@article {Taylore000623, author = {Claire Taylor and Costas Tsakirides and James Moxon and James W Moxon and Michael Dudfield and Klaus Witte and Lee Ingle and Sean Carroll}, title = {Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study}, volume = {4}, number = {2}, elocation-id = {e000623}, year = {2017}, doi = {10.1136/openhrt-2017-000623}, publisher = {Archives of Disease in childhood}, abstract = {Aims To investigate the relationship between exercise participation, exercise {\textquoteleft}dose{\textquoteright} expressed as metabolic equivalent (MET) hours (h) per week, and prognosis in individuals attending an extended, community-based exercise rehabilitation programme.Methods Cohort study of 435 participants undertaking exercise-based cardiac rehabilitation (CR) in Leeds, West Yorkshire, UK between 1994 and 2006, followed up to 1 November 2013. MET intensity of supervised exercise was estimated utilising serial submaximal exercise test results and corresponding exercise prescriptions. Programme participation was routinely monitored. Cox regression analysis including time-varying and propensity score adjustment was applied to identify predictors of long-term, all-cause mortality across exercise dose and programme duration groups.Results There were 133 events (31\%) during a median follow-up of 14 years (range, 1.2 to 18.9 years). The significant univariate association between exercise dose and all-cause mortality was attenuated following multivariable adjustment for other predictors, including duration in the programme. Longer-term adherence to supervised exercise training (\>36 months) was associated with a 33\% lower mortality risk (multivariate-adjusted HR: 0.67; 95\% CI: 0.47 to 0.97; p=0.033) compared with all lesser durations of CR (3, 12, 36 months), even after adjustment for baseline fitness, comorbidities and survivor bias.Conclusion Exercise dose (MET-h per week) appears less important than long-term adherence to supervised exercise for the reduction of long-term mortality risk. Extended, supervised CR programmes within the community may play a key role in promoting long-term exercise maintenance and other secondary prevention therapies for survival benefit.}, URL = {https://openheart.bmj.com/content/4/2/e000623}, eprint = {https://openheart.bmj.com/content/4/2/e000623.full.pdf}, journal = {Open Heart} }