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      Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey

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          Abstract

          Purpose

          This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT).

          Methods

          A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally.

          Results

          A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6–8 weeks (49%) at moderate intensity (54%) for 46–60 min (62%), and serviced 101–500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions.

          Conclusion

          There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes.

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          Most cited references 57

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          Exercise capacity and mortality among men referred for exercise testing.

          Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables. We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival. Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.
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            Intention—Behavior Relations: A Conceptual and Empirical Review

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              Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials.

              To review the effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. A systematic review and meta-analysis of randomized controlled trials was undertaken. Databases such as MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2003. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise training alone or in combination with psychological or educational interventions. We included 48 trials with a total of 8940 patients. Compared with usual care, cardiac rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] = 0.80; 95% confidence interval [CI]: 0.68 to 0.93) and cardiac mortality (OR = 0.74; 95% CI: 0.61 to 0.96); greater reductions in total cholesterol level (weighted mean difference, -0.37 mmol/L [-14.3 mg/dL]; 95% CI: -0.63 to -0.11 mmol/L [-24.3 to -4.2 mg/dL]), triglyceride level (weighted mean difference, -0.23 mmol/L [-20.4 mg/dL]; 95% CI: -0.39 to -0.07 mmol/L [-34.5 to -6.2 mg/dL]), and systolic blood pressure (weighted mean difference, -3.2 mm Hg; 95% CI: -5.4 to -0.9 mm Hg); and lower rates of self-reported smoking (OR = 0.64; 95% CI: 0.50 to 0.83). There were no significant differences in the rates of nonfatal myocardial infarction and revascularization, and changes in high- and low-density lipoprotein cholesterol levels and diastolic pressure. Health-related quality of life improved to similar levels with cardiac rehabilitation and usual care. The effect of cardiac rehabilitation on total mortality was independent of coronary heart disease diagnosis, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date. This review confirms the benefits of exercise-based cardiac rehabilitation within the context of today's cardiovascular service provision.
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                Author and article information

                Affiliations
                [1 ]Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
                [2 ]Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
                [3 ]School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
                [4 ]Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia
                [5 ]Griffith University, Gold Coast, QLD, Australia
                [6 ]Macquarie University, Sydney, NSW, Australia
                [7 ]Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia
                Author notes
                Correspondence: Amanda L Hannan, Faculty of Health Sciences & Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226, Australia, Tel +61 4 1551 0772, Fax +61 7 5595 1652, Email mhannan@ 123456bond.edu.au
                Journal
                Open Access J Sports Med
                Open Access J Sports Med
                Open Access Journal of Sports Medicine
                Open Access Journal of Sports Medicine
                Dove Medical Press
                1179-1543
                2018
                30 April 2018
                : 9
                : 79-89
                5933362 10.2147/OAJSM.S160306 oajsm-9-079
                © 2018 Hannan et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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