1
|
Alikhajeh Y, Afroundeh R, Mohammad Rahimi GR, Bayani B. The Effects of Aquatic Exercise Training on Functional and Hemodynamic Responses in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Biol Res Nurs 2024:10998004241263943. [PMID: 38904085 DOI: 10.1177/10998004241263943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Objective: This study aimed to investigate the impacts of water exercise training on functional and hemodynamic responses in HF patients. Methods: A systematic review and meta-analysis were conducted until February 15, 2024, using multiple databases. Mean difference (MD) with corresponding 95% confidence intervals (CIs) were calculated. Results: Sixteen studies, comprising 349 participants with HF, were included. Water exercise led to enhancements in peak VO2 (MD, 2.85 mL/kg/min; 95% CI, 1.89 to 3.80; p < .00001) and resting heart rate (MD, -4.16 bm; 95% CI, -6.85 to -1.46; p = .002) compared to no exercising controls. Water plus land exercise reduced resting heart rate (MD, -1.41 bm; 95% CI, -2.13 to -0.69; p = .0001) compared to land exercise alone. Furthermore, acute water exercises decreased resting heart rate (MD, -3.85 bm; 95% CI, -6.49 to -1.21; p = .004) and increased stroke volume (MD, 14.68 mL/beat; 95% CI, 8.57 to 20.79; p < .00001) and cardiac output (MD, 0.5 L/min; 95% CI, 0.27 to 0.73; p < .00001) compared to baseline. Conclusion: These findings suggest that water exercise holds promise as an effective intervention for enhancing functional capacity and hemodynamic parameters in individuals with HF, highlighting the importance of further research to optimize its implementation and elucidate long-term benefits.
Collapse
Affiliation(s)
- Yaser Alikhajeh
- Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Roghayyeh Afroundeh
- Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | | | | |
Collapse
|
2
|
Nandanwar SP, Lalwani L, Chilhate PK. Comprehensive Physiotherapy Approach for Pneumonia After Angioplasty in an 83-Year-Old Hypertensive Male Patient: A Case Report. Cureus 2024; 16:e55454. [PMID: 38571823 PMCID: PMC10988022 DOI: 10.7759/cureus.55454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Pneumonia is an infection that causes inflammation in the air sacs of the lungs. Coronary artery disease is a condition characterized by the buildup of plaque in the coronary arteries, which supply blood to the heart. This obstruction restricts blood flow, resulting in chest pain (angina) and, in extreme cases, heart attacks. An important part of successfully treating diseases like peripheral artery disease and coronary artery disease is balloon angioplasty, a commonly used medical procedure for treating narrowed or clogged arteries. An 83-year-old man who had pneumonia after angioplasty was the subject of this case study. The patient had pneumonia after angioplasty, which was managed by proper medications and cardio-respiratory physiotherapy. The patient was intubated and referred for cardio-respiratory physiotherapy. Physiotherapy treatments like mild chest vibrations, suctioning, and bed mobility exercises were given initially. After extubation, physiotherapy treatment continued with deep breathing exercises, coughing techniques, relaxation techniques, and mobility exercises for the upper limbs and lower limbs. Effective physical rehabilitation was necessary in order to minimize complications following angioplasty and allow him to resume his daily activities. Several outcome measures, like the ICU mobility scale, CURB-65 score, and chest X-ray grading scores, were used to monitor the patient's progress during rehabilitation. The benefits of pulmonary rehabilitation programs emphasize the need for tailored approaches in addressing individual patient needs for comprehensive recovery.
Collapse
Affiliation(s)
- Sojwal P Nandanwar
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka K Chilhate
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
3
|
Dijkstra S, Hartog J, Fleer J, van der Harst P, van der Woude LHV, Mariani MA. Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients - a longitudinal cohort study. BMC Sports Sci Med Rehabil 2023; 15:173. [PMID: 38115103 PMCID: PMC10731823 DOI: 10.1186/s13102-023-00786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program. METHODS This cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases. RESULTS Of the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0-10, with higher scores indicating a higher level). CONCLUSIONS The Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.
Collapse
Affiliation(s)
- Sandra Dijkstra
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| |
Collapse
|
4
|
Wen Q, Ma QH, Li LZ, Song XW, Han HK, Huang GY, Tang XL. Research trends and hotspots in exercise rehabilitation for coronary heart disease: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e36511. [PMID: 38115268 PMCID: PMC10727657 DOI: 10.1097/md.0000000000036511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Exercise rehabilitation can improve the prognosis of patients with coronary heart disease. However, a bibliometric analysis of the global exercise rehabilitation for coronary heart disease (CHD) research topic is lacking. This study investigated the development trends and research hotspots in the field of coronary heart disease and exercise rehabilitation. CiteSpace software was used to analyze the literature on exercise therapy for CHD in the Web of Science Core Collection database. We analyzed the data of countries/institutions, journals, authors, keywords, and cited references. A total of 3485 peer-reviewed papers were found, and the number of publications on the topic has steadily increased. The most productive country is the USA (1125), followed by China (477) and England (399). The top 3 active academic institutions are Research Libraries UK (RLUK) (236), Harvard University (152), and the University of California System (118). The most commonly cited journals are Circulation (2596), The most commonly cited references are "Exercise-based cardiac rehabilitation for coronary heart disease" (75), Lavie CJ had published the most papers (48). World Health Organization was the most influential author (334 citations). The research frontier trends in this field are body composition, participation, and function. Research on the effects of physical activity or exercise on patients with CHD is a focus of continuous exploration in this field. This study provides a new scientific perspective for exercise rehabilitation and CHD research and gives researchers valuable information for detecting the current research status, hotspots, and emerging trends for further research.
Collapse
Affiliation(s)
- Qing Wen
- Department of Cardiovascular Internal Medicine 1, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Qun-Hua Ma
- Department of Cardiovascular Internal Medicine 1, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lin-Zhang Li
- Comprehensive care unit, Chengdu Wen jiang District People’s Hospital, Chengdu, China
| | - Xue-Wu Song
- Department of Cardiovascular Internal Medicine 1, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Hu-Kui Han
- Department of Cardiovascular Internal Medicine 1, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Gui-Yu Huang
- General Ward 2, Sichuan Cancer Hospital, Chengdu, China
| | - Xiao-Li Tang
- General Ward 2, Sichuan Cancer Hospital, Chengdu, China
| |
Collapse
|
5
|
Guimarães ALA, Gomes-Neto M, Conceição LSR, Saquetto MB, Gois CO, Carvalho VO. Water-Based Exercises on Peak Oxygen Consumption, Exercise Time, and Muscle Strength in Patients with Coronary Artery Disease: A Systematic Review with Meta-Analysis. Cardiovasc Ther 2023; 2023:4305474. [PMID: 37404774 PMCID: PMC10317579 DOI: 10.1155/2023/4305474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Background There is a growing use of water-based exercises in cardiac rehabilitation programs. However, there is little data concerning the effects of water-based exercise on the exercise capacity of coronary artery disease (CAD) patients. Objective To perform a systematic review to investigate the effects of water-based exercise on peak oxygen consumption, exercise time, and muscle strength in patients with CAD. Methods Five databases were searched to find randomized controlled trials that evaluated the effects of water-based exercise for coronary artery disease patients. Mean differences (MD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Results Eight studies were included. Water-based exercise resulted in an improvement in peak VO2 of 3.4 mL/kg/min (95% CI, 2.3 to 4.5; I2 = 0%; 5 studies, N = 167), exercise time of 0.6 (95% CI, 0.1 to 1.1; I2 = 0%; 3 studies, N = 69), and total body strength of 32.2 kg (95% CI, 23.9 to 40.7; I2 = 3%; 3 studies, N = 69) when compared to no exercising controls. Water-based exercise resulted in an improvement in peak VO2 of 3.1 mL/kg/min (95% CI, 1.4 to 4.7; I2 = 13%; 2 studies, N = 74), when compared to the plus land exercise group. No significant difference in peak VO2 was found for participants in the water-based exercise plus land exercise group compared with the land exercise group. Conclusions Water-based exercise may improve exercise capacity and should be considered as an alternative method in the rehabilitation of patients with CAD.
Collapse
Affiliation(s)
- Alana Lalucha Andrade Guimarães
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
| | - Mansueto Gomes-Neto
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Bahia, Brazil
| | - Lino Sérgio Rocha Conceição
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
| | - Micheli Bernardone Saquetto
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Bahia, Brazil
| | - Caroline Oliveira Gois
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
| | - Vitor Oliveira Carvalho
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
| |
Collapse
|
6
|
Halfwerk FR, Wielens N, Hulskotte S, Brusse-Keizer M, Grandjean JG. A mobilization poster stimulates early in-hospital rehabilitation after cardiac surgery: a prospective sequential-group study. J Cardiothorac Surg 2023; 18:83. [PMID: 36895040 PMCID: PMC9999498 DOI: 10.1186/s13019-023-02173-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/28/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Patients infrequently mobilize at the surgical ward after cardiac surgery. Inactivity results in prolonged hospital stay, readmissions and increased cardiovascular mortality. Next, the course of in-hospital mobilization activities for patients is unclear. The aim was to evaluate early mobilization after heart surgery with a mobilization poster on the Activity Classification Guide for Inpatient Activities score from the American College for Sports Medicine (ACSM). Second, to develop a Thorax Centrum Twente (TCT) score to assess distinctive activities performed. METHODS A poster was developed for the Moving is Improving! study to stimulate hospital mobilization after heart surgery. In this sequential-group study at a cardiothoracic surgery ward, 32 patients were included in the usual care group and 209 patients in the poster mobilization group. Change of ACSM and TCT scores over time were both defined as primary endpoints. Secondary endpoints included length of stay and survival. A subgroup analysis for coronary artery bypass grafting (CABG) was performed. RESULTS ACSM score increased during hospital stay (p < 0.001). No significant increase of ACSM score was observed with a mobilization poster (p = 0.27), nor in the CABG subgroup (p = 0.15). The poster increased mobility to chair, toilet, corridor (all p < 0.01) and cycle ergometer (p = 0.02) as measured by the activity-specific TCT scores, without differences in length of stay or survival. CONCLUSIONS ACSM score measured day-to-day functional changes, without significant differences between the poster mobilization and usual care group. Actual activities measured with the TCT score did improve. The mobilization poster is now new standard care, and effects in other centers and other departments should be assessed. TRIAL REGISTRATION This study does not fall under the ICMJE trial definition and was not registered.
Collapse
Affiliation(s)
- Frank R Halfwerk
- Department of Cardio-Thoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA, Enschede, The Netherlands. .,Department of Biomechanical Engineering, TechMed Centre, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Nicole Wielens
- Department of Cardio-Thoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA, Enschede, The Netherlands
| | - Stephanie Hulskotte
- Department of Cardio-Thoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA, Enschede, The Netherlands
| | | | - Jan G Grandjean
- Department of Cardio-Thoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, PO Box 50000, 7500 KA, Enschede, The Netherlands.,Department of Biomechanical Engineering, TechMed Centre, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| |
Collapse
|
7
|
Terbraak M, Verweij L, Jepma P, Buurman B, Jørstad H, Scholte Op Reimer W, van der Schaaf M. Feasibility of home-based cardiac rehabilitation in frail older patients: a clinical perspective. Physiother Theory Pract 2023; 39:560-575. [PMID: 35068322 DOI: 10.1080/09593985.2022.2025549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
(A) BACKGROUND Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain. (B) OBJECTIVE To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients. (C) METHODS A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses. (D) RESULTS The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks. (E) CONCLUSION Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
Collapse
Affiliation(s)
- Michel Terbraak
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Lotte Verweij
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Patricia Jepma
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Bianca Buurman
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Harald Jørstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.,HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Marike van der Schaaf
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
| |
Collapse
|
8
|
Zheng L, Pan D, Gu Y, Wang R, Wu Y, Xue M. Effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with coronary artery disease: A meta-analysis. Front Cardiovasc Med 2022; 9:961414. [PMID: 36204588 PMCID: PMC9530785 DOI: 10.3389/fcvm.2022.961414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aims to evaluate the effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function and exercise endurance in patients with coronary artery diseases (CAD). Methods We performed a systematic search of the English and Chinese databases from their inception to March 2022. Randomized controlled trials (RCTs) were included to compare high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with CAD. The primary outcomes included peak oxygen uptake (peak VO2) and anaerobic threshold (AT). The secondary outcomes included left ventricular ejection fraction (LVEF), exercises duration (ED), respiratory exchange ratio (RER), resting heart rate (RHR), peak heart rate (PHR) and oxygen pulse (O2 pulse). The continuous variables were expressed as mean differences (MD) along with their corresponding standard deviations (SD), and the I2 test was applied in the assessment of heterogeneity. Results After systematically literature search, 19 studies were finally selected for our meta-analysis (n = 1,036), with 511 patients in the experimental group (high-intensity exercise) and 525 patients in the control group (moderate-intensity exercise). The results showed that high-intensity exercise significantly increased patients' Peak VO2 [MD = 2.67, 95% CI (2.24, 3.09), P < 0.00001], LVEF [MD = 3.60, 95% CI (2.17, 5.03), P < 0.00001], ED [MD = 37.51, 95% CI (34.02, 41.00), P < 0.00001], PHR [MD = 6.86, 95% CI (4.49, 9.24), P < 0.00001], and O2 pulse [MD = 0.97, 95% CI (0.34, 1.60), P = 0.003] compared with moderate-intensity exercise. However, there were no significant differences in AT [MD = 0.49, 95% CI (−0.12, 1.10), P = 0.11], RER [MD = 0.00, 95% CI (−0.01, 0.02), P = 0.56], and RHR [MD = 1.10, 95% CI (−0.43, 2.63), P = 0.16]. Conclusion Our results show that high-intensity exercise training has more significant positive effects compared with moderate-intensity exercise training in improving peak VO2, LVEF, ED, PHR and O2 pulse in patients with CAD, while no significant differences were observed in AT, RER and RHR. To sum up, high-intensity exercise training is better than moderate-intensity exercise training in improving cardiopulmonary function and exercise endurance in patients with CAD. Systematic review registration PROSPERO (CRD42022328475), https://www.crd.york.ac.uk/PROSPERO/.
Collapse
Affiliation(s)
- Liying Zheng
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Deng Pan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yimeng Gu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rumeng Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyan Wu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Mei Xue
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Mei Xue
| |
Collapse
|
9
|
Okur I, Aksoy CC, Yaman F, Sen T. Which high-intensity interval training program is more effective in patients with coronary artery disease? Int J Rehabil Res 2022; 45:168-175. [PMID: 35191412 DOI: 10.1097/mrr.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the study is to examine high-intensity interval training (HIIT) programs and a moderate-intensity continuous training (MICT) program, which are frequently used in cardiac rehabilitation programs in terms of their effects on the functional capacity and quality of life of patients with coronary artery disease (CAD). The study included 20 patients with CAD (mean age, 60.95 ± 5.08 years) who had undergone revascularization surgery. The participants were randomized into HIIT-short, HIIT-long, and MICT groups. All the groups participated in a 24-session exercise-based cardiac rehabilitation program. The participants' exercise capacity was evaluated using the maximal exercise test and estimated VO2max values, functional capacity using the 6-min walk test (6MWT), and quality of life using the Short Form-36 survey and MacNew Heart Disease Health-related Quality of Life (MacNew) questionnaire. It was determined that the estimated VO2max values statistically significantly improved after treatment (P < 0.05), and both HIIT groups were superior to the MICT group (P < 0.05). Only the HIIT groups achieved the minimal clinically important difference in the 6MWT distance. After treatment, only the MICT group had a statistically significant improvement in quality of life. There was no statistically significant difference between the groups in relation to the improvement in the 6MWT distance and quality of life (P > 0.05). The results of our study showed that both HIIT programs were superior to MICT in improving the maximal exercise capacity of patients with CAD, and the three programs had a similar effect on quality of life.
Collapse
Affiliation(s)
- Ismail Okur
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University
| | - Cihan Caner Aksoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kutahya Health Sciences University
| | - Fatima Yaman
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University
| | - Taner Sen
- Department of Cardiology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| |
Collapse
|
10
|
Groothuis RJ, van Keeken HG, de Vries AE, Dijkstra PU. Self-report Versus Measured Physical Activity Levels During Outpatient Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:172-177. [PMID: 34793358 DOI: 10.1097/hcr.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Many patients with coronary artery disease (CAD) do not achieve the recommended physical activity (PA) levels during and after cardiac rehabilitation (CR). The aim of this study was to analyze moderate to vigorous physical activity (MVPA) levels and the differences between perceived (self-reported) and measured (activity monitor) MVPA in CAD patients during CR. The second aim was to analyze which patient characteristics were associated with this difference. METHODS A two-center observational-sectional study was conducted within the Department of Rehabilitation Medicine of the University Medical Center Groningen between January and April 2018. Adults with CAD, following an outpatient CR program, were included. Perceived MVPA was assessed with the Short Questionnaire to Assess Health-enhancing Physical Activity and compared with ActivPAL3 activity monitor outcomes over a period of 7 d. RESULTS Fifty-one patients with CAD (age 59.4 ± 7.1 yr, eight females) were recruited. Four patients (8%) did not achieve the recommended guideline level of ≥150 min/wk of MVPA. Patients spent ≥80% of the week in sedentary activities. Patients overestimated MVPA with a median of 805 (218, 1363) min/wk (P< .001). The selected patient characteristics (age, body mass index, type of CAD, type of CR, social support, and self-efficacy) were not associated with this overestimation. CONCLUSIONS Most patients with CAD, participating in an outpatient CR program, do achieve MVPA exercise recommendations but spend simultaneously too much time in sedentary activities.
Collapse
Affiliation(s)
- Rutger J Groothuis
- Department of Rehabilitation Medicine and Comprehensive Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Mr Groothuis); Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Dr van Keeken); and Departments of Cardiology (Dr de Vries) and Rehabilitation Medicine and Oral and Maxillofacial Surgery (Dr Dijkstra), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | |
Collapse
|
11
|
Artificial Intelligence for Physiotherapy and Rehabilitation. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Muthukrishnan R, Malik GS, Gopal K, Shehata MA. Power walking based outpatient cardiac rehabilitation in patients with post-coronary angioplasty: Randomized control trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1919. [PMID: 34231290 DOI: 10.1002/pri.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this trial was to compare the effectiveness of standardized outpatient cardiac rehabilitation combined with treadmill power walking versus standardized outpatient cardiac rehabilitation alone on health-related quality of life (HQoL), functional exercise capacity (FEC), left ventricular ejection fraction (LVEF) and metabolic equivalent of tasks (METs) in patients who went post coronary angioplasty (CA). Further this study evaluated the association between average numbers of steps taken with above clinical outcomes. METHODS In a pragmatic sequential randomized clinical trial, 24 patients were randomized into two groups (n = 12) and participated in a standardized outpatient cardiac rehabilitation program (SOCRP) with treadmill power walking as an intervention group and SOCRP alone in control group. Scores obtained before and after 4 weeks of intervention, that is, after 12 treatment sessions were assessed using a HQoL questionnaire and 6-min walk test (6 MWT). Average number of steps taken throughout the 4 weeks, METs and LVEF values were obtained by pedometer, exercise stress testing and echocardiogram respectively. RESULTS Significant improvements were found in intergroup and intragroup comparison after 4 weeks of cardiac rehabilitation (p < 0.05). Scores of 6 MWT and LVEF significantly improved in the intervention group (p < 0.003) compared to the control group (p < 0.032). HQoL components that is, global and physical, MET values and average number of steps were significantly higher in the intervention group compared to the control group (p < 0.001). CONCLUSION SOCRP with power walking was more effective in improving HQoL, FEC, LVEF, METs and average numbers of steps than SOCRP alone although both interventions were significant after 4 weeks in patients underwent CA and completed cardiac rehabilitation program. Positive significant associations were found between the average number of steps taken with scores of METs and scores of global and physical domains of HQoL.
Collapse
Affiliation(s)
- Ramprasad Muthukrishnan
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE.,Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, UAE
| | - Gulshan Shahzadi Malik
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE.,Department of Physiotherapy, Thumbay Hospital Dubai, Dubai, UAE
| | - Kumaraguruparan Gopal
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE
| | - Mohamed Abdelsamie Shehata
- Department of Physiotherapy, Thumbay Hospital Dubai, Dubai, UAE.,Department of Cardiology, Thumbay Hospital Dubai, Dubai, UAE.,Ain Shams University Hospital, Cairo, Egypt
| |
Collapse
|
13
|
Lv F, Zhang Y, Min S, Li P, Peng L, Ren L, Yu J, Wang B, Shen Y, Tong S, Jin J, Luo X, Chen J, Chen Y, Li Y, Chen J, Zeng X, Luo F, Xiong Q, Zou L, Guo Y, Cao J, Chen Q, Wu B, Chen G, Liu X, Xie B. Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study. Front Public Health 2021; 9:653055. [PMID: 34095058 PMCID: PMC8172588 DOI: 10.3389/fpubh.2021.653055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to evaluate the level and factors affecting the perioperative exercise intention in China. Design: This study was a cross-sectional survey in Southwest China. Methods: Four hundred and ninety nine participants were randomly sampled in eight medical centers from November 23, 2020 to November 27, 2020. The survey included sociodemographic information and a 24-item modified questionnaire, which aimed to evaluate the attitude toward daily exercise, perception of perioperative exercise, social support and the perioperative exercise intention. A multivariable linear regression model was used to evaluate the effect of different items on the patients' intention for perioperative exercise. Results: A total of 523 responses (95.09%) were collected and 499 (95.41%) were analyzed. The level of exercise intention of the patients during the perioperative period was: 14.83% planned to exercise every day in the hospital, 21.04% planned to exercise every other day, and 35.87% planned to exercise every week. Intensity of daily exercise (P = 0.016), positive attitude of daily exercise (P < 0.001), positive attitude of perioperative exercise (P < 0.001) and social support (P < 0.001) were positively associated with the intention for perioperative exercise. Female (P = 0.012), non-tertiary center (P = 0.011), and preoperative anxiety (P = 0.023) was negatively associated with it. Conclusions: The intention for perioperative exercise was low in Southwest China. The authors aimed to relieve preoperative anxiety, promote the education of perioperative exercise, design perioperative exercise programs, and provide more social support from medical staff and family for inpatients undergoing elective surgery.
Collapse
Affiliation(s)
- Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxi Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lihua Peng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Yu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiwei Shen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Tong
- Department of Anesthesiology, Jiangjin Centre Hospital, Chongqing, China
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Luo
- Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingrui Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Li
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Jin Chen
- Department of Anesthesiology, The People's Hospital of Liangping District of Chongqing, Chongqing, China
| | - Xing Zeng
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Fuquan Luo
- Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Guo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Anesthesiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Xiaoli Liu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing, China
| | - Boli Xie
- Department of Anesthesiology, Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
14
|
Artificial Intelligence for Physiotherapy and Rehabilitation. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Nejkov S, Bokan-Mirković V, Đukić-Macut N, Vuković M. EFFECT OF PREOPERATIVE RESPIRATORY REHABILITATION IN PATIENTS UNDERGOING CARDIAC SURGERY. Acta Clin Croat 2020; 59:597-604. [PMID: 34285430 PMCID: PMC8253066 DOI: 10.20471/acc.2020.59.04.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to evaluate the effects of preoperative respiratory rehabilitation on functional capacity, length of stay in intensive care unit (ICU), duration of mechanical ventilation (MV) and total hospitalization, as well as to estimate arterial blood gas (ABG) values in patients undergoing cardiac surgery. Nineteen patients were included in the randomized observational study, divided into two groups: group A (intervention) and B (control). Preoperative and postoperative rehabilitation was performed in group A, and only postoperative rehabilitation in group B. Rehabilitation was carried out according to a predefined protocol. We used ABG to evaluate respiratory function, two-minute walk test (2MWT) and sit-to-stand test to assess functional capacity. The following data were obtained from medical documentation: duration of MV, length of stay at ICU, occurrence of postoperative pulmonary complications, and length of total hospitalization in both groups. Significant between-group difference was found for the length of total hospitalization and duration of MV (p<0.05 both). Analysis of the mean values of 2MWT on the last day of hospitalization (p=0.005), sit-to-stand test before surgery (p=0.022) and on the last day of hospitalization (p=0.008) showed statistically significant differences. The length of hospital stay significantly correlated with preoperative rehabilitation in group A (r=0.885; p<0.0001). There was no difference in ABG parameters between the groups. The study showed that preoperative respiratory rehabilitation had an effect on reducing duration of MV and length of total hospitalization, and improved functional capacity.
Collapse
Affiliation(s)
| | - Vesna Bokan-Mirković
- 1Clinical Center of Montenegro, Department of Physical Medicine and Rehabilitation, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Faculty of Medicine, University of Prishtina, Kosovska Mitrovica, Serbia
| | - Nataša Đukić-Macut
- 1Clinical Center of Montenegro, Department of Physical Medicine and Rehabilitation, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Faculty of Medicine, University of Prishtina, Kosovska Mitrovica, Serbia
| | - Marina Vuković
- 1Clinical Center of Montenegro, Department of Physical Medicine and Rehabilitation, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Faculty of Medicine, University of Prishtina, Kosovska Mitrovica, Serbia
| |
Collapse
|
16
|
Vromen T, Peek NB, Abu-Hanna A, Kornaat M, Kemps HM. A computerized decision support system did not improve personalization of exercise-based cardiac rehabilitation according to latest recommendations. Eur J Prev Cardiol 2020; 28:572-580. [PMID: 33624044 DOI: 10.1093/eurjpc/zwaa066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/18/2020] [Accepted: 09/05/2020] [Indexed: 11/14/2022]
Abstract
AIMS Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR prescriptions. Pseudo-randomized intervention study. METHODS AND RESULTS Among participating Dutch cardiac rehabilitation centres, ECR programme characteristics of consecutive patients were recorded during 1 year. CDS was used during a randomly assigned 4-month period within this year. Primary outcome was concordance to latest recommendations in three phases (before, during, and after CDS) for 12 ECR programme characteristics. Secondary outcome was variation in training characteristics. We recruited ten Dutch CR centres and enrolled 2258 patients to the study. Overall concordance of ECR prescriptions was 59.9% in Phase 1, 62.1% in Phase 2 (P = 0.82), and 59.9% in Phase 3 (P = 0.56). Concordance varied from 0.0% to 99.9% for the 12 ECR characteristics. There was significant between-centre variation for most training characteristics in Phases 1 and 2. In Phase 3, there was only a significant variation for aerobic and resistance training intensity (P = 0.01), aerobic training volume (P < 0.01), and the number of strengthening exercises but no longer for the other characteristics. Aerobic training volume was often below recommended (28.2%) and declined during the study. CONCLUSION CDS did not substantially improve concordance with ECR prescriptions. As aerobic training volume was often lower than recommended and reduced during the study, a lack of institutional resources might be an important barrier in personalizing ECR prescriptions.
Collapse
Affiliation(s)
- Tom Vromen
- Department of Medical Informatics, Amsterdam UMC, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Niels B Peek
- Health e-Research Centre, Farr Institute of Health Informatics Research, University of Manchester, Vaughan HousePortsmouth Street, Manchester M13 9GB, UK
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, Location AMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Marion Kornaat
- Department of Cardiac Rehabilitation, Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333AL, Leiden, the Netherlands
| | - Hareld M Kemps
- Department of Cardiology, Maxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| |
Collapse
|
17
|
Song W, Liang Q, Cai M, Tian Z. HIF-1α-induced up-regulation of microRNA-126 contributes to the effectiveness of exercise training on myocardial angiogenesis in myocardial infarction rats. J Cell Mol Med 2020; 24:12970-12979. [PMID: 32939968 PMCID: PMC7701575 DOI: 10.1111/jcmm.15892] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 05/30/2020] [Accepted: 08/30/2020] [Indexed: 12/13/2022] Open
Abstract
Exercise training (ET) is a non‐drug natural rehabilitation approach for myocardial infarction (MI). Among the numerous beneficial effects of ET, myocardial angiogenesis is indispensable. In the present study, we investigated the role and mechanism of HIF‐1α and miR‐126 in ET‐induced MI myocardial angiogenesis which may provide new insights for MI treatment. Rat model of post‐MI and human umbilical vein endothelial cells (HUVECs) were employed for our research. Histomorphology, immunohistochemistry, quantitative real‐time PCR, Western blotting and small‐interfering RNA (siRNA) transfection were applied to evaluate the morphological, functional and molecular mechanisms. In vivo results showed that 4‐week ET could significantly increase the expression of HIF‐1α and miR‐126 and reduce the expression of PIK3R2 and SPRED1, while 2ME2 (HIF‐1α inhibitor) partially attenuated the effect of ET treatment. In vitro results showed that HIF‐1α could trigger expression of miR‐126 in HUVECs in both normoxia and hypoxia, and miR‐126 may be involved in the tube formation of HUVECs under hypoxia through the PI3K/AKT/eNOS and MAPK signalling pathway. In conclusion, we revealed that HIF‐1α, whose expression experiences up‐regulation during ET, could function as an upstream regulator to miR‐126, resulting in angiogenesis promotion through the PI3K/AKT/eNOS and MAPK signalling pathway and subsequent improvement of the MI heart function.
Collapse
Affiliation(s)
- Wei Song
- Institute of Sports and Exercise Biology, Shaanxi Normal University, Xi'an, China
| | - Qiaoqin Liang
- Institute of Sports and Exercise Biology, Shaanxi Normal University, Xi'an, China
| | - Mengxin Cai
- Institute of Sports and Exercise Biology, Shaanxi Normal University, Xi'an, China
| | - Zhenjun Tian
- Institute of Sports and Exercise Biology, Shaanxi Normal University, Xi'an, China
| |
Collapse
|
18
|
Zhang C, Soliman-Hamad M, Robijns R, Verberkmoes N, Verstappen F, IJsselsteijn WA. Promoting Physical Activity With Self-Tracking and Mobile-Based Coaching for Cardiac Surgery Patients During the Discharge-Rehabilitation Gap: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16737. [PMID: 32812886 PMCID: PMC7468644 DOI: 10.2196/16737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/29/2020] [Accepted: 03/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. Objective In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). Methods Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. Results The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. Conclusions Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. Trial Registration Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 International Registered Report Identifier (IRRID) PRR1-10.2196/16737
Collapse
Affiliation(s)
- Chao Zhang
- Eindhoven University of Technology, Eindhoven, Netherlands
| | | | | | | | | | | |
Collapse
|
19
|
Becker M, Strunk K, Buschhaus N, Bühn S, Pieper D. Methodological Quality of Physical Therapy Guidelines and Their Suitability for Adaptation: A Scoping Review. Phys Ther 2020; 100:1296-1306. [PMID: 32315432 DOI: 10.1093/ptj/pzaa075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/26/2019] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) can be characterized to the extent that they specifically address physical therapists and mainly contain recommendations for physical therapist interventions. The primary aim of this study was to identify existing physical therapy CPGs regardless of medical condition, with a secondary aim of assessing their methodological quality to determine whether they are potentially suitable for adaptation. METHODS Systematic searches of the Medline and Physiotherapy Evidence Database were performed (August 2019), and the websites of World Confederation for Physical Therapy members were screened (September 2019). Only CPGs published in German or English were included. Two independent reviewers screened records according to previously defined inclusion criteria. Information was extracted regarding country of origin, year of publication, and clinical subject area addressed. Four independent reviewers assessed the quality of physical therapy CPGs using the Appraisal of Guidelines Research and Evaluation instrument. A descriptive data analysis was performed. RESULTS Thirty-five CPGs met the inclusion criteria; 46% (16/35) of the included CPGs were from the United States, and 31% (11/35) were from the Netherlands. Assessment using the Appraisal of Guidelines Research and Evaluation tool resulted in the following domain scores, presented as median percentage (interquartile range): domain 1 (scope and purpose), 76 (63-92); domain 2 (stakeholder involvement), 63 (55-76); domain 3 (rigor of development), 67 (53-75); domain 4 (clarity of presentation), 74 (67-77); domain 5 (applicability), 44 (30-57); and domain 6 (editorial independence), 52 (35-66). CONCLUSIONS In general, the methodological quality of the included CPGs was moderate to good. Possibilities of adapting recommendations from existing CPGs should be considered with the development of new physical therapy CPGs. IMPACT STATEMENT This study can raise awareness of existing physical therapy CPGs and can support their application by physical therapists. Further, the study can support decisions on adapting existing CPGs with the planning of new physical therapy CPGs.
Collapse
Affiliation(s)
- Monika Becker
- Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine, Witten / Herdecke University, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Katharina Strunk
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany, and Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine
| | - Niels Buschhaus
- Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine
| | - Stefanie Bühn
- Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine
| | - Dawid Pieper
- Department Evidence-based Health Services Research, Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine
| |
Collapse
|
20
|
The benefit of a preoperative respiratory protocol and musculoskeletal exercise in patients undergoing cardiac surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:94-100. [PMID: 32728372 PMCID: PMC7379220 DOI: 10.5114/kitp.2020.97267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Introduction Loss of physical activity and pulmonary dysfunction with its associated complications represent two of the most important causes of morbidity and mortality following cardiac surgery. Aim To evaluate whether a physiotherapy program based on respiratory training with or without musculoskeletal mobilization, started preoperatively, may provide a significant improvement in pulmonary and musculoskeletal recovery postoperatively in a sufficiently large sample of patients undergoing elective cardiac surgery. Material and methods One-hundred and two patients with similar baseline and preoperative characteristics were assigned to a preoperative respiratory physiotherapy protocol (group R, n = 34), a preoperative respiratory and motor physiotherapy protocol (group R + M, n = 34), or no preoperative specific physiotherapy protocol but only a simplified perioperative standard physiotherapy protocol (control group, C, n = 34). Data on 6-minute walking test, peak expiratory flow, and from blood gas analysis were retrospectively analyzed. Results As compared with group C, a statistically significant improvement was observed in the two preoperatively treated groups in terms of 1) better pre- (+0.7-0.8 Lt/min, p < 0.05) and postoperative (+1 Lt/min, p < 0.01) peak expiratory flow values; 2) longer pre- (+50-100 m, p < 0.01) and postoperative (+65-170 m, p < 0.01) distance traveled in the 6-minute walking test; 3) better PaO2, SaO2, pH value in postoperative blood gas measurements (p < 0.05, for all comparisons); 4) reduction of postoperative length of in-hospital stay (p < 0.05). Conclusions A benefit of combined respiratory and motor physiotherapy protocols can be expected in the groups of patients preoperatively treated, especially with the respiratory one, either before or after cardiac surgery with a faster recovery of physical-functional activities. Specifically, the motor protocol is associated with greater autonomy of running before or after cardiac surgery.
Collapse
|
21
|
Regan R, Sampath KK, Devan H, Arumugam A. Effectiveness of physiotherapy interventions on disease-specific and generic outcomes for individuals with cardiovascular diseases in India – a systematic review and Meta-analysis. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1792204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Raja Regan
- PSG College of Physiotherapy, Coimbatore, Tamil Nadu, India
| | - Kesava Kovanur Sampath
- Department of Allied Health and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Adjunct Faculty, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Adjunct Faculty, Department of Physiotherapy, Binawan University, Jakarta, Indonesia
| |
Collapse
|
22
|
Gower B, Girard D, Mitchell BL, Gehling T, Maiorana A, Davison K. Lack of Cited Evidence Underpinning Recommendations for Objective Assessment of Cardiovascular Function to Inform Exercise Prescription: A Systematic Review. Sports Med 2020; 50:1469-1481. [PMID: 32297250 DOI: 10.1007/s40279-020-01283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effectiveness of exercise in managing cardiovascular (CV) health and function is well established. Less clear is the process for optimising the safety and efficacy of an intervention, particularly how objective assessments might inform this process. OBJECTIVE The aim of this review was to investigate the cited evidence underpinning recommendations for assessing CV function to inform the safe and effective prescription of exercise in populations with established CV disease, as published in documents to guide practice authored by prominent organisations in cardiology and sports medicine. METHODS A systematic review of position statements and guiding documents on exercise prescription for CV health was conducted. Included documents were published between 1997 and 2016. RESULTS Following removal of duplicates, 3158 documents were considered, with full-text screening required for 334. Twenty-seven documents were included which provided 106 individual recommendations for specific objective assessments. Of the total number of recommendations, 60% had no accompanying citation and 28% of recommendations provided citations that did not directly support the statement made. Additionally, 52% of included documents did not state the methods of document development. That is, it was not clear if there was a literature review and/or expert consensus that was used to form recommendations included within. CONCLUSION Almost no cited evidence underpinning the extracted recommendations from the included guiding documents, nor any acknowledgement of this deficiency was established. There were limited explanations found for the methods involved in developing such guiding documents.
Collapse
Affiliation(s)
- Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Danielle Girard
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Braden L Mitchell
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Thomas Gehling
- TG Exercise Physiology Services, Adelaide, SA, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| |
Collapse
|
23
|
Institutional Guidelines for Resistance Exercise Training in Cardiovascular Disease: A Systematic Review. Sports Med 2020; 49:463-475. [PMID: 30701461 DOI: 10.1007/s40279-019-01059-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Institutional position stands are useful for practitioners when designing exercise routines for specific populations. Resistance training has been included in programs for patients with cardiovascular disease. OBJECTIVE The objective of this systematic review was to analyze institutional guidelines providing recommendations for resistance training applied to cardiovascular disease. METHODS PubMed, Web of Science, and Scopus databases were searched from inception until 30 April, 2018. RESULTS Of 994 articles initially found, 13 position stands were retained. Consensual indications occurred only for number of sets (one to three sets) and training frequency (two to three sessions/week). Recommendations concerning other major training variables were discordant regarding workload (none or loads ranging from < 30% up to 80% 1 repetition maximum) and exercise order (none or vaguely indicating alternation of muscle groups or circuit format), or insufficient regarding intervals between sets and exercises or number and type of exercises. Overall, guidelines lack recommendations of specific procedures for each type of disease at different severity levels, cardiovascular risk during exercise, or criteria for training progression. CONCLUSIONS Recommendations provided by institutional guidelines appear to be insufficient to support adequate resistance training prescription in the context of cardiovascular disease.
Collapse
|
24
|
German recommendations for physical activity and physical activity promotion in adults with noncommunicable diseases. Int J Behav Nutr Phys Act 2020; 17:12. [PMID: 32024526 PMCID: PMC7003325 DOI: 10.1186/s12966-020-0919-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Existing physical activity guidelines predominantly focus on healthy age-stratified target groups. The objective of this study was to develop evidence-based recommendations for physical activity (PA) and PA promotion for German adults (18–65 years) with noncommunicable diseases (NCDs). Methods The PA recommendations were developed based on existing PA recommendations. In phase 1, systematic literature searches were conducted for current PA recommendations for seven chronic conditions (osteoarthrosis of the hip and knee, chronic obstructive pulmonary disease, stable ischemic heart disease, stroke, clinical depression, and chronic non-specific back pain). In phase 2, the PA recommendations were evaluated on the basis of 28 quality criteria, and high-quality recommendations were analysed. In phase 3, PA recommendations for seven chronic conditions were deducted and then synthesised to generate generic German PA recommendations for adults with NCDs. In relation to the recommendations for PA promotion, a systematic literature review was conducted on papers that reviewed the efficacy/effectiveness of interventions for PA promotion in adults with NCDs. Results The German recommendations for physical activity state that adults with NCDs should, over the course of a week, do at least 150 min of moderate-intensity aerobic PA, or 75 min of vigorous-intensity aerobic PA, or a combination of both. Furthermore, muscle-strengthening activities should be performed at least twice a week. The promotion of PA among adults with NCDs should be theory-based, specifically target PA behaviour, and be tailored to the respective target group. In this context, and as an intervention method, exercise referral schemes are one of the more promising methods of promoting PA in adults with NCDs. Conclusion The development of evidence-based recommendations for PA and PA promotion is an important step in terms of the initiation and implementation of actions for PA-related health promotion in Germany. The German recommendations for PA and PA promotion inform adults affected by NCDs and health professionals on how much PA would be optimal for adults with NCDs. Additionally, the recommendations provide professionals entrusted in PA promotion the best strategies and interventions to raise low PA levels in adults with NCDs. The formulation of specific PA recommendations for adults with NCDs and their combination with recommendations on PA promotion is a unique characteristic of the German recommendations.
Collapse
|
25
|
Cartledge S, Thomas E, Hollier K, Maddison R. Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process. BMJ Open 2019; 9:e032279. [PMID: 31796485 PMCID: PMC7003389 DOI: 10.1136/bmjopen-2019-032279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme. DESIGN Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes. PARTICIPANTS An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential). MAIN OUTCOME MEASURE Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted. RESULTS 49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted. CONCLUSIONS For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.
Collapse
Affiliation(s)
- Susie Cartledge
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Emma Thomas
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kerry Hollier
- National Heart Foundation of Australia, Melbourne, Victoria, Australia
| | - R Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
26
|
Abstract
BACKGROUND Exercise is a common recommendation to reduce the risk factors of metabolic syndrome, yet there are limited data on the influence of lifestyle exercise after cardiac events on metabolic syndrome factors. OBJECTIVE The purpose of this study was to determine whether lifestyle exercise improves metabolic syndrome profile in older adults after a cardiac event. METHODS Participants were from a post-cardiac-event lifestyle exercise study. Five metabolic syndrome factors were assessed: waist circumference, triglycerides, high-density lipids, glucose, and systolic and diastolic blood pressure. Objective measures of exercise were obtained from heart rate monitors over a year. Logistic regression was used to determine whether participants who engaged in the minimum recommendation of 130 hours of exercise or greater during the 12-month period improved their metabolic syndrome profile by improving at least 1 metabolic syndrome factor. RESULTS In the sample of 116 participants (74% men; average age, 67.5 years), 43% exercised at the recommended amount (≥130 h/y) and 28% (n = 33) improved their metabolic syndrome profile. After controlling for confounding factors of age, gender, race, diabetes, functional ability, and employment, subjects who exercised at least 130 hours a year were 3.6 times more likely to improve at least 1 metabolic syndrome factor (95% confidence interval, 1.24-10.49). Of the 28% who improved their metabolic syndrome profile, 72% increased their high-density lipoprotein and 60.6% reduced their waist circumference and glucose. CONCLUSIONS After a cardiac event, older patients who engage in lifestyle exercise at the recommended amount have improvement in their metabolic syndrome profile.
Collapse
|
27
|
Moreira JMA, Grilo EN. Quality of life after coronary artery bypass graft surgery - results of cardiac rehabilitation programme. J Exerc Rehabil 2019; 15:715-722. [PMID: 31723562 PMCID: PMC6834704 DOI: 10.12965/jer.1938444.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 01/14/2023] Open
Abstract
Accountability, involvement, empowerment of the patients and families/caregiver, as well as the incentive for health behaviors based on physical exercise and healthy living habits with the support of health professionals, are fundamental in meeting the demands of the current society. The main objective of this report is to describe the process of developing skills in rehabilitation nursing that was possible in the context of the final stage in which an intervention program in the area of cardiac rehabilitation was designed, implemented and evaluated. In this quantitative study with exploratory characteristics, it was used the collection of observable and quantifiable data, from patients submitted to coronary artery bypass grafting. During the study, the Kolmogorov-Smirnov test was applied-being verified the normal distribution-and Student t-test, which aimed at comparing outcomes at the beginning and end of the program. When 6-min walk test was applied, there was an optimization of functional capacity (P=0.05), can be proved by the fact that all the patients had statistically significant improvements in the time-walk relationship. Furthermore, the quality of life in those who participated in the program was moderate in the preoperative period with 53.09%, and at the end a significant improvement was observed with 75.02%. Cardiac rehabilitation is fundamental in the patient submitted to coronary artery bypass grafting, taking into account the educational, physical exercise, and quality of life dimensions. Given the prevalence of risk factors associated with cardiovascular disease, differentiated intervention in rehabilitation nursing becomes essential in the training of patients for self-care.
Collapse
Affiliation(s)
| | - Eugénia Nunes Grilo
- Polytechnic Institute of Castelo Branco, São João de Deus School of Nursing, Dr Lopes Dias School of Health University of Évora, Castelo Branco, Portugal
| |
Collapse
|
28
|
Mehra VM, Gaalema DE, Pakosh M, Grace SL. Systematic review of cardiac rehabilitation guidelines: Quality and scope. Eur J Prev Cardiol 2019; 27:912-928. [PMID: 31581808 DOI: 10.1177/2047487319878958] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiac rehabilitation is a comprehensive model of secondary prevention proven to reduce mortality and morbidity. The World Health Organization is developing a Package of Rehabilitation Interventions for implementation by ministries of health as part of universal healthcare across the continuum. Through a systematic review, we sought to identify the best-quality cardiac rehabilitation guidelines, and extract their recommendations for implementation by member states. A systematic search was undertaken of academic databases and guideline repositories, among other sources, through to April 2019, for English-language cardiac rehabilitation guidelines from the last 10 years, free from conflicts, and with strength of recommendations. Two authors independently considered all citations. Potentially eligible guidelines were rated for quality using the Appraisal of Guidelines for Research and Evaluation tool, and for other characteristics such as being multi-professional, comprehensive and international in perspective; the latter criteria were used to inform selection of 3-5 guidelines meeting inclusion criteria. Equity considerations were also extracted. Altogether, 2076 unique citations were identified. Thirteen passed title and abstract screening, with six guidelines potentially eligible for inclusion in the Package of Rehabilitation Interventions and rated for quality; for two guidelines the Appraisal of Guidelines for Research and Evaluation tool ratings did not meet World Health Organization minimums. Of the four eligible guidelines, three were selected: the International Council of Cardiovascular Prevention and Rehabilitation (2016), National Institute for Health and Care Excellence (#172; 2013) and Scottish Intercollegiate Guideline Network (#150; 2017). Extracted recommendations were comprehensive, but psychosocial recommendations were contradictory and diet recommendations were inconsistent. A development group of the World Health Organization will review and refine the recommendations which will then undergo peer review, before open source dissemination for implementation.
Collapse
Affiliation(s)
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA
| | - Maureen Pakosh
- Library and Information Services, Toronto Rehabilitation Institute, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada
| |
Collapse
|
29
|
The effect of preoperative respiratory physiotherapy and motor exercise in patients undergoing elective cardiac surgery: short-term results. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:81-87. [PMID: 31410095 PMCID: PMC6690146 DOI: 10.5114/kitp.2019.86360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/11/2019] [Indexed: 11/17/2022]
Abstract
Introduction Loss of physical activity and pulmonary dysfunction with its associated complications represent two of the most important causes of morbidity and mortality following cardiac surgery. Few studies have investigated the effects of preoperative interventions targeted at improving cardiorespiratory and musculoskeletal function in the postoperative period. Aim To evaluate whether a physiotherapy program based on respiratory training with or without musculoskeletal mobilization, started preoperatively, may provide a significant improvement in pulmonary and musculoskeletal recovery postoperatively in patients undergoing elective cardiac surgery. Material and methods Patients with similar baseline and preoperative characteristics were randomly assigned to a preoperative respiratory physiotherapy protocol (group A), a preoperative respiratory and motor physiotherapy protocol (group B), or no preoperative specific physiotherapy protocol but only a simplified perioperative standard physiotherapy protocol (control group or group C). Group A consisted of 19 patients, group B of 20, group C of 20. Data on 6-minute walking test, peak expiratory flow, and from blood gas analysis were retrospectively analyzed. Results As compared with group C, a statistically significant improvement was observed in the two preoperatively treated groups A and B in terms of longer pre- and postoperative distance traveled at the 6-minute walking test, better pre- and postoperative peak expiratory flow value, and better PaO2 and SaO2 values in postoperative blood gas measurements (p < 0.05, for all comparisons). A statistically significant reduction of the postoperative length of in-hospital stay was also observed in group B. Conclusions As compared with the control group, substantially better clinical results for respiratory and musculoskeletal function were found in the groups preoperatively treated with physiotherapeutic protocols immediately before as well as after cardiac surgery.
Collapse
|
30
|
Dehghani M, Cheraghi M, Namdari M, Roshan VD. Effects of Phase IV Pedometer Feedback Home-Based Cardiac Rehabilitation on Cardiovascular Functional Capacity in Patients With Myocardial Infarction: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2019. [DOI: 10.15171/ijbsm.2019.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: Pedometer feedback home-based cardiac rehabilitation (PFHCR) programs have been effective in augmenting exercise tolerance. Our aim was to investigate the effects of PFHCR on cardiovascular functional capacity in patients with myocardial infarction (MI).Methods: Forty MI patients were divided into two intervention and two control groups (n=10)in a randomized controlled trial. The intervention group received a PFHCR program including routine medications along with continuous exercise program, whereas the control group received traditional care without PFHCR. Baseline evaluations and cardiovascular stresses were controlled during the 8-week follow-up rehabilitation program in all patients. Data analysis was conducted using one-way ANOVA and paired sample student’s t-test (P ≤ 0.05).Results: At baseline, no significant differences were observed between the groups. After eight weeks of PFHCR, the intervention groups had significantly higher metabolic equivalent(P = 0.001), VO2max (P = 0.001), total exercise times (P = 0.001), and total distance traveled(P = 0.003) when compared with the control groups. However, no significant intra-group or inter-group differences in variables were observed between the men and women.Conclusion: Our results showed that PFHCR exhibited significant optimal effects on the cardiovascular functional capacity in MI patients.
Collapse
Affiliation(s)
- Mostafa Dehghani
- PhD cardiovascular and Respiratory physiology, University of Mazandaran, Babolsar, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Mostafa Cheraghi
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Mehrdad Namdari
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Valiollah Dabidi Roshan
- Department of Sport Physiology, College of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, Iran
| |
Collapse
|
31
|
Vromen T, Peek N, Abu-Hanna A, Kemps HM. Practice Variations in Exercise Training Programs in Dutch Cardiac Rehabilitation Centers: Prospective, Observational Study. Phys Ther 2019; 99:266-275. [PMID: 30690617 DOI: 10.1093/ptj/pzy140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 06/25/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND A recent survey among Dutch cardiac rehabilitation centers demonstrated considerable between-center variations in the contents of exercise training programs. For patients entering cardiac rehabilitation, current guidelines recommend tailored exercise training programs based on patient characteristics and rehabilitation goals. OBJECTIVE This study was to analyze to what extent these patient characteristics are determinants of variations in training programs. DESIGN This was a prospective, observational study with cross-sectional measurements among 10 cardiac rehabilitation centers. METHODS The following data were obtained about patients entering cardiac rehabilitation: referral diagnosis, rehabilitation goals, and exercise training variables. Primary outcomes were variations in total aerobic training time, intensity, and volume before and after case-mix correction for population differences between centers. Secondary outcomes were variations in other training characteristics and the role of exercise testing in the determination of training intensity. Also, the roles of diagnosis and training goals in determining aerobic training time and intensity were studied. RESULTS Data from 700 participants were analyzed. There were significant variations between centers in all aerobic and most resistance training characteristics. For aerobic training intensity, time, and volume, great variations remained after case-mix correction. An exercise test was performed for 656 participants (93.7%) but was used to determine training intensity in only 344 (52.4%) of these participants. In most centers, referral diagnosis and rehabilitation goals were unrelated to aerobic training time or intensity. LIMITATIONS Some form of selection bias cannot be excluded because the competing centers represented a minority of Dutch exercise-based cardiac rehabilitation centers. CONCLUSIONS This study showed that the contents of training programs varied considerably between cardiac rehabilitation centers, independent of population differences. Furthermore, aerobic training time and intensity were mostly unrelated to rehabilitation goals and referral diagnosis.
Collapse
Affiliation(s)
- Tom Vromen
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; and Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands 5504 DB
| | - Niels Peek
- Health e-Research Center, Farr Institute of Health Informatics Research, University of Manchester, Manchester, United Kingdom
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam
| | - Hareld M Kemps
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam; and Department of Cardiology, Maxima Medical Center
| |
Collapse
|
32
|
Abreu A, Pesah E, Supervia M, Turk-Adawi K, Bjarnason-Wehrens B, Lopez-Jimenez F, Ambrosetti M, Andersen K, Giga V, Vulic D, Vataman E, Gaita D, Cliff J, Kouidi E, Yagci I, Simon A, Hautala A, Tamuleviciute-Prasciene E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Pavy B, Kiessling A, Sovova E, Grace SL. Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? Eur J Prev Cardiol 2019; 26:1131-1146. [DOI: 10.1177/2047487319827453] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Santa Maria, Portugal
| | - Ella Pesah
- Department of Kinesiology and Health Sciences, York University, Canada
| | - Marta Supervia
- Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Spain
| | | | | | | | - Marco Ambrosetti
- Istituti Clinici Scientifici Maugeri, Care and Research Institute Department of Cardiac Rehabilitation, Italy
| | - Karl Andersen
- Department of Internal Medicine, University of Iceland, Iceland
| | - Vojislav Giga
- Institute of Cardiovascular Diseases, Clinical Center of Serbia, Serbia
| | - Dusko Vulic
- University of Banja Luka, Center for Medical Research, Bosnia and Herzegovina
| | - Eleonora Vataman
- Institute of Cardiology, Moldova Academy of Science, Republica Moldova
| | - Dan Gaita
- University of Medicine and Pharmacy “Victor Babes”, Cardiovascular Prevention and Rehabilitation Clinic, Romania
| | - Jacqueline Cliff
- Cardiac Rehabilitation Department, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, UK
| | - Evangelia Kouidi
- Department of First Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Ilker Yagci
- Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Turkey
| | - Attila Simon
- Cardiac Rehabilitation Department, State Hospital for Cardiology, Hungary
| | - Arto Hautala
- Cardiovascular Research Group, Oulu University Hospital, Finland
| | | | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Zbigniew Eysymontt
- Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Poland
| | | | - Jo Hayward
- Cardiology Department, Norfolk and Norwich University Hospital, UK
| | - Eva Prescott
- Cardiology Department, Bispebjerg Frederiksberg Hospital, Denmark
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, France
| | - Anna Kiessling
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Sweden
| | - Eliska Sovova
- Department of Internal Medicine, University of Palacky, University Hospital Olomouc, Czech Republic
| | - Sherry L Grace
- Department of Kinesiology and Health Sciences, York University, Canada
- Toronto Rehabiliation Institute, University Health Network, Canada
| |
Collapse
|
33
|
Liu H, Xiao X, Lu CM, Ling DL, Wei RH. A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients. FRONTIERS OF NURSING 2018; 5:217-226. [DOI: 10.1515/fon-2018-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
Objective
Mobile health (mHealth) provides an innovative and effective approach to promote prevention and management of coronary heart disease. However, the magnitude of its effects is unclear. The aim of this systematic review was to examine the impact of mHealth-based cardiac rehabilitation outcomes among coronary heart disease patients.
Methods
Medline, CINAHL, Embase, PubMed, Google Scholar, NICE, and Cochrane library were searched for randomized controlled trials published between January 2002 and March 2017 which compared mHealth with conventional cardiac rehabilitation programs among coronary heart disease patients.
Results
Eight articles were included in this review. The impact of mHealth interventions on physical activity, medicine adherence, smoking cessation, level of anxiety, and quality of life was inconsistent among the articles.
Conclusions
Further research is needed to conclusively determine the impact of mHealth interventions on cardiac rehabilitation outcomes. The limitations of the included studies (e.g., inadequate sample size, failure to address the core components of cardiac rehabilitation programs, and lack of theory-based design) should be taken into account when designing future studies.
Collapse
Affiliation(s)
- Hui Liu
- Cardiac Intensive Care Unit (CCU), Department of Cardiology , The Second Affiliated Hospital of Shantou University Medical College , Shantou , Guangdong 515041 , China
| | - Xiao Xiao
- Obstetrics Department , Southern Medical University Affiliated Shenzhen Maternity and Child Healthcare Hospital , Guangzhou , Guangdong 510515 , China
| | - Chun-Mei Lu
- Department of Nursing , The First People's Hospital of Foshan Affiliated to Sun Yat-Sen University , Foshan , Guangdong 528000 , China
| | - Dong-Lan Ling
- Urology Surgical Department , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong 510260 , China
| | - Rui-Hong Wei
- Nursing Department , The Second Affiliated Hospital of Shantou University , Shantou , Guangdong 515041 , China
| |
Collapse
|
34
|
Perelló-Díez M, Paz-Lourido B. Prevention of postoperative pulmonary complications through preoperative physiotherapy interventions in patients undergoing coronary artery bypass graft: literature review. J Phys Ther Sci 2018; 30:1034-1038. [PMID: 30154596 PMCID: PMC6110234 DOI: 10.1589/jpts.30.1034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/07/2018] [Indexed: 12/20/2022] Open
Abstract
[Purpose] The purpose of this review is to identify which preoperative physiotherapy interventions are applied in patients undergoing Coronary Artery Bypass Graft. [Participants and Methods] A literature review was carried out using the databases EBSCOhost, Pubmed, LILACS, IBECS, Cochrane and PEDro. Taking into consideration the inclusion and exclusion criteria, 14 studies published in 2006-2017 about preoperative physiotherapy to Coronary Artery Bypass Graft in adults were selected. [Results] Preoperative physiotherapy included interventions such as inspiratory muscle training, aerobic exercise, education in breathing exercises and counselling. Most of the studies described a combination of these interventions illustrating benefits for patients as decreasing the risk of developing postoperative pulmonary complications, reducing the length of hospitalization as well as time to extubation, anxiety and depression. [Conclusion] Preoperative Physiotherapy in patients undergoing Coronary Artery Bypass Graft includes different interventions, and their effects have been evaluated mainly through a combination of them. These combined interventions, particularly those with an inspiratory muscle training component reduce postoperative pulmonary complications. More studies are needed to identify their impact for patients.
Collapse
Affiliation(s)
- Marina Perelló-Díez
- Department of Nursing and Physiotherapy, University of the
Balearic Islands: Edifici Beatriu de Pinós, Carretera de Valldemossa Km. 7.5, 07122 Palma,
Balearic Islands, Spain
| | - Berta Paz-Lourido
- Department of Nursing and Physiotherapy, University of the
Balearic Islands: Edifici Beatriu de Pinós, Carretera de Valldemossa Km. 7.5, 07122 Palma,
Balearic Islands, Spain
| |
Collapse
|
35
|
Abstract
Research has demonstrated that the high capacity requirements of the heart are satisfied by a preference for oxidation of fatty acids. However, it is well known that a stressed heart, as in pathological hypertrophy, deviates from its inherent profile and relies heavily on glucose metabolism, primarily achieved by an acceleration in glycolysis. Moreover, it has been suggested that the chronically lipid overloaded heart augments fatty acid oxidation and triglyceride synthesis to an even greater degree and, thus, develops a lipotoxic phenotype. In comparison, classic studies in exercise physiology have provided a basis for the acute metabolic changes that occur during physical activity. During an acute bout of exercise, whole body glucose metabolism increases proportionately to intensity while fatty acid metabolism gradually increases throughout the duration of activity, particularly during moderate intensity. However, the studies in chronic exercise training are primarily limited to metabolic adaptations in skeletal muscle or to the mechanisms that govern physiological signaling pathways in the heart. Therefore, the purpose of this review is to discuss the precise changes that chronic exercise training elicits on cardiac metabolism, particularly on substrate utilization. Although conflicting data exists, a pattern of enhanced fatty oxidation and normalization of glycolysis emerges, which may be a therapeutic strategy to prevent or regress the metabolic phenotype of the hypertrophied heart. This review also expands on the metabolic adaptations that chronic exercise training elicits in amino acid and ketone body metabolism, which have become of increased interest recently. Lastly, challenges with exercise training studies, which could relate to several variables including model, training modality, and metabolic parameter assessed, are examined.
Collapse
Affiliation(s)
- Stephen C. Kolwicz Jr.
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology Department, Ursinus College, Collegeville, PA, United States
| |
Collapse
|
36
|
Maldonado-Martín S, Jayo-Montoya JA, Matajira-Chia T, Villar-Zabala B, Goiriena JJ, Aispuru GR. Effects of combined high-intensity aerobic interval training program and Mediterranean diet recommendations after myocardial infarction (INTERFARCT Project): study protocol for a randomized controlled trial. Trials 2018; 19:156. [PMID: 29499766 PMCID: PMC5834904 DOI: 10.1186/s13063-018-2529-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Exercise therapy has long been used for rehabilitation purposes after myocardial infarction (MI) and the benefit of regular physical exercise is also well-established. High-intensity interval training (HIIT) has been proposed to be more effective than continuous exercise for improving exercise capacity and health-related adaptations to low-volume (LV) and HIIT are also known. Furthermore, the Mediterranean diet (Mediet) has been widely reported to be a model of healthy eating for its contribution to a favorable health status and a better quality of life, reducing overall mortality. This study will investigate the effects of different HIIT programs (high-volume [HV] vs LV) and Mediet recommendations in clinical condition, cardiorespiratory fitness, biomarkers, ventricular function, and perception of quality of life after MI, and compared to an attention control group that is recommended to Mediet and physical activity without supervision sessions. METHODS/DESIGN In this randomized controlled trial, cardiorespiratory fitness, anthropometry, central and peripheral cardiovascular variables, biochemical and nutritional condition, and quality of life will be assessed before and after 16 weeks of intervention in 177 participants diagnosed with MI type 1. All participants will be randomly (1:1:1) assigned to the attention control group or two exercise groups (Mediet recommendations plus supervised aerobic exercise two days/week: (1) HV (40 min) HIIT group and (2) LV (20 min) HIIT group. DISCUSSION This study will be the first clinical trial comparing the effects of two different volumes of HIIT programs with Mediet recommendations for people after MI. The results of this study will provide good evidence for physical rehabilitation in this population. TRIAL REGISTRATION ClinicalTrials.gov, NCT02876952 . Registered on 24 August 2016.
Collapse
Affiliation(s)
- Sara Maldonado-Martín
- Department of Physical Education and Sport, Faculty of Education and Sport, Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Portal de Lasarte, 71, 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country Spain
| | - Jon Ander Jayo-Montoya
- Department of Physical Education and Sport, Faculty of Education and Sport, Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Portal de Lasarte, 71, 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country Spain
| | | | | | - Juan José Goiriena
- Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Basque Country Spain
| | - G. Rodrigo Aispuru
- Primary Care Administration of Burgos, Miranda de Ebro, Burgos, Spain
- Department of Physiology, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Basque Country Spain
| |
Collapse
|
37
|
Shirzadegan R, Gholami M, Hasanvand S, Birjandi M, Beiranvand A. Effects of geranium aroma on anxiety among patients with acute myocardial infarction: A triple-blind randomized clinical trial. Complement Ther Clin Pract 2017; 29:201-206. [DOI: 10.1016/j.ctcp.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
|
38
|
Gomes-Neto M, Durães AR, Reis HFCD, Neves VR, Martinez BP, Carvalho VO. High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:1696-1707. [PMID: 28825321 DOI: 10.1177/2047487317728370] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Exercise is an effective strategy for reducing total and cardiovascular mortality in patients with coronary artery disease. However, it is not clear which modality is best. We performed a meta-analysis to investigate the effects of high-intensity interval versus moderate-intensity continuous training of coronary artery disease patients. Methods We searched MEDLINE, PEDro, LILACS, SciELO and the Cochrane Library (from the earliest date available to November 2016) for controlled trials that evaluated the effects of high-intensity interval versus moderate-intensity continuous training for coronary artery disease patients. Weighted mean differences and 95% confidence intervals were calculated, and heterogeneity was assessed using the I2 test. Results Twelve studies met the study criteria, including 609 patients. High-intensity interval training resulted in improvement in peak oxygen uptake weighted mean difference (1.3 ml/kg/min, 95% confidence interval: 0.6-1.9, n = 594) compared with moderate-intensity continuous training. No significant difference in physical, emotional, and social domain of quality of life was found for participants for participants in the high-intensity interval training group compared with the moderate-intensity continuous training group. Sub-analysis of three studies with isocaloric exercise training showed no significant difference in peak oxygen uptake weighted mean difference (0.4 ml/kg/min, 95% confidence interval: -0.1-0.9, n = 137) for participants in the high-intensity interval training group compared with moderate-intensity continuous training group. Conclusions High-intensity interval training may improve peak oxygen uptake and should be considered as a component of care of coronary artery disease patients. However, this superiority disappeared when isocaloric protocol is compared.
Collapse
Affiliation(s)
- Mansueto Gomes-Neto
- 1 Physical Therapy Department, Federal University of Bahia, Brazil.,2 Programa de Pós Graduação em Medicina e Saúde, Federal University of Bahia, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia, Brazil.,4 The GREAT Group (GRupo de Estudos em ATividade física), Brazil
| | - André R Durães
- 2 Programa de Pós Graduação em Medicina e Saúde, Federal University of Bahia, Brazil
| | - Helena F Correia Dos Reis
- 1 Physical Therapy Department, Federal University of Bahia, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia, Brazil
| | - Victor R Neves
- 5 Physical Therapy Department, State University of Pernambuco, Brazil
| | - Bruno P Martinez
- 1 Physical Therapy Department, Federal University of Bahia, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia, Brazil
| | - Vitor O Carvalho
- 3 Physiotherapy Research Group, Federal University of Bahia, Brazil.,4 The GREAT Group (GRupo de Estudos em ATividade física), Brazil.,6 Physical Therapy Department, Federal University of Sergipe, Brazil
| |
Collapse
|
39
|
Kraal JJ, Vromen T, Spee R, Kemps HMC, Peek N. The influence of training characteristics on the effect of exercise training in patients with coronary artery disease: Systematic review and meta-regression analysis. Int J Cardiol 2017; 245:52-58. [PMID: 28735757 DOI: 10.1016/j.ijcard.2017.07.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/31/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exercise-based cardiac rehabilitation improves exercise capacity of coronary artery disease patients, it is unclear which training characteristic determines this improvement. Total energy expenditure and its constituent training characteristics (training intensity, session frequency, session duration and programme length) vary considerably among clinical trials, making it hard to compare studies directly. Therefore, we performed a systematic review and meta-regression analysis to assess the effect of total energy expenditure and its constituent training characteristics on exercise capacity. METHODS We identified randomised controlled trials comparing continuous aerobic exercise training with usual care for patients with coronary artery disease. Studies were included when training intensity, session frequency, session duration and programme length was described, and exercise capacity was reported in peakVO2. Energy expenditure was calculated from the four training characteristics. The effect of training characteristics on exercise capacity was determined using mixed effects linear regression analyses. The analyses were performed with and without total energy expenditure as covariate. RESULTS Twenty studies were included in the analyses. The mean difference in peakVO2 between the intervention group and control group was 3.97ml·min-1·kg-1 (p<0.01, 95% CI 2.86 to 5.07). Total energy expenditure was significantly related to improvement of exercise capacity (effect size 0.91ml·min-1·kg-1 per 100J·kg, p<0.01, 95% CI 0.77 to 1.06), no effect was found for its constituent training characteristics after adjustment for total energy expenditure. CONCLUSIONS We conclude that the design of an exercise programme should primarily be aimed at optimising total energy expenditure rather than on one specific training characteristic.
Collapse
Affiliation(s)
- Jos J Kraal
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Tom Vromen
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud Spee
- Department of Cardiology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Niels Peek
- Health eResearch Centre, Farr Institute of Health Informatics Research, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
40
|
Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: A systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol 2017; 24:1242-1259. [DOI: 10.1177/2047487317713329] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matthew Hollings
- Exercise, Health and Performance Faculty Research Group, The University of Sydney, Australia
| | - Yorgi Mavros
- Exercise, Health and Performance Faculty Research Group, The University of Sydney, Australia
| | - Jonathan Freeston
- Exercise, Health and Performance Faculty Research Group, The University of Sydney, Australia
| | - Maria Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group, The University of Sydney, Australia
- Sydney Medical School, The University of Sydney, Australia
- Hebrew SeniorLife, Harvard Medical School, USA
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, USA
| |
Collapse
|
41
|
[The exercise training restores the heart rate variability in heart failure patients. A systematic review]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:326-335. [PMID: 28065709 DOI: 10.1016/j.acmx.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular diseases are a significant cause of morbidity and mortality in the general population. In this sense, the autonomic imbalance is the cornerstone of the pathophysiology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure. METHODOLOGY A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group. RESULTS Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P < .001) and low frequency band (LF) (< 0.415±0.096; P=.001). Moreover, the standardised mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF, and LF. CONCLUSION The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure.
Collapse
|
42
|
Hussey L, Sredic D, Bucci C, Barrett IR, McLeod R, Janaudis-Ferreira T, Brooks D. To Be or Not to Be a Cardiorespiratory Physiotherapist: Factors That Influence Career Choice in a Sample of Canadian Physiotherapists. Physiother Can 2017; 69:226-232. [PMID: 30275639 DOI: 10.3138/ptc.2016-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: This study explored the factors that influence choosing or not choosing a career in cardiorespiratory physiotherapy (CRP) from the perspective of a group of currently practising, experienced physiotherapists in Canada. Methods: A modified Dillman approach was used to distribute a cross-sectional, self-administered, online questionnaire to all eligible members of the cardiorespiratory and orthopaedic divisions of the Canadian Physiotherapy Association. A total of 438 participants-21 CRP and 417 non-CRP therapists-completed the survey. The survey response rate was 9.4%. Results: A narrow scope of practice (61.9%) and a lack of interest in CRP subject matter (50.1%) were the most influential factors deterring the respondents from making CRP their career choice. Interest in CRP (81.0%), mentorship (76.2%), access to physical resources (76.2%), and inter-professional practice (71.4%) were the most influential factors in pursuing a career in CRP. Conclusion: Increasing the awareness of the scope of practice for CRP, exposure to positive mentors, and rich practice settings are key factors in promoting physiotherapists' specialisation in CRP.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Dina Brooks
- Department of Physical Therapy.,Rehabilitation Science Institute, University of Toronto, Toronto
| |
Collapse
|
43
|
da Costa Torres D, Dos Santos PMR, Reis HJL, Paisani DM, Chiavegato LD. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Med 2016; 4:2050312116682256. [PMID: 28348739 PMCID: PMC5354181 DOI: 10.1177/2050312116682256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/27/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Muscle atrophy and prolonged inactivity are associated with an increased sensation of fatigue and reduced functional capacity in the postoperative period in patients undergoing coronary artery bypass grafting. Cardiac rehabilitation after hospital discharge is highly recommended and contributes to improvement in functional capacity and quality of life. However, few studies have evaluated the effectiveness of early mobilization protocols during hospitalization on the patterns of physical activity and functional capacity after coronary artery bypass grafting. Objective: To investigate the effectiveness of an early mobilization program on the functional capacity of patients undergoing coronary artery bypass grafting in the short and long term. Methods: This is a prospective, randomized, controlled, single-blind trial protocol that will evaluate 66 consecutive patients undergoing coronary artery bypass grafting. Patients will be randomized into two training groups: the control group (N = 33), which will perform breathing exercises and the intervention group (N = 33), which will perform breathing exercises and aerobic exercises. The groups will receive treatment from first to the seventh postoperative day, twice daily. In the preoperative period, the following outcomes will be assessed: physical activity level (Baecke Questionnaire), Functional Independence Measure, and functional capacity (6-min walking test). Functional capacity will be reassessed after the 7th and 60th postoperative day. Pulmonary complications and length of hospital stay will also be evaluated. Statistical analysis will be calculated using linear mixed models and will be based on intention-to-treat. The level of significance will be set at α = 5%.
Collapse
|
44
|
Fuglsang S, Heiberg J, Hjortdal VE, Laustsen S. Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients. SCAND CARDIOVASC J 2016; 51:99-105. [PMID: 27808563 DOI: 10.1080/14017431.2016.1257149] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Surgically treated type-A aortic dissection patients are often restricted from physical exercise due to a lack of knowledge about the blood pressure increase. Our aims were to evaluate the hemodynamic responses during exercise, and to assess changes in peak oxygen uptake, maximal workload, and quality-of-life after completion of an exercise-based cardiac rehabilitation program. DESIGN Three subgroups were retrospectively identified based on their different eligibility criteria. Group I (n = 10) had performed an exercise-based cardiac rehabilitation program including exercise tests. Group II (n = 9) had followed the program without the tests. Group III (n = 10) had neither been rehabilitated nor tested. For evaluation of hemodynamic parameters, we included a group of surgically treated patients with aortic valve stenosis, group IV (n = 32). Questionnaires were obtained to measure quality-of-life. RESULTS At baseline the group I and IV mean systolic blood pressure changed from 143 ± 16 mmHg and 150 ± 16 mmHg to 200 ± 32 mmHg and 213 ± 27 mmHg, respectively. The group I mean peak oxygen uptake changed from 23.5 ± 7.9 ml/min/kg before rehabilitation to 28.6 ± 8.4 ml/min/kg, p = .001, after rehabilitation. The mean maximal workload changed from 143 ± 80 W before rehabilitation to 178 ± 97 W, p = .003, after rehabilitation. At follow-up, the groups I-III physical quality-of-life score was 45.1 ± 15.0, 40.0 ± 9.0, and 30.0 ± 11.3, p < .025, respectively, and the mental quality-of-life score was 51.1 ± 6, 41.7 ± 6.7, and 32.5 ± 13.3, p < .001, respectively. CONCLUSIONS Our results suggest that type-A aortic dissection patients have hemodynamic responses to exercise that are comparable to other cardiovascular patients. Moreover, we found significant increases in peak oxygen uptake, maximal workload, and quality-of-life after ended ECR.
Collapse
Affiliation(s)
- Simon Fuglsang
- a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Johan Heiberg
- a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Vibeke E Hjortdal
- a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Sussie Laustsen
- b Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital & Centre of Research in Rehabilitation (CORIR) , Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| |
Collapse
|
45
|
Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur J Prev Cardiol 2016; 23:1715-1733. [PMID: 27353128 DOI: 10.1177/2047487316657669] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiac rehabilitation is an important component in the continuum of care for individuals with cardiovascular disease, providing a multidisciplinary education and exercise programme to improve morbidity and mortality risk. Internationally, cardiac rehabilitation programmes are implemented through various models. This review compared cardiac rehabilitation guidelines in order to identify any differences and/or consensus in exercise testing, prescription and monitoring. METHODS Guidelines, position statements and policy documents for cardiac rehabilitation, available internationally in the English language, were identified through a search of electronic databases and government and cardiology society websites. Information about programme delivery, exercise testing, prescription and monitoring were extracted and compared. RESULTS Leading cardiac rehabilitation societies in North America and Europe recommend that patients progress from moderate- to vigorous-intensity aerobic endurance exercise over the course of the programme, with resistance training included as an important adjunct, for maintaining independence and quality of life. North American and European guidelines also recommend electrocardiograph-monitored exercise stress tests. Guidelines for South America and individual European nations typically include similar recommendations; however, those in the United Kingdom, Australia and New Zealand specify lower-intensity exercise and less technical assessment of functional capacity. CONCLUSION Higher-intensity aerobic training programmes, supplemented by resistance training, have been recommended and deemed safe for cardiac rehabilitation patients by many authorities. Based on research evidence, this may also provide superior outcomes for patients and should therefore be considered when developing an international consensus for exercise prescription in cardiac rehabilitation.
Collapse
Affiliation(s)
- Kym Joanne Price
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Brett Ashley Gordon
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Richard Bird
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Amanda Clare Benson
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| |
Collapse
|
46
|
Chen JT, Lin TH, Voon WC, Lai WT, Huang MH, Sheu SH, Chen CK. Beneficial effects of home-based cardiac rehabilitation on metabolic profiles in coronary heart-disease patients. Kaohsiung J Med Sci 2016; 32:267-75. [PMID: 27316586 DOI: 10.1016/j.kjms.2016.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/20/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022] Open
Abstract
Coronary heart disease (CHD) is a major cause of morbidity and mortality in developed countries. Metabolic syndrome (MetS) is associated with increased risk of CHD. Cardiac rehabilitation is considered an effective intervention and a Class I indication in patients with CHD. This study was designed to evaluate the effects of home-based, integrated cardiac rehabilitation (HBICR) of patients with CHD in modifiable risk-factor control and exercise capacity. Sixty-four patients with CHD were investigated and randomized into intervention and control groups. The intervention group received a HBICR containing medication use, exercise program, smoking-cessation counseling, and education regarding risk factors, nutrition, and the necessity of continuing the program, whereas the control group received traditional care. Baseline and follow-up assessments at 3 months and 12 months, including body composition, metabolic syndrome risk score, and biochemical tests were performed in all patients. Additionally, cardiopulmonary function tests were also performed at baseline and 3-month follow-up assessments. There was a significant between-group, within-group, and interaction effect found in the MetS Z scores. Significant within-group effects were also observed in modified Adult Treatment Panel III score, waist circumference, high-density lipoprotein, and low-density lipoprotein. However, several cardiopulmonary parameters did not differ significantly at 3-month follow-up between the two groups, including peak V̇O2, peak heart rate, peak respiratory exchange ratio, anaerobic threshold V̇O2, heart-rate reserve, and heart-rate recovery after 1 min and after 2 min. Our results showed that HBICR exhibited significant positive effects on modifiable risk-factor control in CHD patients.
Collapse
Affiliation(s)
- Jing-Ting Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Taiwan
| | - Tsung-Hsien Lin
- Department of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Department of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Department of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mao-Hsiung Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Department of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Kai Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
47
|
Manolis AS, Manolis AA. Exercise and Arrhythmias: A Double-Edged Sword. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:748-62. [PMID: 27120033 DOI: 10.1111/pace.12879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 12/18/2022]
Abstract
Ample evidence indicates that moderate regular exercise is beneficial for both normal individuals and patients with cardiovascular (CV) disease. However, intense and strenuous exercise in individuals with evident or occult underlying CV abnormalities may have adverse effects with provocation and exacerbation of arrhythmias that may lead to life-threatening situations. Both of these aspects of exercise-induced effects are herein reviewed.
Collapse
Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis A Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| |
Collapse
|
48
|
Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease: A POPULATION-BASED COHORT STUDY IN TAIWAN. J Cardiopulm Rehabil Prev 2016; 36:250-7. [PMID: 26959494 DOI: 10.1097/hcr.0000000000000168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of cardiac rehabilitation (CR) provided within the first 3 months of revascularization on reducing recurrent revascularization in patients with coronary heart disease in Taiwan. METHODS In this population-based cohort study, we used the claims data of 1 million beneficiaries who were randomly selected from all beneficiaries enrolled in Taiwan's National Health Insurance program from 1996 to 2000. Between 2000 and 2007, 2838 patients underwent a first-event revascularization. Of these patients, 442 (15.6%) underwent CR within the first 3 months of admission for revascularization. The remaining 84.4% (n = 2396) served as the non-CR group. All the study patients were followed-up until the end of 2008 for any recurrent revascularization. A propensity score-adjusted Cox proportional hazard model was used to estimate the relative risk of recurrent revascularization associated with CR. RESULTS During the 1- to 9-year follow-up, 69 patients (15.6%) in the CR group and 840 (35.1%) patients in the non-CR group experienced recurrent revascularization. The results of the propensity score-adjusted Cox proportional hazard regression analysis showed that CR was significantly associated with a reduced risk of recurrent revascularization with a hazard ratio of 0.48 (95% CI, 0.37 to -0.62). CONCLUSIONS Cardiac rehabilitation within the first 3 months of revascularization is significantly associated with a reduced risk of recurrent revascularization. This preventive effect was more pronounced in men compared with other subgroups of patients.
Collapse
|
49
|
Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation. Neth Heart J 2016; 23:563-75. [PMID: 26481496 PMCID: PMC4651959 DOI: 10.1007/s12471-015-0761-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Guideline adherence with respect to exercise-based cardiac rehabilitation (CR) is hampered by a large variety of complex guidelines and position statements, and the fact that these documents are not specifically designed for healthcare professionals prescribing exercise-based CR programs. This study aimed to develop clinical algorithms that can be used in clinical practice for prescription and evaluation of exercise-based CR in patients with coronary artery disease (CAD) and chronic heart failure (CHF). Methods The clinical algorithms were developed using a systematic approach containing four steps. First, all recent Dutch and European cardiac rehabilitation guidelines and position statements were reviewed and prioritised. Second, training goals requiring a differentiated training approach were selected. Third, documents were reviewed on variables to set training intensity, modalities, volume and intensity and evaluation instruments. Finally, the algorithms were constructed. Results Three Dutch guidelines and three European position statements were reviewed. Based on these documents, five training goals were selected and subsequently five algorithms for CAD patients and five for CHF patients were developed. Conclusions This study presents evidence-based clinical algorithms for exercise-based CR in patients with CAD and CHF according to their training goals. These algorithms may serve to improve guideline adherence and the effectiveness of exercise-based CR.
Collapse
|
50
|
Impact of Exercise Training in Aerobic Capacity and Pulmonary Function in Children and Adolescents After Congenital Heart Disease Surgery: A Systematic Review with Meta-analysis. Pediatr Cardiol 2016; 37:217-24. [PMID: 26396114 DOI: 10.1007/s00246-015-1270-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022]
Abstract
The aim of the study was to examine the effects of exercise training on aerobic capacity and pulmonary function in children and adolescents after congenital heart disease surgery. We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, (from the earliest date available to January 2015) for controlled trials that evaluated the effects of exercise training on aerobic capacity and pulmonary function (forced expiratory volume in 1 s and forced vital capacity) in children and adolescents after congenital heart disease surgery. Weighted mean differences and 95 % confidence intervals (CIs) were calculated,, and heterogeneity was assessed using the I (2) test. Eight trials (n = 292) met the study criteria. The results suggested that exercise training compared with control had a positive impact on peak VO2. Exercise training resulted in improvement in peak VO2 weighted mean difference (3.68 mL kg(-1) min(-1), 95 % CI 1.58-5.78). The improvement in forced expiratory volume in 1 s and forced vital capacity after exercise training was not significant. Exercise training may improve peak VO2 in children and adolescents after congenital heart disease surgery and should be considered for inclusion in cardiac rehabilitation. Further larger randomized controlled trials are urgently needed to investigate different types of exercise and its effects on the quality of life.
Collapse
|