Comparative Effectiveness of Cardiac Rehabilitation on Functional Capacity and Physical Activity Duration among Post-Revascularization Patients in a Tertiary Care Setting in Pakistan

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Post-cardiac revascularization (CABG, PCI, valve surgery, or other cardiac interventions) (n=501). Intervention: Structured Phase II cardiac rehabilitation attendance (>=15 sessions within 8 weeks) vs. Non-attenders (<15 sessions within 8 weeks or home-based exercise prescription only). Primary outcome: Median change in exercise capacity (Peak METs) from baseline to 8-week follow-up (p=<0.001).

Q: What does this research mean for the field?

Participation in structured cardiac rehabilitation significantly improves exercise capacity and moderate-to-vigorous physical activity duration compared to non-attendance in post-revascularization patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the comparative effectiveness of structured cardiac rehabilitation on functional capacity and physical activity duration among post-revascularization patients.

Farzana Amir Hashmi; Basit Ansari; Mehak Hashmi; Syed Faizan Waseem; Moiz Ahmed Khan

doi:10.21203/rs.3.rs-10981140/v1

November 1, 2026Open Access

Comparative Effectiveness of Cardiac Rehabilitation on Functional Capacity and Physical Activity Duration among Post-Revascularization Patients in a Tertiary Care Setting in Pakistan

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Key result

Structured cardiac rehabilitation attendance (>=15 sessions) increased peak METs (median +1.41 vs +0.76, p<0.001) and weekly physical activity (+175.0 vs +35.0 min, p<0.001) versus non-attendance.

Why the study?

Patients frequently experience diminished functional capacity and quality of life despite coronary revascularization. Although cardiac rehabilitation is a proven strategy for improving post-surgical outcomes, participation remains notably low in low-resource settings such as Pakistan.

Does completing at least 15 sessions of structured outpatient cardiac rehabilitation within 8 weeks improve exercise capacity (Peak METs) and weekly moderate-to-vigorous physical activity duration compared to non-attendance/home-based exercise prescription in post-revascularization patients in Pakistan?

Key Points

To assess the comparative effectiveness of structured cardiac rehabilitation on functional capacity and physical activity duration among post-revascularization patients.
Comparative study of 501 post-revascularization patients (235 PCI, 161 CABG) enrolled between January 2020 and December 2022 at a tertiary cardiac care center in Karachi, Pakistan.
Categorized participants into rehabilitation attenders (n = 250, completed ≥ 15 structured sessions within 8 weeks) and non-attenders (n = 251, attended fewer sessions).
Evaluated peak metabolic equivalents and weekly minutes of moderate-to-vigorous physical activity from baseline to an 8-week follow-up using Wilcoxon signed-rank and Mann-Whitney U tests.
Attenders demonstrated significantly greater median improvements in peak metabolic equivalents compared to non-attenders (1.41 vs 0.76 METs, p < 0.001).
Moderate-to-vigorous physical activity increased significantly more among attenders than non-attenders (median 175.0 vs 35.0 minutes/week, p < 0.001).

Study Design

Type

Cohort (n=501)

Multicenter

No

Structured PICO

Does completing at least 15 sessions of structured outpatient cardiac rehabilitation within 8 weeks improve exercise capacity (Peak METs) and weekly moderate-to-vigorous physical activity duration compared to non-attendance/home-based exercise prescription in post-revascularization patients in Pakistan?

P

Population

501 post-revascularization patients (mean age 57.89 years, 23% female) at a tertiary cardiac center in Pakistan, free of unstable angina or acute heart failure, followed for 8 weeks for primary outcomes.

E

Exposure

Structured Phase II outpatient cardiac rehabilitation (CR) program ('Attenders', n=250) consisting of ≥15 supervised exercise sessions (out of 17 expected) within 8 weeks. Sessions lasted 20-60 minutes and included aerobic endurance training at 60%-80% target heart rate (RPE 4-8 on Borg scale), strength training, stretching, and range of motion exercises, alongside comprehensive counseling for secondary prevention, mandatory educational classes on risk factor modification (diet, diabetes, hypertension, stress, smoking cessation, medication adherence), and individualized diet plans by registered dietitians.

C

Comparator

Non-attenders (n=251) who either did not enroll in Phase II outpatient CR or dropped out after attending <15 sessions within 8 weeks. At hospital discharge, they received initial counseling sessions, a secondary prevention diet plan, and a 6-8 week home-based exercise prescription (endurance, muscle strengthening, and stretching exercises for 20-60 minutes) with instruction on heart rate and symptom monitoring.

O

Outcome

Exercise capacity measured as peak metabolic equivalents (Peak METs) via symptom-limited treadmill exercise tolerance testing, and exercise duration measured as moderate-to-vigorous physical activity (MVPA, ≥3 METs) in minutes per week via validated questionnaires, assessed from baseline to 8-week follow-up and 1-year follow-up.surrogate

Main Result

Absolute Event Rate: 1.41% vs 0.76%

p-value: p=<0.001

In a Pakistani tertiary care setting, attending at least 15 structured cardiac rehabilitation sessions after cardiac revascularization nearly doubled functional capacity gains (1.41 vs 0.76 Peak METs) and increased weekly physical activity five-fold (175 vs 35 minutes/week) compared to non-attendance.

Limitations

Non-randomized observational design may introduce selection bias
Single-center design limits generalizability to other settings
Physical activity duration was assessed using self-report questionnaires subject to recall and social desirability bias
Relatively short 8-week follow-up period for primary outcome assessment
The 15-session threshold used to define compliance may be arbitrary

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Implication

Greater METs and activity gains with structured CR attendance; hypothesis-generating and should not yet change practice without randomized confirmation.

Abstract

INTRODUCTION Cardiovascular disease remains a leading cause of global morbidity and mortality, with revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention being commonly performed interventions. Despite these procedures, patients frequently experience diminished functional capacity and quality of life. Cardiac rehabilitation (CR) is a proven strategy for improving post-surgical outcomes, yet participation remains notably low in low-resource settings such as Pakistan. METHODS This comparative study enrolled 501 post-revascularization patients at a tertiary cardiac care center in Karachi, Pakistan between January 2020 and December 2022. Participants were categorized into attenders (n = 250) who completed ≥ 15 structured CR sessions within 8 weeks, and non-attenders (n = 251) who attended fewer sessions. Exercise capacity was measured using peak metabolic equivalents, while exercise duration was assessed as moderate-to-vigorous physical activity in minutes per week. Assessments were conducted at baseline, 8-week follow-up, and one-year follow-up. Non-parametric statistical tests including Wilcoxon signed-rank and Mann-Whitney U tests were employed for analysis. RESULTS Both groups demonstrated improvements in peak metabolic equivalents and moderate-to-vigorous physical activity from baseline to follow-up. However, CR attenders showed significantly greater median improvements in peak metabolic equivalents (1.41 vs 0.76, p < 0.001) and moderate-to-vigorous physical activity (175.0 vs 35.0 minutes/week, p < 0.001) compared to non-attenders. Baseline characteristics including age, gender, and blood pressure were comparable between groups. CONCLUSION Structured CR significantly enhances exercise capacity and physical activity duration in post-revascularization patients, with attenders demonstrating substantially greater improvements than non-attenders. These findings underscore the vital role of organized CR in optimizing recovery outcomes in low-resource settings and support the expansion of such programs in Pakistan.

Discussion

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Cite This Study

Hashmi et al. (2026) conducted a cohort in Post-cardiac revascularization (CABG, PCI, valve surgery, or other cardiac interventions) (n=501). Structured Phase II cardiac rehabilitation attendance (>=15 sessions within 8 weeks) vs. Non-attenders (<15 sessions within 8 weeks or home-based exercise prescription only) was evaluated on Median change in exercise capacity (Peak METs) from baseline to 8-week follow-up (p=<0.001). Structured cardiac rehabilitation attendance (>=15 sessions) increased peak METs (median +1.41 vs +0.76, p<0.001) and weekly physical activity (+175.0 vs +35.0 min, p<0.001) versus non-attendance.

synapsesocial.com/papers/6ae92596a8a6b2adf62f600c https://doi.org/10.21203/rs.3.rs-10981140/v1

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Comparative Effectiveness of Cardiac Rehabilitation on Functional Capacity and Physical Activity Duration among Post-Revascularization Patients in a Tertiary Care Setting in Pakistan

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative Effectiveness of Cardiac Rehabilitation on Functional Capacity and Physical Activity Duration among Post-Revascularization Patients in a Tertiary Care Setting in Pakistan

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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