1
|
Mulligan K, Harris K, Rixon L, Burls A. A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions. Disabil Rehabil 2024:1-18. [PMID: 38832888 DOI: 10.1080/09638288.2024.2353855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/04/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions. METHODS A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted. RESULTS The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials. CONCLUSION This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.
Collapse
Affiliation(s)
- Kathleen Mulligan
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katherine Harris
- Centre for Genomics and Child Health, the Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Lorna Rixon
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Amanda Burls
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| |
Collapse
|
2
|
Terbraak M, Major M, Jørstad H, Scholte op Reimer W, van der Schaaf M. Home-based cardiac rehabilitation in older adults: expert-recommendations for physiotherapist-led care to improve daily physical functioning and reduce comorbidity-related barriers. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023; 26:288-298. [PMID: 39380594 PMCID: PMC11460311 DOI: 10.1080/21679169.2023.2276712] [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: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 10/10/2024]
Abstract
Background Cardiac rehabilitation (CR) can reduce mortality and improve physical functioning in older patients, but current programs do not support the needs of older patients with comorbidities or frailty, for example due to transport problems and physical limitations. Home-exercise-based cardiac rehabilitation (HEBCR) programs may better meet these needs, but physiotherapy guidelines for personalising HEBCR for older, frail patients with cardiovascular disease are lacking. Purpose To provide expert recommendations for physiotherapists on how to administer HEBCR to older adults with comorbidities or frailty. Methods This Delphi study involved a panel of Dutch experts in physiotherapy, exercise physiology, and cardiology. Three Delphi rounds were conducted between December 2020 and February 2022. In the first round panellists provided expertise on applicability and adaptability of existing CR-guidelines. In the second round panellists ranked the importance of statements about HEBCR for older adults. In the third round panellists re-ranked statements when individual scores were outside the semi-interquartile range. Consensus was defined as a semi-interquartile range of ≤ 1.0. Results Of 20 invited panellists, 11 (55%) participated. Panellists were clinical experts with a median (interquartile range) work experience of 20 (10.5) years. The panel reached a consensus on 89% of statements, identifying key topics such as implementing the patient perspective, assessing comorbidity and frailty barriers to exercise, and focusing on personal goals and preferences. Conclusion This Delphi study provides recommendations for personalised HEBCR for older, frail patients with cardiovascular disease, which can improve the effectiveness of CR-programs and address the needs of this patient population. Prioritising interventions aimed at enhancing balance, lower extremity strength, and daily activities over interventions targeting exercise capacity may contribute to a more holistic and effective approach, particularly for older adults.
Collapse
Affiliation(s)
- Michel Terbraak
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mel Major
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Harald Jørstad
- Amsterdam UMC location University of Amsterdam, Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wilma Scholte op Reimer
- Amsterdam UMC location University of Amsterdam, Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Marike van der Schaaf
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Rehabilitation, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Yu T, Gao M, Sun G, Graffigna G, Liu S, Wang J. Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:447. [PMID: 37697249 PMCID: PMC10496326 DOI: 10.1186/s12872-023-03470-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally. OBJECTIVE To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients. METHODS Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases. RESULTS A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase. CONCLUSION This study characterized CR engagement, and explored demographic, medical, and psychological factors-with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.
Collapse
Affiliation(s)
- Tianxi Yu
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Min Gao
- Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, No.300 Guang Zhou Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Guozhen Sun
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China.
| | | | - Shenxinyu Liu
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Jie Wang
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| |
Collapse
|
4
|
Yang Z, Sun L, Sun Y, Dong Y, Wang A. A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study. Patient Prefer Adherence 2023; 17:851-860. [PMID: 36999162 PMCID: PMC10044075 DOI: 10.2147/ppa.s404287] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic. Patients and Methods A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data. Results A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior. Conclusion The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.
Collapse
Affiliation(s)
- Zhen Yang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Longfeng Sun
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Yuanhui Sun
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Yu Dong
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| |
Collapse
|
5
|
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
|
6
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 768] [Impact Index Per Article: 384.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 920] [Impact Index Per Article: 460.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
|
8
|
Feng L, Li G, An J, Liu C, Zhu X, Xu Y, Gao Y, Li J, Liu J, Yan J, Wang Y, Ren J, Yang L, Qi Z. Exercise Training Protects Against Heart Failure Via Expansion of Myeloid-Derived Suppressor Cells Through Regulating IL-10/STAT3/S100A9 Pathway. Circ Heart Fail 2021; 15:e008550. [PMID: 34911348 DOI: 10.1161/circheartfailure.121.008550] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise training (ET) has a protective effect on the progression of heart failure, however, the specific mechanism has not been fully explored. Myeloid-derived suppressor cells (MDSCs) are a group of myeloid-derived immunosuppressive cells, which showed a protective effect in the progression of heart failure. Thus, we hypothesized that the protective effect of ET on heart failure may be related to the infiltration of MDSCs. METHODS C57BL/6 mice were made to run on a treadmill 6× a week for 4 weeks followed by isoproterenol injection from third week. Heart function was evaluated by echocardiography and the proportion of MDSCs was detected by flow cytometry. Hypertrophic markers, cardiac fibrosis, and inflammatory factors were detected by real-time PCR, ELISA, histological staining, and Western blot. RESULTS ET treatment in isoproterenol-induced heart failure mice (n=7) enhanced cardiac function (57% increase in FS%, P=0.002) and improved morphological changes compared with isoproterenol mice (n=17). ET further caused 79% increasing in cardiac MDSCs in isoproterenol mice (P<0.001). In addition, depletion of MDSCs by 5-Fluorouracil blunted the cardio-protective effect of ET. T-cell proliferation assay showed that ET did not affect the suppressive activity of MDSCs. Furthermore, we found that ET activated the secretion of IL (interleukin)-10 by macrophages in isoproterenol mice. MDSCs expansion and cardio protection was not present in tamoxifen-inducible macrophage-specific IL-10 knockout mice. Western blot results confirmed that IL-10 regulated the differentiation of MDSCs through the translocation of p-STAT3 (signal transducer and activator of transcription 3)/S100A9 (S100 calcium-binding protein A9) to the nucleus. CONCLUSIONS ET could increase MDSCs by stimulating the secretion of IL-10 from macrophage, which was through IL-10/STAT3/S100A9 signaling pathway, thereby achieving the role of heart protection.
Collapse
Affiliation(s)
- Lifeng Feng
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Guangru Li
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Jiale An
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Chang Liu
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Xiaolong Zhu
- Department of Pathogen Biology, Basic Medical College, Tianjin Medical University, China. (X.Z., J.R.).,Department of Cardiovascular Surgery, Tianjin Chest Hospital, China (X.Z.)
| | - Yang Xu
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Yang Gao
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.).,Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, China (Y.G., L.Y., Z.Q.)
| | - Jing Li
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Jie Liu
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Jie Yan
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Yachen Wang
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.)
| | - Jiling Ren
- Department of Pathogen Biology, Basic Medical College, Tianjin Medical University, China. (X.Z., J.R.).,Immunology Department, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Tianjin Medical University, China. (J.R.)
| | - Liang Yang
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.).,Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, China (Y.G., L.Y., Z.Q.)
| | - Zhi Qi
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China (L.F., G.L., J.A., C.L., Y.X., Y.G., J. Li, J. Liu, J.Y., Y.W., L.Y., Z.Q.).,Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, China (Y.G., L.Y., Z.Q.).,School of Tropical Medicine and Laboratory Medicine, Key Laboratory of Emergency and Trauma of Ministry of Education, Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, China (Z.Q.)
| |
Collapse
|
9
|
Lin H, Zhu Y, Zheng C, Hu D, Ma S, Chen L, Wang Q, Chen Z, Xie J, Yan Y, Huang X, Liao W, Kitakaze M, Bin J, Liao Y. Antihypertrophic Memory After Regression of Exercise-Induced Physiological Myocardial Hypertrophy Is Mediated by the Long Noncoding RNA Mhrt779. Circulation 2021; 143:2277-2292. [PMID: 33757294 PMCID: PMC8177494 DOI: 10.1161/circulationaha.120.047000] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exercise can induce physiological myocardial hypertrophy (PMH), and former athletes can live 5 to 6 years longer than nonathletic controls, suggesting a benefit after regression of PMH. We previously reported that regression of pathological myocardial hypertrophy has antihypertrophic effects. Accordingly, we hypothesized that antihypertrophic memory exists even after PMH has regressed, increasing myocardial resistance to subsequent pathological hypertrophic stress. METHODS C57BL/6 mice were submitted to 21 days of swimming training to develop PMH. After termination of exercise, PMH regressed within 1 week. PMH regression mice (exercise hypertrophic preconditioning [EHP] group) and sedentary mice (control group) then underwent transverse aortic constriction or a sham operation for 4 weeks. Cardiac remodeling and function were evaluated with echocardiography, invasive left ventricular hemodynamic measurement, and histological analysis. LncRNA sequencing, chromatin immunoprecipitation assay, and comprehensive identification of RNA-binding proteins by mass spectrometry and Western blot were used to investigate the role of Mhrt779 involved in the antihypertrophic effect induced by EHP. RESULTS At 1 and 4 weeks after transverse aortic constriction, the EHP group showed less increase in myocardial hypertrophy and lower expression of the Nppa and Myh7 genes than the sedentary group. At 4 weeks after transverse aortic constriction, EHP mice had less pulmonary congestion, smaller left ventricular dimensions and end-diastolic pressure, and a larger left ventricular ejection fraction and maximum pressure change rate than sedentary mice. Quantitative polymerase chain reaction revealed that the long noncoding myosin heavy chain-associated RNA transcript Mhrt779 was one of the markedly upregulated lncRNAs in the EHP group. Silencing of Mhrt779 attenuated the antihypertrophic effect of EHP in mice with transverse aortic constriction and in cultured cardiomyocytes treated with angiotensin II, and overexpression enhanced the antihypertrophic effect. Using chromatin immunoprecipitation assay and quantitative polymerase chain reaction, we found that EHP increased histone 3 trimethylation (H3K4me3 and H3K36me3) at the a4 promoter of Mhrt779. Comprehensive identification of RNA-binding proteins by mass spectrometry and Western blot showed that Mhrt779 can bind SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4 (Brg1) to inhibit the activation of the histone deacetylase 2 (Hdac2)/phosphorylated serine/threonine kinase (Akt)/phosphorylated glycogen synthase kinase 3β(p-GSK3β) pathway induced by pressure overload. CONCLUSIONS Myocardial hypertrophy preconditioning evoked by exercise increases resistance to pathological stress via an antihypertrophic effect mediated by a signal pathway of Mhrt779/Brg1/Hdac2/p-Akt/p-GSK3β.
Collapse
Affiliation(s)
- Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Yingqi Zhu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Cankun Zheng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Donghong Hu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Lin Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Qiancheng Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Zhenhuan Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Jiahe Xie
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Yi Yan
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.).,Department of Cardiology, Translational Research Center for Regenerative Medicine and 3D Printing Technologies, The Third Affliated Hospital of Guangzhou Medical University, Guangzhou, China (Y.Y.)
| | - Xiaobo Huang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.)
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong, China (W.L.)
| | - Masafumi Kitakaze
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.).,Cardiovascular Division of the Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (M.K.)
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.).,National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China (J.B., Y.L.)
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China (H.L., Y.Z., C.Z., D.H., S.M., L.C., Q.W., Z.C., J.X., Y.Y., X.H., M.K., J.B., Y.L.).,National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China (J.B., Y.L.).,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China (Y.L.)
| |
Collapse
|
10
|
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
|
11
|
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
|
12
|
Hornikx M, Buys R, Cornelissen V, Deroma M, Goetschalckx K. Effectiveness of high intensity interval training supplemented with peripheral and inspiratory resistance training in chronic heart failure: a pilot study. Acta Cardiol 2020; 75:339-347. [PMID: 31125296 DOI: 10.1080/00015385.2019.1591676] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based therapy in chronic heart failure (CHF). There is still debate about the optimal training protocol in CHF. The use of high intensity interval training (HIIT) supplemented with peripheral (PRT) and inspiratory resistance training (IRT) might be more beneficial because of the higher impact on the peripheral and inspiratory muscles, with less symptoms of dyspnoea and lower amount of dropouts as a result. We compared our standard exercise-based CR programme, mainly consisting of moderate intensity interval training to a programme combining HIIT, PRT and IRT (resistance training supplemented HIIT (RHIIT) programme).Design: Randomised controlled pilot study.Methods: Twenty patients with CHF were randomised on a 1:1 basis to the standard or RHIIT programme. At baseline and after 3 months, peak exercise capacity (VO2peak), peripheral (QF) and inspiratory respiratory muscle strength (MIP), quality of life (QOL) and physical activity were measured.Results: The RHIIT programme resulted in a significantly larger improvement in QF (ΔQF RHIIT programme: 19.3 ± 11.8 vs standard programme: -6.89 ± 19.0 Nm (p < .01)) and MIP (ΔMIP RHIIT programme: -44.9 ± 29.9 vs standard programme: 0.56 ± 19.4 cmH2O (p < .01)). Both programmes equally improved in VO2peak (p = .91), whereas ventilatory efficiency and physical activity remained stable.Conclusion: HIIT supplemented with PRT and IRT might be applicable as standard protocol in CHF. Larger studies are warranted to confirm our findings. The RHIIT programme resulted in similar training effects in VO2peak in a shorter training period. This might be beneficial in a chronic patient population such as CHF, where adherence is difficult.
Collapse
Affiliation(s)
- Miek Hornikx
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Veronique Cornelissen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Michel Deroma
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
13
|
Harris C, Ignatowicz A, Lasserson DS. What are physiotherapists and occupational therapists doing in services that replace acute hospital admission? A systematic review. Int J Clin Pract 2020; 74:e13462. [PMID: 31830350 DOI: 10.1111/ijcp.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Alternatives to acute hospital admission are required to accommodate the increasing pressures on health services. Since physiotherapists and occupational therapists are integral to inpatient teams, they may also be integral to admission replacement services, and thus their roles in these services merit investigation. AIMS Primarily to determine the presence and roles of physiotherapists and occupational therapists in services replacing acute hospital admission. The secondary outcome is to determine the impact of therapists in such services. METHODS Five electronic databases were searched, with keywords related to therapy, discharge, and admission replacement. Inclusion criteria were that studies explicitly described at least one therapist role within a service replacing acute hospital admissions. Two authors independently reviewed all potentially eligible studies. Two reviewers independently assessed data extracted from included studies into a standardized data extraction form. RESULTS Fifteen studies (3 Hospital at Home, 12 Early Supported Discharge) were included. Both clinical (eg, exercise prescription) and non-clinical (eg, organization and study outcome assessments) therapist roles were described in different admission substitution services. Some roles were only reported among teams, not individually ascribed to therapists. CONCLUSIONS The roles of therapists in services that replace hospital admission are rarely described in detail, with wide variation in reported roles, including across service types and patient populations. This review could not determine the impact of individual therapists on patient or service-level outcomes. Future studies need to more clearly define therapist roles and impact.
Collapse
Affiliation(s)
- Ciara Harris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | | | - Daniel S Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| |
Collapse
|
14
|
Marchese LDD, Chermont S, Warol D, Oliveira LBD, Pereira SB, Quintão M, Mesquita ET. Controlled Study of Central Hemodynamic Changes in Inspiratory Exercise with Different Loads in Heart Failure. Arq Bras Cardiol 2020; 114:656-663. [PMID: 32491006 DOI: 10.36660/abc.20180375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Inspiratory muscle weakness contributes to exercise intolerance and decreased quality of life in patients with heart failure. Studies with inspiratory muscle training show improvement in inspiratory muscle strength, functional capacity and quality of life. However, little is known about the central hemodynamic response (CHR) during inspiratory exercise (IE). Objective To evaluate CHR in a single IE session with different loads (placebo, 30% and 60%) in heart failure. Methods Randomized placebo-controlled clinical trial in patients with heart failure with reduced ejection fraction, functional class II and III. Twenty patients aged 65 ± 11 years completed a single session of inspiratory exercise, in 3 cycles of 15 minutes, with a 1-hour washout, involving loads of 30% (C30), 60% (C60) and placebo, using a linear load resistor (PowerBreathe Light). The noninvasive hemodynamic study was performed by cardiothoracic bioimpedance (Niccomo™ CardioScreen®). Statistical analysis was performed with Student's t-test and Pearson's correlation, and P≤0.05 was considered significant. Results An increase in heart rate (HR) was observed with C30 (64 ± 15 vs 69 ± 15 bpm; p = 0.005) and C60 (67 ± 14 vs 73 ± 14 bpm, p = 0.002). A decrease was observed in systolic volume (SV) with C30 (73 ± 26 vs 64 ± 20 ml; p = 0.004). Cardiac output (CO), on its turn, increased only with C60 (4.6 ± 1.5 vs 5.3 ± 1.7 l/min; p = -0.001). Conclusion When using the 60% load, in a single IE session, changes in CHR were observed. HR and CD increased, as did the Borg scales and subjective sensation of dyspnea. The 30% load reduced the SV. (Arq Bras Cardiol. 2020; 114(4):656-663).
Collapse
Affiliation(s)
- Luana de Decco Marchese
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Clínica de Insuficiência Cardíaca, Centro Universitário Serra dos Órgãos, Teresópolis, RJ, Brasil
| | - Sergio Chermont
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Hospital do Coração, São Paulo, SP, Brasil
| | | | | | | | - Mônica Quintão
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Instituto Nacional do Câncer, Rio de Janeiro, RJ – Brazil
| | | |
Collapse
|
15
|
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
|
16
|
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
|
17
|
Hu S, Liu H, Hu Z, Li L, Yang Y. Follistatin-like 1: A dual regulator that promotes cardiomyocyte proliferation and fibrosis. J Cell Physiol 2020; 235:5893-5902. [PMID: 32017077 DOI: 10.1002/jcp.29588] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Follistatin-like 1 (FSTL1) is a key factor in maintaining cardiac growth and development. It can be activated by exercise training and has a dual role in promoting cardiomyocyte proliferation and fibrosis, but its underlying mechanism is not fully understood. To elucidate the dual mechanism and target of FSTL1 regulating of cardiomyocyte proliferation and myocardial fibrosis, and the mechanism by which exercise-regulated FSTL1 improves cardiovascular disease, we explored the signal transduction pathway of FSTL1 promoting cardiomyocyte proliferation and fibrosis, and compared the effects of different modes of exercise on the dual role of FSTL1. We believe that the dual role of promoting cardiomyocyte proliferation and fibrosis may be related to the ratio of cardiomyocyte and myocardial interstitial cell proliferation, different stages of the disease, different degrees of fibrosis, immune repair process, and transforming growth factor-β activation. Compared with long-term excessive endurance exercise, moderate resistance exercise can activate cardiomyocyte proliferation pathway through FSTL1, which is one of the effective ways to prevent cardiovascular disease.
Collapse
Affiliation(s)
- Siyuan Hu
- Graduate School, Wuhan Sports University, Wuhan, China.,School of Sports Art, Hunan University of Chinese Medicine, Changsha, China
| | - Hua Liu
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Zhixi Hu
- Institute of Chinese Medicine Diagnosis, Hunan University of Chinese Medicine, Changsha, China
| | - Lin Li
- Institute of Chinese Medicine Diagnosis, Hunan University of Chinese Medicine, Changsha, China
| | - Yi Yang
- College of Health Science, Wuhan Sports University, Wuhan, China
| |
Collapse
|
18
|
Dipp T, Macagnan FE, Schardong J, Fernandes RO, Lemos LC, Plentz RDM. Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial. Braz J Phys Ther 2019; 24:280-286. [PMID: 31122717 DOI: 10.1016/j.bjpt.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. OBJECTIVE The aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. METHODS This randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. RESULTS The inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O - 95%CI 0.4-37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. CONCLUSION A short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).
Collapse
Affiliation(s)
- Thiago Dipp
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Fabrício Edler Macagnan
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Jociane Schardong
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Rafael Oliveira Fernandes
- Department of Physiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Luisa Cioato Lemos
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Rodrigo Della Méa Plentz
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| |
Collapse
|
19
|
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
|
20
|
Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines. J Cardiopulm Rehabil Prev 2019; 39:9-18. [DOI: 10.1097/hcr.0000000000000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
21
|
Shen H, Zhao J, Zhou X, Li J, Wan Q, Huang J, Li H, Wu L, Yang S, Wang P. Impaired chronotropic response to physical activities in heart failure patients. BMC Cardiovasc Disord 2017; 17:136. [PMID: 28545575 PMCID: PMC5445286 DOI: 10.1186/s12872-017-0571-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
Abstract
Background While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients. Methods Forty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed. Results Of 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients. Conclusion The study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients. Trial registration ClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.
Collapse
Affiliation(s)
- Hong Shen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Zhao
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA
| | - Jingbo Li
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Qing Wan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Huang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Li
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shungang Yang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Ping Wang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
| |
Collapse
|
22
|
Shi J, Bei Y, Kong X, Liu X, Lei Z, Xu T, Wang H, Xuan Q, Chen P, Xu J, Che L, Liu H, Zhong J, Sluijter JPG, Li X, Rosenzweig A, Xiao J. miR-17-3p Contributes to Exercise-Induced Cardiac Growth and Protects against Myocardial Ischemia-Reperfusion Injury. Am J Cancer Res 2017; 7:664-676. [PMID: 28255358 PMCID: PMC5327641 DOI: 10.7150/thno.15162] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Limited microRNAs (miRNAs, miRs) have been reported to be necessary for exercise-induced cardiac growth and essential for protection against pathological cardiac remodeling. Here we determined members of the miR-17-92 cluster and their passenger miRNAs expressions in two distinct murine exercise models and found that miR-17-3p was increased in both. miR-17-3p promoted cardiomyocyte hypertrophy, proliferation, and survival. TIMP-3 was identified as a direct target gene of miR-17-3p whereas PTEN was indirectly inhibited by miR-17-3p. Inhibition of miR-17-3p in vivo attenuated exercise-induced cardiac growth including cardiomyocyte hypertrophy and expression of markers of myocyte proliferation. Importantly, mice injected with miR-17-3p agomir were protected from adverse remodeling after cardiac ischemia/reperfusion injury. Collectively, these data suggest that miR-17-3p contributes to exercise-induced cardiac growth and protects against adverse ventricular remodeling. miR-17-3p may represent a novel therapeutic target to promote functional recovery after cardiac ischemia/reperfusion.
Collapse
|
23
|
Frankenstein L, Fröhlich H, Cleland JGF. Multidisciplinary Approach for Patients Hospitalized With Heart Failure. ACTA ACUST UNITED AC 2016; 68:885-91. [PMID: 26409892 DOI: 10.1016/j.rec.2015.05.008] [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: 04/01/2015] [Accepted: 05/04/2015] [Indexed: 12/24/2022]
Abstract
Acute heart failure describes the rapid deterioration, over minutes, days or hours, of symptoms and signs of heart failure. Its management is an interdisciplinary challenge that requires the cooperation of various specialists. While emergency providers, (interventional) cardiologists, heart surgeons, and intensive care specialists collaborate in the initial stabilization of acute heart failure patients, the involvement of nurses, discharge managers, and general practitioners in the heart failure team may facilitate the transition from inpatient care to the outpatient setting and improve acute heart failure readmission rates. This review highlights the importance of a multidisciplinary approach to acute heart failure with particular focus on the chain-of-care delivered by the various services within the healthcare system.
Collapse
Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
| |
Collapse
|
24
|
Major ME, Kwakman R, Kho ME, Connolly B, McWilliams D, Denehy L, Hanekom S, Patman S, Gosselink R, Jones C, Nollet F, Needham DM, Engelbert RHH, van der Schaaf M. Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge. Crit Care 2016; 20:354. [PMID: 27793165 PMCID: PMC5086052 DOI: 10.1186/s13054-016-1508-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/26/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? METHODS A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5. RESULTS Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed. CONCLUSIONS A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.
Collapse
Affiliation(s)
- M. E. Major
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R. Kwakman
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - M. E. Kho
- McMaster University, School of Rehabilitation Science, Hamilton, Canada
| | - B. Connolly
- Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, Lane Fox Clinical Respiratory Physiology Research Unit, London, UK
| | - D. McWilliams
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Therapy Services, Birmingham, UK
| | - L. Denehy
- The University of Melbourne, Department of Physiotherapy, Melbourne, Australia
| | - S. Hanekom
- Stellenbosch University, Physiotherapy Division, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - S. Patman
- The University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia
| | - R. Gosselink
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - C. Jones
- University of Liverpool, Musculoskeletal Biology, Institute of Ageing & Chronic Disease, Liverpool, UK
| | - F. Nollet
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - D. M. Needham
- Johns Hopkins University Baltimore, Outcomes after Critical Illness and Surgery Group, Baltimore, USA
- Johns Hopkins University School of Medicine Division of Pulmonary and Critical Care Medicine, Baltimore, USA
- Johns Hopkins University School of Medicine Baltimore, Department of Physical Medicine and Rehabilitation, Baltimore, USA
| | - R. H. H. Engelbert
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - M. van der Schaaf
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
| |
Collapse
|
25
|
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
|
26
|
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
|
27
|
Affiliation(s)
- E E van der Wall
- Netherlands Society of Cardiology/Holland Heart House, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands.
| |
Collapse
|
28
|
|
29
|
Gielen S, Merkus D, Duncker DJ. Guiding the failing heart to exercise. Neth Heart J 2014; 23:4-5. [PMID: 25475513 PMCID: PMC4268208 DOI: 10.1007/s12471-014-0637-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- S Gielen
- Department of Internal Medicine III, Martin-Luther-University Halle/Wittenberg, University Hospital, Halle/Saale, Germany
| | | | | |
Collapse
|