Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice

Abstract

Introduction: Exercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia.

Design: Cross-sectional survey.

Methods: Australian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics.

Results: 297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1-2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (<6%) made use of technology, such as mobile phones or the internet, to deliver or support exercise training.

Conclusions: While advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients.

Keywords: CORONARY ARTERY DISEASE; QUALITY OF CARE AND OUTCOMES.

Figure 1

Flow chart of survey participants and responses.

Figure 2

Frequency counts of exercise intensities routinely prescribed in programmes (n=194) grouped by method/scale. The colour of the bar represents the corresponding level of intensity (green= low; yellow= moderate; red=high, eg, green and yellow bars represent low to moderate intensity programmes). See online supplementary appendix 5 for the same results with intensity levels based on new classifications by the American College of Sports Medicine.