Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation

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 randomized 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.