Icbm2014 ter hoeve
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Transcript of Icbm2014 ter hoeve
How effective is cardiac rehabilitation to improve physical activity habits?
A systematic review
Nienke ter Hoeve, Bionka Huisstede, Henk Stam, Ron van Domburg,
Madoka Sunamura, Rita van den Berg-Emons
Rotterdam
Cardiac Rehabilitation (CR) is multidisciplinairy
• group exercise sessions twice a week
• group education sessions on lifestyle and cardiovascular risk factors
• smoking cessation/ nutritional counseling/stress management
Health benefits
20-30% reduction mortality
favourable effects several cardiovascular risk factors
Guidelines CR:
“minimum of 5 times 30 minutes of moderate-intensity activities per week”
Known: CR programmes improve risk factors, quality of life, physical fitness
Unknown: are CR programmes sufficient to improve activity level
Goal cardiac rehabilitation: improving physical activity levels
To review the short-term (<6 months) & long-term (>6 months) effects of CR on physical activity levels
1. Literature search
– Search string
2. Study selection
– In- & exclusion criteria
– title, abstract, full text
Performing a systematic review
I. Study population: patients with an acute coronary syndrome
II. Intervention: exercise-based CR
III. Outcome measure: physical activity level
IV. Minimal follow-up: completion of CR
V. The article was written in English, Dutch,
French or German
Inclusion criteria
26 RCTs
CR vs. no intervention (9)
CR of different duration (10)
Two different types of CR (7)
1. Literature search
2. Study selection
3. Data extraction -short/mid/long duration CR
-short/long term results
4. Quality assessment
5. Data analysis
Performing a systematic review
Data analysis: best-evidence synthesis
Duration CR RCT low/high quality
short-term effects < 6mnts after
completion CR
long term-effects ≥6 mnts after
completion CR
Centre-based CR versus no intervention
short (1-3mnts) Best evidence synthesis: limited evidence moderate evidence
medium (4-11mnts) Best evidence synthesis: no evidence limited evidence
long (≥12 mnts) Best evidence synthesis: conflicting evidence no RCT
Home-based CR versus no intervention
short (1- 3mnts) no RCT
medium (4-11mnts) no RCT
long (≥12 mnts) Best evidence synthesis: moderate evidence no evidence
CR versus no intervention?
Conclusion: no clear evidence for centre-based CR, more research needed for
home-based CR
Duration RCT
short-term effects < 6mtns after completion
CR
long-term effects ≥6mnts after completion CR
Centre-based vs home-based
short (1-3mnts) Best evidence synthesis: no RCT no evidence
mid (4-11mnts) Best evidence synthesis: no RCT moderate evidence
long (≥12 mnts) Best evidence synthesis: no evidence no RCT
Centre-based versus home-based
Conclusion: Moderate evidence that home-based CR has better long-term effects,
more research needed
RCT low/high quality
short-term effects < 6mtns after
completion CR
long-term effects ≥6mnts after
completion CR
CR of medium (4-11mnts) versus short duration (1-3mnts)
Best evidence synthesis: conflicting evidence no evidence
CR of long (≥12 mnts) versus short duration (1-3mnts)
Best evidence synthesis: conflicting evidence no evidence
CR of long (≥12 mnts) versus medium duration (4-11mnts)
Best evidence synthesis: conflicting evidence no RCT
Conclusion: no clear evidence that extending duration is more effective
Optimal duration
Duration RCT
short-term effects < 6mtns after completion
CR
long-term effects ≥6mnts after completion CR
Low-volume vs high-volume training group
short (1-3mnts) Best evidence synthesis: no RCT no evidence
CR including a self-efficacy intervention to increase physical activity vs standard CR
mid(4-11mnts) Best evidence synthesis: no evidence no RCT
CR including self-monitoring to increase physical activity vs standard CR
mid(4-11mnts) Best evidence synthesis: no RCT limited evidence
CR based on problem-based learning to increase physical activity vs standard CR
long (≥12 mnts) Best evidence synthesis no evidence No RCT
Conclusion: no clear evidence that increasing training volume or adding an extra
intervention is more effective
Type of CR
Current standard CR seems insufficient to improve and maintain physical activity habits
No clear evidence that increasing training volume, extending duration or adding an extra intervention leads to greater physical activity levels
“Active lifestyle is essential, future research should focus on finding successful interventions “
Conclusions
Effective behavioral interventions (Chase 2011, Ferrier et al., 2011):
Motivational interviewing:
• self-monitoring
• goal-setting
• identifying barriers
• plan for relapse
3 sessions during CR, 3 booster sessions in first year after CR
OPTICARE: OPTimal CArdiac REhabilitation
2016:
“how to get and keep cardiac patients active?”
OPTICARE: OPTimal CArdiac REhabilitation
Randomized Controlled Trial:
300 intervention, 300 phone-based program, 300 controls