Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Internal Medicine Neurology Oncology Pediatrics Respiratory Medicine Surgery
Congress Coverage
2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting

Keynote Webinar | Spotlight on Diet and Diabetes

Watch on-demand

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. 
ADVANCED SEARCH
Log in
Top
Netherlands Heart Journal

Open Access 20-11-2023 | Obesity | Review Article

Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial

Authors: Iris den Uijl, Madoka Sunamura, Rutger M. W. Brouwers, Henk J. Stam, Eric Boersma, Rita J. G. van den Berg-Emons, Nienke ter Hoeve

Published in: Netherlands Heart Journal

Login to get access

Abstract

Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.
Literature
1.
Obesity Collaborators GBD. Health effects of overweight and obesity in 195 countries over 25 years. New Engl J Med. 2017;377:13–27. CrossRef
2.
Kotseva K, De Backer G, De Bacquer D, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: results from the European society of cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol. 2019;26:824–35. CrossRefPubMed
3.
Wanahita N, Messerli FH, Bangalore S, et al. Atrial fibrillation and obesity—results of a meta-analysis. Am Heart J. 2008;155:310–5. CrossRefPubMed
4.
Zhuang J, Lu Y, Tang K, Peng W, Xu Y. Influence of body mass index on recurrence and quality of life in atrial fibrillation patients after catheter ablation: a meta-analysis and systematic review. Clin Cardiol. 2013;36:269–75. CrossRefPubMedPubMedCentral
5.
Piepoli MF, Hoes AW, Agewall S, et al. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;2016:2315. CrossRef
6.
Revalidatiecommissie NVVC/ NHS en projectgroep PAAHR. Multidisciplinary guidelines cardiac rehabilitation on 2011. Multidisciplinaire Richtlijn Hartrevalidatie, Vol. 2011. Utrecht: Nederlandse Vereniging voor Cardiologie; 2011.
7.
Den Uijl I, Ter Hoeve N, Sunamura M, et al. Cardiac rehabilitation designed for patients with obesity: OPTICARE XL RCT results on health-related quality of life and psychosocial well-being. Disabil Rehabil. 2023;45:1046–55. CrossRef
8.
Den Uijl I, Van den Berg-Emons RJ, Sunamura M, et al. Effects of a dedicated cardiac rehabilitation program for patients with obesity on body weight, physical activity, sedentary behaviour and physical fitness: the OPTICARE XL randomized controlled trial. Phys Ther J. 2023;103:pzad55. CrossRef
9.
Visser L, den Uijl I, Redekop W, et al. Cost-effectiveness of a cardiac rehabilitation program specifically designed for patients with obesity within the OPTICARE XL randomized controlled trial. Arch Phys Med Rehabil. 2023;104:855–62. CrossRefPubMed
10.
Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: A scientific statement from the American Heart Association Exercise, Cardiac rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circ. 2007;115:2675–82.
11.
Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;1:CD1800.
12.
De Vries H, Kemps HM, van Engen-Verheul MM, Kraaijenhagen RA, Peek N. Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients. Eur Heart J. 2015;36:1519–28. CrossRefPubMed
13.
Francis T, Kabboul N, Rac V, et al. The effect of cardiac rehabilitation on health-related quality of life in patients with coronary artery disease: a meta-analysis. Can J Cardiol. 2019;35:352–64. CrossRefPubMed
14.
Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis. 2011;53:397–403. CrossRefPubMed
15.
Takura T, Ebata-Kogure N, Goto Y, et al. Cost-effectiveness of cardiac rehabilitation in patients with coronary artery disease: A meta-analysis. Cardiol Res Pract. 2019;4:2019:1840894.
16.
NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387:1377–96.
17.
Gunstad J, Luyster F, Hughes J, et al. The effects of obesity on functional work capacity and quality of life in phase II cardiac rehabilitation. Prev Cardiol. 2007;10:64–7. CrossRefPubMed
18.
Den Uijl I, Ter Hoeve N, Sunamura M, et al. Physical Activity and Sedentary Behavior in Cardiac Rehabilitation: Does Body. zab, Vol. 142. Mass: Index Matter? Phys Ther; 2021. p. 101.
19.
Lavie CJ, Pandey A, Lau DH, Alpert MA, Sanders P. Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: effects of weight loss and exercise. J Am Coll Cardiol. 2017;70:2022–35. CrossRefPubMed
20.
Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. Br Med J. 2019;366:4570. CrossRef
21.
22.
Manzoni GM, Villa V, Compare A, et al. Short-term effects of a multi-disciplinary cardiac rehabilitation program on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study. Psychol Health Med. 2011;16:178–89. CrossRefPubMed
23.
Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–6. CrossRefPubMedPubMedCentral
24.
De Bacquer D, Jennings CS, Mirrakhimov E, et al. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. Eur Heart J Qual Care Clin Outcomes. 2022;8:568–76. CrossRefPubMed
25.
Ades PA, Savage PD. The Treatment of Obesity in Cardiac Rehabilitation: a review and practical recommendations. J Cardiopulm Rehabil Prev. 2021;41:295–301. CrossRefPubMedPubMedCentral
26.
Ayabe M, Brubaker PH, Dobrosielski D, et al. Target step count for the secondary prevention of cardiovascular disease. Circ J. 2008;72:299–303. CrossRefPubMed
27.
Ho SS, Dhaliwal SS, Hills AP, Pal S. The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. Bmc Public Health. 2012;12:1–10. CrossRef
28.
Schjerve IE, Tyldum GA, Tjønna AE, et al. Both aerobic endurance and strength training programs improve cardiovascular health in obese adults. Clin Sci. 2008;115:283–93. CrossRef
29.
De Dirk B, Dallongeville J, Heidrich J, et al. Management of overweight and obese patients with coronary heart disease across Europe. Eur J Prev Cardiol. 2010;17:447–54. CrossRef
30.
Ter Hoeve N, Sunamura M, Stam HJ, et al. Effects of two behavioral cardiac rehabilitation interventions on physical activity: a randomized controlled trial. Int J Cardiol. 2018;255:221–8. CrossRefPubMed
31.
Aldcroft SA, Taylor NF, Blackstock FC, O’Halloran PD. Psychoeducational rehabilitation for health behavior change in coronary artery disease: a systematic review of controlled trials. J Cardiopulm Rehabil Prev. 2011;31:273–81. CrossRefPubMed
32.
Chase J‑AD. Systematic review of physical activity intervention studies after cardiac rehabilitation. J Cardiovasc Nurs. 2011;26:351–8. CrossRefPubMed
33.
Ferrier S, Blanchard CM, Vallis M, Giacomantonio N. Behavioural interventions to increase the physical activity of cardiac patients: a review. Eur J Prev Cardiol. 2011;18:15–32. CrossRef
34.
Braakhuis HE, Berger MA, Bussmann JB. Effectiveness of healthcare interventions using objective feedback on physical activity: A systematic review and meta-analysis. J Rehabil Med. 2019;51:151–9. CrossRefPubMed
35.
Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Part B):2985–3023.
36.
37.
Gremeaux V, Troisgros O, Benaïm S, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. 2011;92:611–9. CrossRefPubMed
38.
Stiggelbout M, De Gecombineerde Leefstijlinterventie RH. Goed Op Weg!? Ned Tijdschr Leefstijlgeneesk. 2023;2:64–9.
39.
Brouwers RWM, van Exel HJ, van Hal JMC, et al. Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Neth Heart J. 2020;28:443–51. CrossRefPubMedPubMedCentral
Metadata
Title
Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial
Authors
Iris den Uijl
Madoka Sunamura
Rutger M. W. Brouwers
Henk J. Stam
Eric Boersma
Rita J. G. van den Berg-Emons
Nienke ter Hoeve
Publication date
20-11-2023
Publisher
Bohn Stafleu van Loghum
Published in
Netherlands Heart Journal
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-023-01832-w
Webinar | 16-05-2023 | 17:30 (CET)

Keynote Webinar | Spotlight on Cardio-Oncology

Watch now

An expert-led symposium exploring the most pertinent issues in cardio-oncology, with a focus on the new ESC guidelines. Highlights include preventative approaches in cardio-oncology, toxicity risk-stratification strategies, the clinical management of myocarditis as an adverse effect of immune checkpoint inhibitor-treatments, and the utility of biomarkers in long-term follow-up of cardiovascular disease risk in cancer patients.
Prof. Rudolf de Boer
Prof. Lorenz Lehmann
Dr. Teresa Lopéz Fernández
Image Credits