Immediate and Long-term Effects of Exercise Rehabilitation on Daily Physical Activity of Patients with Cardiopulmonary Disorders

• Author / Creator

  Ramadi, Ailar

• It is well known that there is an inverse relationship between physical activity (PA) and mortality in patients with cardiopulmonary disorders. Consequently, PA is considered the core component of cardiopulmonary rehabilitation programs. Despite the health benefits, the adherence to regular PA following completion of the programs seems challenging. The rehabilitation delivery model has been proposed as a potential factor that might influence participants’ long-term PA adherence. Thus, detailed investigation on the PA behavior of cardiopulmonary patients as they progress through different exercise rehabilitation programs from entry to completion and following-up seems warranted. The purpose of this thesis was to study the immediate and long-term impact of different exercise rehabilitation programs on daily PA and exercise capacity in patients with cardiopulmonary disorders. The first study used a multi-sensor device to examine the immediate impact of an exercise rehabilitation program on daily PA of cardiopulmonary patients. At the end of the program participants improved their exercise capacity and demonstrated a PA behavior change at the lower end of the PA continuum. Indeed they spent less time sedentary and increased the time spent in light PA. However, the observed improvements in PA and exercise capacity were not related. The second study used a multi-sensor device to compare the long-term impact of a fast-track versus traditional center-based cardiac rehabilitation (CR) on the PA of coronary artery disease (CAD) patients 6 months following CR entry. The key finding from this study was that participation in CR programs did not result in long-term PA behavior change irrespective of the delivery model. Although participants in both traditional and fast-track CR had higher exercise capacity at 6 months following CR entry, their overall daily PA was not significantly different from what was recorded at baseline. Our third study compared the long-term effectiveness of home versus center-based CR on sustainability of exercise capacity changes 1 year after completing the CR program. The key finding from this study was that participants were relatively successful in maintaining their achieved gains in exercise capacity for at least 1 year post-CR, independent of CR venue. Although exercise capacity decreased in center-based group from CR completion to 1 year follow-up, the observed decline was clinically insignificant. At the 1 year follow-up, exercise capacity was significantly higher than the baseline values in both groups. The major findings from the three studies in this thesis were that 1) participation in exercise rehabilitation program appears to improve habitual PA at the end of the program; 2) following removal from the program participants resume their baseline PA level despite maintaining the achieved gains in the exercise capacity regardless of the program delivery model. Combined these findings may imply that an increase in exercise capacity alone may not be sufficient to change the habitual sedentary lifestyle. Thus, in order to improve exercise capacity and PA behavior, they need to be targeted independently. CR participants may benefit from structured strategies which promote long-term PA adherence in addition to facilitating exercise capacity improvement. Considering the entire spectrum of PA from sedentary behavior to spontaneous light intensity PA in addition to moderate-vigorous PA (MVPA) is imperative when promoting the PA behavior change. An extensive and accurate assessment of daily PA upon CR entry could provide clinicians with valuable information on the best aspect to target in the PA spectrum and to customize programs to participants’ needs and abilities.

• Subjects / Keywords

  • Physical Activity
  • Exercise
  • Rehabilitation
  • Cardiopulmonary

• Graduation date

  Spring 2016

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R31J97K13

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.