EXERCISE IN AUSTRALIAN CARDIAC REHAB
A snapshot of nationwide practiceACRA ASM 2015:
Past, Present,
Future
EXERCISE TRAINING IN AUSTRALIAN CARDIAC REHAB
A snapshot of current nationwide practice
Bridget Abell, Professor Paul Glasziou, Professor Tammy Hoffmann
Centre for Research in Evidence-Based Practice
Faculty of Health Sciences and Medicine
Bond University, Gold Coast
Why the need for a survey?
Global Perspectives
1
Cardiac rehabilitation programs play an integral role in secondary
prevention and are included in clinical guidelines for coronary heart
disease management globally
2
Exercise training is considered a core component, but there is conflicting
guidance/lack of guidance about the format this training should take
3
Surveys in Europe1-2 and the UK3-4 show large clinical practice
variations in exercise training and inconsistencies with research
recommendations
1. Bjarnason-Wehrens, 2010; 2. Vromen, 2013; 3. Brodie, 2006; 4. Thompson, 1997
Why the need for a survey?
Local Perspectives
5. Woodruffe, 2015; 6. Australian Cardiovascular Health and Rehabilitation Association & National Heart Foundation, 2004
Aim
To conduct a nationwide survey of the current
status of exercise-based cardiac rehabilitation
services, with particular focus on the individual
elements of the exercise intervention.
Who was involved?
Any form of outpatient (Phase II) exercise-based cardiac rehabilitation
October 2014- March 2015
Email to participate via Survey Monkey
Up to 2 reminders, phone confirmation
What was in the survey?
Multiple choice and short answer questions
1
Program demographics
2
Overall program style and content
3
Exercise training components
Results
Participants
Email invitations sent to potentially
eligible CR sites (n=398)
Sites ineligible for
participation
Sites eligible for participation
(n=297)
Refusal to participate
or non-responsive to all
contact attempts (n=46)
(n=93)
Sites with unclear eligibility
(n=8)
Refusal to participate
or non-responsive to all
contact attempts (n=8)
82%
Participated in survey
(n=251)
Return completed
surveys
Returned mostly
completed surveys
Returned surveys <50%
of questions complete
(n=225)
(n=19)
(n=7)
74%
6%
2%
Results
Program Demographics
Largest number of programs in rural areas (40%)
Most run at no cost to patient (68%)
Most operating >10 years (62%)
Most
frequently
enroll 101-500 patients (39%)
Rural
Locations
29% enroll less than 50 patients
Results
Program Style/Content
Majority offer comprehensive services for all patients (72%)
Most common location was a hospital outpatient setting (81%)
Only 18% offered a choice of more than one location
Few used novel technologies/methods and usually for education only
Videoconferencing (6%), Internet (3%), Mobile Phone (2%)
Rural Locations
Results
Exercise Components
Functional capacity testing
Modality
Supervision
Program duration and frequency
Session time
Exercise intensity
Exercise adherence
Do participants undergo any form of exercise or fitness testing?
91%
62%
Perform some type of pre-program
functional assessment
Perform some type of post-program
functional assessment
Treadmill exercise stress test (3%)
Other submaximal test (6%)
83%
Track progress
66%
Set exercise intensity
44%
Symptom monitoring
42%
Risk stratification
All others combined:
VO2, shuttle walk, TUG
(5%)
6 minute walk test (86%)
What type of exercise modality is used by the participants in your program?
CYCLING
92%
WALKING (NOT ON TREADMILL)
82%
TREADMILL
78%
ARM ERGOMETER
63%
STAIRS/STEPPER
58%
ROWER
28%
CROSS-TRAINER
20%
GAMES (E.G BALL GAMES)
9%
POOL EXERCISES/POOL AEROBICS
3%
MINI-TRAMP
3%
SWIMMING
1%
ZORBA DANCE
<1%
BOXING
<1%
100%
96%
used aerobic
training
included resistance
training
Which health professional routinely supervises the exercise component?
87%
Nurse
66%
Physiotherapist
How long is the exercise program which your service provides for each participant?
>12 weeks (5%) <6 weeks (11%)
9-12 weeks (10%)
83%
weeks to ongoing
66%
Mean
duration of 7 weeks (S.D 1.7)
Ranged from 3
44%
4%
78% of all programs last
6-8 weeks
How many times per week are participants required to exercise as part of the program?
Varied between once per week and daily
83%
66%
44%
4%
Mean frequency of 1.5
55%
Reported weekly
sessions
times per week (S.D 0.7)
42%
Reported twice
weekly sessions
How long does each exercise session last?
≤30 mins (6%)
>60 mins (8%)
83%
Mean session duration of 56
mins (S.D 13)
Ranged from 15-30 mins to 120 mins
66%
87%
44%
of sites had sessions lasting
31-60 mins
4%
Exercise intensity in your program is prescribed based on?
44%
Modified Borg Scale (1-10)
66%
Borg s Rating o’ Perceived Exertion (6-20)
83%
Heart rate
predicted from age
*Borg, 1998
Heart rate
46%
from exercise testing
6%
Borg
4%
34%
11%
46%
80%
11%mBorg
What level/s of intensity is generally used in your exercise prescription?
50-60%
11-14
50-75%
10-13
60-80%
13-14
55%
11-12
11-13 BORG
Borg
BORG s
11-15
12
60-70%
75%
12-13
12-14
13
Heart
rate
16
55-80%
% he
60%mHR
70%
60-85%
75-85%
65-75%
70-80%
80%
65-80%
70-85%
3-6
3
2-5
3-4 mBORG
3-5
4-5
2-4
5-6
4-6
modified BORG
50-60%
60% Low to moderate intensity
10% High intensity only
4-7
Modified Borg
Which of the following best describes the adherence of participants with the exercise
component of your program?
High (>75% completion)
59%
Moderate
Low
29% 13%
Summary and Implications
Where to from here?
Exercise interventions in Australian cardiac rehabilitation programs vary
widely across many components, however this does not necessarily mean
we are o’’ering a menu-based approach
Individual programs offer few choices, and much of Australia's CR service
remains within traditional models of care
Many CR staff wish to offer additional services but are restricted by
budget, time and resources
?
Does our real-li’e provision of exercise training meet clinical guideline
recommendations or the level observed in research trials?
Thank you.
For your listening today and to all those who contributed to the survey.
[email protected]