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A controlled trial of hospital versus home-based exercise in cardiac patients
Arthur HM, Smith KM, Kodis J, McKelvie R
Medicine and Science in Sports and Exercise 2002 Oct;34(10):1544-1550
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Large numbers of patients who stand to benefit from the exercise training component of cardiac rehabilitation are not being served due to access issues. Home-based exercise training may be a potentially useful alternative to training in institutional environments. PURPOSE: The purpose of this study was to examine the benefit of 6 months of hospital-based exercise training versus 6 months of monitored, home-based exercise training with respect to physical, quality of life, and social support outcomes in patients after coronary artery bypass graft (CABG) surgery. METHODS: Randomized controlled trial of "direct-to-home" (Home; = 120) versus "direct-to-hospital" (Hosp; = 122) exercise training, 35 to 49 d post CABG surgery. The primary outcome was peak exercise capacity, measured by peak oxygen consumption (VO2) on a symptom-limited cycle ergometer exercise test. Secondary outcomes were health-related quality of life (measured by the SF-36) and social support (measured by the ISEL). Measurements were taken at baseline and after 3 and 6 months of exercise training. RESULTS: The study groups had similar demographic and health profiles at baseline. Peak VO2 improved significantly in both groups after 6 months of exercise training; 36% in the Hosp group (1,222.1 +/- 269.0 mL/min to 1,497.2 +/- 594.3 mL/min; p < 0.0001) and 31% in the Home group (1,260.3 +/- 306.5 mL/min to 1,433.4 +/- 589.7 mL/min; p < 0.05). The Home group reported greater total social support than the Hosp group at 3 (36.2 +/- 4.5 versus 34.0 +/- 6.7; p < 0.0001) and 6 months (36.0 +/- 4.9 versus 34.6 +/- 6.4; p = 0.05). The Home group demonstrated a greater improvement in health-related quality of life (physical) by 6 months in comparison to the Hosp patients (51.2 +/- 6.4 versus 48.6 +/- 7.1; p = 0.004). CONCLUSION: This study suggests that low-risk CABG surgery patients may be served as well or better with a monitored, home-based exercise program than with an institution-based program.

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