Ecologically Optimizing Exercise Maintenance in Men and Women Post-Cardiac Rehabilitation: A Randomized Controlled Trial of Efficacy with Economics (ECO-PCR)

Project Background

Cardiac rehabilitation (CR) is an evidence-based, standard of care for those who have experienced an acute coronary syndrome, coronary revascularization procedures and other cardiac conditions. With the implementation of evidence-based referral strategies, access to this important intervention has increased significantly.   The challenge, however, of ensuring the long-term maintenance of exercise behaviours, proven to reduce risk, remains. This study will investigate the efficacy and cost-effectiveness of a novel intervention to increase long-term exercise maintenance in patients with coronary artery disease following the completion of CR. The intervention uses an exercise ‘facilitator’ to assist in the transition of patients from structured, supervised exercise to self-managed home- or appropriate community-based exercise programs.

Study Design and Purpose

This is a 78-week, three-site (University of Ottawa Heart Institute, Toronto Rehabilitation Institute and Peter Munk Cardiac Centre (Toronto)), randomized (1:1), allocation-concealed, controlled, parallel-group, superiority study evaluating the efficacy of the exercise facilitator intervention to improve long-term exercise maintenance in patients exiting CR compared to usual care. Those randomized to the intervention group will receive 5 small group teleconferences and 3 personal calls over a 50 week period lead by a trained exercise facilitator who will guide them through their exercise maintenance strategy.  Participants will be provided with an exercise journal to record their activity and progress. In addition, they will have access to community Heart Wise Exercise demonstrations at locations in their community. 

Significance of the Research

CR programs are successful in ensuring patients initiate regular exercise.  However, long-term maintenance of exercise behaviour remains a challenge. Few CR programs have incorporated strategies to assist patients in making a successful transition from supervised to self-managed home- and/or community-based exercise.  In most CR programs, long-term maintenance is addressed briefly or not at all.  Effective transition to post-cardiac rehab care, focused on maintaining and enhancing gains in levels of activity experienced during CR, would protect and augment the investment in exercise-adoption.