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More than a third of cardiac patients suffer from obesity and standard cardiac rehabilitation (CR) programs are suboptimal in this increasing patient population. To address this issue, the OPTICARE XL CR program was developed to provide a dedicated cardiac rehabilitation approach for patients with obesity.
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Although we did not observe long-term effectiveness of the OPTICARE XL CR program, the short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable.
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The after-care phase of the OPTICARE XL CR program needs to be redesigned to expand the short-term effects.
Introduction
Patients with obesity in standard CR programs
The OPTICARE XL trial: outcomes and lessons learned
The OPTICARE XL CR program
OPTICARE XL CR | Standard CR | |
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Duration of program | Part I: 12 weeks | 6–12 weeks |
Part II: 9‑month after-care program | No after-care program | |
Participating patients | Only patients with obesity | Patients with and without obesity |
Group size: 6–8 patients | Group size 10–25 patients | |
Exercise program | 60–90 min supervised exercise sessions (twice a week during part 1) | 60–90 min supervised exercise sessions (twice a week) |
Combination of endurance and resistance training | Mainly endurance training | |
Designed for patients with obesity | Designed for patients of all BMI classes | |
Counselling sessions | General group information sessions on lifestyle and risk factors | General group information sessions on lifestyle and risk factors |
Facultative counselling in smoking cessation, stress management or healthy diet coaching on indication | Facultative counselling in smoking cessation, stress management or healthy diet coaching on indication | |
Additional intensive coaching during part I by means of two modules (in total 16 sessions), focussing on (1) healthy diet and (2) active lifestyle. Behavioural change techniques were applied, such as self-monitoring, goal setting | No additional coaching | |
Six booster sessions during part II | ||
Technology | An activity tracker was provided to promote an active lifestyle during part I and part II | No use of additional technologies |
Voluntary participation in a group chat in part II |
Outcomes of the OPTICARE XL trial
Outcome | Long-term difference* between OPTICARE XL and standard CR | Short-term difference* between OPTICARE XL and standard CR |
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Weight loss (kg) | No significant difference between groups | Significant difference: −3.6 in OPTICARE XL CR vs −1.8 in standard CR, p = 0.002 |
Physical activity (steps per day) | No significant difference between groups | Numerically larger improvement in OPTICARE XL CR: +880 vs +481, p = 0.324 |
Physical fitness (6-minute walk test) | No significant difference between groups | No significant difference between groups |
Health-related quality of life (MacNew questionnaire) | No significant difference between groups | No significant difference between groups |
Cost-effectiveness | NA | No significant difference between groups |