Outpatient Rehabilitation Programmes for Myocardial Ischemia, Heart Failure, and COPD: Satisfaction, Participation, Test Outcomes, and Factors Associated With Positive Changes in Test Results as Well as Level of Participation

Following standard referral after diagnosis of myocardial ischemia, heart failure, or COPD, patients are offered structured outpatient rehabilitation programmes in which supervised physical exercise is a key component. Depending on diagnosis and risk stratification, rehabilitation is delivered at North Zealand Hospital and/or in collaborating municipalities.

This prospective intervention study without a control group is conducted in routine clinical practice. Participants are invited when they enroll in existing group-based rehabilitation programmes. The intervention itself is not experimental and follows standardized, implemented rehabilitation protocols.

Patients with myocardial ischemia and heart failure participate in six weeks of supervised group-based exercise at the hospital, twice weekly, followed by six weeks of rehabilitation in municipal settings. Patients with COPD participate in group-based exercise for up to 12 weeks delivered at the hospital or via telerehabilitation. Exercise sessions include warm-up, aerobic interval training, light resistance training for major muscle groups, and stretching, with intensity guided by the Borg Rating of Perceived Exertion scale.

The primary focus of the study is participation (enrollment, attendance, and dropout) and satisfaction with rehabilitation. Secondary outcomes include changes in physical function, quality of life, musculoskeletal pain, and physical activity. Measurements are obtained before and after the hospital-based rehabilitation period, after any municipal rehabilitation period, and for physical activity additionally at three months after completion.

Sociodemographic and clinical variables obtained from questionnaires and patient records are used to examine factors associated with participation, dropout, and changes in outcomes. The study aims to generate real-world evidence to support optimization of rehabilitation delivery and continuity across healthcare sectors.

Study Type Observational Patient Registry / Prospective Cohort

Conditions

Myocardial Ischemia Heart Failure Chronic Obstructive Pulmonary Disease (COPD)

Interventions Intervention Type: Other Intervention Name: Standard outpatient exercise-based rehabilitation Description: Standardized, guideline-based group exercise programmes delivered as part of routine cardiac and pulmonary rehabilitation (hospital-based, municipal-based, and telerehabilitation).

Outcome Measures Participation and adherence Enrollment rate, attendance rate, and dropout during hospital- and municipality-based rehabilitation Time frame: Up to 12 weeks Satisfaction with rehabilitation (questionnaire) Time frame: End of hospital-based rehabilitation and follow-up 30-second sit-to-stand test Six-minute walk test Time frame: Baseline, post-rehabilitation, and follow-up Quality of life EQ-5D (heart disease) COPD Assessment Test (CAT) Time frame: Baseline, post-rehabilitation, follow-up Musculoskeletal pain Numeric Rating Scale (five body regions) Time frame: Baseline, post-rehabilitation, follow-up Physical activity level Modified IPAQ questionnaire Time frame: Baseline, post-rehabilitation, and three months after completion

Eligibility Criteria Inclusion Criteria Adults referred from North Zealand Hospital (Hillerød or Frederikssund) with a rehabilitation plan for group-based rehabilitation for myocardial ischemia, heart failure, or COPD Enrollment in standard outpatient rehabilitation Provided informed consent Exclusion Criteria None

Enrollment Estimated enrollment: 840 participants

Inclusion criteria

• Patients from North Zealand Hospital (Hillerød and Frederikssund) referred with a rehabilitation plan for group-based rehabilitation for myocardial ischemia, heart failure, or COPD at North Zealand Hospital
• Patient consent to participate in the project

Exclusion criteria

• None