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Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR) : study protocol for a randomised controlled trial and economic evaluation

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Ennis, Stuart, Lobley, Grace, Worrall, Sandra, Powell, Richard, Kimani, Peter K., Khan, Amir Jahan, Banerjee, Prithwish, Barker, Thomas and McGregor, Gordon (2018) Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR) : study protocol for a randomised controlled trial and economic evaluation. BMJ Open, 8 (3). e019748. doi:10.1136/bmjopen-2017-019748

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Official URL: http://dx.doi.org/10.1136/bmjopen-2017-019748

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Abstract

Introduction

Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy. This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. Delayed participation in CR exercise training promotes muscle atrophy, reduces cardiovascular fitness and prolongs recovery. Limited data suggest no detrimental effect of beginning CR exercise training as early as 2 weeks post-surgery, but randomised controlled trials are yet to confirm this. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy.

Methods and analysis

In this assessor-blind randomised controlled trial, 140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2–3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme. Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness.

Ethics and dissemination

Recruitment commenced on July 2017 and will complete by December 2019. Results will be disseminated via national governing bodies, scientific meetings and peer-reviewed journals.

Item Type: Journal Article
Alternative Title:
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Heart -- Diseases -- Patients -- Rehabilitation -- Cost effectiveness
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: March 2018
Dates:
DateEvent
March 2018Published
23 February 2018Accepted
22 September 2017Submitted
Volume: 8
Number: 3
Article Number: e019748
DOI: 10.1136/bmjopen-2017-019748
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
Jeremy Pilcher Memorial Fund University Hospitals Coventry and Warwickshire NHS Trusthttp://viaf.org/viaf/152707181
UNSPECIFIEDMedical and Life Sciences Research Fundhttp://dx.doi.org/10.13039/100012335
UNSPECIFIEDAtrium Health Ltd (Firm)UNSPECIFIED

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