title: Improved Exercise Tolerance and Quality of Life With Cardiac Rehabilitation of Older Patients After Myocardial Infarction: Results of a Randomized, Controlled Trial Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX Self-efficacy regarding physical activity is superior to self-assessed activity level, in long-term prediction of cardiovascular events in middle-aged men The effect of home-based cardiac rehabilitation program on self efficacy of patients referred to cardiac rehabilitation center Peak Oxygen Uptake after Cardiac Rehabilitation: A Randomized Controlled Trial of a 12-Month Maintenance Program versus Usual Care Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation Long-term Exercise Adherence After High-intensity Interval Training in Cardiac Rehabilitation: A Randomized Study. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery The physical activity scale for the elderly (PASE): evidence for validity. The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial. Barriers to participation in cardiac rehabilitation. A home-based maintenance exercise program after center-based cardiac rehabilitation: effects on blood lipids, body composition, and functional capacity. [A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem]. Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume Are aerobic interval training and continuous training isocaloric in coronary artery disease patients?
abstract: Background —Whether cardiac rehabilitation ( CR ) is effective in patients older than 75 years , who have been excluded from most trials , remains unclear . We enrolled patients 46 to 86 years old in a r and omized trial and assessed the effects of 2 months of post-myocardial infa rct ion ( MI ) CR  on total work capacity ( TWC , in kilograms per meter ) and health-related quality of life ( HRQL ) . Methods and Results —Of 773 screened patients , 270 without cardiac failure , dementia , disability , or contraindications to exercise were r and omized to outpatient , hospital-based CR ( Hosp-CR ) , home-based CR ( Home-CR ) , or no CR within 3 predefined age groups ( middle-aged , 45 to 65 years ; old , 66 to 75 years ; and very old , > 75 years ) of 90 patients each .  TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline , after CR , and 6 and 12 months later . Within each age group , TWC improved with Hosp-CR and Home-CR and was unchanged with no CR . The improvement was similar in middle-aged and old persons but smaller , although still significant , in very old patients . TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR .  HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients . Complications were similar across treatment and age groups . Costs were lower for Home-CR than for Hosp-CR . Conclusions —Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group . However , with lower costs and more prolonged positive effects , Home-CR may be the treatment of choice in low-risk older patients Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Background Self-efficacy has been determined to be a strong predictor of who will engage in physical activity . We aim ed to evaluate the associations between self-efficacy to perform physical activity  ,  self-reported leisure-time physical activity  and cardiovascular events in a population -based cohort of middle-aged Swedish men with no previous cardiovascular disease , or treatment with cardiovascular drugs . Methods Analyses are based on 377 men r and omly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men ( n = 1728 ) and who had answered a question about their competence to perform exercise ( as an assessment of physical self-efficacy ) . The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity . Cardiovascular events were recorded during 13-years of follow-up . Results The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy ( 32.1 % vs 17.1 % , p < 0.01 ) . Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 ( 95 % CI 1.2 to 3.0 ) , of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio , heart rate , fasting plasma glucose , serum triglycerides , systolic blood pressure , apoB/apoA-I ratio and leisure-time physical activity . ConclusionS elf-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men , without known CVD or treatment with cardiovascular drugs Background The prevalence of coronary heart disease is increasing worldwide contributing to mortality and morbidity of millions of people . Cardiac rehabilitation is an interdisciplinary activity with the aim of facilitating and improving the physical , psychological and emotional state of the patients with cardiac complications . This study aim ed to evaluate the probable positive effects of continuing cardiac rehabilitation programs at home on self-efficacy of the patients with cardiac complications . Method In a r and omized controlled trial , 80 patients referred to rehabilitation center from Feb 2009 to Jan 2010 were r and omly divided into case and control groups . Both groups received routine cardiac rehabilitation programs in the rehabilitation center . In addition , the case group received education and practical training in various rehabilitation measures along with home visits of a community health nurse throughout the follow-up period . General Self Efficacy Scale ( GSES ) was used to assess self-efficacy between two groups at baseline and follow-up periods . Collected data from GSES question naires were analyzed using Minitab software and repeated measurement analysis model . Results No first time ( before beginning of rehabilitation program ) GESE differences were observed between case ( 26.36 ± 0.84 ) and control ( 28.53 ± 0.54 ) groups ( P = 0.44 ) . In the final measurement , GESE in case group was 36.59 ± 5.65 vs. 26.5 ± 0.91 in the control group . There was a statistically significant difference in self-efficacy between two groups and in different measurements ( P = 0.000 ) . Conclusion Home-based cardiac rehabilitation has a positive effect on patients ’ self-efficacy and therefore it is recommended for the patients suffering from heart diseases . Trial registration RCT registration number : I RCT 201106086747N1 Background Exercise capacity is a strong predictor of survival in patients with coronary artery disease ( CAD ) . Exercise capacity improves after cardiac rehabilitation exercise training , but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program . There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients . We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care . Material s and Methods Two-centre , open , parallel r and omized controlled trial with 12 months follow-up comparing usual care to a maintenance program . The maintenance program consisted of one monthly supervised high intensity interval training session , a written exercise program and exercise diary , and a maximum exercise test every third month during follow-up . Forty-nine patients ( 15 women ) on optimal medical treatment were included following discharge from cardiac rehabilitation . The primary endpoint was change in peak oxygen uptake at follow-up ; secondary endpoints were physical activity level , quality of life and blood markers of cardiovascular risk . Results There was no change in peak oxygen uptake from baseline to follow-up in either group ( intervention group 27.9 ( ±4.7 ) to 28.8 ( ±5.6 ) mL·kg ( -1 ) min ( −1 ) , control group 32.0 ( ±6.2 ) to 32.8 ( ±5.8 ) mL·kg ( −1 ) min ( −1 ) , with no between-group difference , p = 0.22 ) . Quality of life and blood biomarkers remained essentially unchanged , and both self-reported and measured physical activity levels were similar between groups after 12 months . Conclusions A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake  in CAD patients after discharge from cardiac rehabilitation compared to usual care . This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group . Trial Registration Clinical Trials.gov Background Methods to ensure sustained benefits of cardiac rehabilitation need to be explored . The aim was to assess the effect of a home-based intervention ( INT ) on exercise adherence and risk factors after cardiac rehabilitation . Design Prospect i ve r and omized study . Methods We evaluated patients who were followed for 1 year after either inpatient ( ICR ) or outpatient cardiac rehabilitation ( OCR ) by assessment of exercise capacity , physical activity , risk factors and quality of life  , both at the completion of rehabilitation , and after 1 year . Patients were r and omized to either be instructed how to use a diary of physical activities complemented by quarterly group meetings ( INT ) or to receive st and ard treatment ( usual care ) . Results Two hundred and sixty-one patients gave consent to be reevaluated after 1 year . Of these patients 33 were lost to follow-up ( two deaths ) ; thus 228 patients had complete 1-year follow-up data ( 195 male and 33 female , 91 % with coronary artery disease ) . At 1-year follow-up significantly more patients of the INT group than of the control group adhered to regular physical activity ( 73 vs. 40 % , P < 0.0001 ) . Moreover , INT patients showed a better evolution of body mass index and lipid values . In a stepwise multiple regression analysis the following variables showed a significant impact on regular physical activity at follow-up : study INT [ odds ratio ( OR ) : 4.19 , P < 0.0001 ] , previous cardiac surgery ( OR : 2.50 , P = 0.008 ) , BMI at baseline ( OR : 0.89 , P = 0.018 ) and quality of life at baseline ( OR : 1.58 , P = 0.041 ) . Conclusion Sustained benefits of cardiac rehabilitation can be documented 1 year after both inpatient and outpatient programmes . Self-monitoring of physical activity greatly increased long-term adherence to regular exercise , which in turn was associated with greater improvements of risk factors and quality of life Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based BACKGROUND AND PURPOSE Exercise adherence in general is reported to be problematic after cardiac rehabilitation . Additionally , vigorous exercise is associated with impaired exercise adherence . As high-intensity interval training ( HIT ) is frequently used as a therapy to patients with coronary artery disease in cardiac rehabilitation , the objective was to assess long-term exercise adherence following an HIT cardiac rehabilitation programme . METHODS A multicentre r and omized study was carried out . Eligible participants were adults who had previously attended a 12-week HIT cardiac rehabilitation programme , as either a home-based or hospital-based HIT ( treadmill exercise or group exercise ) .  The primary outcome was change in peak oxygen uptake ; secondary outcomes were self-reported and objective ly measured physical activity . RESULTS Out of 83 eligible participants , 76 were available for assessment ( 68 men/8 women , mean age 59 ( 8) years ) at a one-year follow-up . Peak oxygen uptake was significantly elevated above baseline values , ( treadmill exercise : 35.8 ( 6.4 ) vs. 37.4 ( 7.4 ) ml kg(-1 ) min(-1 ) , group exercise : 32.7 ( 6.5 ) vs. 34.1 ( 5.8 ) ml kg(-1 ) min(-1 ) and home-based exercise : 34.5 ( 4.9 ) vs. 36.7 ( 5.8 ) ml kg(-1 ) min(-1 ) at baseline and follow-up , respectively ) , with no significant differences between groups . The majority of the participants ( > 90 % ) met the recommended daily level of 30 minutes of moderate physical activity . The home-based group showed a strong trend towards increased physical activity compared with the hospital-based groups . DISCUSSION The results from this study have shown that both home-based and hospital-based HIT in cardiac rehabilitation induce promising long-term exercise adherence , with maintenance of peak oxygen uptake significantly above baseline values at a one-year follow-up . The implication for physiotherapy practice is that HIT in cardiac rehabilitation induces satisfactory long-term exercise adherence Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during  cardiac rehabilitation ( CR ) on exercise capacity and habitual physical activity . Design Six-year follow-up of patients who participated in a r and omised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery . Setting Outpatient CR centre in Central -South Ontario , Canada . Participants 196 Patients who participated in the original r and omised controlled trial and who attended an evaluation 1 year after CR . Interventions 6 months of home or hospital-based exercise training during CR . Main outcome measures Peak oxygen uptake ( peak Vo2 ) , Physical Activity Scale in the Elderly ( PASE ) to assess habitual activity , semi-structured interviews to assess vital status , demographic and descriptive information . Results Of the 196 eligible patients , 144 ( 75.5 % ; 74 Hospital , 70 Home ) were available for participation . Patients were predominantly male ( n=120 ; 83.3 % ) aged 70±9.5 years .  Clinical and sociodemographic outcomes were similar in both groups . While exercise performance declined over time , there were significant between-group differences in peak Vo2 ( 1506±418 ml/min vs 1393±341 ml/min ; p=0.017 ) and PASE scores ( 166.7±90.2 vs 139.7±66.5 ; p=0.001 ) at 6-year follow-up in favour of the home group . Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR . Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo2 and persistent physical activity compared with traditional hospital-based CR We assessed the validity of the Physical Activity Scale for the Elderly ( PASE ) in a sample of sedentary adults ( 56 men , 134 women , mean age + /- [ SD ] 66.5+/-5.3 years ) who volunteered to participate in a r and omized controlled trial on the effect of aerobic conditioning on psychological function . Construct validity was established by correlating PASE scores with physiologic and performance characteristics : peak oxygen uptake , resting heart rate and blood pressure , percent body fat , and balance . The mean PASE scores were higher in men than in women ( men = 145.8+/-78.0 ; women = 123.9+/-66.3 , P<0.05 ) , and in those age 55 - 64 years compared with those age 65 years and over ( 55 - 64 = 144.2+/-75.8 ; 65 and over = 118.9+/-63.9 , P<0.05 ) .  PASE scores were also significantly higher in those who did not report a chronic health condition ( cardiovascular disease , hypertension , cancer , or recent surgery ) .  PASE scores were significantly associated ( P<0.05 ) with peak oxygen uptake ( r = 0.20 ) , systolic blood pressure ( r = -0.18 ) and balance score ( r = 0.20 ) . No significant associations of  PASE score and diastolic blood pressure , resting heart rate , or percent body fat were noted . These results provide additional evidence for the validity of the PASE as a measure of physical activity suitable for use in epidemiology studies on the association of physical activity , health , and physical function in older individuals AIM Previous studies have reported lifestyle and risk factor deterioration following completion of a cardiac rehabilitation program ( CRP ) . We report the results of a one-year Extensive Lifestyle Management Intervention ( ELMI ) aim ed at preventing these adverse changes . METHODS AND RESULTS A total of 302 men and women with ischaemic heart disease were recruited following completion of a CRP and r and omized to either the  ELMI  ( consisting of exercise sessions , telephone follow-ups and risk factor and lifestyle counselling ) or  usual care . The primary outcome was global cardiovascular risk using the Framingham and Procam risk scores . Secondary outcomes included risk factors and lifestyle behaviours . Baseline characteristics were similar between the two groups . Adherence to the ELMI was high . There was a non-significant trend in favour of the ELMI between for both the Framingham ( 6.6+/-3.1 to 6.2+/-2.9 vs 6.6+/-3.2 to 6.7+/-3.2 , P=0.138 ) and Procam ( 20.0+/-20.0 to 20.6+/-19.5 vs 19.1+/-18.7 to 21.8+/-19.1 , P=0.089 ) scores . There were no differences in secondary outcomes . CONCLUSIONS A one-year multi-factorial post-CRP intervention results in modest , non-significant benefits to global risk compared to usual care . The absence of deterioration in the usual care group may be due to improved practice s in usual care BACKGROUND Participation rates in  cardiac rehabilitation after myocardial infa rct ion ( MI ) remain low . Studies investigating the predictive value of psychosocial variables are sparse and often qualitative . We aim ed to examine the demographic , clinical , and psychosocial predictors of participation in cardiac rehabilitation after MI in the community . METHODS Olmsted County , Minnesota , residents hospitalized with MI between June 2004 and May 2006 were prospect ively recruited , and a 46-item question naire was administered before hospital dismissal . Associations between variables and cardiac rehabilitation participation were examined using logistic regression . RESULTS Among 179 survey respondents ( mean age 64.8 years , 65.9 % male ) , 115 ( 64.2 % ) attended cardiac rehabilitation . The median ( 25th-75th percentile ) number of sessions attended within 90 days of MI was 13 ( 5 - 20 ) . Clinical characteristics associated with rehabilitation participation included younger age ( odds ratio [ OR ] 0.95 per 1-year increase ) , male sex ( OR 1.93 ) , lack of diabetes ( OR 2.50 ) , ST-elevation MI ( OR 2.63 ) , receipt of reperfusion therapy ( OR 7.96 ) , in-hospital cardiologist provider ( OR 18.82 ) , no prior MI ( OR 4.17 ) , no prior cardiac rehabilitation attendance ( OR 3.85 ) , and referral to rehabilitation in the hospital ( OR 12.16 ) . Psychosocial predictors of participation included placing a high importance on rehabilitation ( OR 2.35 ) , feeling that rehabilitation was necessary ( OR 10.11 ) , better perceived health before MI ( excellent vs poor OR 7.33 ) , the ability to drive ( OR 6.25 ) , and post- secondary education ( OR 3.32 ) . CONCLUSIONS Several clinical and psychosocial factors are associated with decreased participation in cardiac rehabilitation programs  after MI in the community . As many are modifiable , addressing them may improve participation and outcomes BACKGROUND Previous research indicates that patients exiting a 12-week cardiac rehabilitation program ( CRP )  have difficulty maintaining an adequate exercise program . Thus , the authors ' purpose was to determine if a home-based exercise program would enable patients to maintain/improve their blood lipids , body composition , and functional capacity after exiting the CRP . METHODS Thirty-one patients exiting an initial 12-week CRP were assigned r and omly to the home-based ( HB ) intervention or the st and ard care ( SC ) condition . After one home visit , the HB participants ( n = 16 ) were contacted by telephone every other week by CRP staff and completed and returned weekly exercise logs . The SC participants ( n = 15 ) had no contact with the CRP other than to schedule follow-up tests . A third group ( n = 17 ) , r and omly selected from patients that elected to remain in the center-based CRP ( CB ) for the same duration , also were examined . All groups underwent  exercise testing , fasting blood lipid analysis , and body composition assessment before starting CRP ( 0 M ) , after 3 months ( 3 M ) in a st and ard CRP , and after 9 months ( 12 M ) in either HB , SC , or CB condition ( 12 months after starting CRP ) . RESULTS Analysis of variance indicated that there were significant increases in metabolic equivalents and high-density lipoprotein , in all three groups , over time . However , analysis of covariance revealed no significant differences between the HB , SC , and CB groups at 12 M for any variable . CONCLUSIONS These data indicate that the HB program was as effective as the CB program at improving/maintaining functional capacity , blood lipids , and body weight/composition . The similar success of the SC group is likely due to their prior experience in CRP and knowledge of follow-up testing . Home-based maintenance program could be offered as a low-cost alternative to CB programs AIM To analyze the impact of a home exercise training ( ET ) program on quality of life , motor activity ( MA ) , dietary habit , functional and biochemical parameters , and clinical course of the disease in patients who have experienced acute coronary syndrome ( ACS ) and /or endovascular coronary intervention ( ECI ) . SUBJECTS AND METHOD The trial included 100 patients after ECL who were r and omized into 2 groups : those who had gone through Patient School ( PS ) and received a 6-week course of controlled ET ( a study group ( Group S ) ) and those who had gone through PS only ( a control group ( Group C ) . The patients of both groups were recommended a home ET program and , according to its implementation , they formed 2 subgroups : Subgroup A ( home ET+ ) comprising 51 patients who had trained themselves at home ) and Subgroup B ( home ET- ) consisting of 46 patients who had not . The follow-up lasted 1 year . Quality of life , risk factors , lifestyle and clinical parameters were assessed . RESULTS As time elapsed , the patients ' motivation to perform home ET ;  and , accordingly , the proportion of those who had trained themselves decreased in Group S to 67 and 61 % and in Group C to 39 and 40 % after 6 and 12 months , respectively . Among the reasons for refusal to perform home ET , disease was reported by only 5.6 % of the patients ( by all from Group C ) . The comprehensive physical rehabilitation program ( RP ) ( controlled ET in combination with home ET ) produced the best effect in raising the level of daily MA , exercise performance with a 21.3-fold increase in cardiac performance ( p < 0.05 ) and a 14.3-fold decrease in heart rate increment in response to exercises . Group C patients who had refused the home ET program , as compared to those in the same group who had trained themselves at home , showed the worst daily MA levels , none body mass index reduction , and a rise in the low-density lipoprotein cholesterol ( by 20.3 % ; p < 0.05 ) and in the number of angina attacks ( by 1.9 times ; p < 0.05 ) . CONCLUSION RP in the early-stage , which encompasses an educational program ( PS ) , a short-term course of controlled ET and home ET used in patients with ACS , including in those after ECI , has clear clinical benefits . The participation of patients with coronary heart disease ( CHD ) in the home ET programs increases their motivation and , hence , the proportion of those who participate in therapeutic and rehabilitation measures . Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI Objective : To assess whether exercise volume during phase II rehabilitation affects long-term clinical benefits in patients with coronary artery disease . Design : Prospect i ve r and omized clinical trial with long-term follow-up . Setting : Hospital outpatient clinic . Subjects : Coronary artery disease patients ( age 65 ± 9 years , 82 % males ) attending a phase II rehabilitation programme  were r and omized into two groups of exercise volumes : 40- versus 60-minute training sessions . Patients exercised for three days per week for seven weeks , at 65 % of baseline oxygen uptake capacity . Next , they were followed up for 18 months . Out of 165 patients with coronary artery disease who completed the exercise intervention  , 119 attended the 18-month follow-up assessment . Main measurements : Body anthropometrics , resting haemodynamics , blood lipid profile , glycaemia , and C-reactive protein level , smoking behaviour , habitual physical activity , cardiovascular disease incidence and mortality . Results : In total population , a significant worsening of various cardiovascular disease risk factors was found at 18 months follow-up ( P<0.05 ) , and few patients ( 27 % of total group ) adhered to the recommended minimal physical activity level . No difference in change of body anthropometrics , resting haemodynamics , blood lipid profile , glycaemia , and C-reactive protein level , and smoking behaviour was seen between different exercise volumes ( P>0.05 ) . In addition , total cardiovascular disease incidence ( 13 % versus 22 % in 40- versus 60-minute group , respectively ) and habitual physical activity were not different between groups ( P>0.05 ) . Conclusion : In patients with coronary artery disease following cardiac rehabilitation , the cardiovascular disease risk profile worsened significantly during long-term follow-up . A smaller exercise volume during phase II rehabilitation generated equal long-term clinical benefits compared to a greater exercise volume Background Aerobic interval training ( IT ) seems to be superior to continuous training ( CT ) in improving exercise capacity ( peak oxygen uptake ( VO2 ) ) in coronary artery disease ( CAD ) patients in some , but not in all studies . Based on theoretical calculations , these comparative studies stated that the energy expenditure ( EE ) of both programmes is similar . To date , the caloricity of both programmes has never been objective ly measured . Therefore , our aim was to objective ly measure the EE of the IT and CT programmes described in the protocol of the SAINTEX-CAD study ( based on Wisloff et al. ; ITw and CTw ) , and the actually performed training intensities in the SAINTEX-CAD study by Conraads et al. ( ITc and CTc ) . Methods Following a two-week run-in period with three IT and three CT training sessions , 18 male CAD patients ( mean age 62.4 ± 6.1 years ) performed four training sessions in r and om order on the cycle ergometer : an ITw , CTw , ITc and CTc test session . The EE was assessed by indirect calorimetry using gas exchange measurements obtained with the Oxycon mobile . Results We found a higher EE for CTc compared to ITc ( 352 ± 90.8 kcal versus 269 ± 70.7 kcal ; p = 0.026 ) , while CTw and ITw seemed to be isocaloric ( 317 ± 85.2 kcal versus 273 ± 65.3 kcal ; p = 0.42 ) . Higher lactate levels were reached after IT sessions ( ITw 5.42 ± 1.42 mmol/l , ITc 5.05 ± 1.38 mmol/l ) compared to CT sessions ( CTw 2.45 ± 1.04 mmol/l , CTc 3.41 ± 1.44 mmol/l ) ( p < 0.01 ) . Lactate levels increased above baseline levels ( 1.91 ± 0.34 mmol/l ) except for the CTw session . Conclusion CTc expended significantly more energy compared to ITc , showing that the programmes used in the SAINTEX-CAD study were not isocaloric . In contrast , isocaloricity was met for CTw and ITw
target: Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC .
background: Background Exercise-based cardiovascular rehabilitation ( CR ) improves exercise capacity ( EC ) , lowers cardiovascular risk profile and increases physical functioning in the short term .
  However , uptake of and adherence to a physically active lifestyle in the long run remain problematic .
  Home-based ( HB ) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity ( PA ) .
  The current systematic review and meta- analysis aim ed to compare the longer-term effects of HB exercise programmes with usual care ( UC ) or centre-based ( CB ) CR in patients referred for CR .