Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

Background: Recent evidence suggests that routine exercise-based cardiac rehabilitation (CR) may not lead to a substantial increase in estimated peak oxygen uptake (VO2peak). This could reduce the potential benefits of CR and explain why CR no longer improves patient survival in recent studies. We aimed to determine whether routine exercise-based CR increases VO2peak using gold-standard maximal cardiopulmonary exercise testing (CPET), and to quantify the exercise training stimulus which might be insufficient in patients undertaking CR. Methods: We studied the effects of a routine, twice weekly, exercise-based CR programme for eight weeks (intervention group) compared with abstention from supervised exercise training (control group) in patients with coronary heart disease. The primary outcome was VO2peak measured using CPET. We also measured changes in body composition using dual X-ray absorptiometry, carotid intima-media thickness, hs-CRP and N-terminal pro B-type natriuretic peptide at baseline, 10 weeks and 12 months. We also calculated the Calibre 5-year all-cause mortality risk score. Results: Seventy patients (age 63.1 SD10.0 years; BMI 29.2 SD4.0 kg.m(-2); 86% male) were recruited (n=48 intervention; n=22 controls). The mean aerobic exercise training duration was 23 min per training session, and the mean exercise training intensity was 45.9% of heart rate reserve. VO2peak was 23.3ml.kg(-1).min(-1) at baseline, and there were no changes in VO2peak between groups at any time point. The intervention had no effect on any of the secondary endpoints. Conclusion: Routine CR does not lead to an increase in VO2peak and is unlikely to improve long-term physiological outcomes. (C) 2020 The Authors. Published by Elsevier B.V.