The effectiveness of an online exercise program in early cardiac rehabilitation after cardiac surgery

Cardiac rehabilitation (CR) has shown to be an effective treatment to reduce
mortality and morbidity among cardiac patients who underwent cardiac surgery.
Exercise training is a major component of CR. It usually starts in the hospital
and continues in an outpatient setting six weeks after discharge from the
hospital. In the intervening period patients continue rehabilitation by
themselves with the advices they received in the hospital. Research has shown
that patients experience this intervening period as stressful. They feel
insufficiently supported and are in need of more information and advice. No
general consensus exists concerning the best timing of exercise-based CR.
Although, there seems to be a positive relation between the timing of the start
of an exercise program and physical functioning, no study has compared the
effects of early CR with traditional CR (starting at six weeks after hospital
discharge). By starting the exercise program in an earlier phase, immediately
after discharge from the hospital, patients might start the traditional
outpatient CR in a better physical condition and gain better health outcomes.

This study aims to investigate the experiences with and effects of an early
online exercise-based CR program among patients after cardiac surgery.

A quasi-experimental study will be conducted comparing patients who completed a
traditional outpatient exercise-based CR program (control group) with patients
who completed an early (home-based) online exercise CR program (in the first 6
weeks after discharge from the hospital) as adjuvant to the traditional
outpatient exercise-based CR program (intervention group).

To evaluate experiences with the online exercise CR program, in-depth
interviews will be conducted with some patients (n=15).

Online exercise program which consists of three modules: exercises, monitoring
health status and communication (with physical therapist).

By starting the exercise program in an earlier phase, we respond to the needs
of patients to get more (tailored) support in the first weeks after discharge
from the hospital. Furthermore, we expect that patients will start the
traditional outpatient CR in better physical condition and gain better health
outcomes. From literature we know that there are no indications that early
enrollment in exercise-based CR after MI or cardiac surgery is harmful to
patients. Moreover, only low to moderate strenuous exercises will be conducted.
Exercises will be tailored and the intensity will be build, dependent on the
performance and willing of the patient. So, we don*t expect extra risks for the
patients, related to participation in this study.

The patient is free to determine when he completes the exercises.There are
three measurement points: at baseline (clinical phase) and at the start and end
of the traditional outpatient exercise-based CR program. The outcome measures
mostly exist of questionnaires, which take maximally 20 minutes at a time to
complete. Furthermore the 6 minutes walktest will be conducted. This test will
be completed in the hospital. The first and last test are part of usual care.
This means that we will ask the patient to visit the hospital for one extra
time (for this study). Finally, patients are asked to wear an accelerometer
for several weeks (control group: 3x 1 week; intervention group: 1x 6 weeks and
1x 1 week). An accelerometer is a small device that can be worn without
hindrance of daily activities.

In-depth interviews will be conducted with some patients in the intervention
group (n=15) to evaluate their experiences with the program. This interview is
optional / voluntarily, takes maximally 45 minutes of their time and will be
conducted at the patients' home or another location according to the patients'
preference.


All in all, the burden for the patients seems acceptable and in proportion to
the benefits.