Abstract
Abstract
Background: Studies conducted both in Norway and Europe have found low achievement of current guidelines regarding cardiovascular risk factors. Physical activity (PA) positively affects several risk factors of coronary heart disease (CHD), but few CHD patients have an adequate PA-level. Extended cardiac rehabilitation (CR) increases maintenance of PA-level.
Objectives: The purpose of the study was to explore whether extended CR had an additional effect on the lipid profile in patients with CHD. Further, we wanted to investigate the achievement of current guidelines in regards of PA.
Design: A randomised controlled study
Methods: Participants (112 men/22 women) who had completed standard CR were randomly assigned to either extended cardiac rehabilitation run by municipality (MBG), home-based extended cardiac rehabilitation (HBG) or a control group (CG). The extended cardiac rehabilitation groups (MBG and HBG) completed 1 session of interval training (4 times 4 minutes) for 8 weeks and were encouraged to two optional additional exercises per week. After 8 weeks the MBG got a follow-up session every third month until 1 year after inclusion. The control group received standard lifestyle advice at baseline and had no follow-up throughout the year. Primary outcome was measurements of change in lipids, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Secondary outcomes were change in PA, HbA1c and body mass index.
Results: At 1-year follow up 50% of all participants and 56% of participants on high-intensive statin therapy (HIST) achieved LDL-C levels below 1,8 mmol/L. 73 (88%) participants were found adherent to their lipid lowering therapy. The majority of participants (97% and 91,5%) met the recommended target for both triglycerides and weekly level of moderate PA, respectively. Total cholesterol and LDL-C levels increased significantly within HBG and CG. Triglyceride levels decreased significantly in MBG. HbA1c decreased significantly within MBG and CG. There were significant differences between groups regarding HDL-C, triglycerides and HbA1c.
Conclusion: Our findings suggest that current lipid lowering therapy in patients with CHD is inadequate. We suggest that a larger proportion of patients should be using HIST, Ezetimibe combined with statins or PCSK9 inhibitors. Further, extended cardiac rehabilitation was not found to have any additional effect on the lipid profile. The majority of participants reached recommended PA-levels at both baseline and 1-year, suggesting that extended CR does not lead to higher PA-levels.
Keywords: Cardiac rehabilitation, exercise, lipids, coronary heart disease
