Home-based Exercise for Frail Individuals Prior to Cardiac Surgery

Launched by DR. TODD A DUHAMEL · Apr 17, 2023

Keywords

ClinConnect Summary

This clinical trial is looking at whether a home-based exercise program, guided by a physiotherapist through virtual sessions, can help frail adults who are waiting for heart surgery. The study aims to find out if patients are interested in this type of program, if they can successfully complete the exercises three times a week, and whether the online resources provided (like videos and live support) are helpful for them to exercise safely and effectively. The research will also track any changes in physical activity and health for these individuals during the program.

To participate, individuals must be at least 18 years old and scheduled for certain heart surgeries while showing signs of moderate frailty. Participants will meet virtually with a physiotherapist four times over three weeks, starting with an assessment and exercise demonstration, followed by follow-up sessions to check progress and technique. They will also complete exercises on their own at home and keep a diary of their activities. Additionally, some participants in Winnipeg will wear accelerometers to monitor their physical activity during the study. Having a support person to assist with technology and safety during exercises is also necessary.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Adults (≥ 18 years of age) undergoing elective isolated coronary artery bypass graft (CABG), aortic valve repair or replacement for moderate aortic stenosis or severe regurgitation, mitral valve repair or replacement for moderate stenosis or severe regurgitation or combined CABG/valve procedures.
• • 2. Patients with a Clinical Frailty Score (CFS) between 3 (managing well) and 6 (living with moderate frailty) as determined by the Cardiac Surgeons or the Nurse Practitioner and/or a score of less than/= 60 on the Short Form 36 Physical Function (SF-36 PF).
• • 3. Patients with an estimated wait time of 3 weeks or longer.
• • 4. Have access to the internet and hardware (smartphone, tablet, computer) to support video telerehabilitation.
• • 5. Have a support person (family member, friend, or caregiver) who is available for all exercise sessions (virtual and independent home exercises). This person should be able to provide technical assistance if needed (help navigate a device to join the telerehabilitation session, set up the device to best view the patient while exercising), is physically capable to stand beside the patient and provide physical assistance if the patient were to lose their balance and is able to respond to any unexpected emergency while the patient is exercising (i.e. provide assistance and/or call 911 if needed).
• Exclusion Criteria:
• 1. Patients who have unstable or recent unstable cardiac syndrome as defined by:
• • 1. Severe heart failure (NYHA IV) or angina (CCS class IV) symptoms.
• • 2. Critical left main (LM) coronary disease (\>50% stenosis).
• • 3. Hospitalization for arrhythmias, congestive heart failure (CHF), or acute coronary syndrome (ACS).
• 2. Patients who have severe left ventricular obstructive disease as defined by:
• • a. Severe aortic or mitral stenosis (aortic or mitral valve area \<1.0 cm2 or mean gradient \> 40 mmHg or \> 10 mmHg respectively); or dynamic left ventricular outflow obstruction.
• • 3. Patients who have demonstrated exercise induced ventricular arrhythmias or have experienced a recent hospitalization for arrhythmias.
• • 4. Patients who have cognitive deficits that would preclude prehabilitation.
• • 5. Patients who have physical limitations that would preclude their ability to complete the pre-defined exercises in the intervention.