The proposal of this study is to verify if it is feasible and effective to offer a home based cardiac rehabilitation program, that includes the components of health education and physical exercises mostly unsupervised and oriented by telephone and to compare the treatment adherence, the effects in the functional capacity, and the control of coronary risk factors in relation to the traditional cardiac rehabilitation offered mostly supervised and center based.
This study will be developed with patients with coronary disease submitted to angioplasty or myocardial revascularization surgery, provided they are considered of low and moderate risk for the practice of physical exercise of moderate intensity, according to the risk stratification proposed by the American Association of Cardiovascular and Pulmonary Rehabilitation. Volunteers will be recruited at the outpatient at the University Hospital's Cardiac Rehabilitation Centre. The study will be made in conformity with the CONSORT guidelines for non-pharmacological interventions. After being invited to the study, the volunteer whose accept the participation and sign the consent form will be randomized into two different groups: Traditional cardiac rehabilitation (mostly supervised) and Telerehabilitation (mostly unsupervised). The randomization will be made through the www.randomization.com website in blocks of four volunteers each. A blind researcher will evaluate participants before and after test, and will fulfill the database. Intervention The parameters for the exercise prescription will be the same for both groups. Exercise sessions will be constituted of 5-10 minutes of warm up, 40 minutes of aerobic activity with heart rate between 60 and 80% of the heart rate reserve, and 5-10 minutes of cool down. The educational sessions will be given to both groups in six meetings with 40 minutes each, and items regarding the control of risk factors and treatment of cardiovascular diseases will be approached. After the period of 12 weeks of intervention all participants will be stimulated to continue to practice physical exercises at home or at the community, and they will be invited to a re-evaluation after three months. Groups: Traditional cardiac rehabilitation as control group (CentreRehab) The CentreRehab group will be made supervised exercises and health educational activities, personally at cardiac rehabilitation centre. This intervention will last 12 weeks, with a total of 60 sessions: 24 supervised and 36 at home (to complete five exercise's sessions for week). The participants of this group will be oriented to fulfill a training diary with information regarding the frequency of the exercises, the presence of symptoms, and the use of the scale of perceived exertion during exercises at home. Home-based cardiac rehabilitation (HomeRehab) The participants of the HomeRehab group will make the exercise mostly at home. There will be weekly phone calls, in person educational sessions, and monthly meetings to check the execution of the previous stage, solve doubts, or identify the presence of symptoms or undesirable effects. This intervention will have the duration of 12 weeks, with a total of 60 sessions: 2 supervised and 58 at home (to complete five exercise's sessions for week). In the first week, all individuals of HomeRehab group will receive a training regarding the use of the monitoring equipment. A heart rate monitor with the heart rate zone individually calculated will be given to the participant at the first session of the face-to-face training to monitoring exercises at home. Furthermore, all participants of this group will use a step counter (pedometer) to stimulate the execution of the exercises as well as training diary to be fulfilled with information regarding the frequency of the exercises, the presence of symptoms during the exercise, the perceived exertion, and the number of daily steps. The monthly meetings will take place to the educational activity, and to verify if the exercises and fulfilment of the training diary are correct as well as to clarify any kind of the participant's doubts.
This intervention will have the duration of 12 weeks, with a total of 60 sessions: 2 supervised and 58 at home (to complete five exercise's sessions for week).
This intervention will last 12 weeks, with a total of 60 sessions: 24 supervised and 36 at home (to complete five exercise's sessions for week).
Federal University of Minas Gerais
Belo Horizonte, Minas Gerais, Brazil
Change in adherence on CR sessions
it will be analyzed by the percentage of participants which completed the minimum of 75% of the sessions
Time frame: after 3 and 6 months of the intervention
Cost
total sum of the costs of each procedure applied to different groups considering the table of payments for procedures and services of the hospital.
Time frame: after 3 and 6 months of the intervention
Usability
it will be analyzed using the System Usability Scale (SUS) after 3 months. The System Usability Scale (SUS) is a widely used self-administered instrument for the evaluation of usability of a wide range of products and user interfaces. The main value of the SUS is that it provides a single reference score for the participants' view of the usability of a product or service. The SUS's scores vary in a value between zero and 100. A SUS's scores higher than 68 is considered above average, and any value below.
Time frame: For TeleRehab group after 3 months of the intervention
Change in morbidity
It will be evaluated through a survey to identify the number of hospitalizations, complications, and presence of clinical events during the period of 3 and 6 months.
Time frame: after 3 and 6 months of the intervention
Change in quality of life
Quality of life will be assessed by the Short-Form 36 (SF-36) questionnaire, a generic questionnaire, easy to administrate, that considers the individual perception about its own health status. It's composed by 36 items, divides in eight domains: physical functioning, physical role functioning, bodily pain, general health perceptions, vitality, social role functioning, emotional role functioning, and mental health. Data will be analyzed from the transformation of the answers in each domain in a scale from zero (0) to one hundred (100). This questionnaire won't have a cut point, and the analysis is made based in the hit score, resulting in a worse or better general health state.
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
51
Time frame: At baseline, after 3 and 6 months
Change in scores of depression
The Patient Health Questionnaire-9 (PHQ-9) is a simple test, used for depression screening. The PHQ-9 is an instrument that has nine items, disposed in a scale of four points, from zero (not once) to three (almost every day), with a score that varies from zero to 27, to asses frequency of signs and symptoms of depression in the last two weeks. It is estimated, as a positive indicator of major depression, a value equal or higher than 10.
Time frame: At baseline, after 3 and 6 months
Change in functional capacity
Functional Capacity will be analyzed using the Incremental Shuttle walk test, a walk test that evaluates functional capacity through the analysis of the walked distance at incremental shuttle walk test in meters.
Time frame: At baseline, after 3 and 6 months
Change in level of physical activity
Score at the Duke Activity Status Index, a questionnaire developed to evaluate functional capacity mostly in patients with cardiovascular diseases. This questionnaire is composed of 12 items, which asses daily life activities such as personal hygiene, locomotion, domestic tasks, sexual function, and recreation, with the respective metabolic costs. Each item has a specific weight, based on its metabolic cots. The weight of the positive answers is summed up in order to obtain a total score that goes from zero to 58.2. The higher the punctuation, higher the functional capacity.
Time frame: At baseline, after 3 and 6 months
Change in Blood pressure
Systolic and diastolic blood pressure measured at rest
Time frame: At baseline, after 3 and 6 months
Change in Waist circumference
measurement of the waist circumference in centimeters.
Time frame: At baseline, after 3 and 6 months
Change in fasting blood glucose
assessed through blood exams, as mg/dL
Time frame: At baseline, after 3 and 6 months
Change in glycated hemoglobin
values, in %, will be assessed through blood tests.
Time frame: At baseline, after 3 and 6 months
Change in total cholesterol
In mg/dL, will be assessed through blood tests.
Time frame: At baseline, after 3 and 6 months
Change in knowledge about coronary artery disease
Will be analyzed using the CADE-Q SV. This questionnaire was designed to be a true/false/I don't know questionnaire, with 20 items (4 in each domain). Each correct answer equals to 1 point; therefore, the maximum score possible is 20 overall, 4 by domain, and 1 per item.
Time frame: At baseline, after 3 and 6 months