Snoeren, L. (Lonneke) (2020) Long-term effects of a combined pre- and post-operative cardiac rehabilitation program on the level of physical activity, functional capacity and self-efficacy of elective patients awaiting open-heart surgery. thesis, Human Movement Sciences.
Full text available on request.Abstract
Problem The benefits associated with cardiac rehabilitation (CR) and physical activity in cardiac patients are well-known. However, worsening of these benefits and low levels of physical activity on the long-term after standard post-operative CR program are found. Therefore, the aim of this study was to investigate the long-term effects of a combined pre- and post-operative multidisciplinary CR program compared to the standard outpatient post-operative CR program on the level of physical activity, functional capacity and self-efficacy. Additionally, the relationship between the level of physical activity and functional capacity and the possible contribution of self-efficacy to the level of physical activity of cardiac patients was investigated. Methods This study was part of an ongoing randomized controlled trial, executed in the University Medical Center Groningen (UMCG). Patients admitted to receive elective open-heart surgery were either randomized to the intervention group (pre- and post-operative CR) or the standard group (post-operative CR). At baseline, three to four months after surgery and one year after surgery, the level of physical activity (Actigraph wGT3X-BT), functional capacity (6MWT) and cardiac self-efficacy (CSE questionnaire) were measured. Results Between May 2017 and January 2020, 71 patients were included in the study (intervention, N=36; standard N=35). The repeated measures analysis of variance revealed that both groups did not improve the level of physical activity over the long-term. Functional capacity and self-efficacy of cardiac patients improved similarly in both groups. The Spearman Rank Order correlation showed that the level of physical activity is associated with functional capacity. The regression analyses indicated that self-efficacy of cardiac patients could not explain the variance in the level of physical activity. Conclusion A combined pre- and post-operative CR program does not effectively improve physical activity level on the long-term and is equally effective compared to the standard post-operative CR program in improving functional capacity and self-efficacy of cardiac patients. Thus, a combined pre- and post-operative CR program is not superior over the standard post-operative CR program in improving clinical outcomes on the long-term. Implications The findings of this study showed that it is not necessary to offer an alternative pre- and post-operative CR program to improve outcomes on the long-term. It is important that CR programs focus on strategies to stimulate the individual cardiac patient to continue behavior change after completion of a CR program and thereby improve clinical outcomes on the long term. It must be remembered that, despite the current findings, it is somewhat premature to draw a definite conclusion, more research investigating a larger sample size and possible moderators is required. Keywords: Cardiac patients, elective open-heart surgery, cardiac rehabilitation, physical activity, functional capacity, self-efficacy.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Keeken, dr. H.G. van and Hartog, J. and Dijkstra, S. |
| Faculty: | Medical Sciences |
| Date Deposited: | 20 May 2022 09:44 |
| Last Modified: | 20 May 2022 09:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3377 |
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