Optimal cardiac rehabilitation for obese patients

Obese cardiac patients currently participate in usual cardiac rehabilitation
(CR) programs. However, effects achieved are substantially smaller than in
non-obese patients, and non-lasting.

Aim is to determine (cost-) effectiveness and underlying working mechanisms of
a novel CR program specific for obese cardiac patients, OPTICARE-XL, in
comparison with usual CR.

Multicenter randomized controlled trial

*OPTICARE XL: A one-year tailor-made behavioral group intervention including
after-care, specific for obese patients, with strong focus on self-management.
Upon usual education sessions and facultative modules (stress
management/smoking cessation), OPTICARE-XL includes peer group modules on
healthy weight and active lifestyle management. Besides, the usual fitness
training is more tailored (aerobic and muscle strength training).
Or
*USUAL CARE: Usual 3-month CR group program without after-care in which both
obese and non-obese patients participate. Usual CR combines aerobic fitness
training with education sessions and facultative modules (stress
management/smoking cessation).

Both groups will receive minimally CR as recommended by the guidelines.
Subjects randomized to the OPTCARE XL will receive on top of that behavioural
therapy for healthy diet (1x/week 60 min during 12 weeks) and to stimulate an
active lifestyle (1x/3 weeks 45 minutes during 12 weeks) and a behavioural
after-care program is organized with 6 meeting (1 hour each) between weeks
13-52. Besides, the exercise program during the first 12 weeks will be more
tailored.
Independent of randomization, all participant are invited to visit the
rehabilitation center 4 times for a physical examination and to perform 2 short
fitness tests (30 min in total). Besides, patients receive 4 times a number of
questionnaires (30 min) and blood samples will be collected 4 times in a
laboratory. Furthermore, subjects will wear a small accelerometer around their
waist 4 times for 7 days during waking hours. During this period they also keep
a dairy in which they note the wear time of the accelerometer. The
questionnaires may be possible personal and / or confrontational for patients.
In addition, blood samples can result in small bruises or pain. Despite the
accelerometer is only small, wearing it can be experienced as a burden.
Patients will have no direct benefit from participating in this study.

In a subpopulation (n=50, included in the intervention or control group at
'Capri Hartrevalidation' in Rotterdam) participating in a supplementary
echocardiography study (voluntarily), two echocardiographic examinations (30-45
minutes per echo) are performed at the hospital