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| Name | Class |
|---|---|
| Heart and Stroke Foundation of Ontario | OTHER |
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The purpose of this study is to compare women's cardiac rehabilitation program adherence across three program models.
Heart disease is the leading cause of morbidity and mortality for women in Canada. Cardiac rehabilitation (CR) is an outpatient secondary prevention program composed of structured exercise and comprehensive education and counseling. CR participation results in lower morbidity and mortality, among other benefits. Unfortunately, women are significantly less likely to adhere to these programs than men. While the traditional model of CR care is a hospital-based mixed-sex program, women are the minority in such programs, and state that these programs do not meet their care preferences. Two other models of CR care have been developed: hospital-based women-only (sex-specific) and monitored home-based programs. Other than through our controlled pilot testing of 36 patients, women's adherence to these program models is not well known.
CR4HER is a 3 parallel arm pragmatic RCT designed to compare program adherence to traditional hospital-based CR with males and females, home-based CR, and women-only hospital-based CR. Power calculations based on our pilot study suggest a sample size of 261 patients is needed to detect a difference in adherence by program model using ANCOVA. Participants are female CAD, acute coronary syndrome, percutaneous coronary intervention, bypass surgery, or valve surgery inpatients recruited from 5 hospitals. Also, female patients referred to participating cardiac rehabilitation (3) centres with one of the aforementioned diagnosis will be approached to participate. The primary outcome variable is program adherence operationalized as CR site-reported percentage of prescribed sessions completed by phone or on-site, as reported by a staff member who is blind to study objectives. Secondary outcomes are exercise capacity operationalized as VO2peak on a graded stress test, and exercise, dietary, smoking and medication adherence behaviours measured in hospital and 1 week post-CR. By identifying the CR program model which results in the greatest adherence for women, we can optimize their participation and potentially their cardiac outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Women-Only Cardiac Rehabilitation | Active Comparator | The women-only CR programs include on-site group exercise training sessions 1-2 days/week. Participants are encouraged to walk at home on alternate days of the week. Education sessions are also given in a group format, wherein participants engage in on-site female-only group exercise sessions, as well as female-only group education sessions. |
|
| Co-ed Cardiac Rehabilitation | Active Comparator | The traditional hospital-based co-ed CR programs include on-site group exercise training sessions 1-2 days/week. Participants are encouraged to walk at home on alternate days of the week. Education sessions are also given in a group format. |
|
| Home-Based Cardiac Rehabilitation | Active Comparator | In the monitored home-based programs, patients attend an intake appointment where an exercise test is performed as the basis for exercise prescription. Patients are given written guidelines for aerobic conditioning based on their treadmill test. Patients are cautioned about symptoms, and taught how to check their heart rate during walking sessions. Patients are provided with reading materials regarding CVD, risk factors and lifestyle modification. These are discussed with an allied health professional from the home-based CR program by telephone during weekly scheduled telephone calls. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cardiac Rehabilitation | Behavioral | comparison of multiple cardiac rehabilitation program models |
|
| Measure | Description | Time Frame |
|---|---|---|
| CR Program Adherence | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Exercise Capacity | Exercise capacity as measured by VO2peak on a graded stress test. | 6 months |
| Exercise | Mean daily steps as measured by a pedometer over 7 days |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sherry L Grace, PhD | University Health Network & York University | Principal Investigator |
| Heather M Arthur, PhD | McMaster University | Study Chair |
| Paul Oh, MD | Toronto Rehabilitation Institute | Study Chair |
| Caroline Chessex, MD | University Health Network, Toronto | Study Chair |
| Stephanie Brister, MD | University Health Network, Toronto | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hamilton Health Sciences Centre | Hamilton | Ontario | L8N3Z5 | Canada | ||
| Mount Sinai |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26682921 | Derived | Grace SL, Midence L, Oh P, Brister S, Chessex C, Stewart DE, Arthur HM. Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial. Mayo Clin Proc. 2016 Feb;91(2):140-8. doi: 10.1016/j.mayocp.2015.10.021. Epub 2015 Dec 10. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Women-Only Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| FG001 | Co-ed Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| FG002 | Home-Based Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Women-Only Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| BG001 | Co-ed Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | CR Program Adherence | Participants with available data for adherence | Posted | Mean | Standard Deviation | percentage of sessions attended | 6 months |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Women-Only Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Sherry L Grace | University Health Network & York University | 416.736.2100 | 22364 | sgrace@yorku.ca |
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| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D054058 | Acute Coronary Syndrome |
| D006331 | Heart Diseases |
| D003324 | Coronary Artery Disease |
| D017060 | Patient Satisfaction |
| D010358 | Patient Participation |
| D010349 | Patient Compliance |
| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
| D003327 | Coronary Disease |
| D001161 | Arteriosclerosis |
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| ID | Term |
|---|---|
| D000072038 | Cardiac Rehabilitation |
| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
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| 6 months |
| Self-reported Exercise | The Godin Leisure-time Exercise Questionnaire will be administered in the pre and post-test surveys. It is a brief and reliable instrument to assess usual leisure-time physical activity behaviour during a one-week period. For the first question, weekly frequencies of strenuous, moderate, and light activities are multiplied by nine, five, and three, respectively. Part two of the questionnaire calculates the frequency of weekly leisure-time activities pursued. Total weekly leisure activity is calculated by summing the products of the separate components. Scores begin at zero, with higher scores indicating greater physical activity. For example, scores equal to or greater than 20 are indicative of someone who is "active". There is no max score. | 6 months |
| Diet | The Diet Habit Survey was used to assess diet. It is an inexpensive, reliable, and valid instrument for rapid assessment of eating habits and diet composition. Its 9 questions are related to the consumption of cholesterol, saturated fat, complex carbohydrate (including fiber), and salt. Greater scores indicate better diets, both for the total score and for each area. The total score indicates the level of fat in the diet (with scores equal to or greater than 236 corresponding to a low-fat diet 20% or less). Scores can begin at 56 and have no upper range. | 6 months |
| Medication Adherence | The 4-item Morisky Medication Adherence Scale was used, which is scored as yes = 0, no = 1, such that a higher score indicates higher medication adherence. Scores range from 0 to 4, with patients scoring 2 or above considered adherent. | 6 months |
| Smoking | Current smoking status | 6 months |
| Toronto |
| Ontario |
| M3K 1G5 |
| Canada |
| Toronto Rehabilitation Institute | Toronto | Ontario | M4G1R7 | Canada |
| Sunnybrook Health Sciences Centre | Toronto | Ontario | M4N3M5 | Canada |
| University Health Network | Toronto | Ontario | M5G2C4 | Canada |
| BG002 | Home-Based Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Sex/Gender, Customized | Number | participants |
|
| Race/Ethnicity, Customized | Number | participants |
|
| Region of Enrollment | Number | participants |
|
Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models
|
|
| Secondary | Exercise Capacity | Exercise capacity as measured by VO2peak on a graded stress test. | Participants with available data for exercise capacity | Posted | Mean | Standard Deviation | mL/(kg·min) | 6 months |
|
|
|
| Secondary | Exercise | Mean daily steps as measured by a pedometer over 7 days | Participants with available data for exercise | Posted | Mean | Standard Deviation | Daily steps | 6 months |
|
|
|
| Secondary | Self-reported Exercise | The Godin Leisure-time Exercise Questionnaire will be administered in the pre and post-test surveys. It is a brief and reliable instrument to assess usual leisure-time physical activity behaviour during a one-week period. For the first question, weekly frequencies of strenuous, moderate, and light activities are multiplied by nine, five, and three, respectively. Part two of the questionnaire calculates the frequency of weekly leisure-time activities pursued. Total weekly leisure activity is calculated by summing the products of the separate components. Scores begin at zero, with higher scores indicating greater physical activity. For example, scores equal to or greater than 20 are indicative of someone who is "active". There is no max score. | Participants with available data for self-reported exercise | Posted | Mean | Standard Deviation | Scores on a scale | 6 months |
|
|
|
| Secondary | Diet | The Diet Habit Survey was used to assess diet. It is an inexpensive, reliable, and valid instrument for rapid assessment of eating habits and diet composition. Its 9 questions are related to the consumption of cholesterol, saturated fat, complex carbohydrate (including fiber), and salt. Greater scores indicate better diets, both for the total score and for each area. The total score indicates the level of fat in the diet (with scores equal to or greater than 236 corresponding to a low-fat diet 20% or less). Scores can begin at 56 and have no upper range. | Participants with available data for diet | Posted | Mean | Standard Deviation | Scores on a scale | 6 months |
|
|
|
| Secondary | Medication Adherence | The 4-item Morisky Medication Adherence Scale was used, which is scored as yes = 0, no = 1, such that a higher score indicates higher medication adherence. Scores range from 0 to 4, with patients scoring 2 or above considered adherent. | Participants with available data for medication adherence | Posted | Mean | Standard Deviation | Scores on a scale | 6 months |
|
|
|
| Secondary | Smoking | Current smoking status | Participants with available data for current smoking status. Reported values in the table represent number of participants who were current smokers. | Posted | Number | Participants | 6 months |
|
|
|
| 0 |
| 55 |
| 0 |
| 55 |
| EG001 | Co-ed Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models | 0 | 59 | 0 | 59 |
| EG002 | Home-Based Cardiac Rehabilitation | Cardiac Rehabilitation: comparison of multiple cardiac rehabilitation program models | 0 | 55 | 0 | 55 |
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| D001157 |
| Arterial Occlusive Diseases |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |
| D010342 | Patient Acceptance of Health Care |
| D013812 |
| Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |