Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Pre programme level of fitness did have a significant effect on
improvements in fitness both in this study and previous studies
(Shiran et al 1997, Pierson et al 2004). There may be many factors
contributing to fitness improvement, both patient factors and
programme factors. One identified reason for this was that patients
feel safer participating in exercise in a supervised programme
structure and could therefore set themselves new limits (McKee et
al 2007, Hammond et al 1998, Stahle et al 2000). The programme
does not seem to have as good an effect on the more fit patients.
We have previously shown that a substantial subgroup of patients
reported that exercise was one of the aspects of the cardiac
rehabilitation programme that they were least satisfied with, in
these patients some of the qualitative reasons for this included
“…was this fit already” ( McKee et al 2007). Although the exercise is
individually prescribed it may be that the level of exercise
prescribed (60% VO2 max) particularly for the already fit patients is
not enough to increase fitness further. Increasing exercise to 70%
VO2 max is recommended for later stages of cardiac rehabilitation
exercise programmes but usually only when telemetry monitoring of
patients is available.
Limitations
The study population reflects the normal cardiac rehabilitation
programme population and therefore contain patients that may
exhibit a degree of cardiovascular limitation due to their disorder or
due to their prescribed drugs and consequently these may influence
their response to both the exercise test and the exercise
programmes. The use of MET’s derived from a sub-maximal
exercise stress test with a pre determined termination point meant
that a proportion of patients attained ceiling level at both the pre
and post programme exercise stress test, this prevented these
patients showing the exact level of improvement above the ceiling
point.
Conclusion: Significant increases in fitness occur following
participation in the cardiac rehabilitation programme, with greater
changes occurring in the least fit. However there are still a
substantial number of patients classified as sedentary from a fitness
point of view after the cardiac rehabilitation programme and there
was a small decline in the fitness of the most fit post the
rehabilitation programme. Any improvement in fitness is cardio
protective to some degree, but we need to ask the question: Is this
improvement enough to reduce risk or should we be setting the
goals higher?
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