***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Wu S-K , Lin Y-W , Chen C-L , Tsai S-W : Cardiac rehabilitation vs. home exercise after coronary artery bypass graft surgery : a comparison of heart rate recovery . Am J Phys Med Rehabil 2006;85:711–717 . Objective : The autonomic dysfunction is known to adversely affect clinical outcome in patients with cardiovascular disease , and exercise training has been shown to modify the sympathovagal control of heart rate . The purpose s of this study were to investigate the effect of cardiac rehabilitation on heart rate recovery in patients who received coronary artery bypass grafting ( CABG )  and compare the effect with that of a home-based exercise program . Design : Fifty-four male patients having undergone CABG were r and omly assigned to a cardiac rehabilitation exercise program ( n = 18 ) , a home-based exercise program ( n = 18 ) , and a control group ( n = 18 ) for 12 wks to evaluate the differences in heart rate recovery among groups . Results : Patients in the cardiac rehabilitation group had significant increases in heart rate recovery ( 19.1 ± 6.2 vs. 14.0 ± 5.4 beats/min , P = 0.022 ) compared with those in the control group . There were no significant differences in heart rate recovery between cardiac rehabilitation and home-based exercise groups ( 16.2 ± 4.8 beats/min ) or between home-based exercise and control groups . All three groups had significantly improved heart rate recovery compared with their baseline data ( P < 0.001 , < 0.001 , and 0.007 ) . Conclusion : Our results point out that a cardiac rehabilitation exercise program has a positive effect on heart rate recovery in patients having undergone CABG and is consistent with the autonomic improvement . Although the home-based exercise group did not reveal statistical significance s over those in the control group , it had comparable efficacy to that demonstrated in the cardiac rehabilitation group Background —Whether cardiac rehabilitation ( CR ) is effective in patients older than 75 years , who have been excluded from most trials , remains unclear . We enrolled patients 46 to 86 years old in a r and omized trial and assessed the effects of 2 months of post-myocardial infa rct ion ( MI ) CR  on total work capacity ( TWC , in kilograms per meter ) and health-related quality of life ( HRQL ) . Methods and Results —Of 773 screened patients , 270 without cardiac failure , dementia , disability , or contraindications to exercise were r and omized to outpatient , hospital-based CR ( Hosp-CR ) , home-based CR ( Home-CR ) , or no CR within 3 predefined age groups ( middle-aged , 45 to 65 years ; old , 66 to 75 years ; and very old , > 75 years ) of 90 patients each .  TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline , after CR , and 6 and 12 months later . Within each age group , TWC improved with Hosp-CR and Home-CR and was unchanged with no CR . The improvement was similar in middle-aged and old persons but smaller , although still significant , in very old patients . TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR .  HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients . Complications were similar across treatment and age groups . Costs were lower for Home-CR than for Hosp-CR . Conclusions —Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group . However , with lower costs and more prolonged positive effects , Home-CR may be the treatment of choice in low-risk older patients BACKGROUND Participation in cardiac rehabilitation  after acute myocardial infa rct ion is sub-optimal . Offering home-based rehabilitation may improve uptake . We report the first r and omized study of cardiac rehabilitation to include patient preference . AIM To compare the clinical effectiveness of a home-based rehabilitation with hospital-based rehabilitation after myocardial infa rct ion and to determine whether patient choice affects clinical outcomes . DESIGN Pragmatic r and omized controlled trial with patient preference arms . SETTING Rural South West Engl and . METHODS Patients admitted with uncomplicated myocardial infa rct ion were offered hospital-based rehabilitation classes over 8 - 10 weeks or a self-help package of six weeks ' duration ( the Heart Manual ) supported by a nurse . Primary outcomes at 9 months were mean depression and anxiety scores on the Hospital Anxiety Depression scale , quality of life after myocardial infa rct ion ( MacNew ) score and serum total cholesterol . RESULTS Of the 230 patients who agreed to participate , 104 ( 45 % ) consented to r and omization and 126 ( 55 % ) chose their rehabilitation programme . Nine month follow-up data were available for 84/104 ( 81 % ) r and omized and 100/126 ( 79 % ) preference patients . At follow-up no difference was seen in the change in mean depression scores between the r and omized home and hospital-based groups ( mean difference : 0 ; 95 % confidence interval , -1.12 to 1.12 ) nor mean anxiety score ( -0.07 ; -1.42 to 1.28 ) , mean global MacNew score ( 0.14 ; -0.35 to 0.62 ) and mean total cholesterol levels ( -0.18 ; -0.62 to 0.27 ) . Neither were there any significant differences in outcomes between the preference groups . CONCLUSIONS Home-based cardiac rehabilitation with the Heart Manual was as effective as hospital-based rehabilitation for patients after myocardial infa rct ion . Choosing a rehabilitation programme did not significantly affect clinical outcomes Aerobic capacity , measured as the peak oxygen uptake , is a strong predictor of survival in cardiac patients .  Aerobic interval training ( AIT ) , walking/running four times four minutes at 85–95 % of peak heart rate , has proven to be effective in increasing peak oxygen uptake in coronary heart disease patients . As some patients do not attend organized rehabilitation programs , home-based exercise should be an alternative . We investigated whether AIT could be performed effectively at home , and compared the effects on peak oxygen uptake with that observed after a st and ard care , four-week residential rehabilitation . Thirty patients undergoing coronary artery bypass surgery were r and omized to residential rehabilitation or home-based AIT .  At six months follow-up , peak oxygen uptake increased 4.6 ( ±2.7 ) and 3.9 ( ±3.6 ) mL·kg−1 min−1 ( both p<0.005 , non-significant between-group difference ) after residential rehabilitation and AIT , respectively . Quality of life increased significantly in both groups , with no statistical significant difference between groups . We found no evidence for a different treatment effect between patients r and omized to home-based AIT compared to patients attending organized rehabilitation ( 95 % confidence interval −1.8 , 3.5 ) . AIT patients reported good adherence to exercise training . Even though these first data indicate positive effects of home-based AIT in patients undergoing coronary artery bypass surgery , more studies are needed to provide supporting evidence for the application of this rehabilitation strategy . Trial Registration Clinical Trials.gov Purpose To compare the effects of home-based and hospital-based exercise programs on exercise capacity , quality of life , psychological symptoms , and hemodynamic parameters in heart failure ( HF ) patients . Methods Seventy-four patients were r and omized into either a hospital-based exercise  ( Group 1 ) or a  home-based exercise ( Group 2 ) group . Prior to and after the 8-week rehabilitation program , the two groups were compared with respect to their functional capacity [ maximal oxygen uptake ( pVO2 ) and 6-min walk test ( 6MWT ) ] , quality of life ( Medical Outcomes Study and the 36-item Short Form Survey , SF-36 ) , psychological symptoms [ Beck Depression Inventory ( BDI ) and State-Trait Anxiety Inventory ] , and hemodynamic parameters [ ( left ventricular diastolic diameter in diastole , left ventricular diameter in systole , Mitral Early diastolic peak flow velocity (E)/late diastolic peak flow velocity ( A ) , Mitral E/Mitral early peak velocity ( Em ) , Tei index , right ventricular systolic peak velocity ( Sm ) , tricuspid annular plane systolic excursion , systolic pulmonary arterial pressure ( SPAP ) , and left and right ventricular ejection fraction ( LVEF and RVEF ) ] . Results After the exercise programs , significant improvement was observed in pVO2 , 6MWT and subscales of physical function , general health , and vitality of SF 36 , as well as BDI and LVEF in both groups ( P < 0.05 ) . A comparison of the two exercise groups revealed no significant differences between them regarding the analyzed variables ( P > 0.05 ) . Conclusion Both the hospital-based and home-based exercise groups improved significantly in functional capacity , quality of life , depression symptoms , and LVEF . Based on these results , we believe that physicians can recommend home-based exercise under strict supervision for stable HF patients . However , additional research should be conducted in this area To evaluate the efficacy of exercise training for increasing functional capacity in the 6 months after clinical ly uncomplicated myocardial infa rct ion , 198 men 52 + /- 9 years of age participated in a training study . They were r and omly assigned to one of four exercise protocol s : 8 to 26 weeks of training at home ( group 1 , n = 66 ) or in a group program ( group 2 , n = 61 ) following treadmill testing performed 3 weeks after infa rct ion , treadmill testing at 3 weeks without subsequent training ( group 3 , n = 34 ) , and treadmill testing for the first time at 26 weeks ( control , n = 37 ) . At 26 weeks functional capacity was significantly higher in patients training at home or in a group program than that in patients without training or in control patients : 8.1 + /- 1.5 , 8.5 + /- 1.3 , 7.5 + /- 1.8 , and 7.0 + /- 1.7 METs , respectively ( p less than .05 and p less than .001 ) . No significant differences in functional capacity were noted between patients training at home and those in a group program . No training-related complications occurred . Home and group training are equally effective in increasing functional capacity of low-risk patients after myocardial infa rct ion Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based Background : The benefits of cardiac rehabilitation ( CR )  after myocardial infa rct ion ( MI ) are increasingly recognised and is recommended in national guidelines . Aims : To explore patients ' experience of MI and to identify the factors which influence the choice patients make given the option of hospital or home-based CR after MI . Method : Qualitative study using semi-structured interviews and interpretive phenomenological analysis ( IPA ) . This study was embedded within a r and omised trial with preference arms . Results : Seventeen participants were interviewed before their rehabilitation programme .  Ten expressed a preference for home-based and seven for hospital-based rehabilitation . Common to both groups was shock and disbelief , which led to a loss of confidence . They expressed a strong desire to make lifestyle changes and looked for specific advice , guidance and support from knowledgeable experts . The hospital-based group had an emphasis on supervision  during exercise , needed the camaraderie of a group , were willing to make travel arrangements and believed they lacked 
    Output:
    
Home-based and centre-based CR provide similar benefits in terms of clinical and health-related quality of life outcomes at equivalent cost for those with heart failure and following myocardial infa rct ion and revascularisation