Immediately after consenting to participate, patients were given a 5-question education quiz (Textbox 2) to establish their baseline cardiac education level.

Education quiz

How often should you exercise?

What are the most important things to consider when grocery shopping for heart-healthy foods?

How often should you take your blood pressure medication?

What are the symptoms of heart failure?

What type of medicine is used to control your cholesterol?

For their first 3 visits, participants spent approximately 5 minutes on the treadmill, increasing at intervals of 1 minute if deemed appropriate by the staff. The remainder of each session took place on other types of exercise equipment, as per standard of care. Beginning at their fourth visit, patients were allowed to use the treadmill for up to 15 minutes at each visit. Patients walked at a fixed walking speed as self-paced treadmills are not used at the facility. In addition, research has shown that participants using fixed walking speeds had increased stride length compared with participants on self-paced treadmills [9].

All patients were scheduled to complete between 18 and 36 sessions, as decided by their care team and insurance provider. Typically, low-risk patients were encouraged to complete between 18 and 24 sessions, moderate-risk patients were encouraged to complete between 24 and 30 sessions, and high-risk patients were encouraged to complete between 30 and 36 sessions. CR staff recommended that patients complete the maximum number of possible sessions for their risk level, but the final number was decided by the patient.

Patients were contacted again 2 months after their final CR treatment. It was decided to follow up with patients at 2 months postrehabilitation, as, on average, patients were expected to complete approximately 2 months of treatment. This phone call was designed to follow up on patients’ health following treatment and to assess their retention of education by repeating the 5-question education test conducted at their initial and final visits. Previous studies have shown that the use of VR increases the retention of education in students learning complex anatomical concepts [10]. Patients who could not be reached by phone were contacted via email. Those who stopped attending CR sessions before their determined treatment length were also contacted to follow-up and debrief from the study. At least three attempts were made to contact each participant before considering them lost to follow-up.

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