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PURPOSE Despite the documented benefits of participating in rehabilitation programs, access to cardiac rehabilitation is limited for a large number of people with coronary artery disease (CAD). There is potential to increase participation in exercise training if home-based exercise were a viable option. METHODS We conducted a retrospective database review of 1,042 patients who took part in exercise rehabilitation following coronary artery bypass graft surgery (CABGS) between 1992 and 1998. Of these, 713 patients took part in supervised exercise, and 329 were in an unsupervised, home-based group. All exercise protocols were based upon American College of Sports Medicine guidelines, and patients in both groups received exercise prescriptions that were similar in intensity, frequency, and duration. RESULTS There were no differences between groups at baseline. Following 6 months of exercise training, there were substantial improvements in peak VO2, peak workload, and peak MET levels in both the supervised and unsupervised groups (P < 0.0001). Patients in the supervised group had significant improvements in both LDL and HDL-cholesterol, whereas the home-based group showed improvement in HDL-cholesterol only. When analyzed by sex, men performed better than women for all measures of exercise capacity; however, women in both groups showed approximate 20% improvements (P < 0.05) in exercise capacity as well as improvements in HDL-cholesterol. CONCLUSION Stable post CABGS patients who receive a detailed exercise prescription to follow at home do as well as those in supervised rehabilitation.

PURPOSE To examine the relationship between clinical workload and aerobic fitness. METHODS Twenty healthy intern and resident volunteers were studied in a cross over manner to compare their aerobic fitness after a 1 month "easy" clinical rotation (ECR) to that after a 1 month "hard" clinical rotation (HCR). The ECR and HCR were prospectively estimated as requiring 70 (HCR) total hours per week of hospital work respectively. Aerobic fitness was determined by directly measuring peak oxygen uptake (peakVO2) during peak cycle exercise testing after each rotation. Clinical workload for the month preceding the exercise test was estimated by documenting the amount of hospital work and sleep lost because of on-call duties. The average weekly amount of effective aerobic training for each rotation was also documented. RESULTS Trainees had a 206.4 (P = 0.0019, 95% CI 94-318.8) mL/min or 3 mL/kg/min (P = 0.0019, 95% CI 1.5-4.4) improvement of peakVO2 after the ECR compared with the HCR. Trainees averaged 1 (95% CI 0.16-1.81) less hour per week of exercise training, 34.1 more hours per week of hospital work (95% CI 23.0-45.3, P < 0.0001) and lost 19.1 hours more sleep per month (95% CI 11.8-26.4, p < 0.0001) during the HCR compared with the ECR. There was no correlation between changes in peakVO2 and changes in exercise training between the two rotations. CONCLUSION Clinical workload seems to adversely affect aerobic fitness independent of changes in exercise training. This supports previous less-objective survey data.