Background: The authors discovered a disparity among our clinical staff (RNs and EPs) after analyzing the initial workloads and daily exercise progression practices for patients in our Phase II program (CR). Consequent to this discovery, we designed, developed, and implemented within our relational database, a special purpose graphic visual analyzer (GVA) that allows the clinician to initiate workloads based on objective clinical parameters and then visually monitor real-time patient progress. Our research was designed to evaluate the efficacy of this approach.

Methods: Three hundred twelve and 335 consecutive patients who had completed 20 sessions of CR the year prior to and after GVA deployment served respectively as control and experimental groups. The groups were statistically homogeneous in key demographic and physiologic variables. Clinicians were blinded to the research design and processes. Exercise progression was calculated as the difference from initial and discharge mean session CR workloads calculated in METs and prescribed by our clinicians during 40-minute CR sessions conducted 3 times weekly.

Results: We analyzed these data via t test and analysis of covariance. When clinicians prescribed and advanced exercise workloads utilizing a GVA, CR subjects had significantly greater work gains (P <= .002) even when controlling for their estimated initial fitness levels via entry graded exercise testing (P <= .001).

Discussion: The safe and appropriate prescription and advancement of exercise workloads for CR patients are ever present challenges for the clinician. The use of database-supported continuous visual feedback has proven to be efficacious in achieving these ends.