Individual and service level factors that determine fitness measurement and outcomes in patients enrolled in a cardiac rehabilitation programme.

Aim: Despite the recommendations by professional associations and clinical guidelines to measure physical fitness pre- and post-cardiac rehabilitation (CR) programmes, less than one third of CR patients have undertaken such an assessment. The Incremental Shuttle Walk Test (ISWT) is the most common fitness measurement tests in the UK. The minimum clinically important difference (MCID) for this test in CR patients is an improvement of 70 metres.
The main aims of this thesis were firstly, to examine the association between a patient undertaking a fitness test at baseline and completing their CR programme; secondly, to identify the predictors of the distance walked during the ISWT at baseline assessment; and thirdly, to identify the determinants of achieving the MCID for the ISWT.
Method: A critical review of the literature was conducted and an online survey was sent to 303 CR centres across the UK. Data from three observational studies using National Audit of Cardiac Rehabilitation (NACR) relating to CR patients was analysed. Stepwise linear regression and logistic regressions were used.
Result: Patients who undertook a fitness test were 1.48 times more likely to complete their CR programme. Age, gender and self-reported physical fitness were the predictors of the ISWT distance explaining 32% of the variance. Reference values for the ISWT baseline distance walked were produced. Fifteen determinants of achieving the MCID were identified.
Conclusion: Assessing fitness at baseline is not only a means of providing data to assist exercise prescription but also one of the most significant determinants of CR completion. The reference values produced will aid clinicians to set patient goals, improve patient risk assessment, and provide feedback relating to their fitness. Being aware of the determinants of achieving the MCID is important in helping clinicians to tailor the CR programme for the benefit of patients.