Early cardiac rehabilitation exercise training after sternotomy as effective as late training: JAMA

UK: Commencing exercise training 2 weeks after sternotomy was as beneficial as starting 6 weeks after sternotomy for improving the 6-minute walk distance, says an article published in the Journal of American Medical Association - Cardiology.

Based on the results, the researchers suggest that clinicians and CR professionals can consider starting exercise training as early as 2 weeks after sternotomy but with appropriate precautions. 

Although there is no evidence to support this recommendation, cardiac rehabilitation (CR) exercise training should not begin until 6 weeks following sternotomy. Limited evidence suggests that beginning sooner is not harmful, but clinical studies are required. As a result, Stuart Ennis and colleagues undertook this trial to examine the efficacy and safety of CR exercise training that began either 2 weeks (early CR) or 6 weeks (usual-care CR) following sternotomy.

This was a randomized clinical study that recruited participants from June 12, 2017, to March 17, 2020. Participants were sternotomy patients from two outpatient National Health Service rehabilitation centers: University Hospital in Coventry, UK, and Hospital of St Cross in Rugby, UK. Participants were randomly randomized to either 2 weeks or 6 weeks of twice-weekly supervised CR exercise instruction following sternotomy.

Exercise training followed current recommendations, which included functional strength and cardiovascular components. At baseline, following CR, and 12 months after randomization, outcomes were examined. The primary result was the difference in 6-minute walk test distance between before and after CR. Functional fitness, safety, and quality of life were secondary goals.

The key findings of this study were as follows:

1. A total of 158 individuals were allocated to research groups at random, with 118 patients included in the primary analysis.

2. Early CR was not inferior to usual-care CR; in the early CR group, the mean change in 6-minute walk distance from the baseline to after CR was 28 m larger.

3. The mean differences in secondary endpoints were not statically important, demonstrating that early CR was not inferior.

4. In usual-care CR and early CR, there were 46 vs 58 adverse events and 14 vs 18 major adverse events, respectively.

5. There was no difference in the chance of individuals experiencing an unfavorable or significant adverse event across the groups.

In conclusion, according to the findings of this randomized clinical study, in cardiac surgery patients having median sternotomy, a supervised CR exercise program beginning as early as 2 weeks after sternotomy was as beneficial as commencing at 6 weeks. Clinicians and rehabilitation specialists can begin exercise programs as early as 2 weeks after sternotomy if a gradual, customized strategy is used.

Reference:

Ennis S, Lobley G, Worrall S, et al. Effectiveness and Safety of Early Initiation of Poststernotomy Cardiac Rehabilitation Exercise Training: The SCAR Randomized Clinical Trial. JAMA Cardiol. Published online June 22, 2022. doi:10.1001/jamacardio.2022.1651