Beyond phase 2: The impact of phase 3 cardiac rehabilitation on physical activity

Abstract Introduction Phase 3 Cardiac Rehabilitation (CR) is a maintenance exercise program for which clinical benefits are less well defined comparing to phase 2. Purpose To assess impact of phase 3 CR on physical activity (PA) levels. Methods A single-center cohort study was conducted, involving patients (pts) who completed a phase 2 CR program at least 6 months prior to the study and who answered the International Physical Activity Questionnaire (IPAQ) short form version 2.0. The patients were divided in 2 groups according to progression to phase 3 program to a specialized CR center (group 1) and non-CR center (group 2). The populations were compared. Results A total of 110 pts were included (78% male; mean age 61,5±11 years). Regarding clinical data, 59% had hypertension, 10% were diabetic, 79% had dyslipidemia and 20% were smokers, 86% pts with ischemic heart disease. Concerning exercise program methodologies, only 25,5% of pts enrolled a structured phase 3 CR center (group 1). Regarding the intensity of PA, the group 1 had a higher number of minutes (min) per week undertaking moderate to vigorous activity (211±108 min vs 147±132 min, p=0,028) and a higher energy requirement in total metabolic equivalents (METs) per week (1033±356 vs 734±684), p 0,001) comparing to group 2. Concerning the categorical score, a higher proportion of pts were attributed a moderately or higher level of total PA (OR 4.485 CI 1.549-12.984) after computing activity on all domains accessed by the IPAQ form in group 1. These positive outcomes were consistent across gender and body mass index categories. The subgroup analysis of younger pts (70years) showed similar results when evaluating min/week of moderate-vigorous PA, total MET/week (p=0,018 and p=0,002 respectively) and categorical score of total PA (OR 5.9 CI 1.6-22.4), while the older population did not exhibit significant differences. Conclusion These findings are promising, suggesting that continuing with a structured phase 3 program may contribute to sustained physical activity and potentially better overall cardiovascular health, especially for the younger population. This underscores the importance of continued research in this area, namely whether there are specific factors influencing the outcomes in different age groups.