Are physical fitness outcomes in patients attending cardiac rehabilitation determined by the mode of delivery?

Background: Cardiac rehabilitation (CR) is a well-evidenced and effective secondary intervention proven to reduce mortality and readmission in patients with cardiovascular disease. Improving physical fitness outcomes is a key target for CR programmes, with supervised group-based exercise dominating the mode of the delivery. However, the method of traditional supervised CR fails to attract many patients and may not be the only way of improving physical fitness.

Methods: Using real-world routine clinical data from the National Audit of Cardiac Rehabilitation across a 5-year period, this study evaluates the extent of association between physical fitness outcomes, incremental shuttle walk and 6 min walk test, and mode of delivery, delivered as traditional supervised versus facilitated self-delivered.

Results: The proportion of patients receiving each mode were 80.6% supervised with 19.4% to self-delivered. The study analysis comprised of 10 142 patients who were included in the two models. The self-delivered group contained a greater proportion of females and older patients. The regression model showed no clinical or statistical significance between mode of delivery and post-CR physical fitness outcomes.

Conclusions: This study is unique as it has identified through a routine clinical population that regardless of the mode of delivery of rehabilitation, patients improve their physical fitness outcomes at meaningful levels. This study provides a strong evidence base for patients to be offered greater choice in the mode of CR delivery as improvements in physical fitness are comparable.