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Middleton WA, Savage PD, Khadanga S, Rengo JL, Ades PA, Gaalema DE. Anxiety Predicts Worse Cardiorespiratory Fitness Outcomes in Cardiac Rehabilitation for Lower Socioeconomic Status Patients. J Cardiopulm Rehabil Prev 2024; 44:162-167. [PMID: 38300271 PMCID: PMC11065622 DOI: 10.1097/hcr.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE The purpose of this study was to show that patients in cardiac rehabilitation (CR) with lower socioeconomic status (SES) have worse clinical profiles and higher rates of psychiatric difficulties and they have lower cardiorespiratory fitness (CRF) improvements from CR than their counterparts with higher SES. Improvement in CRF during CR predicts better long-term health outcomes. Research suggests that higher anxiety impairs CRF in structured exercise regimes and is overrepresented among patients with lower SES. However, no study has determined whether this relationship holds true in CR. METHODS This study is a secondary analysis of a randomized controlled trial to improve CR attendance among patients with lower SES. Anxiety (ASEBA ASR; Achenbach System of Empirically Based Assessment, Adult Self Report) and CRF measures (metabolic equivalent tasks [METs peak ]) were collected prior to CR enrollment and 4 mo later. Regression was used to examine the association of anxiety with CRF at 4 mo while controlling for other demographic and clinical characteristics. RESULTS Eight-eight participants were included in the analyses, 31% of whom had clinically significant levels of anxiety ( T ≥ 63). Higher anxiety significantly predicted lower exit CRF when controlling for baseline CRF, age, sex, qualifying diagnosis, and number of CR sessions attended ( β =-.05, P = .04). Patients with clinically significant levels of anxiety could be expected to lose >0.65 METs peak in improvement. CONCLUSIONS The results from this study suggest that anxiety, which is overrepresented in populations with lower SES, is associated with less CRF improvement across the duration of CR. The effect size was clinically meaningful and calls for future research on addressing psychological factor in CR.
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Affiliation(s)
- William A Middleton
- Author Affiliations: Vermont Center on Behavior and Health (Mr Middleton and Drs Ades and Gaalema) and Departments of Psychiatry (Dr Gaalema) and Psychology (Mr Middleton and Dr Gaalema), The University of Vermont (Messrs Savage and Rengo and Drs Khadanga and Ades), Burlington; and Division of Cardiology, The University of Vermont College of Medicine, Burlington (Drs Khadanga and Ades)
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Keteyian SJ, Steenson K, Grimshaw C, Mandel N, Koester-Qualters W, Berry R, Kerrigan DJ, Ehrman JK, Peterson EL, Brawner CA. Among Patients Taking Beta-Adrenergic Blockade Therapy, Use Measured (Not Predicted) Maximal Heart Rate to Calculate a Target Heart Rate for Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2023; 43:427-432. [PMID: 37311037 PMCID: PMC10615658 DOI: 10.1097/hcr.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Among patients in cardiac rehabilitation (CR) on beta-adrenergic blockade (βB) therapy, this study describes the frequency for which target heart rate (THR) values computed using a predicted maximal heart rate (HR max ), correspond to a THR computed using a measured HR max in the guideline-based heart rate reserve (HR reserve ) method. METHODS Before CR, patients completed a cardiopulmonary exercise test to measure HR max , with the data used to determine THR via the HR reserve method. Additionally, predicted HR max was computed for all patients using the 220 - age equation and two disease-specific equations, with the predicted values used to calculate THR via the straight percent and HR reserve methods. The THR was also computed using resting heart rate (HR) +20 and +30 bpm. RESULTS Mean predicted HR max using the 220 - age equation (161 ± 11 bpm) and the disease-specific equations (123 ± 9 bpm) differed ( P < .001) from measured HR max (133 ± 21 bpm). Also, THR computed using predicted HR max resulted in values that were infrequently within the guideline-based HR reserve range calculated using measured HR max . Specifically, 0 to ≤61% of patients would have had an exercise training HR that fell within the guideline-based range of 50-80% of measured HR reserve . Use of standing resting HR +20 or +30 bpm would have resulted in 100% and 48%, respectively, of patients exercising below 50% of HR reserve . CONCLUSIONS A THR computed using either predicted HR max or resting HR +20 or +30 bpm seldom results in a prescribed exercise intensity that is consistent with guideline recommendations for patients in CR.
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Affiliation(s)
| | | | - Crystal Grimshaw
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI
| | - Noah Mandel
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI
| | | | - Robert Berry
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI
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Arnar DO, Oddsson SJ, Gunnarsdottir T, Gudlaugsdottir GJ, Gudmundsson EF, Ketilsdóttir A, Halldorsdottir H, Hrafnkelsdottir TJ, Hallsson H, Amundadottir ML, Thorgeirsson T. Improving outpatient care for heart failure through digital innovation: a feasibility study. Pilot Feasibility Stud 2022; 8:242. [PMID: 36451212 PMCID: PMC9709356 DOI: 10.1186/s40814-022-01206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart failure (HF) affects over 26 million people worldwide. Multidisciplinary management strategies that include symptom monitoring and patient self-care support reduce HF hospitalization and mortality rates. Ideally, HF follow-up and self-care support includes lifestyle-change recommendations and remote monitoring of weight and HF symptoms. Providing these via a digital solution may be ideal for improving HF disease outcomes and reducing the burden on providers and healthcare systems. This study's main objective was to assess the feasibility of a digital solution including remote monitoring, lifestyle-change, and self-care support for HF outpatients in Iceland. METHODS Twenty HF patients (mean age 57.5 years, 80% males) participated in an 8-week study. They were provided with a digital solution (SK-141), including lifestyle-change and disease self-care support, a remote symptom monitoring system, and a secure messaging platform between healthcare providers and patients. This feasibility study aimed to assess patient acceptability of this new intervention, retention rate, and to evaluate trends in clinical outcomes. To assess the acceptability of SK-141, participants completed a questionnaire about their experience after the 8-week study. Participants performed daily assigned activities (missions), including self-reporting symptoms. Clinical outcomes were assessed with the Hospital Anxiety and Depression Scale and the Kansas City Cardiomyopathy Questionnaire at the study's beginning and end with an online survey. RESULTS Of the 24 patients invited, 20 were elected to participate. The retention rate of participants throughout the 8-week period was high (80%). At the end of the 8 weeks, thirteen participants completed a questionnaire about their experience and acceptability of the SK-141. They rated their experience positively including on questions whether they would recommend the solution to others (6.8 on a scale of 1-7), whether the solution had improved their life and well-being (5.7 on a scale of 1-7), and whether it was user friendly (5.5 on a scale of 1-7). Many of the clinical parameters studied exhibited a promising trend towards improvement over the 8-week period. CONCLUSION The digital solution, SK-141, was very acceptable to patients and also showed promising clinical results in this small feasibility study. These results encourage us to conduct a longer, more extensive, adequately powered, randomized-controlled study to assess whether this digital solution can improve the quality of life and clinical outcomes among HF patients.
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Affiliation(s)
- David O Arnar
- Cardiovascular Centre, Landspitali - The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland.
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | | | | | - Gudbjorg Jona Gudlaugsdottir
- Cardiovascular Centre, Landspitali - The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
| | | | - Audur Ketilsdóttir
- Cardiovascular Centre, Landspitali - The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
| | - Hulda Halldorsdottir
- Cardiovascular Centre, Landspitali - The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
| | - Thordis Jona Hrafnkelsdottir
- Cardiovascular Centre, Landspitali - The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Brawner CA, Pack Q, Berry R, Kerrigan DJ, Ehrman JK, Keteyian SJ. Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation. Am J Cardiol 2022; 175:139-144. [PMID: 35570164 PMCID: PMC9647718 DOI: 10.1016/j.amjcard.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to test the hypothesis that an individualized exercise training target heart rate (HR) based on a maximal graded exercise test (GXT) is associated with greater improvements in exercise tolerance during cardiac rehabilitation (CR) compared with no GXT. In this retrospective study, we identified patients who completed 9 to 36 visits of CR between 2001 and 2016, with a length of stay ≤18 weeks and a visit frequency of 1 to 3 days per week. Patients were grouped based on whether their exercise was guided by a target HR determined from a GXT. To assess the relation between GXT and change in exercise training metabolic equivalents of task (METs), we used generalized linear models adjusted for age, gender, race, referral reason, CR visits, CR frequency, METs at start, CR location, and year of participation. Out of 4,455 patients (37% female, 48% White, median age = 62 years), 53% were prescribed a target HR based on a GXT. Compared with no GXT, a GXT was associated with a significantly greater increase in covariate-adjusted METs during CR and percentage change from start (+0.44 METs [95% confidence interval [CI] 0.38 to 0.51] and +17% [95% CI 14% to 19%], respectively). In a sensitivity analysis limited to patients with 24 to 36 visits at ≥2 days per week (n = 1,319), a GXT was associated with a significantly greater increase in covariate-adjusted exercise training METs (+0.51 [95% CI 0.36 to 0.66]; +19% [95% CI 13% to 24%]). In conclusion, to maximize the potential increase in exercise capacity during CR, patients should undergo a GXT to determine an individualized exercise training target HR.
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Affiliation(s)
- Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
| | - Quinn Pack
- Division of Cardiovascular Medicine, Baystate Medical, Springfield, Massachusetts
| | - Robert Berry
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Dennis J Kerrigan
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
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Effect of Cardiac Rehabilitation Therapy Combined with WeChat Platform Education on Patients with Unstable Angina Pectoris after PCI. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7253631. [PMID: 35295174 PMCID: PMC8920656 DOI: 10.1155/2022/7253631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study is to explore the effect of cardiac rehabilitation therapy combined with WeChat platform education on patients with unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI). Methods Eighty-eight UAP patients undergoing PCI in our hospital from June 2018 to June 2021 were chosen as the study subjects and were grouped according to the intervention methods. Specifically, patients receiving routine treatment only were included as the control group (CG) and those receiving cardiac rehabilitation therapy combined with WeChat platform education based on the routine treatment were included as the study group (SG), with 44 cases in each group. The clinical efficacy was compared between the two groups after intervention. Results Compared with CG, SG achieved notably better biochemical indexes of TC, TG, FBG, FIB, LDL-c, and HDL-c after 12 months of intervention (P < 0.05), lower systolic pressure (SBP), and diastolic pressure (DBP) after intervention (P < 0.05), and higher scores of limited mobility, anginal stability, anginal frequency, subjective perception, treatment satisfaction, and total SAQ after 12 months of intervention (P < 0.05). The LVEF levels of both groups increased after intervention (P < 0.05), and the LVEF level was higher in SG than in CG (P < 0.05). The incidence of adverse cardiac events such as heart failure, ventricular arrhythmia, and sudden cardiac death was slightly higher in CG than in SG within 12 months of intervention, with no statistical difference (P > 0.05). The UAP recurrence rate and incidence of myocardial infarction in CG were obviously higher than those in SG (P < 0.05). Conclusion Cardiac rehabilitation therapy combined with WeChat platform education intervention measures for UAP patients after PCI can effectively control the biochemical indexes such as blood lipid and blood glucose, improve the cardiac function, stabilize the disease condition, lower the recurrence rate, and reduce the incidence of other cardiac adverse events.
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Ezzatvar Y, Izquierdo M, Núñez J, Calatayud J, Ramírez-Vélez R, García-Hermoso A. Cardiorespiratory fitness measured with cardiopulmonary exercise testing and mortality in patients with cardiovascular disease: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:609-619. [PMID: 34198003 PMCID: PMC8724619 DOI: 10.1016/j.jshs.2021.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is inversely associated with mortality in apparently healthy subjects and in some clinical populations, but evidence for the association between CRF and all-cause and/or cardiovascular disease (CVD) mortality in patients with established CVD is lacking. This study aimed to quantify this association. METHODS We searched for prospective cohort studies that measured CRF with cardiopulmonary exercise testing in patients with CVD and that examined all-cause and CVD mortality with at least 6 months of follow-up. Pooled hazard ratios (HRs) were calculated using random-effect inverse-variance analyses. RESULTS Data were obtained from 21 studies and included 159,352 patients diagnosed with CVD (38.1% female). Pooled HRs for all-cause and CVD mortality comparing the highest vs. lowest category of CRF were 0.42 (95% confidence interval (95%CI): 0.28-0.61) and 0.27 (95%CI: 0.16-0.48), respectively. Pooled HRs per 1 metabolic equivalent (1-MET) increment were significant for all-cause mortality (HR = 0.81; 95%CI: 0.74-0.88) but not for CVD mortality (HR = 0.75; 95%CI: 0.48-1.18). Coronary artery disease patients with high CRF had a lower risk of all-cause mortality (HR = 0.32; 95%CI: 0.26-0.41) than did their unfit counterparts. Each 1-MET increase was associated with lower all-cause mortality risk among coronary artery disease patients (HR = 0.83; 95%CI: 0.76-0.91) but not lower among those with heart failure (HR = 0.69; 95%CI: 0.36-1.32). CONCLUSION A better CRF was associated with lower risk of all-cause mortality and CVD. This study supports the use of CRF as a powerful predictor of mortality in this population.
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Affiliation(s)
- Yasmin Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia 46010, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Julio Núñez
- Department of Cardiology, Valencia University Hospital, Biomedical Research Institute (INCLIVA), Valencia 46010, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid 28029, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia 46010, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain; Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago 71783-5, Chile.
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Albert NM. Heart Failure is Everywhere: Insuring Diversity in Care Across Gender, Age, Race and Ethnicities. J Card Fail 2021; 27:722-723. [PMID: 34088385 DOI: 10.1016/j.cardfail.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Keteyian SJ, Grimshaw C, Brawner CA, Kerrigan DJ, Reasons L, Berry R, Peterson EL, Ehrman JK. A Comparison of Exercise Intensity in Hybrid Versus Standard Phase Two Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:19-22. [PMID: 33351540 PMCID: PMC7768817 DOI: 10.1097/hcr.0000000000000569] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare exercise training intensity during standard cardiac rehabilitation (S-CR) versus hybrid-CR (combined clinic- and remote home-/community-based). METHODS The iATTEND (improving ATTENDance to cardiac rehabilitation) trial is currently enrolling subjects and randomizing patients to S-CR versus hybrid-CR. This substudy involves the first 47 subjects who completed ≥18 CR sessions. Patients in S-CR completed all visits in a typical phase II clinic-based setting and patients in hybrid-CR completed up to 17 of their sessions remotely using telehealth (TH). Exercise training intensity in both CR settings is based on heart rate (HR) data from each CR session, expressed as percent HR reserve. RESULTS Among patients in both study groups, there were no serious adverse events or falls that required hospitalization during or within 3 hr after completing a CR session. Expressed as a percentage of HR reserve, the overall mean exercise training intensities during both the S-CR sessions and the TH-CR sessions from hybrid-CR were not significantly different at 63 ± 12% and 65 ± 10%, respectively (P = .29). CONCLUSION This study showed that hybrid-CR delivered using remote TH results in exercise training intensities that are not significantly different from S-CR.
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Affiliation(s)
- Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Crystal Grimshaw
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Clinton A. Brawner
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Dennis J. Kerrigan
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Lisa Reasons
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Robert Berry
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | - Edward L. Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Jonathon K. Ehrman
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
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Elgersma KM, Brown RJL, Salisbury DL, Stigen L, Gildea L, Larson K, Schorr EN, Kirk LN, Treat-Jacobson D. Adherence and exercise mode in supervised exercise therapy for peripheral artery disease. JOURNAL OF VASCULAR NURSING 2020; 38:108-117. [PMID: 32950111 DOI: 10.1016/j.jvn.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Supervised exercise therapy (SET) is a first-line treatment for people with peripheral artery disease (PAD). However, data on patient adherence to SET are limited. In addition, while intermittent treadmill exercise has been widely tested, no studies have investigated recumbent total body stepping (step-ex). We examined whether exercise mode (treadmill walking [n = 17], step-ex [n = 18], or a multimodal approach [n = 18]) affected adherence to a 12-week SET program. We also investigated the potential safety and viability of step-ex for people with PAD by looking at change in exercise training capacity (highest metabolic equivalent of tasks [METs] achieved and highest total MET-minutes achieved per session). The 53 participants comprised 50% female candidates (n = 26) and were (mean [SD]) 74.2 (8.3) years old, with an ankle-brachial index of 0.70 (0.19). Overall adherence to SET was 62%. There was a difference in adherence between groups (P = .022), with the multimodal group (73.6% [21.5%]) higher than the treadmill group (50.2% [28.8%], P = .010). Treadmill participants (n [%]) (8 [47.1%]) dropped out at a higher rate than the multimodal group (3 [16.7%], P = .053). All groups increased the exercise training capacity. The multimodal group achieved greater improvement in total MET-minutes achieved per session (61.5 [45.1]) than the treadmill group (14.7 [44.3]) (P = .008).A multimodal approach to PAD exercise therapy resulted in higher adherence and greater change in exercise training capacity. Step-ex was safe for people with PAD. While further study is warranted, it is appropriate for SET programs to consider a multimodal approach using step-ex, especially given the varied health and physical ability of the PAD population.
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Affiliation(s)
| | | | | | - Laurissa Stigen
- University of Minnesota, School of Nursing, Minneapolis, Minnesota
| | - Lois Gildea
- University of Minnesota, School of Nursing, Minneapolis, Minnesota
| | | | - Erica N Schorr
- University of Minnesota, School of Nursing, Minneapolis, Minnesota
| | - Laura N Kirk
- University of Minnesota, School of Nursing, Minneapolis, Minnesota
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Gerlach S, Mermier C, Kravitz L, Degnan J, Dalleck L, Zuhl M. Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis. Arch Phys Med Rehabil 2019; 101:690-699. [PMID: 31738893 DOI: 10.1016/j.apmr.2019.10.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/22/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. DATA SOURCE Databases were searched for randomized studies using single modality continuous exercise. STUDY SELECTION Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. DATA EXTRACTION Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). DATA SYNTHESIS There was a significant difference in effect size between studies that used cycling, Hedges' g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges' g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges' g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges' g=0.40 (95% CI, 0.09-0.71; k=4, P<.001). Conversely, among treadmill studies (n=9), FC was higher among CHF patients, Hedges' g=0.94 (95% CI, 0.23-1.65; k=2) compared to CAD, Hedges' g=0.33 (95% CI, 0.19-0.47; k=5; P<.01). CONCLUSIONS According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.
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Affiliation(s)
- Stephanie Gerlach
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; Department of Health, Physical Education and Recreation, Missouri Western State University, St. Joseph, MO.
| | - Christine Mermier
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - Len Kravitz
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - James Degnan
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM
| | - Lance Dalleck
- Recreation, Exercise and Sport Science Department, Western Colorado University, Gunnison, CO
| | - Micah Zuhl
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; School of Health Sciences, Central Michigan University, Mt. Pleasant, MI
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Piotrowicz E, Piotrowicz R, Opolski G, Pencina M, Banach M, Zaręba W. Hybrid comprehensive telerehabilitation in heart failure patients (TELEREH-HF): A randomized, multicenter, prospective, open-label, parallel group controlled trial-Study design and description of the intervention. Am Heart J 2019; 217:148-158. [PMID: 31654944 DOI: 10.1016/j.ahj.2019.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022]
Abstract
Guidelines recommend exercise training as a component of heart failure (HF) management. There are large disparities in access to rehabilitation and introducing hybrid comprehensive telerehabilitation (TR) consisting of remote monitoring of training in patients' homes might be an optimal solution in Poland. PURPOSE The primary objective of the TELEREH-HF trial is to determine whether introducing TR will significantly increase days alive and out of hospital compared with usual care. The secondary objectives including assessment the effects of TR compared to usual care on all-cause and cardiovascular mortality and all-cause, cardiovascular and HF hospitalization. The tertiary analyses include: evaluation of the safety, effectiveness, quality of life, depression, anxiety, patients' acceptance of and adherence to TR. METHODS The TELEREH-HF study is a randomized, multicenter, prospective, open-label, parallel group controlled trial in 850 HF patients after a hospitalization incident in NYHA I-III and LVEF≤40%. Patients were randomized to TR + usual care (TR group) or to usual care only (control group) and are followed for a maximum of 24 months. The TR group patients underwent a 9-week TR program consisting of an initial stage (1 week) conducted at hospital and a basic stage (8-week) home-based TR five times weekly. RESULTS All patients were randomized and completed initial intervention in the TR group. The follow up of both groups is in progress. CONCLUSION The TELEREH-HF trial will provide novel data on the effects of telerhabilitation on hospitalization and mortality in HF patients, and on safety, quality of life, depression, anxiety and acceptance of and adherence to this intervention.
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Haeny T, Nelson R, Ducharme J, Zuhl M. The Influence of Exercise Workload Progression Across 36 Sessions of Cardiac Rehabilitation on Functional Capacity. J Cardiovasc Dev Dis 2019; 6:jcdd6030032. [PMID: 31489917 PMCID: PMC6787655 DOI: 10.3390/jcdd6030032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022] Open
Abstract
Defining time frames throughout cardiac rehabilitation (CR) to progress exercise workloads may lead to improve functional capacity outcomes. The purpose of this study was to investigate the role of exercise progression on functional capacity among cardiac patients enrolled in CR. This was a retrospective database analysis study. Extracted data included: Demographic, functional capacity (in METs), and exercise intensity during exercise sessions 2, 12, 24, and 36 of CR from 150 patients who completed a 36-session program. Progression of exercise was determined by calculating percent change in treadmill exercise workload within predefined time frames of CR. The time frames were percent change from exercise session 2 to 12 (“%ΔS2–S12), 12 to 24 (%ΔS12–S24), and 24 to 36 (%ΔS24–S36). A multiple linear regression model was developed to predict change in functional capacity (ΔMETs). A significant proportion (21%) of total variation in ΔMETs was predicted by %ΔS2–12, %ΔS12–24, %ΔS24–36, age, sex, and body mass index (BMI). Percent changes between sessions 12 to 24 (%ΔS12–24; β = 0.17, p = 0.03) and 24 to 36 (%ΔS24–36; β = 0.23, p < 0.01) were significant predictors. Progressing patients between sessions 12 to 24 and 24 to 36 predicted significant changes in functional capacity and reinforced the importance of exercise progression across all 36 sessions of CR.
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Affiliation(s)
- Truman Haeny
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Rachael Nelson
- School of Health Sciences, Central Michigan University, Mt. Pleasant, MI 48859, USA.
| | - Jeremy Ducharme
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Micah Zuhl
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
- School of Health Sciences, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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