Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during cardiac rehabilitation (CR) on exercise capacity and habitual physical activity.

Design Six-year follow-up of patients who participated in a randomised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery.

Setting Outpatient CR centre in Central-South Ontario, Canada.

Participants 196 Patients who participated in the original randomised controlled trial and who attended an evaluation 1 year after CR.

Interventions 6 months of home or hospital-based exercise training during CR.

Main outcome measures Peak oxygen uptake (peak Vo₂), Physical Activity Scale in the Elderly (PASE) to assess habitual activity, semi-structured interviews to assess vital status, demographic and descriptive information.

Results Of the 196 eligible patients, 144 (75.5%; 74 Hospital, 70 Home) were available for participation. Patients were predominantly male (n=120; 83.3%) aged 70±9.5 years. Clinical and sociodemographic outcomes were similar in both groups. While exercise performance declined over time, there were significant between-group differences in peak Vo₂ (1506±418 ml/min vs 1393±341 ml/min; p=0.017) and PASE scores (166.7±90.2 vs 139.7±66.5; p=0.001) at 6-year follow-up in favour of the home group.

Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR. Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo₂ and persistent physical activity compared with traditional hospital-based CR.