Original article: cardiovascular
Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program

https://doi.org/10.1016/j.athoracsur.2003.10.091Get rights and content

Abstract

Background

Postoperative exercise therapy aims at recovering, as soon as possible, independence in the basic physical activities; but the type, intensity, and therefore the costs of the programs, vary widely. The aim of this study was to compare the effectiveness of a low frequency (once daily, not in the weekend) program with a high frequency (twice daily, including the weekend) one and to assess whether the latter would yield sufficient benefit for the patient to justify higher costs in material and personnel (physiotherapists) after uncomplicated coronary artery bypass graft (CABG) surgery.

Methods

Two-hundred and forty-six patients were randomly allocated to either a low or high frequency exercise program. Endpoints were the functional level as measured by the achievement of five activity milestones, the patient's independence (functional independence measures [FIM]) as assessed by a structured interview, the amount of daily physical activity (activity monitor), and patient satisfaction (questionnaire). Except for patient satisfaction, all measurements were done in the first week after surgery.

Results

Patients with the high frequency exercise program achieved functional milestones faster than patients with the low frequency exercise program (p = 0.007). The frequency of the exercise program had no influence on functional independence as measured with the FIM or quantity of physical activity. The satisfaction degree was greater in the high frequency group (p = 0.032), although the low frequency group was not dissatisfied.

Conclusions

A high frequency exercise program leads to earlier performance of functional milestones and yields more satisfaction after uncomplicated CABG surgery and this should lead to an earlier discharge. On the other hand, if the shortage of physiotherapists remains unchanged or even increases, the low frequency program also yields excellent functional results, albeit at the cost of a somewhat longer hospital stay: but it would allow a sensible redistribution of the physiotherapists activity towards complicated and, therefore, more demanding patients.

Section snippets

Study design

The study featured a prospective single blinded, randomized trial comparing the functional relevance of two standardized exercise programs (high and low frequency) executed during the early postoperative course in patients undergoing uncomplicated CABG surgery.

The study protocol was approved by the local medical ethics committee. All patients were informed about the study protocol and gave written informed consent.

Randomization procedure

During 12 periods of 30 days each the patients benefited from a standardized

Postoperative course

One hundred and seventy-six patients were discharged home and 68 were moved to another hospital for social or medical reasons (not influencing physical functioning). Significantly more patients in the low frequency group had a rethoracotomy (Table 3). Two patients had a prolonged ( > 2 weeks) hospital stay due to mediastinitis. Median length of stay was 7 days for both the high and low frequency group (range, from 5 to 11 and from 5 to 18, respectively) (p = 0.510). The mean number of exercise

Comment

The patients in the high frequency group achieved four out of five clinical milestones significantly faster than the patients in the low frequency group. There were, however, no differences in other measures of functional independence and physical activity as assessed on the sixth postoperative day. Patients' satisfaction was significantly higher in the high frequency group, although the low frequency group was not dissatisfied.

The difference between the two groups in achieving the milestones

Acknowledgements

We thank the physical therapists and medical and nursing staff of the cardiothoracic surgery team of the LUMC for their assistance with the recruitment and treatment of the patients and with data collection. The study was financially supported by “Vereniging Academische Ziekenhuizen” and the Leiden University Medical Center, the Netherlands. Health Insurance Board (College voor Zorgverzekeringen) (Grant number 99221).

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