'Open gym' approach shortens wait times for cardiac rehab

Longer wait times for initial cardiac rehabilitation sessions have been linked to decreased participation. Looking to mitigate this issue, Vanderbilt University researchers implemented a group enrollment and "open gym" format for rehab patients and studied its effect on wait times.

After multivariable adjustment, they found the new approach decreased wait times by 22 percent, or 3.7 days. However, in this study of more than 600 people, participation between patients who received individual appointments did not significantly differ with those who participated in the group enrollment/open gym format. Patients in both groups also showed equal gains in six-minute walk distance and Patient Health Questionnaire scores, suggesting similar clinical benefit.

“Although our study demonstrates a significant decrease in wait times, we did not identify a statistically significant increase in cardiac rehabilitation participation rates,” lead researcher Justin M. Bachmann, MD, of Vanderbilt’s departments of medicine and health policy, and colleagues wrote in the Journal of Cardiopulmonary Rehabilitation and Prevention. “This may be because the Dayani Center already had very high participation rates at the beginning of the study (54 percent compared with approximately 20 percent nationally), limiting our statistical power.”

The researchers evaluated 603 patients enrolled in cardiac rehab at Vanderbilt University Medical Center—255 who received usual care (individual appointments) and 348 who participated in the group enrollment format. Those participating in the group enrollment/open gym strategy were invited to exercise from 8-11:30 a.m. or 1-4 p.m. on Mondays, Wednesdays and Fridays.

While the 10 a.m.-to-noon time slot proved most popular, “staff learned to accommodate variable patient loads,” according to the researchers.

“Peak cardiac rehabilitation times in an open gym format are likely to differ between institutions, and thus, a trial period is essential in guiding staff schedules,” they suggested.

Bachmann and colleagues believe their study may have demonstrated even greater support for the group enrollment/open gym method if it were conducted in a different region. They noted several factors, including the rehab program’s location within a large academic medical center and the surrounding population’s relatively high education and socioeconomic status, likely led to greater participation across both groups.

“It is possible that programs with cardiac rehabilitation attendance rates closer to the national average could see a larger increase in participation after changing to a group enrollment and open gym format, as the high participation rates seen in our study would most likely bias our results toward the null,” they wrote.

In addition, the authors cautioned rehab centers against implementing group enrollment without open gym sessions, or vice versa. During initial exploratory work, they found issues with both approaches.

“Implementation of group enrollment without an open gym resulted in an unwieldy scheduling process in which newly enrolled patients signed up for subsequent cardiac rehabilitation sessions at the same time and essentially competed for the most convenient slots (generally between 10 a.m. and 2 p.m.),” Bachmann et al. wrote. “Similarly, it was burdensome to implement an open gym without group enrollment sessions as initial CR visits require significant staff time and are difficult to conduct with a full gym.”