A study that aims to discover the effectiveness of cardiac rehabilitation exercise (CRE) based on two exercise groups: Individual exercise and participation within a group.
All participants in this exercise will be individuals suffering from chronic heart failure (CHF) and, as atypical with patients suffering from chronic heart failure, symptoms of depression due to the disease might be present.
Patients would be evaluated based on supervised, exercise training and results produced at the end of the study will be analysed and conclusions determining whether solo exercise or group participation exercise is a more successful approach in reduction of the mortality rate and raising the quality of life.
The prevalence of cardiovascular disease in the United Kingdom (UK) is a serious issue and it is one of the leading causes of death. With a percentage as high as 28%, it is known to be a major problem in the UK. In addition, in 2012, coronary heart disease affected approximately than 2.3 million of the population the UK and is the single leading cause of death – Accounting for an estimated 74,000 deaths alone that would have consisted of 16% for males and 10% for females. Thus, measures have been taken to deal with how rampant and widespread this concern has evolved into over the years.
Based on evidence provided, exercise intervention shows 13-26% reduction in all mortality.
26-46% reduction in cardiac mortality, is a largely cost-effective intervention. Improves the quality of life (QoL), functional capacity of recovering patient, supports an early return to work and empowers the development of self-management skills.
Furthermore, a 30% reduced risk of cardio vascular disease compared to people with the
lowest levels of physical activity, but a 65% reduced risk compared to people with the lowest levels of cardiorespiratory fitness. Thus, substantiating that having a high level of cardiorespiratory fitness results in a greater decrease in cardiovascular disease risk than simply having high levels of physical activity. Patients who attend CR have a 40-70% decrease in anxiety, depression and hostility, along with a 70% decrease in mortality risk (Lavie et al. 2009)
With studies showing exercise to be an effective manner in combating cardiovascular disease. Thus, it was paramount that research had to be conducted on how such procedures are executed and whether it would prove to be useful for all, especially on patients suffering from cardiovascular disease.
Population selection criteria is determined by patients who suffer from Class II chronic heart failure (CHF), who experience marked reductions in their exercise capacity which has detrimental effects on their activities of daily living and ultimately, their health-related quality of life. It is estimated that the total annual cost of heart failure to the UK National Health Service is currently around £1 billion or around 2% of the total UK health budget; approximately, 70% of this total is due to the costs of hospitalisation. Admissions due to heart failure are projected to rise by 50% over the next 25 years, largely due to ageing of the population.
A circuit training-based workout regime is to be utilised with the alternating between aerobic exercise with muscular strength and endurance exercise as an active recovery. This interval training is found to be more effective and less tedious than continuous intensity training.
To classify participants risk stratification requires consideration of their medical history, symptoms and risk factors, and current PA levels, combined with the participant’s desired activity level, to determine whether consent from an appropriate health care provider is required to begin exercising.
– Low risk (Asymptomatic, ? 1 risk factor)
– Medium risk (Asymptomatic, ? 2 risk factors)
– High risk (known medical condition, signs and symptoms of disease present)
This, places cardiac patients in the high risk of suffering an adverse event compared to other exercisers, which necessitates supervision by specialist cardiac rehab exercise instructors.
As a comparative study by Sagar et al. 2013, based on exercise-based rehabilitation for heart failure, the following findings were as followed:
Objective – In order to update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.
Methods A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control.
Results 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (50%) and a random-effect model used. Dichotomous outcomes were expressed as RRs and 95% CIs. For continuous outcomes, we sought the mean change and SD in outcome between baseline and follow-up for both exercise and control groups, and when not available, the absolute mean (and SD) outcome at follow-up for both groups was used. We calculated mean difference (MD) or standardised MD (SMD), and 95% CI for each study. Heterogeneity between studies was assessed qualitatively (by comparing the characteristics of included studies) and quantitatively (using the I2 statistic).
The potential heterogeneity is to be looked into based on the effect of exercise-based CR by two approaches: (1) within trial: subgroup analyses (supported by subgroup ; treatment group interaction term), and (2) between trial: meta-regression. Meta-regression was used to examine the association between the effect of exercise on all-cause mortality and health-related quality of life up to 12 months (as these outcomes contained the most trials).
Specific study level covariates included in meta-regression analyses included: dose of aerobic exercise (calculated as the overall number of weeks of training multiplied by the average number of sessions per week multiplied by the average duration of sessions in minutes); type of exercise (group or individual); type of rehabilitation (Aerobic, resistance or flexibility); overall risk of bias (‘low’, ie, absence of bias in ?5 of 8 of the risk of bias items or ‘high’—absence of bias in