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Association Between Exercise Capacity and Health-Related Quality of Life During and After Cardiac Rehabilitation in Acute Coronary Syndrome Patients: A Substudy of the OPTICARE Randomized Controlled Trial

Published:January 02, 2020DOI:https://doi.org/10.1016/j.apmr.2019.11.017

      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)
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