title: Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial.
abstract: The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart valve surgery.
  
  
  
  The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVRtrial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2peak and secondary outcome was self-reported mental health measured by Short Form-36.
  
  
  
  76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02).
  
  
  
  Cardiac rehabilitation after heart valve surgery significantly improves VO2peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group.
  
  
  
  NCT01558765, Results.
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Kirstine L
authors: KL
authors: Sibilitz
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Department of Cardiology, Gentofte Hospital, Gentofte, Denmark.
authors: Selina K
authors: SK
authors: Berg
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Department of Cardiology, Gentofte Hospital, Gentofte, Denmark.
authors: Trine B
authors: TB
authors: Rasmussen
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Bachelor's Degree Programme in Nursing, Metropolitan University College, Copenhagen, Denmark.
authors: Signe Stelling
authors: SS
authors: Risom
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Lau C
authors: LC
authors: Thygesen
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Faculty of Health and Technology, Bachelor's Degree Programme in Physiotherapy, Department of Rehabilitation and Nutrition, Metropolitan University College, Copenhagen, Denmark.|CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Tang
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Zealand University Hospital, Department of Cardiology, Køgevej 7-13, 4000 Roskilde, Denmark.
authors: Tina B
authors: TB
authors: Hansen
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
authors: Pernille Palm
authors: PP
authors: Johansen
authors: Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Christian
authors: C
authors: Gluud
authors: Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Jane
authors: J
authors: Lindschou
authors: Cardiology Clinic, Tiefenau Hospital and University of Bern, Bern, Switzerland.
authors: Jean Paul
authors: JP
authors: Schmid
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Christian
authors: C
authors: Hassager
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Køber
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.|Institute of Health Research, University of Exeter Medical School, Exeter, England.
authors: Rod S
authors: RS
authors: Taylor
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.|Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark.|National Centre of Rehabilitation and Palliation, University of Southern Denmark, and University Hospital of Odense, Odense, Denmark.
authors: Ann-Dorthe
authors: AD
authors: Zwisler
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation*; D003718:Denmark; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006351:Heart Valves / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010101:Oxygen Consumption; D010349:Patient Compliance; D010353:Patient Education as Topic; D020127:Recovery of Function; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome