A controlled trial of hospital versus home-based exercise in cardiac patients

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; N = 120) versus "direct-to-hospital" (Hosp; N = 122) exercise training, 35-49 d post CABG surgery. The primary outcome was peak exercise capacity, measured by peak oxygen consumption ((V)over dotO(2)) 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 (V)over dotO(2) improved significantly in both groups after 6 months of exercise training; 36% in the Hosp group (1222.1 +/- 269.0 mL(.)min(-1) to 1497.2 +/- 594.3 mL(.)min(-1); P < 0.0001) and 31% in the Home group (1260.3 +/- 306.5 mL(.)min(-1) to 1433.4 +/- 589.7 mL(.)min(-1); P < 0.05). The Home group reported greater total social support than the Hosp group at 3 (36.2 +/- 4.5 vs 34.0 +/- 6.7; P < 0.0001) and 6 months (36.0 +/- 4.9 vs 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 vs 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.