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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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WRAP-Early-initiation-of-post-sternotomy-cardiac-Kimani-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-No Derivative Works 4.0. Download (693Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjopen-2017-019748
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 | ||||||||||||
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| Alternative Title: | |||||||||||||
| Subjects: | R Medicine > RC Internal medicine | ||||||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Medicine > Warwick Medical School |
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| 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: |
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| 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: |
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