Highlights
- •Cardiac rehabilitation (CR) results in improvement in exercise capacity and health-related quality of life (HRQOL).
- •The improvements in exercise capacity and HRQOL persist during long-term follow-up.
- •Exercise capacity and the global and physical aspect of quality of life are weakly associated.
- •The association between exercise capacity and HRQOL is independent of timing relative to CR.
Abstract
Objective
To examine the strength of the association between exercise capacity and health-related
quality of life (HRQOL) during and after cardiac rehabilitation (CR) in patients with
acute coronary syndrome (ACS) who completed CR.
Design
Prospective cohort study.
Setting
Outpatient CR center.
Participants
Patients (N=607) with ACS who completed CR.
Interventions
Multidisciplinary 12-week exercise-based CR program.
Main Outcome Measures
At baseline (pre-CR), the 6-Minute Walk Test (6MWT) was performed to determine exercise
capacity, and the MacNew Heart Disease Health-related Quality of Life questionnaire
was used to assess HRQOL. Measurements were repeated immediately after completion
of CR (post-CR): at 12 months and 18 months follow-up. Multivariable linear regression,
including an interaction term for time and exercise capacity, was applied to study
the association between exercise capacity and HRQOL at different time points relative
to CR, whereas model parameters were estimated by methods that accounted for dependency
of repeated observations within individuals.
Results
Mean age in years ± SD was 58±8.9 and 82% of participants were male. Baseline mean
6MWT distance in meters ± SD was 563±77 and median (25th-75th percentile) global HRQOL
was 5.5 (4.6-6.1) points. Mean 6MWT distance (P<.001) and the global (P<.001), physical (P<.001), emotional (P<.001) and social (P<.001) domains of HRQOL improved significantly during CR and continued to improve
during follow-up post-CR. Independent of the timing relative to CR (ie, pre-CR, post-CR,
or during follow-up), a difference of 10 m 6MWT distance was associated with a mean
difference in the global HRQOL domain of 0.007 (95% confidence interval [CI], 0.001-0.014)
points (P=.029) and a mean difference in the physical domain of 0.009 (95% CI, 0.001-0.017)
points (P=.023).
Conclusions
Better exercise capacity was significantly associated with higher scores on the global
and physical domains of HRQOL, irrespective of the timing relative to CR, albeit these
associations were weak. Hence, CR programs in secondary prevention should continue
to aim at enhancing both HRQOL and exercise capacity.
Keywords
List of abbreviations:
6MWT (6-Minute Walk Test), ACS (acute coronary syndrome), CABG (coronary artery bypass graft), CAD (coronary artery disease), CI (confidence interval), CR (cardiac rehabilitation), CVD (cardiovascular disease), HRQOL (health-related quality of life), OPTICARE (Optimal Cardiac Rehabilitation), RCT (randomized controlled trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 02, 2020
Footnotes
Clinical Trial Registration No.: NCT01395095.
Supported by the Capri Cardiac Rehabilitation Rotterdam and the Zilveren Kruis Healthcare Insurance Company (grant no. Z687).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
