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Background: Comprehensive cardiac rehabilitation (CCR) has demonstrated favorable effects for recently hospitalized chronic heart failure (CHF) patients. However, currently proposed CCR models are not acceptable for many CHF patients, because they live in remote geographic location, have difficulty in transportation, or do not have the sufficient financial resources to pay for an outpatient program. Whereas, home-based programs have been reported to be equally effective as center-based programs. Moreover, its adherence is higher than that of center-based programs. However, there are no trials evaluating home-based programs in the early post-hospital period. This is an important clinical question, because recently hospitalized CHF patients were experienced the high rate of rehospitalization compared with stable outpatients. Purpose: To assessed the efficacy of a home-based exercise program for recently hospitalized CHF patients. Methods: This study was designed as a prospective randomized controlled trial. We recruited consecutive CHF patients hospitalized from January through December, 2013 in Tokushima Red Cross Hospital, Japan. Intervention group was monitored by using activity monitors for three months and followed up weekly through telephone interviews by a physical therapist to assess their walking steps and symptoms. It was followed by an original step chart to increase the number of walking steps gradually to achieve the target number. Control group was received usual care by either their cardiologist or general practitioner. Six-min walk distance and health-related quality of life were measured at baseline, a month, and three months. Additionally, rehospitalization due to worsening heart failure within six months was assessed. Results: In total, sixty-three patients identified as being suitable for the intervention, of whom fifty-two (83%) agreed in this study (intervention group; n = 26, control group; n = 26), and 68% of the intervention group patients completed the program. Exercise intervention significantly improved the six-min walk distance (median, 76.0 versus 27.5 m; p < 0.01) and health-related quality of life (physical component summary and role/social component summary; p < 0.01). Rehospitalization within six months was required by four patients (15%) in the intervention group and eight patients (30%) in the usual care (p = 0.20). No adverse events were observed during exercise in intervention group. Conclusion(s):In this study, the home-based exercise program monitored by using activity monitors and telephone interviews for recently hospitalized CHF patients was safety and effective in improving participation rate, adherence, physical function, and quality of life. Implications: We should promote the home-based exercise program for recently hospitalized CHF patients without access to traditional CCR programs. Keywords: Cardiac rehabilitation; Home-based exercise; Chronic heart failure
source: / article/S0031-9406(15)01478-9/pdf
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