An Evidence-Based Protocol: Exercise Training for Patients with Coronary Heart Disease

This dissertation, "An Evidence-based Protocol: Exercise Training for Patients With Coronary Heart Disease" by Jannie Gem, Shum, 沈寧寧, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Background Coronary heart disease deprives millions of lives in the world annually and this number has increased steadily in recent years. In Hong Kong, coronary heart disease claimed 4360 lives in 2009 and it is one of the major burdens of the healthcare system. In order to reduce cardiac mortality and morbidity and to enhance patients' quality of life, cardiac rehabilitation program is developed. Exercise training is a pivotal part of the cardiac rehabilitation program. Objective The main objective of this translational nursing research is to translate quality research evidences regarding the effects of exercise training in improving quality of life of patients with coronary heart disease to the local setting. This is achieved by developing an evidence-based protocol. Methods A systematic search of literature was conducted in 5 electronic databases. 8 relevant randomized controlled trials were eventually obtained. Then, the 8 identified studies were summarized to form a table of evidence and the critical appraisal was performed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. After performing the quality assessment, evidences were assembled for synthesis and recommendations are made for developing the evidence-based protocol. Since the implementation potential of the proposed exercise training program is considered to be high, an evidence-based protocol is developed for the local context. In order to implement the evidence-based protocol smoothly, implementation plan is developed in which a communication plan and a pilot test are included. Lastly, evaluation plan is established to assess the effectiveness of the program in fulfilling its objectives. Results In total, 7 recommendations are made based on the 8 appraised studies. According to the SIGN's "Grades of recommendation," all the recommendations in the protocol are graded with "A." The significance of this evidence-based protocol is that it adds a symptom-limited exercise test for evaluating participant's level of exercise tolerance before the start of exercise training, so that exercise intensity can be tailored. It is relatively safer than the current practice. Conclusion A 6-week exercise training program for patients with coronary heart disease is effective in improving their quality of life and increasing their level of physical activity. Since the program has a high implementation potential in the local context and is safer than the current practice, the evidence-based exercise training protocol is worthwhile to be introduced to the cardiac units in Hong Kong. DOI: 10.5353/th_b4833925 Subjects: Coronary heart disease - Patients - Rehabilitation Exercise therapy Evidence-based nursing