Supervised exercise for acute coronary patients in primary care: a randomized clinical trial.

Background. Functional capacity is a prognostic factor for coronary patients; accordingly, they are recommended to walk. Objective. To assess whether an exercise program supervised in primary care increases their functional capacity more than unsupervised walking. Methods. A randomized clinical trial was carried out at eight primary care centres of the Spanish Health Service and involving 97 incident cases of low-risk acute coronary patients, <80 years old, randomly assigned to either an unsupervised walking program (UW group; n = 51) or a 6-month cycle ergometer exercise program with gradually increasing frequency and workload intensity supervised by primary care nurses (SE group; n = 46). The two groups received the same common components of secondary prevention care. Changes in functional capacity were assessed in terms of peak oxygen consumption (VO 2 peak) during exercise testing measured at baseline and at 7 months by cardiologists blinded to group assignment. Results. Overall, 76% of participants completed the study, 30 in the SE and 44 in the UW. Both groups increased baseline-adjusted VO 2 peak: 5.56 ml/kg per minute in the SE (95% confidence interval [CI] 3.38–7.74) and 1.64 ml/kg per minute in the UW (95% CI −0.15 to 3.45). The multivariate-adjusted difference between groups was 4.30 ml/kg per minute (95% CI 1.82–6.79; P = 0.001) when analyzing completers and 2.83 ml/kg per minute (95% CI 0.61–5.05; P = 0.01) in the intention-to-treat analysis, including all participants with baseline values carried forward for those lost to follow-up. Conclusions. A cycle ergometer exercise program supervised by primary care nurses increased the functional capacity of coronary patients more than unsupervised walking with a clinically relevant difference.