Authors (including presenting author) :
CHOI CH (1), WONG CW (1), LAM CS (1), HO MH (2), NG SP (2), WU WY (2), WONG MY (3), CHANG KW (3)
Affiliation :
(1) Department of Medicine & Geriatrics, (2) Department of Physiotherapy, (3) Department of Occupational Therapy, Pok Oi Hospital
Introduction :
Over the past three decades, leading international guidelines recommended patient-centered progression of aerobic training from moderate- to high-intensity zone to optimize Cardiorespiratory Fitness (CRF) - the key prognostic marker and determinant of patient-centered functional goals. However, rigid EBCR program designs and safety concern are barriers for implementation.
Objectives :
To evaluate a pilot flexible-course, teamwork-based, goals-oriented phase II EBCR program – putting “HOPE” of shared goals between participants and committed professionals following guidelines-directed rehabilitation therapy into reality.
Methodology :
We conducted an evidence-based medically supervised program with risk stratification for 27 Post-Percutaneous Coronary Intervention (PCI) patients in January between 2017 and 2020. The program included a 30-minute ECG-monitored treadmill training conducted by physiotherapists once- to tri-weekly over flexible duration. Exercise prescription was based on Heart Rate Reserve (HRR) ranging from moderate-intensity (40 – 59%) to high-intensity (60 – 80%) zone. Estimated CRF (eCRF) was derived from the maximal Treadmill Tests (TT) in the first, ±interim and last sessions.
Result & Outcome :
Program effectiveness goal of achieving “Fitter” status (eCRF ≥10 METs) had a 2-fold increase of 72.7% (n=16) at exit compared with 36.4% (n=8) at entry (P=0.008) and the mean eCRF gain was 2.0±1.1 METs (P<0.001). The top responder, a 39-year-old policeman, gained 3.6 METs equivalent to a 9-fold increase of 0.4 METs attained earlier from a moderate-intensity training center. Program efficiency goal on “Progresser” status (exercise training ≥75% of exercise prescription range) was attained by 16 completers (72.7%) and the mean peak training intensity of all 22 completers was 76.9±11.0 %HRR. Patient-centered functional goal of getting medical clearance was met by all 11 completers (“Fitter” Status: n=6 at entry & 11 at exit) who needed “high-fit” levels to resume labor work, commercial driving and habitual high-intensity jogging exercise. Patient safety goal was met. Neither mortality nor major acute cardiovascular events were reported during mean follow-up 52.0±10.3 months. CONCLUSION POH Cardiac rehabilitation “HOPE” program, optimizing patient-centered progression towards high-intensity aerobic training, made the “HOPE” of achieving program effectiveness, efficiency, patient-centered functional and safety goals into reality.
