The integration of a hybrid cardiac rehabilitation program for a selected patient population in a clinical setting: a feasibility study

Background and Aim Although worldwide participation rates among patients eligible for cardiac rehabilitation are low due to accessibility challenges and conflicting commitments, traditional cardiac rehabilitation programs have a centre-based group approach. The feasibility of implementing a hybrid cardiac rehabilitation program (HCR) for a selected patient population in a clinical setting of centre-based cardiac rehabilitation (CBCR) was assessed with the aim to bridge the participation gap. Methods With the goal of keeping weaker, more unstable or less motivated patients from unsupervised training, inclusion criteria for the HCR were established. A cardiopulmonary exercise test (CPET) and anamnesis were used to get insight in the patient’s exercise capacity, potential risks, motivation and barriers to home-based exercise sessions. In the HCR, a four-week introductory period with three supervised exercise sessions per week was followed by a combination of supervised sessions (2/w) and home workouts (1/w) for nine weeks. During the introduction period, the patient's response to exercise was examined by monitoring heart rate response and training was provided in the use of the smartphone Polar Beat application. Feedback on the training volume of the home workouts was provided by the physical therapist using the data from the smartphone application. Results Between March 2021 and September 2022, 227 cardiac patients were referred to the University Hospital’s cardiac rehabilitation centre. Seventy-four patients (33%) were allocated in the novel HCR and 153 patients (67%) were allocated to the traditional CBCR group. The dropout rate in the HCR group was comparable with the dropout rate in the CBCR group (16% vs. 15%). Since feedback on the training volume of the home-based sessions was provided during a supervised exercise session in the same week, the additional workload was limited for the physical therapist. There was overlap between the patient flow of the HCR and CBCR program which facilitated clinical implementation. Conclusions Integrating a hybrid cardiac rehabilitation program for a selected patient population within the traditional offering of a supervised exercise program may be a possible way to bridge the participation gap with a limited additional workload. Patient flow at the CR centre.