How much do the benefits cost? Effects of a home-based training programme on cardiovascular fitness, quality of life, programme cost and adherence for patients with coronary disease

Abstract

Objective: To evaluate cost, adherence and effects on cardiovascular function and quality of life of a home-based cardiac rehabilitation programme for patients with coronary disease. Design: A randomized, prospective controlled trial. Setting: Department of Rehabilitation, University Hospital, Brazil. Subjects: Thirty-nine low-risk patients were assigned to a home exercise training group (n = 19) or a control group (n = 20). Interventions: The home group performed home-based training for three months with biweekly telephone monitoring. Main outcome measures: The aerobic capacity and the quality of life (Medical Outcomes Study 36-Item Short Form Survey (SF-36)) of all patients were evaluated before and after the three-month period. Adherence was evaluated weekly. Programme cost was estimated using the Brazilian Classification of Medical Procedures. Results: After training, the home group had higher peak Vo₂ from 28.8 (6.4) to 31.7 (8.1) mL/kg per minute, peak heart rate from 135 (22) to 143 (20) bpm, work rate from 4780 (2021) to 7103 (3057) kpm/min and exercise time from 11.5 (1.9) to 13.6 (2.3) minutes (P ≤ 0.05). The control group showed reduction in peak Vo₂ from 28.6 (6.6) to 26.8 (7.2) mL/kg per minute, peak Vo₂ pulse from 15.5 (3.9) to 14.3 (3.8) mL/bpm and exercise time from 11.5 (2.3) to 11.4 (2.7) minutes (P ≤ 0.05). The home group reported improvements in all domains of SF-36. The control group showed improvement in only three domains of SF-36. In the home group the average cost per patient was US$502.71 and the adherence achieved 100%. Conclusion: The programme seems to provide an efficient low-cost approach to cardiac rehabilitation in low-risk patients.