Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial

• Published in: British heart journal 2003-02, Vol.89 (2), p.155-160
• Main Authors: Fitchet, A, Doherty, P J, Bundy, C, Bell, W, Fitzpatrick, A P, Garratt, C J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analysis; Anxiety; Anxiety - etiology; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - prevention & control; Arrhythmias, Cardiac - psychology; Bias; Biological and medical sciences; Cardiac arrhythmia; Cardiac patients; Cardiology; Cardiomyopathy; Cardiovascular disease; Cardiovascular Medicine; Care and treatment; CCR; comprehensive cardiac rehabilitation; Defibrillators, Implantable; Demographic aspects; Depression - etiology; Diseases of the cardiovascular system; Exercise; Exercise - physiology; Exercise Test; Exercise Therapy - methods; Female; HAD; Health aspects; Heart attacks; Heart Diseases - physiopathology; Heart Diseases - psychology; Heart Diseases - rehabilitation; Heart failure; hospital anxiety and depression score; Humans; ICD; implantable cardioverter defibrillator; Implantable cardioverter-defibrillators; Ischemia; Male; Medical examination; Medical sciences; Middle Aged; Program Evaluation; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); rate of perceived exertion; Rehabilitation; RPE; Studies; Ventricular Dysfunction, Left - physiopathology
• ISSN: 1355-6037; 0007-0769; 1468-201X
• DOI: 10.1136/heart.89.2.155

Objective: To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD). Design: Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34–74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage. Results: Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR. Conclusions: CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings.