 52week follow-up (2 [arm]×2 [time]). Secondary objectives will be assessed using mixed-model repeated measures analyses to compare differences between groups over time. Mean costs and quality-adjusted life years for each arm will be estimated.
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Electronic address: breid@ottawaheart.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Reid
authors.affiliation: Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada. Electronic address: chris.blanchard@Dal.Ca.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Blanchard
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Electronic address: EWooding@ottawaheart.ca.
authors.forename: Evyanne
authors.initials: E
authors.lastname: Wooding
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Electronic address: jharris@ottawaheart.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harris
authors.affiliation: University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada. Electronic address: murray.krahn@theta.utoronto.ca.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Electronic address: apipe@ottawaheart.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pipe
authors.affiliation: University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. Electronic address: caroline.chessex@uhn.ca.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chessex
authors.affiliation: University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; York University - Bethune 368, 4700 Keele St., Toronto, ON M3J 1P3, Canada. Electronic address: sgrace@yorku.ca.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D061725:Accelerometry; D000072038:Cardiac Rehabilitation / Q000191:economics* / Q000379:methods*; D015897:Comorbidity; D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012107:Research Design; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012959:Socioeconomic Factors
keywords: Exercise, physical; Health care economics; Heart diseases; Rehabilitation