Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands 5504 DB.
Health e-Research Center, Farr Institute of Health Informatics Research, University of Manchester, Manchester, United Kingdom.
Phys Ther. 2019 Mar 1;99(3):266-275. doi: 10.1093/ptj/pzy140.
A recent survey among Dutch cardiac rehabilitation centers demonstrated considerable between-center variations in the contents of exercise training programs. For patients entering cardiac rehabilitation, current guidelines recommend tailored exercise training programs based on patient characteristics and rehabilitation goals.
This study was to analyze to what extent these patient characteristics are determinants of variations in training programs.
This was a prospective, observational study with cross-sectional measurements among 10 cardiac rehabilitation centers.
The following data were obtained about patients entering cardiac rehabilitation: referral diagnosis, rehabilitation goals, and exercise training variables. Primary outcomes were variations in total aerobic training time, intensity, and volume before and after case-mix correction for population differences between centers. Secondary outcomes were variations in other training characteristics and the role of exercise testing in the determination of training intensity. Also, the roles of diagnosis and training goals in determining aerobic training time and intensity were studied.
Data from 700 participants were analyzed. There were significant variations between centers in all aerobic and most resistance training characteristics. For aerobic training intensity, time, and volume, great variations remained after case-mix correction. An exercise test was performed for 656 participants (93.7%) but was used to determine training intensity in only 344 (52.4%) of these participants. In most centers, referral diagnosis and rehabilitation goals were unrelated to aerobic training time or intensity.
Some form of selection bias cannot be excluded because the competing centers represented a minority of Dutch exercise-based cardiac rehabilitation centers.
This study showed that the contents of training programs varied considerably between cardiac rehabilitation centers, independent of population differences. Furthermore, aerobic training time and intensity were mostly unrelated to rehabilitation goals and referral diagnosis.
最近对荷兰心脏康复中心的一项调查显示，运动训练计划的内容在各中心之间存在相当大的差异。对于进入心脏康复的患者，目前的指南建议根据患者的特点和康复目标制定量身定制的运动训练计划。
本研究旨在分析这些患者特征在多大程度上决定了训练计划的差异。
这是一项前瞻性、观察性研究，对 10 个心脏康复中心进行了横断面测量。
收集进入心脏康复的患者以下数据：转诊诊断、康复目标和运动训练变量。主要结果是在对中心间人群差异进行病例组合校正后，总有氧运动时间、强度和量的变化。次要结果是其他训练特征的变化以及运动测试在确定训练强度中的作用。此外，还研究了诊断和训练目标在确定有氧运动时间和强度中的作用。
共分析了 700 名参与者的数据。各中心的所有有氧运动和大多数抗阻运动特征均存在显著差异。在病例组合校正后，有氧运动强度、时间和量仍存在较大差异。对 656 名参与者（93.7%）进行了运动测试，但仅对其中 344 名（52.4%）参与者使用运动测试来确定训练强度。在大多数中心，转诊诊断和康复目标与有氧运动时间或强度无关。
由于竞争中心只代表荷兰基于运动的心脏康复中心的一小部分，因此不能排除某种形式的选择偏倚。
本研究表明，培训计划的内容在心脏康复中心之间存在很大差异，与人群差异无关。此外，有氧运动时间和强度与康复目标和转诊诊断大多无关。
