Effectiveness and cost-effectiveness of a novel tailor-made cardiac rehabilitation program for obese patients with coronary artery disease
Obese patients in cardiac rehabilitation:
Cardiac rehabilitation integrates aerobic fitness training with group education sessions regarding risk factors for cardiovascular disease.
In non-obese patients with coronary artery disease, cardiac rehabilitation was proven effective in the improvement of quality of life, cardio metabolic risk and fitness. Furthermore, cardiac rehabilitation reduces the risk of re-hospitalisation and premature death. However, in obese cardiac patients (Body Mass Index >30), usual cardiac rehabilitation programs are far from optimal. While obese patients entering cardiac rehabilitation have higher cardio metabolic risk, poorer fitness and poorer mental health, there is growing evidence that effects achieved during usual cardiac rehabilitation are substantially smaller than in non-obese patients, and non-lasting. We hypothesize that a novel tailor-made program (OPTICARE-XL) will lead to behavioural change towards a healthier lifestyle, resulting in improved health and quality of life in a cost-effective way.
The OPTICARE XL randomized controlled trial:
We investigate, in a multicentre randomized controlled trial, the effectiveness and cost-effectiveness of the OPTICARE-XL intervention in comparison with usual cardiac rehabilitation.In the period 2017-2019, a total of 201 obese patients with coronary artery disease or atrium fibrillation who fulfilled the guidelines for participation in cardiac rehabilitation were included in the trial. Patient were included at Capri Cardiac Rehabilitation (Rotterdam and the Hague) and Maxima Medical Centre (Eindhoven). Patients were randomized to: 1] OPTICARE-XL (n=102): A one-year tailor-made behavioural group intervention including after-care, specific for obese patients, with strong focus on self-management. Upon usual education sessions and facultative modules (stress management/smoking cessation), OPTICARE-XL includes peer group modules on healthy weight and active lifestyle management, and tailored fitness training (aerobic and muscle strength training). 2] USUAL CARE (n=99): Usual 3-month cardiac rehabilitation group program without after-care in which both obese and non-obese patients participate. Usual cardiac rehabilitation combines aerobic fitness training with education sessions and facultative modules (stress management/smoking cessation). Participating patients were followed for a time period of 1.5 years. Outcomes include health-related quality of life, body composition, cardio metabolic risk, daily physical activity, sedentary behaviour and fitness. Last follow-up measurements were performed in July 2020 and results are expected end 2021. The OPTICARE-XL is performed in a collaboration with Capri Cardiac Rehabilitation and Maxima Medical centre. This research was funded by the Dutch Organisation for Health Research and Development (ZonMw, Grant number 843001792) and Capri Cardiac Rehabilitation.
12-2016 / 12-2021
Clinical focus area