Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation.
OBJECTIVE
To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation.


METHODS
Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency ablation for atrial fibrillation were given the choice to perform a 12-week exercise programme in either a supervised centre-based, or a self-management home-based setting. Exercise capacity and physical and mental health outcomes were assessed for up to 24months after hospital discharge. Outcomes between settings were compared using a time×setting interaction using a mixed effects regression model.


RESULTS
Across the 158 included patients, an equivalent proportion preferred to undertake exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p=0.233). At baseline, those who preferred a home-based setting reported better physical health (mean difference in physical component score: 5.0, 95% CI 2.3 to 7.4; p=0.001) and higher exercise capacity (mean between group difference 15.9watts, 95% CI 3.7 to 28.1; p=0.011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings.


CONCLUSIONS
The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent and provides similar health benefits. Whilst these findings support that patients should be given the choice between exercise-settings when initiating cardiac rehabilitation, further confirmatory evidence is needed.
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Bachelor's Degree Program in Physiotherapy, Dept. of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark. Electronic address: Lars.Hermann.Tang@rsyd.dk.
Lars H
LH
Tang
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Selina
S
Kikkenborg Berg
CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Jan
J
Christensen
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Bachelor's Degree Program in Physiotherapy, Dept. of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark.
Jannik
J
Lawaetz
Department of Health Sciences, University of York, England, United Kingdom.
Patrick
P
Doherty
Institute of Health Research, University of Exeter Medical School, Exeter, England, United Kingdom; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; National Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Denmark; Odense University Hospital, Denmark.
Rod S
RS
Taylor
CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark.
Henning
H
Langberg
National Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Denmark; Odense University Hospital, Denmark.
Ann-Dorthe
AD
Zwisler
D001281:Atrial Fibrillation / Q000534:rehabilitation* / Q000601:surgery; D000072038:Cardiac Rehabilitation / Q000379:methods*; D017115:Catheter Ablation; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006349:Heart Valve Diseases / Q000534:rehabilitation* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D057240:Patient Preference; D011182:Postoperative Care / Q000379:methods; D011788:Quality of Life; D013997:Time Factors
Atrial fibrillation; Cardiac rehabilitation; Exercise setting; Exercise training; Heart valve diseases; Patient preference