1
|
Scrutinio D, Guida P, La Rovere MT, Vecchia LAD, Forni G, Raimondo R, Scalvini S, Passantino A. Incremental prognostic value of functional impairment assessed by 6-min walking test for the prediction of mortality in heart failure. Sci Rep 2024; 14:3089. [PMID: 38321196 PMCID: PMC10847418 DOI: 10.1038/s41598-024-53817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024] Open
Abstract
Natriuretic peptides (NP) are recognized as the most powerful predictors of adverse outcomes in heart failure (HF). We hypothesized that a measure of functional limitation, as assessed by 6-min walking test (6MWT), would improve the accuracy of a prognostic model incorporating a NP. This was a multicenter observational retrospective study. We studied the prognostic value of severe functional impairment (SFI), defined as the inability to perform a 6MWT or a distance walked during a 6MWT < 300 m, in 1696 patients with HF admitted to cardiac rehabilitation. The primary outcome was 1-year all-cause mortality. After adjusting for the baseline multivariable risk model-including age, sex, systolic blood pressure, anemia, renal dysfunction, sodium level, and NT-proBNP-or for the MAGGIC score, SFI had an odds ratio of 2.58 (95% CI 1.72-3.88; p < 0.001) and 3.12 (95% CI 2.16-4.52; p < 0.001), respectively. Adding SFI to the baseline risk model or the MAGGIC score yielded a significant improvement in discrimination and risk classification. Our data suggest that a simple, 6MWT-derived measure of SFI is a strong predictor of death and provide incremental prognostic information over well-established risk markers in HF, including NP, and the MAGGIC score.
Collapse
Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | | | | | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
| |
Collapse
|
2
|
Bracewell NJ, Plasschaert J, Conti CR, Keeley EC, Conti JB. Cardiac rehabilitation: Effective yet underutilized in patients with cardiovascular disease. Clin Cardiol 2022; 45:1128-1134. [PMID: 36054282 DOI: 10.1002/clc.23911] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/12/2022] Open
Abstract
Cardiac rehabilitation is a comprehensive program that treats patients with multiple cardiac conditions including post-myocardial infarction, stable angina, post-coronary artery bypass surgery, chronic heart failure, and peripheral vascular disease with structured exercise, and nutrition and risk factor counseling. It is an effective tool that has been shown to improve not only quality of life but also reduce adverse cardiac events, including death. While the value of cardiac rehabilitation is supported by a large body of evidence and its recommendation by the American Heart Association/American College of Cardiology it is significantly underutilized due to both patient and systemic factors. Continued efforts should be made to remove the obstacles to make cardiac rehabilitation available to all those who qualify.
Collapse
Affiliation(s)
- Natalie J Bracewell
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Jeffrey Plasschaert
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Charles Richard Conti
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ellen C Keeley
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Jamie B Conti
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
3
|
Giuliano C, Vicendese D, Vogrin S, Lane R, Driscoll A, Dinh D, Palmer K, Levinger I, Neil C. Predictors of Referral to Cardiac Rehabilitation in Patients following Hospitalisation with Heart Failure: A Multivariate Regression Analysis. J Clin Med 2022; 11:jcm11051232. [PMID: 35268323 PMCID: PMC8910897 DOI: 10.3390/jcm11051232] [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: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This exploratory observational case−control study investigated the rate of referral to cardiac rehabilitation (CR) among patients hospitalised with heart failure (HF) and identified factors associated with referral. Methods: Patients hospitalised with HF as identified by the Victorian Cardiac Outcomes Registry HF study were included. Factors found to be univariately associated with referral were selected for multivariate logistic regression. Results: Among 1281 patients (mean age: 76.9 years; 32.8% HFrEF and 33.9% HfpEF), 125 (9.8%) were referred to CR. Patients referred were younger (73.6 (2.7, 81.5) vs. 80.2 (71.1, 86.5) p < 0.001) and were more likely to be men (72%, p < 0.001). Factors associated with referral included inpatient percutaneous coronary intervention (OR, 3.31; 95% CI, 1.04−10.48; p = 0.04), an aetiology of ischaemic or rhythm-related cardiomyopathy, and anticoagulants prescribed on discharge. Factors that lowered the likelihood of referral included older age, female, receiving inpatient oxygen therapy, and the presence of chronic obstructive pulmonary disease (COPD) or anaemia. Conclusions: The rate of referral to CR following hospitalisation with HF is low. Shortfalls are particularly evident among females, older patients, and in those with COPD or anaemia. Future studies should focus on improving referral processes and translating proven strategies that increase referrals to CR into practice.
Collapse
Affiliation(s)
- Catherine Giuliano
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Correspondence:
| | - Don Vicendese
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia;
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC 3086, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
| | - Rebecca Lane
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 8001, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3216, Australia;
- Department of Cardiology, Austin Health, Melbourne, VIC 3084, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Katie Palmer
- Department of Physiotherapy, Monash Health, Melbourne, VIC 3175, Australia;
- School of Primary and Allied Health Care, Monash University, Frankston, VIC 3199, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
| | - Christopher Neil
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
Collapse
|
5
|
Epstein E, Patel N, Maysent K, Taub PR. Cardiac Rehab in the COVID Era and Beyond: mHealth and Other Novel Opportunities. Curr Cardiol Rep 2021; 23:42. [PMID: 33704611 PMCID: PMC7947942 DOI: 10.1007/s11886-021-01482-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review The COVID-19 pandemic has forced many center-based cardiac rehabilitation (CBCR) programs to close or limit their usual offerings. In order for patients to continue to benefit from CR, programs need to rapidly adapt to the current environment. This review highlights ways CR has evolved, and reviews the history of CR and recent advancements in telemedicine including remote patient monitoring, and mobile health that can be applied to CR. Recent Findings Despite that initial studies indicate that home-based CR (HBCR) is safe and effective, HBCR has faced several challenges that have prevented it from becoming more widely implemented. Many previous concerns can now be addressed through the use of new innovations in home-based healthcare delivery. Summary Since its inception, CR has become increasingly recognized as an important tool to improve patient mortality and quality of life in a broad range of cardiac diseases. While there has been little need to modify the delivery of CR since the 1950s, COVID-19 now serves as the necessary impetus to make HBCR an equal alternative to CBCR.
Collapse
Affiliation(s)
- Elizabeth Epstein
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Neeja Patel
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Kathryn Maysent
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Pam R. Taub
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| |
Collapse
|
6
|
Ribeiro F, Takahashi C, Vanzella LM, Laurino MJL, Lima IM, Silva VEDS, Silva JPLN, Valente HB, da Silva AKF, Christofaro DGD, Vanderlei LCM. An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac rehabilitation programs? Clin Rehabil 2020; 35:775-784. [PMID: 33292000 DOI: 10.1177/0269215520978499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study evaluated the capacity of cardiac risk stratification protocols on simple complications that occur during activities of a cardiovascular rehabilitation program. DESIGN Observational longitudinal cohort study. SETTING Outpatient clinic of cardiovascular rehabilitation. SUBJECT Patients diagnosed with cardiovascular disease and/or risk factors. INTERVENTIONS Not applicable. MAIN MEASURES The relationship between the cardiac risk classes of seven risk stratification protocols and the occurrence of simple complications (such angina, abnormal changes in blood pressure, arrhythmias, fatigue, muscle pain, pallor) was assessed using the chi-square test, and when statistical significance was observed, sensitivity, specificity and accuracy were determined. RESULTS About 76 patients were analyzed. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a statistically significant relationship between simple complications and cardiac risk classes (P-value = 0.046), however the results of sensitivity (0.53), specificity (0.52), and accuracy (0.53) were not significant. The other protocols analyzed were not significant: American College of Sports Medicine (P-value = 0.801), Brazilian Society of Cardiology (P-value = 0.734), American Heart Association (P-value = 0.957), Pashkow (P-value = 0.790), Society French Cardiology (P-value = 0.314), and Spanish Society of Cardiology (P-value = 0.078). CONCLUSION The AACVPR protocol showed a significant relationship between the risk classes and the occurrence of simple complications, however, the low values obtained for sensitivity, specificity and accuracy show that it is not useful for this purpose. CLINICAL TRIALS REGISTRATION NCT03446742.
Collapse
Affiliation(s)
- Felipe Ribeiro
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Carolina Takahashi
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Lais Manata Vanzella
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Maria Julia Lopez Laurino
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Isabelle Maina Lima
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Vitor Eduardo Dos Santos Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - João Pedro Lucas Neves Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Heloisa Balotari Valente
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Anne Kastelianne França da Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Diego Giulliano Destro Christofaro
- Department of Physical Education, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Luiz Carlos Marques Vanderlei
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| |
Collapse
|
7
|
Zinckernagel L, Ersbøll AK, Holmberg T, Pedersen SS, Timm HU, Zwisler AD. What are the prevalence and predictors of psychosocial healthcare among patients with heart disease? A nationwide population-based cohort study. BMJ Open 2020; 10:e037691. [PMID: 33040000 PMCID: PMC7549489 DOI: 10.1136/bmjopen-2020-037691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Psychosocial healthcare is recommended, but little is known about how patients perceive the level of care and whether subgroups of patients experience less psychosocial healthcare than others. We examined the prevalence of patient-reported psychosocial healthcare and factors predicting patient-reported lack of psychosocial healthcare among patients with heart disease. DESIGN A cohort study. SETTING Denmark, nationwide. PARTICIPANTS A registry-based random sample of 5000 patients with incident heart disease in 2013. MEASURES Patient-reported psychosocial healthcare was obtained from a survey and potential predictors before disease onset from registries. We used multivariable logistic regression analysis to determine predictors of patient-reported lack of care. RESULTS We received responses from 56%; 40% reported lacking information on psychosocial aspects, 51% lacking psychosocial rehabilitation and support and 32% reported lacking both types of psychosocial healthcare. The type of heart disease was the strongest predictor of patient-reported lack of psychosocial healthcare, especially among patients with atrial fibrillation (OR: 3.11-3.98). Older age (OR: 1.48-2.05), female gender (OR: 1.27-1.53) and no contact with general practitioner (OR: 1.47-1.84) also predicted patient-reported lack of psychosocial healthcare. Patients outside the labour force (OR: 1.29) and living in the capital region (OR: 1.50) more frequently reported lacking psychosocial rehabilitation and support, and patients with recent (OR: 1.63) or past (OR: 1.33) anxiety or depression and severe comorbidities (OR: 1.34) more frequently reported lacking both types of psychosocial healthcare. CONCLUSIONS Many patients with heart disease reported lacking psychosocial healthcare. Importantly, patients who most need psychosocial healthcare are not those who report receiving it. Our results call for action to translate guidelines into clinical practice.
Collapse
Affiliation(s)
- Line Zinckernagel
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Annette Kjær Ersbøll
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Teresa Holmberg
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, the University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Helle Ussing Timm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| |
Collapse
|
8
|
Interrater Reliability Across 7 Established Risk Stratification Protocols in Cardiac Rehabilitation. Arch Phys Med Rehabil 2020; 102:470-479. [PMID: 33035513 DOI: 10.1016/j.apmr.2020.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the interrater agreement among physiotherapists in using 7 risk stratification (RS) protocols to evaluate participants of cardiac rehabilitation (CR) and the main factors associated with disagreements that emerged during the RS process. DESIGN Cross-sectional observational study. SETTING Outpatient rehabilitation center. PARTICIPANTS Patients (N=72) enrolled in CR with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age was 65.62±12.14 y, and mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 29.18±4.56. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The main outcome was to the agreement between 2 physiotherapists in the patients' RS process, using 7 protocols established in the literature for use in CR: American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine, American Heart Association, Sociedade Brasileira de Cardiologia, Sociedad Española de Cardiología, and Société Française de Cardiologie. In addition, the main disagreement factors were assessed. RESULTS Interrater agreement was classified as moderate-to-good in the 7 included RS protocols (kappa index between 0.53-0.76). The most important aspects that led to disagreement between physiotherapists were reported in 5 categories. The protocol with the greater agreement index was the American College of Sports Medicine (93.10%; n=67), and the one with the greater disagreement was the American Association of Cardiovascular and Pulmonary Rehabilitation (27.80%; n=20). CONCLUSIONS Moderate-to-good interrater agreement among physiotherapists in using 7 RS protocols was observed. Major disagreements were the definition of abnormal hemodynamic responses, rhythm disorders, left ventricular dysfunction, and interpretation of the patient's clinical characteristics.
Collapse
|
9
|
|
10
|
Goodman JM, Marzolini S. Adding Life to Years in Cardiac Rehabilitation: Importance of Measuring Quality of Life. Can J Cardiol 2019; 35:235-237. [PMID: 30825946 DOI: 10.1016/j.cjca.2018.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada; University Health Network/Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada.
| | - Susan Marzolini
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; University Health Network/Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| |
Collapse
|
11
|
|
12
|
Kato J, Koike A, Kuroki K, Takayanagi Y, Takahashi M, Konno H, Sekiguchi Y, Nogami A, Aonuma K. Safety and efficacy of in-hospital cardiac rehabilitation following antiarrhythmic therapy for patients with electrical storm. J Cardiol 2019; 73:171-178. [DOI: 10.1016/j.jjcc.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/27/2018] [Accepted: 08/06/2018] [Indexed: 11/25/2022]
|
13
|
Santa-Clara H, Melo X, Willi R, Pinto R, Santos V, Almeida JP, Martins R, Clijsen R, Mendes M, Fernhall B. Energy expenditure during an exercise training session for cardiac patients. Appl Physiol Nutr Metab 2018; 43:292-298. [DOI: 10.1139/apnm-2017-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increasing energy expenditure (EE) in cardiac patients remains a challenge. Exercise approaches in cardiac rehabilitation/secondary prevention programs (CR/SP) have consistently resulted in minimal weight loss, due in part to the low exercise-related EE. The purpose of this study was to measure the EE among patients participating in a routine exercise session of Phase III maintenance CR/SP, where a recreational activity was introduced. Twelve overweight/obese male patients with coronary artery disease (aged 62.6 ± 8.5 years) had their total EE measured during a combined aerobic (circuit workout (ACW) and recreational activity) and resistance training (RT) session using a portable gas analyzer. Subjects were instructed to exercise at 60%–70% of heart rate reserve. Activity EE was calculated from total EE and resting EE. The duration of the session was 75.3 ± 1.5 min, of which 59.7 ± 8.8 min were above moderate intensity (3–6 METs). Activity EE was 309 ± 76 kcal, concurring to a total EE of 457 ± 80 kcal (3.9 ± 0.8 METs-h). ACW, recreational activity, and RT fulfilled 34.4% ± 6.4%, 25.0% ± 5.3%, and 14.2% ± 2.7% of the activity EE, respectively. Absolute intensities (METs) were significantly different between the RT (3.9 ± 1.0) and the ACW (6.9 ± 1.8) and recreational activity (5.9 ± 0.8). In conclusion, a combined aerobic and resistance training following standard exercise prescription practices, coupled with a recreational activity, is an effective tool to promote exercise above moderate intensity in male coronary artery disease patients. Clinicians can adopt concepts from recreational activity to develop CR/SP sessions.
Collapse
Affiliation(s)
- Helena Santa-Clara
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
| | - Xavier Melo
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
- Ginásio Clube Português, Lisboa, 1250-111, Portugal
| | - Romina Willi
- University College Physiotherapy Thim van der Laan, Health Department, Landquart, 7302, Switzerland
| | - Rita Pinto
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
| | - Vanessa Santos
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
| | - José P. Almeida
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
| | - Rodrigo Martins
- Faculdade de Motricidade Humana – Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana, Lisboa, 1499-002, Portugal
- Instituto Português do Desporto e Juventude, Lisboa, 1990-100, Portugal
| | - Ron Clijsen
- University College Physiotherapy Thim van der Laan, Health Department, Landquart, 7302, Switzerland
| | - Miguel Mendes
- Departamento de Cardiologia - Hospital de Santa Cruz/CHLO, Lisboa, 2790-134, Portugal
| | - Bo Fernhall
- College of Applied Health Sciences - University of Illinois at Chicago, Chicago, IL 60612, USA
| |
Collapse
|
14
|
Rosario MBD, Lovell NH, Fildes J, Holgate K, Yu J, Ferry C, Schreier G, Ooi SY, Redmond SJ. Evaluation of an mHealth-Based Adjunct to Outpatient Cardiac Rehabilitation. IEEE J Biomed Health Inform 2017; 22:1938-1948. [PMID: 29990228 DOI: 10.1109/jbhi.2017.2782209] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A pilot study was conducted to determine if a smartphone-based adjunct to standard care could increase the completion rate of a cardiac rehabilitation program (CRP). Based on historical completion rates, 66 participants who were about to commence a hospital-based CRP were randomized so that half received three devices embedded with near-field communication, namely, a smartphone [pre-installed with an application (app) designed specifically for cardiac rehabilitation], portable blood pressure monitor, and weight scale while completing the CRP. The completion rate among participants who were randomized to the intervention group was 88%, compared to 67% in the control group ( = 0.038). This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( 5/week) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP. No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP. A statistically significant correlation ( = 0.472; = 0.013) was found between the average time participants walked each day (as estimated via the smartphone app) and participants' six minute walking distance (6MWD) before they were discharged from the CRP (a clinically validated measurement).
Collapse
|
15
|
Ragupathi L, Stribling J, Yakunina Y, Fuster V, McLaughlin MA, Vedanthan R. Availability, Use, and Barriers to Cardiac Rehabilitation in LMIC. Glob Heart 2017; 12:323-334.e10. [PMID: 28302548 DOI: 10.1016/j.gheart.2016.09.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a cornerstone of secondary prevention of ischemic heart disease. It is critically important in low- and middle-income countries (LMIC), where the burden of ischemic heart disease is substantial and growing. However, the availability and utilization of CR in LMIC is not systematically known. OBJECTIVES This study sought to characterize the availability, use, and barriers to the use of CR. METHODS Electronic databases (Cochrane Library, EMBASE, PubMed, Web of Science) were searched from January 1, 1980 to May 31, 2013 for articles on CR in LMIC. Citations on availability, use, and/or barriers to CR were screened for inclusion by title, abstract, and full text. Data were summarized by region or country to determine the characteristics of CR in LMIC and gaps in the peer-reviewed biomedical publications. RESULTS Our search yielded a total of 5,805 citations, of which 34 satisfied full inclusion and exclusion criteria. The total number of CR programs available ranged from 1 in Algeria and Paraguay to 51 in Serbia. Referral rates for CR ranged from 5.0% in Mexico to 90.3% in Lithuania. Attendance rates ranged from 31.7% in Bulgaria to 95.6% in Lithuania, and CR attendance was correlated with higher educational background. The most commonly cited barrier to CR in LMIC was lack of physician referral. CONCLUSIONS Our results illustrate that the published reports reflects heterogeneity of CR availability and use in LMIC. Overall, CR is insufficiently available and underutilized. Further characterization of CR in LMIC, especially in Asia and Africa, is necessary to develop targeted strategies to improve availability and utilization. Patient, physician, and systems factors must be addressed to overcome barriers to participation in CR in LMIC.
Collapse
Affiliation(s)
- Loheetha Ragupathi
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Judy Stribling
- Samuel J. Wood Library, Weill Cornell Medical College, New York, NY, USA
| | - Yuliya Yakunina
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mary Ann McLaughlin
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
16
|
Tooth L, McKenna K. Contemporary Issues in Cardiac Rehabilitation: Implications for Occupational Therapists. Br J Occup Ther 2016. [DOI: 10.1177/030802269605900312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the acceptance of the beneficial effects of early mobilisation for patients after myocardial infarction, cardiac rehabilitation has undergone dramatic change. Highly structured and inflexible exercise programmes have given way to flexible and comprehensive modern programmes, which embrace the use of education, counselling and risk factor modification principles. Contemporary skills required by occupational therapists include being able to adapt services to a vast array of cardiac conditions, foster risk factor modification, enhance compliance, tailor education to learning and coping styles, assess the patient's level of risk and need for rehabilitation, and provide accelerated and alternate programmes. This article discusses the principles, directions and benefits of modern cardiac rehabilitation and the implications for occupational therapists.
Collapse
|
17
|
Santos AAS, Silva AKF, Vanderlei FM, Christofaro DGD, Gonçalves AFL, Vanderlei LCM. Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation. Braz J Phys Ther 2016; 20:298-305. [PMID: 27556385 PMCID: PMC5015671 DOI: 10.1590/bjpt-rbf.2014.0159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/26/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac risk stratification is related to the risk of the occurrence of events induced by exercise. Despite the existence of several protocols to calculate risk stratification, studies indicating that there is similarity between these protocols are still unknown. OBJECTIVE To evaluate the agreement between the existing protocols on cardiac risk rating in cardiac patients. METHOD The records of 50 patients from a cardiac rehabilitation program were analyzed, from which the following information was extracted: age, sex, weight, height, clinical diagnosis, medical history, risk factors, associated diseases, and the results from the most recent laboratory and complementary tests performed. This information was used for risk stratification of the patients in the protocols of the American College of Sports Medicine, the Brazilian Society of Cardiology, the American Heart Association, the protocol designed by Frederic J. Pashkow, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Société Française de Cardiologie, and the Sociedad Española de Cardiología. Descriptive statistics were used to characterize the sample and the analysis of agreement between the protocols was calculated using the Kappa coefficient. Differences were considered with a significance level of 5%. RESULTS Of the 21 analyses of agreement, 12 were considered significant between the protocols used for risk classification, with nine classified as moderate and three as low. No agreements were classified as excellent. Different proportions were observed in each risk category, with significant differences between the protocols for all risk categories. CONCLUSION The agreements between the protocols were considered low and moderate and the risk proportions differed between protocols.
Collapse
Affiliation(s)
- Ana A S Santos
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | - Anne K F Silva
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | - Franciele M Vanderlei
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | - Diego G D Christofaro
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, UNESP, Presidente Prudente, SP, Brazil
| | - Aline F L Gonçalves
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| | - Luiz C M Vanderlei
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
| |
Collapse
|
18
|
Prado DML, Rocco EA, Silva AG, Silva PF, Lazzari JM, Assumpção GL, Thies SB, Suzaki CY, Puig RS, Furlan V. The influence of aerobic fitness status on ventilatory efficiency in patients with coronary artery disease. Clinics (Sao Paulo) 2015; 70:46-51. [PMID: 25672429 PMCID: PMC4311117 DOI: 10.6061/clinics/2015(01)09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/12/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To test the hypotheses that 1) coronary artery disease patients with lower aerobic fitness exhibit a lower ventilatory efficiency and 2) coronary artery disease patients with lower initial aerobic fitness exhibit greater improvements in ventilatory efficiency with aerobic exercise training. METHOD A total of 123 patients (61.0±0.7 years) with coronary artery disease were divided according to aerobic fitness status into 3 groups: group 1 (n = 34, peak VO₂<17.5 ml/kg/min), group 2 (n = 67, peak VO₂>17.5 and <24.5 ml/kg/min) and group 3 (n = 22, peak VO₂>24.5 ml/kg/min). All patients performed a cardiorespiratory exercise test on a treadmill. Ventilatory efficiency was determined by the lowest VE/VCO₂ ratio observed. The exercise training program comprised moderate-intensity aerobic exercise performed 3 times per week for 3 months. Clinicaltrials.gov: NCT02106533 RESULTS: Before intervention, group 1 exhibited both lower peak VO2 and lower ventilatory efficiency compared with the other 2 groups (p<0.05). After the exercise training program, group 1 exhibited greater improvements in aerobic fitness and ventilatory efficiency compared with the 2 other groups (group 1: ▵ = -2.5±0.5 units; group 2: ▵ = -0.8±0.3 units; and group 3: ▵ = -1.4±0.6 units, respectively; p<0.05). CONCLUSIONS Coronary artery disease patients with lower aerobic fitness status exhibited lower ventilatory efficiency during a graded exercise test. In addition, after 3 months of aerobic exercise training, only the patients with initially lower levels of aerobic fitness exhibited greater improvements in ventilatory efficiency.
Collapse
Affiliation(s)
- Danilo M L Prado
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Enéas A Rocco
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Alexandre G Silva
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Priscila F Silva
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Jaqueline M Lazzari
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | | | - Sheyla B Thies
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Claudia Y Suzaki
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Raphael S Puig
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| | - Valter Furlan
- Cardiovascular Rehabilitation, Amil, Grupo Total Care, São Paulo, SP, Brazil
| |
Collapse
|
19
|
Lee CW, Wang JH, Hsieh JC, Hsieh TC, Wu YZ, Chen TW, Huang CH. Supervised Phase II Cardiac Exercise Therapy Shortens the Recovery of Exercise Capacity in Patients with Acute Myocardial Infarction. J Phys Ther Sci 2014; 26:1503-8. [PMID: 25276046 PMCID: PMC4175267 DOI: 10.1589/jpts.26.1503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/12/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effects of Phase II cardiac exercise therapy (CET) on
exercise capacity and changes in coronary risk factors (CRFs) of patients with acute
myocardial infarction (AMI). [Subjects] Thirty male subjects with AMI were divided into an
experimental group (EG) and a control group (CG). Another 30 age-matched subjects with
patent coronary arteries served as a normal-control group (NCG). [Methods] Subjects in EG
(n=20) trained using a stationary bicycle for 30 min at their target heart rate twice a
week for 8 weeks. Exercise capacity was defined as the maximal metabolic equivalents
(METs) that subjects reached during the symptom-limited maximal exercise test. HR, BP and
RPP were recorded. Subjects in EG and CG received exercise tests and screening for CRFs at
the beginning of, end of, and 3 months after Phase II CET, while subjects in NCG
participated only in the 1st test. [Results] METs of CG did not improve until the 3rd
test, while RPP at the 2nd test showed a significant increase. However, EG showed
increased METs at the 2nd test without increase of RPP, and increased their high density
lipoprotein cholesterol (HDL-C) during the follow-up period between the 2nd and 3rd tests.
[Conclusion] Phase II CET shortens the recovery time of exercise capacity, helps to
maintain the gained exercise capacity and increases HDL-C in phase III.
Collapse
Affiliation(s)
- Chih-Wei Lee
- Department of Physical Therapy, Tzu Chi University, Taiwan
| | - Ji-Hung Wang
- Division of Cardiology, Department of Medicine, Tzu-Chi Medical Center, Taiwan
| | - Jen-Che Hsieh
- Division of Cardiology, Department of Medicine, Tzu-Chi Medical Center, Taiwan
| | | | - Yu-Zu Wu
- Department of Physical Therapy, Tzu Chi University, Taiwan
| | - Tung-Wei Chen
- Physical Education Office, National Taipei University of Technology, Taiwan
| | | |
Collapse
|
20
|
Silva AKFD, Barbosa MPDCDR, Bernardo AFB, Vanderlei FM, Pacagnelli FL, Vanderlei LCM. Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols. Braz J Cardiovasc Surg 2014; 29:255-65. [PMID: 25140477 PMCID: PMC4389445 DOI: 10.5935/1678-9741.20140067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/21/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Gather and describe general characteristics of different protocols of risk stratification for cardiac patients undergoing exercise. METHODS We conducted searches in LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO electronic databases, using the following descriptors: Cardiovascular Disease, Rehabilitation Centers, Practice Guideline, Exercise and Risk Stratification in the past 20 years. RESULTS Were selected eight studies addressing methods of risk stratification in patients undergoing exercise. CONCLUSION None of the methods described could cover every situation the patient can be subjected to; however, they are essential to exercise prescription.
Collapse
Affiliation(s)
- Anne Kastelianne França da Silva
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, Presidente Prudente, SP, Brazil
| | | | - Aline Fernanda Barbosa Bernardo
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, Presidente Prudente, SP, Brazil
| | - Franciele Marques Vanderlei
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, Presidente Prudente, SP, Brazil
| | | | - Luiz Carlos Marques Vanderlei
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, Presidente Prudente, SP, Brazil
| |
Collapse
|
21
|
Lee CW, Wang JH, Hsieh JC, Hsieh TC, Huang CH. Effects of Combined Phase III and Phase II Cardiac Exercise Therapy for Middle-aged Male Patients with Acute Myocardial Infarction. J Phys Ther Sci 2014; 25:1415-20. [PMID: 24396201 PMCID: PMC3881468 DOI: 10.1589/jpts.25.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/07/2013] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To investigate the effects of cardiac exercise therapy (CET) on exercise
capacity and coronary risk factors (CRFs) of patients with acute myocardial infarction
(AMI). [Methods] Patients who participated in an 8-week supervised, hospital-based phase
II and 6-month home-based phase III CET with monthly telephone and/or home visits were
defined as the exercise group (EG) (n=20), while those who did not receive phase II or
phase III CET were defined as the no-exercise group (NEG) (n=10). CRFs were evaluated pre-
and post-phase II and eight months after discharge. One and two-way repeated measures
ANOVA were used to perform intra- and inter-group comparisons. [Results] Thirty men with
AMI aged 49.3 ± 8.3 years were studied. EG increased their exercise capacity (METs) (6.8 ±
1.6 vs.10.0 ± 1.9) after phase II CET and was able to maintain it at 8-month follow-up.
Both groups had significantly fewer persons who kept on smoking compared to the first
examination. High density lipoprotein cholesterol (HDL-C) increased from 38.1 ± 11.0 to
43.7 ± 8.7 mg/dl at follow-up in EG while no significant difference was noted in NEG.
[Conclusion] After phase III CET subjects had maintained the therapeutic effects of
smoking cessation, and increasing exercise capacity obtained in phase II CET. HDL-C in EG
continued to improve during phase III CET.
Collapse
Affiliation(s)
- Chih-Wei Lee
- Department of Physical Therapy, Tzu Chi University: 701 Zhongyang Rd., Sec 3, Hualien, 97004 Hualien, Taiwan
| | - Ji-Hung Wang
- Division of Cardiology, Department of Medicine, Tzu-Chi Medical Center, Taiwan
| | - Jen-Che Hsieh
- Division of Cardiology, Department of Medicine, Tzu-Chi Medical Center, Taiwan
| | | | - Chien-Hui Huang
- Department of Physical Therapy, Tzu Chi University: 701 Zhongyang Rd., Sec 3, Hualien, 97004 Hualien, Taiwan
| |
Collapse
|
22
|
Artham SM, Lavie CJ, Milani RV, Ventura HO. Value of weight reduction in patients with cardiovascular disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 12:21-35. [PMID: 20842479 DOI: 10.1007/s11936-009-0056-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OPINION STATEMENT Obesity is an independent risk factor for cardiovascular (CV) disease and contributes markedly to individual CV risk factors, including hypertension, diabetes mellitus, dyslipidemia, and other chronic conditions, such as osteoarthritis, obstructive sleep apnea, and physical deconditioning. Obesity, defined as a body mass index ≥30 kg/m(2), is associated with increased morbidity and mortality, particularly in severely obese patients with a body mass index ≥35 kg/m(2). Physical activity, healthy eating and behavioral modification are three pivotal approaches to treating obesity. Some individuals may benefit from pharmacologic agents to achieve meaningful weight loss. Unfortunately, there are few such agents at present with proven efficacy and safety profiles. In this review, we discuss the obesity epidemic and its detrimental effects on the CV system, and focus on exercise training and on established pharmacologic agents as well as those on the horizon. We conclude by summarizing the surgical therapeutic options available to treat obesity and the evidence supporting the CV benefits of surgery, and discuss the potential adverse effects of both pharmacologic and surgical options.
Collapse
Affiliation(s)
- Surya M Artham
- Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | | | | | | |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW Cardiac rehabilitation has been established as an effective treatment for patients with ischemic heart disease for many years. Despite this, utilization remains low. The purpose of this article is to review the latest research on the benefit, utilization, and implementation of cardiac rehabilitation. RECENT FINDINGS Recent research is supportive of the beneficial effects of cardiac rehabilitation in patients with heart failure as well as in older patients. Unfortunately, cardiac rehabilitation continues to be considerably underutilized with poor referral and enrollment rates. Implementing quality performance measures, automated referral systems, and the option of home-based cardiac rehabilitation for some patients may all help to increase participation. In addition, innovative exercise training regimens may help to enhance the beneficial effects of cardiac rehabilitation. SUMMARY Cardiac rehabilitation appears beneficial in an increasing array of cardiovascular diseases. Ongoing efforts to improve its use are essential for optimal disease management.
Collapse
|
24
|
Cole JA, Smith SM, Hart N, Cupples ME. Systematic review of the effect of diet and exercise lifestyle interventions in the secondary prevention of coronary heart disease. Cardiol Res Pract 2010; 2011:232351. [PMID: 21197445 PMCID: PMC3010651 DOI: 10.4061/2011/232351] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/03/2010] [Indexed: 11/29/2022] Open
Abstract
The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease (CHD) remains unclear. This systematic review aimed to determine their effectiveness and included randomized controlled trials of lifestyle interventions, in primary care or community settings, with a minimum follow-up of three months, published since 1990. 21 trials with 10,799 patients were included; the interventions were multifactorial (10), educational (4), psychological (3), dietary (1), organisational (2), and exercise (1). The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes. In trials that examined mortality and morbidity, significant benefits were reported for total mortality (in 4 of 6 trials; overall risk ratio (RR) 0.75 (95% confidence intervals (CI) 0.65, 0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63 (95% CI 0.47, 0.84)), and nonfatal cardiac events (5 of 9 trials; overall RR 0.68 (95% CI 0.55, 0.84)). The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult. However, the beneficial effects observed in this review are encouraging and should stimulate further research.
Collapse
Affiliation(s)
- Judith A. Cole
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Dunluce Health Centre, 1 Dunluce Avenue, Belfast BT9 7HR, UK
| | - Susan M. Smith
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, AMNCH, Tallaght, Dublin 24, Ireland
| | - Nigel Hart
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Dunluce Health Centre, 1 Dunluce Avenue, Belfast BT9 7HR, UK
| | - Margaret E. Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Dunluce Health Centre, 1 Dunluce Avenue, Belfast BT9 7HR, UK
| |
Collapse
|
25
|
|
26
|
Sandström L, Ståhle A. Rehabilitation of elderly with coronary heart disease – Improvement in quality of life at a low cost. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/14038190510010287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Ades PA, Savage PD, Toth MJ, Harvey-Berino J, Schneider DJ, Bunn JY, Audelin MC, Ludlow M. High-calorie-expenditure exercise: a new approach to cardiac rehabilitation for overweight coronary patients. Circulation 2009; 119:2671-8. [PMID: 19433757 DOI: 10.1161/circulationaha.108.834184] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND More than 80% of patients entering cardiac rehabilitation (CR) are overweight, and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change. METHODS AND RESULTS We performed a randomized controlled clinical trial to evaluate the effect of high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) compared with standard CR exercise (7 to 800 kcal/wk) on weight loss and risk factors in 74 overweight patients with coronary heart disease. Both groups were counseled for weight loss and taking evidence-based preventive medications. High-calorie-expenditure exercise resulted in double the weight loss (8.2+/-4 versus 3.7+/-5 kg; P<0.001) and fat mass loss (5.9+/-4 versus 2.8+/-3 kg; P<0.001) and a greater waist reduction (-7+/-5 versus -5+/-5 cm; P=0.02) than standard CR exercise at 5 months. High-calorie-expenditure exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the ratio of total to high-density lipoprotein cholesterol and components of the metabolic syndrome, more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased high-density lipoprotein cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to high-density lipoprotein cholesterol (each P<0.05). Significant weight loss was maintained at 1 year. CONCLUSIONS High-calorie-expenditure exercise promotes greater weight loss and more favorable cardiometabolic risk profiles than standard CR for overweight coronary patients.
Collapse
Affiliation(s)
- Philip A Ades
- Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Dolansky MA, Moore SM. Older adults' use of postacute and cardiac rehabilitation services after hospitalization for a cardiac event. Rehabil Nurs 2008; 33:73-81. [PMID: 18330386 DOI: 10.1002/j.2048-7940.2008.tb00207.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to describe older patients' use of postacute care (PAC) and outpatient cardiac rehabilitation (CR) services after a cardiac event and to describe the differences between older adults who use these services and those who do not. Under a longitudinal descriptive design, data were collected during hospitalization for a cardiac event, 3 and 6 weeks later, and 4 and 6 months later Of the 60 older adults in the sample, 73% used PAC after discharge. Older adults discharged home without PAC services had fewer complications and were less depressed than those who used PAC. Older adults discharged to a skilled nursing facility had poorer physical function both before the cardiac event and during hospitalization. Twenty-five percent participated in outpatient CR. Older adults who went to CR were male, had better physical function, and did not live alone. Understanding the use of PAC and CR services will help with discharge planning and customizing PAC and CR services for older adults to optimize cardiac recovery. The integration of CR principles into PAC may be an opportunity to enhance recovery for older adults, especially because only a small percentage of older adults attend CR.
Collapse
Affiliation(s)
- Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | | |
Collapse
|
29
|
Abstract
Using the disablement model, the authors examined the following questions in adults 70 years of age and older during the 6 weeks following hospitalization for a cardiac event: (a) What are the patterns in physical performance, self-report of functional limitations, and disability, and (b) to what extent does physical performance in the hospital and self-report of functional limitations pre-event predict 6-week disability? Data were collected before discharge and 3 and 6 weeks later on a sample of 60 older adults after a cardiac event. Results show that although the majority of participants improved in their objective physical performance, 70% self-reported no improvement or worsening. Physical performance during hospitalization is a better predictor of disability than a pre-event self-report of functional limitations, even when controlling for depression, gender, and comorbidity. Assessment of objective physical performance prior to discharge will help to identify older adults at risk for progressive disability.
Collapse
|
30
|
Abstract
The benefits of individualizing risk factor therapies and exercise protocols in patients participating in early outpatient cardiac rehabilitation are reviewed. Risk factor intervention modules for modifications of lipid abnormalities and obesity are outlined. Specific individualized exercise regimens are described for patients characterized by the presence of obesity, older age, intermittent claudication, and chronic heart failure, which provide favorable outcomes related to risk factor measures and physical functioning. With adoption and application of an individualized approach for cardiac rehabilitation patients, programs are evolving to become secondary prevention centers for patients with established coronary heart disease.
Collapse
Affiliation(s)
- Philip A Ades
- Cardiac Rehabilitation and Prevention, South Burlington, VT 05403, USA.
| |
Collapse
|
31
|
|
32
|
Sakuragi S, Takagi S, Suzuki S, Sakamaki F, Takaki H, Aihara N, Yasumura Y, Goto Y. Patients with large myocardial infarction gain a greater improvement in exercise capacity after exercise training than those with small to medium infarction. Clin Cardiol 2006; 26:280-6. [PMID: 12839046 PMCID: PMC6654408 DOI: 10.1002/clc.4950260608] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It remains unclear whether patients with large-size myocardial infarction (MI) achieve the same benefit from exercise training as do those with small- to medium-size MI. HYPOTHESIS This study was designed to determine the magnitude and mechanisms underlying improvement in exercise capacity in patients with large-size MI after cardiac rehabilitation. METHODS In all, 296 patients who participated in a cardiac rehabilitation program after acute MI were divided into two groups according to the peak serum creatine phosphokinase (CPK) level: the group with large infarction (Group 1) (> or = 5000 U/l peak CPK, 64 patients) and the group with less extensive infarction (Group 2) (< 5000 U/I, 232 patients). Exercise capacity was assessed before and after a 3-month cardiac rehabilitation program that included exercise training. RESULTS Before exercise training, both the peak work rate (p < 0.05) and peak oxygen uptake (VO2) (p < 0.01) were significantly lower in Group 1 than in Group 2. After exercise training, the changes in peak work rate and peak VO2 were significantly greater in Group 1 than in Group 2 (both p < 0.01). The infarction size measured by the peak CPK level correlated significantly with both the baseline exercise capacity and its improvement after exercise training, although these correlations were insignificant in a multivariate analysis. In the multivariate analysis, the improvement in exercise capacity is determined by age and baseline exercise capacity, which is determined by the duration of inactivity, minute ventilation (VE)/VCO2 slope and left ventricular end-diastolic pressure. CONCLUSIONS Compared with patients with small- to medium-size myocardial infarction, patients with large infarction gain a greater improvement in exercise capacity after exercise training due to reversal of physical deconditioning and improvement in congestive heart failure.
Collapse
Affiliation(s)
- Satoru Sakuragi
- Division of Cardiology, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Dolansky MA, Moore SM, Visovsky C. Older Adults' Views of Cardiac Rehabilitation Programs: Is it Time to Reinvent? J Gerontol Nurs 2006; 32:37-44. [PMID: 16502760 DOI: 10.3928/0098-9134-20060201-10] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In spite of the documented benefits of cardiac rehabilitation program (CRP) participation, older adults are not likely to participate. Older adults' expectations of and experiences with CRPs are not known. It is also not known whether women and men differ in their expectations and experiences. This descriptive study used a convenience sample of 40 older adults who had experienced an acute cardiac event to identify patients' views of CRPs. Focus groups revealed that older adults do not have an accurate understanding of what to expect in CRPs, and that older adults' experiences in CRPs were generally positive. Older adults suggested CRPs could be improved by including more socialization opportunities, offering varied forms of exercise, enhancing teaching about stress management, and adapting teaching strategies. In this study, "strength of physician referral" was identified as the main reason for participating or not participating in a CRP. Older men feared physical pain with exercise and older women expressed a need for emotional support. A major finding in this study was the report of adverse events (i.e., exhaustion, collapse) during exercise experienced by individuals who did not go to a CRP. Because the majority of adults participating in CRPs are older, transforming CRPs to meet the needs of these older adults is important. Future research on the effectiveness of alternative CRP models will provide evidence to ensure the delivery of quality, cost-effective care.
Collapse
Affiliation(s)
- Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | |
Collapse
|
34
|
Moore SM, Charvat JM, Gordon NH, Pashkow F, Ribisl P, Roberts BL, Rocco M. Effects of a CHANGE intervention to increase exercise maintenance following cardiac events. Ann Behav Med 2006; 31:53-62. [PMID: 16472039 DOI: 10.1207/s15324796abm3101_9] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event. PURPOSE The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designed to increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems. METHOD Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups. RESULTS Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08-2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity. CONCLUSIONS Counseling interventions that use contemporary behavior change strategies, such as the CHANGE intervention, can reduce the number of individuals who do not exercise following cardiac events.
Collapse
|
35
|
Hall JP, Wiseman VL, King MT, Ross DL, Kovoor P, Zecchin RP, Moir FM, Robert Denniss A. Economic evaluation of a randomised trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction. Heart Lung Circ 2006; 11:10-8. [PMID: 16352063 DOI: 10.1046/j.1444-2892.2002.00105.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although there have been a number of economic evaluations of cardiac rehabilitation after acute myocardial infarction (AMI), none has considered only low-risk patients or control groups with no rehabilitation at all. METHODS An economic evaluation was included in a randomised controlled trial of patients following uncomplicated AMI. Eligible patients were randomised to return to normal activities after 6 weeks of standard rehabilitation (REHAB, n = 70) or to early return to normal activities 2 weeks after AMI with no formal rehabilitation (ERNA, n = 72). Outcomes were assessed weekly for 6 weeks, then 3, 6 and 12 months post-AMI. Outcomes included four quality of life (QOL) measures (physical abilities, distress, usual/social activities, self-care) and four measures of return to normal activities (paid and unpaid return to any work and to pre-AMI level of work). Statistical analysis included repeated-measures regression (QOL outcomes) and survival analysis (work outcomes). RESULTS There were no statistically significant differences between the two groups in any of the outcomes measured or in the use of other health services. The net cost that could be saved by the health service by targeting rehabilitation to high-risk patients was approximately $300 (Australian, 1999) per low-risk patient. CONCLUSIONS Early return to normal activities without formal rehabilitation is cost-effective for low-risk patients.
Collapse
Affiliation(s)
- Jane P Hall
- Centre for Health Economics Research and Evaluation (CHERE), Sydney, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. OBJECTIVES We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation. Part I: predicting resource consumption. Med Care. 2005;43:844-855). RESEARCH DESIGN We considered all rehabilitation admissions from 5 Italian inpatient facilities during a 12-month period for which total cost of care had already been estimated and daily cost predicted through regression model. We ascertained recovery trends by impairment category through repeated MDS-PAC schedules and factorial analysis of functional status. We defined effective stay and daily resource consumption by impairment category and used these parameters to calculate reimbursement for the admission. We compared our reimbursement with predicted cost through regression analysis and evaluated the goodness of fit through residual analysis. RESULTS We calculated reimbursement for 2079 admissions. The r(2) values for the reimbursement to cost correlation ranged from 0.54 in the whole population to 0.56 for "multiple trauma" to 0.85 for "other medical disorders." The best fit was found in the central quintiles of the cost and severity distributions. CONCLUSION For each impairment category, we determined the number of days of effective hospital stay and the trends of functional gain. We demonstrated, at least within the Italian health care system, the feasibility of a reimbursement system that matches costs with functional recovery. By linking reimbursement to effective stay adjusted for trends of functional gain, we suggest it is possible to avoid both needless cuts and extensions of hospital admissions.
Collapse
Affiliation(s)
- Carlo Saitto
- Department of Epidemiology, Local Health Authority RME, Rome, Italy
| | | | | | | | | |
Collapse
|
37
|
Lavie CJ, Milani RV. Cardiac Rehabilitation and Exercise Training Programs in Metabolic Syndrome and Diabetes. ACTA ACUST UNITED AC 2005; 25:59-66. [PMID: 15818190 DOI: 10.1097/00008483-200503000-00001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Carl J Lavie
- Exercise LaboratoriesDepartment of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
38
|
Yu CM, Lau CP, Chau J, McGhee S, Kong SL, Cheung BMY, Li LSW. A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention. Arch Phys Med Rehabil 2005; 85:1915-22. [PMID: 15605326 DOI: 10.1016/j.apmr.2004.05.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the long-term effect of a cardiac rehabilitation and prevention program (CRPP) on quality of life (QOL) and its cost effectiveness. DESIGN Prospective, randomized controlled trial. SETTING University-affiliated outpatient cardiac rehabilitation and prevention center. PARTICIPANTS A total of 269 patients (76% men; mean age, 64+/-11 y) with recent acute myocardial infarction (AMI; n=193) or after elective percutaneous coronary intervention (PCI; n=76) were randomized in a ratio of 2 to 1. INTERVENTION Patients received either CRPP (an 8-wk exercise and education class in phase 2) or conventional therapy without exercise program (control group). They were followed until they had completed all 4 phases of the program (ie, 2 y). MAIN OUTCOME MEASURES QOL assessments, by using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Symptoms Questionnaire, were performed at the end of each phase. Direct health care cost was calculated, whereas cost utility was estimated as money spent (in US dollars) per quality-adjusted life-year (QALY) gained. RESULTS In the CRPP group, 6 of the 8 SF-36 dimensions improved significantly by phase 2 and were maintained throughout the study period. Patients were less anxious and depressed, and felt more relaxed and contented. In the control group, none of the SF-36 dimensions were improved by phase 2, and bodily pain was increased. In phase 4, only 4 dimensions were improved. Symptoms were unchanged except for increased hostility score. There was a significant gain in net time trade-off in the CRPP group after phase 2. The direct health care expenses in the CRPP and control groups were 15,292 dollars and 15,707 dollars per patient, respectively. Therefore, the cost utility calculated was 640 dollars saved per QALY gained. Savings attributable to CRPP were primarily explained by the lower rate (13% vs 26% of patients, chi2 test=3.9, P <.05) and cost of subsequent PCI (P =.01). CONCLUSIONS In an era of managing patients with coronary heart disease, a short-course CRPP was highly cost effective in providing better QOL to patients with recent AMI or after elective PCI. In addition, the improvement of QOL was quick and sustained for at least 2 years after CRPP.
Collapse
Affiliation(s)
- Cheuk-Man Yu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Cardiac rehabilitation was originally conceived to counteract the deconditioning and comorbidities associated with prolonged bed rest after a myocardial infarction. Contemporary cardiac rehabilitation has taken a more comprehensive approach, with a broader range of participating patients. Relevant cardiovascular outcomes of cardiac rehabilitation can be classified as primary clinical outcomes, intermediate clinical outcomes, and quality-of-life outcomes. In this article, the effects of exercise training alone and, more importantly, the value of comprehensive cardiac rehabilitation are reviewed from the point of view of individual cardiovascular outcomes.
Collapse
Affiliation(s)
- Philip A Ades
- Division of Cardiology, Department of Medicine, University of Vermont College of Medicine, Fletcher-Allen Health Care, Burlington, VT 05401, USA.
| | | | | |
Collapse
|
40
|
Barnason S, Zimmerman L, Nieveen J, Schmaderer M, Carranza B, Reilly S. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. Heart Lung 2003; 32:147-58. [PMID: 12827099 DOI: 10.1016/s0147-9563(03)00036-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients >/= 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization. DESIGN A randomized clinical trial with repeated measures was used. SAMPLE A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients. RESULTS HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P <.05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P <.01) and lower reported stress (t = 3.77, P <.01) at 3 months after surgery was reported by HCI subjects. CONCLUSIONS Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.
Collapse
Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing, Lincoln 68588-0620, USA
| | | | | | | | | | | |
Collapse
|
41
|
Moore SM, Dolansky MA, Ruland CM, Pashkow FJ, Blackburn GG. Predictors of women's exercise maintenance after cardiac rehabilitation. JOURNAL OF CARDIOPULMONARY REHABILITATION 2003; 23:40-9. [PMID: 12576911 DOI: 10.1097/00008483-200301000-00008] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Less than 50% of persons who participate in cardiac rehabilitation (CR) programs maintain an exercise regimen for as long as 6 months after completion. This study was conducted to identify factors that predict women's exercise following completion of a CR program. METHODS In this prospective, descriptive study, a convenience sample of 60 women were recruited at completion of a phase II CR program. Exercise was measured using a heart rate wristwatch monitor over 3 months. Predictor variables collected at the time of the subjects' enrollment were age, body mass index, cardiac functional status, comorbidity, muscle or joint pain, motivation, mood state, social support, self-efficacy, perceived benefits or barriers, and prior exercise. RESULTS Of women, 25% did not exercise at all following completion of a CR program and only 48% of the subjects were exercising at 3 months. Different predictors were found of the various dimensions of exercise maintenance. Predictors of exercise frequency were comorbidity and instrumental social support. Instrumental social support was the only predictor of exercise persistence. Comorbidity was the only predictor of exercise intensity. The only predictor of the total amount of exercise was benefits or barriers. CONCLUSIONS Interventions aimed at increasing women's exercise should focus on increasing their problem-solving abilities to reduce barriers to exercise and increase social support by family and friends. Because comorbidity was a significant predictor of exercise, women should be encouraged to use exercise techniques that reduce impact on muscles and joints (eg, swimming) or exercising for short periods several times a day.
Collapse
Affiliation(s)
- Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
| | | | | | | | | |
Collapse
|
42
|
Isla P, Jesús Gómez M, Gil D, Merino O, Roig C, Vivas E, Ortigosa L. Factores de riesgo y autovaloración del paciente en un primer episodio de cardiopatía isquémica. ENFERMERIA CLINICA 2003. [DOI: 10.1016/s1130-8621(03)73820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Daly J, Sindone AP, Thompson DR, Hancock K, Chang E, Davidson P. Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. PROGRESS IN CARDIOVASCULAR NURSING 2002; 17:8-17. [PMID: 11872976 DOI: 10.1111/j.0889-7204.2002.00614.x] [Citation(s) in RCA: 279] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.
Collapse
Affiliation(s)
- John Daly
- School of Nursing, Family and Community Health, College of Social and Health Sciences, University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia.
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Although Phase II Cardiac Rehabilitation (CR) is effective at reconditioning people following cardiac events, it has had limited effectiveness in assisting participants to maintain the long-term exercise necessary for secondary prevention of cardiovascular events. This article describes a promising new intervention, CHANGE (Change Habits by Applying New Goals and Experiences), designed to enhance individuals' problem solving, self-efficacy, and relapse prevention skills regarding long-term exercise. Five small-group, nurse-led sessions are used to provide the intervention during the last three weeks of the formal CR program, and at one and two months following CR. Pilot data indicate that the CHANGE intervention has a positive effect on number and length of exercise sessions, number of minutes exercised, and time spent in target heart rate (HR) zone as measured by wristwatch HR monitors for three months following CR. The CHANGE intervention was found to be acceptable to clients and feasible to clinicians.
Collapse
Affiliation(s)
- Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA.
| | | |
Collapse
|
45
|
Ferrand-Guillard C, Ledermann B, Kotzki N, Bénaïm C, Givron P, Messner-Pellenc P, Pélissier J. [Is it necessary to rehabilitate coronary artery disease patients based on ventilatory threshold?]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2002; 45:204-15. [PMID: 12020988 DOI: 10.1016/s0168-6054(02)00204-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To compare the efficiency of two programs of exercise-based rehabilitation that are different for heart rate (HR) training in patients with coronary artery disease: heart rate (HR) according to Karvonen formula (HR training =70% (max HR -rest HR) +rest HR) or HR recorded at the gas exchange ventilatory threshold (VT). TYPE: Controlled randomised clinical trial. SETTING Cardiovascular rehabilitation unit. METHOD Twenty-four male patients (54 +/-9.5 years old) with coronary artery disease were allocated at random to one of the two groups: KHR group (n =13) according to Karvonen formula (n =11), and VTHR group according to VT determined by exertion test (n =13). The exercised-based program was similar for all the patients, differing only in HR training (five daily sessions a week for four weeks). Assessment tests were performed at D1 and D28 and included: - an exercise test with measure of HR and double product (HR x blood pressure) at rest, submaximal and maximal intensity, with measure of oxygen consumption and gas exchanges at rest and at maximum exercise; - specific functional tests based on daily life activities; - dyspnea assessment at maximal intensity; - quality of life measurement by SF36. It was taken notice of the drugs taken by the patients, specially betablockers. RESULTS At inclusion, the two groups were not different for parametric (age, body mass index) and non parametric values (medical or surgical treatment, comorbidity). Even though HR training was significantly different (p <10(-6)), at the end of the program there was a significant increase of power and oxygen consumption at VT (+42.6%, p <10(-6); +18.6%, p <10(-5)) and at maximal intensity (+18.7 %, p <10(-6); 14.2 %, p <10(-5)), but differences between the two groups were not significant; double product was significantly lower at rest (-13.9 %, p <10(-5)) and at submaximal exertion (-10.6 %, p < 10(-3)). Yet, the two groups differed in HR, and HR increased in VTHR group and decreased in KHR, the difference being significant at VT (p =0.05), at submaximal (p =0.037) and maximal exercise (p = 0.05). Dyspnea at maximal intensity was higher in VTHR but SF36 values were not different. DISCUSSION AND CONCLUSION These results confirm the efficiency of cardiac training program according to Karvonen formula as to ventilatory threshold. However, there is a negative chronotropic effect of cardiac training according to Karvonen formula with a higher intensity, which corresponds to a less cardiac work for a same activity.
Collapse
Affiliation(s)
- C Ferrand-Guillard
- Unité de rééducation et réadaptation cardio-vasculaire, département de médecine physique et réadaptation, CHU Carémeau, 30029 cedex, Nîmes, France
| | | | | | | | | | | | | |
Collapse
|
46
|
Stuart CL, Marret J, Kelley GA, Nelson R. Predictors of physical activity in older adults in an independent living retirement community. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2002; 11:160-2, 191. [PMID: 11986528 DOI: 10.1111/j.1076-7460.2002.01116.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was undertaken to examine potential predictors of physical activity in older adults in an independent living retirement community. Participants received a self-developed questionnaire that included questions regarding age, gender, educational attainment, physical activity habits, and physicians' physical activity counseling habits. One hundred nine of 150 questionnaires (72.7%) were completed and returned. Multivariate regression analyses revealed that younger age (p=0.013), higher educational attainment (p=0.003), positive attitude toward physical activity (p=0.030), and receiving advice from a physician to be physically active (p=0.001) were all positive predictors of increased physical activity. The results demonstrate that younger age, higher educational attainment, a positive attitude toward physical activity, and receiving advice from a physician to be physically active result in increased physical activity levels of older adults in an independent living retirement community.
Collapse
Affiliation(s)
- Cheri L Stuart
- Department of Kinesiology, Northern Illinois University, De Kalb, IL, USA
| | | | | | | |
Collapse
|
47
|
Affiliation(s)
- P A Ades
- Department of Medicine, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, USA.
| |
Collapse
|
48
|
Brennan PF, Moore SM, Bjornsdottir G, Jones J, Visovsky C, Rogers M. HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. J Adv Nurs 2001; 35:699-708. [PMID: 11529972 DOI: 10.1046/j.1365-2648.2001.01902.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients' individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients' use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.
Collapse
Affiliation(s)
- P F Brennan
- Moehlman Bascan Professor of Nursing and Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Ades PA, Balady GJ, Berra K. Transforming exercise-based cardiac rehabilitation programs into secondary prevention centers: a national imperative. JOURNAL OF CARDIOPULMONARY REHABILITATION 2001; 21:263-72. [PMID: 11591040 DOI: 10.1097/00008483-200109000-00003] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P A Ades
- Division of Cardiology, Fletcher-Allen Health Care, University of Vermont College of Medicine, Burlington, VT, USA.
| | | | | |
Collapse
|
50
|
Mittag O, Kolenda KD, Nordman KJ, Bernien J, Maurischat C. Return to work after myocardial infarction/coronary artery bypass grafting: patients' and physicians' initial viewpoints and outcome 12 months later. Soc Sci Med 2001; 52:1441-50. [PMID: 11286367 DOI: 10.1016/s0277-9536(00)00250-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nonmedical factors play an important role in determining whether patients resume their work after myocardial infarction or CABG. The main questions dealt with in this study are: What is the respective basis of physicians' and patients' judgements as far as vocational disabilities are concerned, and what are the decisive factors that facilitate a prediction as to who will return to work and who will not? 132 male patients participating in a cardiac rehabilitation program served as subjects. The age group was limited to patients between 40 and 59 yr of age. The work situation 12 months following rehabilitation is known for 119 subjects; 74 had resumed their occupations. Results of regression analyses show that patients' and physicians' views on disabilities and re-employment are based on different factors. The physicians derive their estimates mainly from medical variables (cardiac status and comorbidity), whereas the patients' views are based on the overall health status, their former job status, job satisfaction, and negative incentives for the return to work. Three variables were found that allow a prediction to be made as to re-employment in 85% of all cases: (1) age, (2) patients' feelings about the extent to which they are disabled by their cardiac problem, and (3) the physicians' views on the extent to which the patient is vocationally disabled by his overall medical situation. Medical variables (e.g. cardiac status) had little relevance to re-employment. The results are discussed with regard to the consequences for cardiac rehabilitation.
Collapse
Affiliation(s)
- O Mittag
- ühlenberg-Klinik der LVA, Malente, Germany.
| | | | | | | | | |
Collapse
|