title: Individualized vs. group exercise in improving quality of life and physical activity in patients with cardiac disease and low exercise capacity: results from the DOPPELHERZ trial.
abstract: OBJECTIVE
  Important goals of cardiac rehabilitation maintenance programs (CMP) are to increase leisure time physical activity (LTPA) and improve health-related quality of life (HRQoL). Elderly patients with cardiac disease and low exercise capacity are simultaneously the most severely affected and have the most to gain from exercise-based rehabilitation. Individualized combined exercise (ICE) may be an effective modality to achieve these goals. We compared six months of ICE to CMP in their effects on LTPA and HRQoL.
  
  
  METHODS
  Sixty patients (70 ± 9 years, 39% female) with cardiac disease and low exercise capacity (<6 MET) were randomly allocated to six months of once-weekly ICE or CMP. The patients in ICE performed moderate endurance and resistance exercise on machines, based on intensities from individual peak exercise testing. Patients in CMP performed weekly sessions of calisthenics, flexibility, coordination and relaxation activities. LTPA and HRQoL were assessed with accelerometry and questionnaires at baseline and six months.
  
  
  RESULTS
  Sixty patients completed the trial. ICE increased vigorous PA (ICE: Δ + 12 MET-min/d, CMP: Δ -5 MET-min/d, p = .02) and steps per day (ICE: +1586 steps/d, CMP: -838 steps/d, p < .01) compared to CMP after six months. ICE significantly improved in several components of HRQoL (vitality, emotional health, social health, positive and negative affect (all p < .05) compared to CMP.
  
  
  CONCLUSIONS
  ICE resulted in significant improvements in physical activity levels and health related quality of life in moderate to high-risk patients compared to CMP. Implications for rehabilitation Relatively low volumes and intensities of exercise may lead to substantial improvements in both physical activity levels and health-related quality of life Exercise modes in cardiac rehabilitation maintenance programs should not be limited to calisthenics and large group-based exercise Supplemental resistance exercise may improve health-related quality of life and increase physical activity levels in patients with low exercise capacity Moderate to high-risk elderly patients also benefit from individualized endurance-resistance exercise.
authors: a Department of Prevention and Sports Medicine , Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich , Germany.|b Division of Cardiovascular Medicine , Stanford University , Stanford , CA , USA.
authors: Jeffrey Wilcox
authors: JW
authors: Christle
authors: a Department of Prevention and Sports Medicine , Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich , Germany.
authors: Anna
authors: A
authors: Schlumberger
authors: c Klinikum rechts der Isar, Technische Universitat Munchen, Institute of Medical Statistics and Epidemiology , Munich , Germany.
authors: Bernhard
authors: B
authors: Haller
authors: d Department of Respiratory Medicine & Pulmonary Rehabilitation , Schoen Klinik Berchtesgadener Land , Schoenau am Koenigssee , Germany.
authors: Rainer
authors: R
authors: Gloeckl
authors: a Department of Prevention and Sports Medicine , Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich , Germany.|e Partner Site Munich Heart Alliance , DZHK (German Center for Cardiovascular Research) , Munich , Germany.|f Klinkum rechts der Isar, Else-Kroener-Fresenius-Zentrum , Munich , Germany.
authors: Martin
authors: M
authors: Halle
authors: a Department of Prevention and Sports Medicine , Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich , Germany.
authors: Axel
authors: A
authors: Pressler
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods / Q000523:psychology; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods / Q000523:psychology; D017079:Exercise Tolerance; D005260:Female; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Cardiac disease; exercise; physical activity