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Mierzyńska A, Jaworska I, Piotrowicz R, Kowalik I, Pencina M, Opolski G, Zareba W, Banach M, Orzechowski P, Główczynska R, Szalewska D, Pluta S, Kalarus Z, Irzmanski R, Piotrowicz E. The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial. J Clin Psychol Med Settings 2024; 31:403-416. [PMID: 38108961 DOI: 10.1007/s10880-023-09985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase-in the older group.Trial registry number NCT02523560 (Clinical Trials.gov), date of registration: August 14, 2015.
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Affiliation(s)
- Anna Mierzyńska
- National Institute of Cardiology, 04-628, Warsaw, Poland.
- Department of Cardiac Surgery, Military Institute of Medicine - National Research Institute, 04-141, Warsaw, Poland.
| | - Izabela Jaworska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Ryszard Piotrowicz
- National Institute of Cardiology, 04-628, Warsaw, Poland
- College of Rehabilitation, 01-234, Warsaw, Poland
| | - Ilona Kowalik
- National Institute of Cardiology, 04-628, Warsaw, Poland
| | - Michael Pencina
- Duke University's School of Medicine, Durham, NC, 27710, USA
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Wojciech Zareba
- University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, 90-419, Łódź, Poland
| | - Piotr Orzechowski
- Telecardiology Center, National Institute of Cardiology, 04-628, Warsaw, Poland
| | - Renata Główczynska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Dominika Szalewska
- Department of Rehabilitation Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Sławomir Pluta
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland
| | - Robert Irzmanski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, 90-419, Łódź, Poland
| | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, 04-628, Warsaw, Poland
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Nuraeni A, Suryani S, Trisyani Y, Sofiatin Y. Efficacy of Cognitive Behavior Therapy in Reducing Depression among Patients with Coronary Heart Disease: An Updated Systematic Review and Meta-Analysis of RCTs. Healthcare (Basel) 2023; 11:healthcare11070943. [PMID: 37046869 PMCID: PMC10094182 DOI: 10.3390/healthcare11070943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE The aim of this review is to identify the efficacy of cognitive behavior therapy (CBT) and the characteristics of CBT therapy that effectively improve depression among patients with coronary heart disease (CHD). METHODS Studies that assessed CBT efficacy in decreasing depression among CHD patients with randomized controlled trials (RCTs) were searched through PsycINFO, PubMed, CINAHL, Academic Search Complete, Scopus, and Google Scholar. Two reviewers independently screened and critically appraised them using the Cochrane risk-of-bias tool. The fixed- and random-effect models were applied to pool standardized mean differences. RESULTS Fourteen RCTs were included in the quantitative analysis. Depression was significantly lower in the CBT group (SMD -0.37; 95% CI: -0.44 to -0.31; p < 0.00001; I2 = 46%). Depression in the CBT group was significantly lower in the short-term follow-up (SMD -0.46; 95% CI: -0.69 to -0.23; p < 0.0001; I2 = 52%). Moreover, the subsequent therapy approaches were effective in reducing depression, including face-to-face and remote CBT, CBT alone or combination therapy (individual or mixed with a group), and frequent meetings. CONCLUSIONS CBT therapy effectively reduces depression, particularly in short-term follow-up. The application of CBT therapy in CHD patients should consider these findings to increase the efficacy and efficiency of therapy. Future research is needed to address generalizability.
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Affiliation(s)
- Aan Nuraeni
- Doctoral Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Suryani Suryani
- Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Yanny Trisyani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Yulia Sofiatin
- Department of Epidemiology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
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Freene N, McManus M, Mair T, Tan R, Davey R. Association of device-measured physical activity and sedentary behaviour with cardiovascular risk factors, health-related quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees with coronary heart disease. BMC Sports Sci Med Rehabil 2022; 14:169. [PMID: 36071477 PMCID: PMC9454132 DOI: 10.1186/s13102-022-00562-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022]
Abstract
Background Few studies have considered the relationship between risk factors, physical activity and sedentary behaviour in people with heart disease. Here we examine the independent relationship of device-measured physical activity and sedentary behaviour on risk factors, quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees. Methods Hospital-based phase II cardiac rehabilitation participants with coronary heart disease were assessed at the start and end of cardiac rehabilitation (6-weeks), 6 and 12-months. Physical activity (moderate-to-vigorous (MVPA), light-intensity (LIPA); min/day) and sedentary behaviour (min/day, bouts, breaks) were measured using an ActiGraph accelerometer. Risk factors included waist circumference, body mass index, systolic blood pressure (SBP), fasting blood lipid and glucose levels, anxiety and depression. Quality-of-life and exercise capacity were also collected. Associations were assessed with Generalized Estimating Equation modeling. Results Sixty-seven participants were included (mean age = 64 (SD 9) years; 81% male). An association was found between higher MVPA and lower high density lipoprotein (p ≤ 0.001). No significant (p ≤ 0.001) associations were found between sedentary behaviour variables and other outcomes. At p < 0.05 several associations were significant. Increased MVPA and LIPA were associated with decreased total cholesterol. Higher MVPA was associated with decreased SBP, whereas higher LIPA was associated with decreased waist circumference and body mass index. Higher sedentary behaviour bouts and breaks were associated with increased total cholesterol, anxiety and depression, and decreased SBP over time. Conclusions Any intensity of physical activity was associated with decreased total cholesterol. Increased LIPA was associated with improved measures of adiposity, while breaking up sedentary behaviour and increasing MVPA may decrease SBP over time. Further investigation of MVPA, LIPA and the distribution of sedentary behaviour is indicated in cardiac rehabilitation attendees to explore their relationship with risk factors. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx. Registered 22 September 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00562-7.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia. .,Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | | | - Tarryn Mair
- Exercise Physiology, Canberra Health Services, Garran, ACT, Australia
| | - Ren Tan
- Canberra Health Services, Garran, ACT, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
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Heimburg K, Cronberg T, Tornberg ÅB, Ullén S, Friberg H, Nielsen N, Hassager C, Horn J, Kjærgaard J, Kuiper M, Rylander C, Wise MP, Lilja G. Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Resusc Plus 2022; 11:100275. [PMID: 36164471 PMCID: PMC9508620 DOI: 10.1016/j.resplu.2022.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Limitations in physical function are common in cardiac arrest survivors. Age and gender are associated with limitations in physical function. Cognitive impairment is a predictive variable for physical limitations. Anxiety and depression symptoms are associated with physical limitations. Physical function should be addressed at follow-up after cardiac arrest.
Title Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Background Out-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. Aims To describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. Methods A cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results 287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. Conclusion Self-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registration ClinicalTrials.gov Identifier: NCT01946932.
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Tully PJ, Ang SY, Lee EJ, Bendig E, Bauereiß N, Bengel J, Baumeister H. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev 2021; 12:CD008012. [PMID: 34910821 PMCID: PMC8673695 DOI: 10.1002/14651858.cd008012.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression occurs frequently in individuals with coronary artery disease (CAD) and is associated with a poor prognosis. OBJECTIVES To determine the effects of psychological and pharmacological interventions for depression in CAD patients with comorbid depression. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases up to August 2020. We also searched three clinical trials registers in September 2021. We examined reference lists of included randomised controlled trials (RCTs) and contacted primary authors. We applied no language restrictions. SELECTION CRITERIA We included RCTs investigating psychological and pharmacological interventions for depression in adults with CAD and comorbid depression. Our primary outcomes included depression, mortality, and cardiac events. Secondary outcomes were healthcare costs and utilisation, health-related quality of life, cardiovascular vital signs, biomarkers of platelet activation, electrocardiogram wave parameters, non-cardiac adverse events, and pharmacological side effects. DATA COLLECTION AND ANALYSIS Two review authors independently examined the identified papers for inclusion and extracted data from the included studies. We performed random-effects model meta-analyses to compute overall estimates of treatment outcomes. MAIN RESULTS Thirty-seven trials fulfilled our inclusion criteria. Psychological interventions may result in a reduction in end-of-treatment depression symptoms compared to controls (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.92 to -0.19, I2 = 88%; low certainty evidence; 10 trials; n = 1226). No effect was evident on medium-term depression symptoms one to six months after the end of treatment (SMD -0.20, 95% CI -0.42 to 0.01, I2 = 69%; 7 trials; n = 2654). The evidence for long-term depression symptoms and depression response was sparse for this comparison. There is low certainty evidence that psychological interventions may result in little to no difference in end-of-treatment depression remission (odds ratio (OR) 2.02, 95% CI 0.78 to 5.19, I2 = 87%; low certainty evidence; 3 trials; n = 862). Based on one to two trials per outcome, no beneficial effects on mortality and cardiac events of psychological interventions versus control were consistently found. The evidence was very uncertain for end-of-treatment effects on all-cause mortality, and data were not reported for end-of-treatment cardiovascular mortality and occurrence of myocardial infarction for this comparison. In the trials examining a head-to-head comparison of varying psychological interventions or clinical management, the evidence regarding the effect on end-of-treatment depression symptoms is very uncertain for: cognitive behavioural therapy compared to supportive stress management; behaviour therapy compared to person-centred therapy; cognitive behavioural therapy and well-being therapy compared to clinical management. There is low certainty evidence from one trial that cognitive behavioural therapy may result in little to no difference in end-of-treatment depression remission compared to supportive stress management (OR 1.81, 95% CI 0.73 to 4.50; low certainty evidence; n = 83). Based on one to two trials per outcome, no beneficial effects on depression remission, depression response, mortality rates, and cardiac events were consistently found in head-to-head comparisons between psychological interventions or clinical management. The review suggests that pharmacological intervention may have a large effect on end-of-treatment depression symptoms (SMD -0.83, 95% CI -1.33 to -0.32, I2 = 90%; low certainty evidence; 8 trials; n = 750). Pharmacological interventions probably result in a moderate to large increase in depression remission (OR 2.06, 95% CI 1.47 to 2.89, I2 = 0%; moderate certainty evidence; 4 trials; n = 646). We found an effect favouring pharmacological intervention versus placebo on depression response at the end of treatment, though strength of evidence was not rated (OR 2.73, 95% CI 1.65 to 4.54, I2 = 62%; 5 trials; n = 891). Based on one to four trials per outcome, no beneficial effects regarding mortality and cardiac events were consistently found for pharmacological versus placebo trials, and the evidence was very uncertain for end-of-treatment effects on all-cause mortality and myocardial infarction. In the trials examining a head-to-head comparison of varying pharmacological agents, the evidence was very uncertain for end-of-treatment effects on depression symptoms. The evidence regarding the effects of different pharmacological agents on depression symptoms at end of treatment is very uncertain for: simvastatin versus atorvastatin; paroxetine versus fluoxetine; and escitalopram versus Bu Xin Qi. No trials were eligible for the comparison of a psychological intervention with a pharmacological intervention. AUTHORS' CONCLUSIONS In individuals with CAD and depression, there is low certainty evidence that psychological intervention may result in a reduction in depression symptoms at the end of treatment. There was also low certainty evidence that pharmacological interventions may result in a large reduction of depression symptoms at the end of treatment. Moderate certainty evidence suggests that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment. Evidence on maintenance effects and the durability of these short-term findings is still missing. The evidence for our primary and secondary outcomes, apart from depression symptoms at end of treatment, is still sparse due to the low number of trials per outcome and the heterogeneity of examined populations and interventions. As psychological and pharmacological interventions can seemingly have a large to only a small or no effect on depression, there is a need for research focusing on extracting those approaches able to substantially improve depression in individuals with CAD and depression.
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Affiliation(s)
- Phillip J Tully
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Ser Yee Ang
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Emily Jl Lee
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Eileen Bendig
- Department of Clinical Psychology and Psychotherapy Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy Institute of Psychology and Education, Ulm University, Ulm, Germany
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Factors Associated With Attendance at a 1-yr Post-Cardiac Rehabilitation Risk Factor Check. J Cardiopulm Rehabil Prev 2021; 40:E22-E25. [PMID: 31972633 DOI: 10.1097/hcr.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with coronary artery disease (CAD) often fail to maintain secondary prevention gains after completing cardiac rehabilitation (CR). Follow-up appointments aimed at assessing cardiac status and encouraging maintenance of health behaviors after CR completion are generally offered but not well-attended. This study explored patient characteristics and barriers associated with nonattendance at a 1-yr follow-up visit following CR completion. METHODS Forty-five patients with CAD who completed a 12-wk outpatient CR program but did not attend the 1-yr follow-up appointment were included. Participants responded to a survey consisting of open-ended questions about follow-up attendance, a modified version of the Cardiac Rehabilitation Barriers Scale, and self-report items regarding current health practices and perceived strength of recommendation to attend. Thematic analysis was used to derive categories from open-ended questionnaire responses. Linear regression was used to assess characteristics associated with appointment attendance barriers. RESULTS Barrier themes were as follows: (1) lack of awareness; (2) perception of appointment as unnecessary; (3) practical or scheduling issues; (4) comorbid health issues; and (5) anticipated an unpleasant experience at the appointment. Greater self-reported barriers (mean ± SD = 1.97/5.00 ± 0.57) were significantly associated with lower perceived strength of recommendation to attend the follow-up appointment (2.82/5.00 ± 1.45), P = .005. CONCLUSIONS Providing a stronger recommendation to attend, enhancing patient awareness, highlighting potential benefits, and supporting self-efficacy might increase 1-yr follow-up appointment attendance and, in turn, support long-term adherence to cardiovascular risk reduction behaviors.
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Changes in Physical Performance and Their Association With Health-Related Quality of Life in a Mixed Nonischemic Cardiac Population That Participates in Rehabilitation. J Cardiopulm Rehabil Prev 2021; 40:102-107. [PMID: 31033637 DOI: 10.1097/hcr.0000000000000416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Exercise-based cardiac rehabilitation improves physical performance and health-related quality of life (HRQoL). However, whether improvements in physical performance are associated with changes in HRQoL has not been adequately investigated in a nonischemic cardiac population. METHODS Patients who were ablated for atrial fibrillation, who underwent heart valve surgery or who were treated for infective endocarditis, and who participated in 1 of 3 randomized controlled rehabilitation trials were eligible for the current study. Change in physical performance and HRQoL were measured before and after a 12-wk exercise intervention. Physical performance was assessed using a cardiopulmonary exercise test, a 6-min walk test, and a sit-to-stand test. Health-related quality of life was assessed using the generic 36-Item Short Form Health Survey and the disease-specific HeartQoL questionnaire. Spearman correlation coefficient (ρ) and linear regressions quantified the association between changes in physical outcome measures and changes in HRQoL. RESULTS A total of 344 patients were included (mean age: 60.8 ± 11.6 yr and 77% males). Associations between changes in physical outcome measures and HRQoL ranged from very weak to weak (ρ = -0.056 to 0.228). The observed associations were more dominant within physical dimensions of the HRQoL compared with mental or emotional dimensions. After adjusting for sex, age, and diagnosis, changes in physical performance explained no more than 20% of the variation in the HRQoL. CONCLUSION The findings show that the positive improvement in HRQoL from exercise-based cardiac rehabilitation cannot simply be explained by an improvement in physical performance.
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Stevens D, Loffler KA, Buman MP, Dunstan DW, Luo Y, Lorenzi-Filho G, Barbe FE, Anderson CS, McEvoy RD. CPAP increases physical activity in obstructive sleep apnea with cardiovascular disease. J Clin Sleep Med 2021; 17:141-148. [PMID: 32951632 DOI: 10.5664/jcsm.8792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES Uncertainty exists over whether continuous positive airway pressure (CPAP) treatment improves moderate to vigorous physical activity levels in those with obstructive sleep apnea. We aimed to determine effects of CPAP on moderate to vigorous physical activity among participants with co-occurring cardiovascular disease and obstructive sleep apnea. METHODS The Sleep Apnea cardioVascular Endpoints (SAVE) trial recruited participants with confirmed cardiovascular disease history and obstructive sleep apnea, 45-75 years old. The 2,687 participants (1,346 randomized to CPAP plus usual care and 1,341 to usual care alone) were followed up for a mean of 3.7 years. Self-reported physical activity was recorded at baseline, 6, 24, and 48 months using the Godin-Shepard Leisure Time Exercise Questionnaire (LTEQ). We also determined effects on any limitation of physical activity reported on the physical functioning subscale of the 36-item short form questionnaire (SF-36) and proportions of participants reaching guideline recommended physical activity levels. RESULTS Among 2,601 participants with available data, those in the CPAP group reported significantly more physical activity compared to the usual care group, with approximately 20% higher reported moderate activities on the LTEQ during follow-up (adjusted mean 95% confidence interval) scores: 8.7, 7.5-9.9 vs 7.3, 6.1-8.5; P = .003). Those in the CPAP group also reported less limitation in physical activity (adjusted between-group difference in SF-36 physical functioning subscale score 1.66, 95% confidence interval 0.87-2.45; P < 0.001), and more reported sufficient levels of physical activity to meet recommendations. CONCLUSIONS CPAP has positive effects on improving physical activity levels, consistent with long-term health benefits. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea to Prevent Cardiovascular Disease (SAVE); URL: https://clinicaltrials.gov/ct2/show/NCT00738179; Identifier: NCT00738179; and Registry: Australian New Zealand Clinical Trials Registry; Name: Sleep Apnea cardioVascular Endpoints study-An investigation of continuous positive airway pressure for the treatment of obstructive sleep apnea to prevent cardiovascular disease; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83062&isReview=true; Identifier: ACTRN12608000409370.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, Victoria, Australia
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | | | - Ferran E Barbe
- Respiratory Department, IRBLleida, Catalonia, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute China, Health Science Center, Peking University, Beijing, China.,Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Sleep Health Service, Sleep and Respiratory Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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Sabe M, Kaiser S, Sentissi O. Physical exercise for negative symptoms of schizophrenia: Systematic review of randomized controlled trials and meta-analysis. Gen Hosp Psychiatry 2020; 62:13-20. [PMID: 31751931 DOI: 10.1016/j.genhosppsych.2019.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The negative symptoms of schizophrenia contribute strongly to functional impairment but are inadequately treated by antipsychotic medication. Several studies have suggested that physical exercise could reduce the negative symptoms. METHODS We conducted a systematic review and a meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of physical exercise interventions in improving the negative symptoms of schizophrenia using different databases and trial registries. RESULTS Seventeen RCTs were included in the meta-analysis (n = 954 patients). Overall, the results revealed a significant beneficial effect of physical exercise on negative symptoms. We conducted a subgroup analysis differentiating between aerobic interventions (12 RCTs) and non-aerobic interventions (5 RCTs). Aerobic exercise reduced negative and positive symptoms, while this was not the case for non-aerobic interventions. A sensitivity analysis including only studies with a low risk of bias confirmed the effect on negative but not on positive symptoms. CONCLUSION Aerobic exercise had a beneficial effect on negative symptoms, albeit with a small effect size. The conclusions are limited by the fact that the included studies did not assess patients for predominant or primary negative symptoms. Given the important role of exercise for physical health, the additional effects on negative symptoms are promising and justify further research to disentangle the effects on primary and secondary negative symptoms.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
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Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation. Curr Opin Organ Transplant 2019; 24:705-713. [PMID: 31689261 DOI: 10.1097/mot.0000000000000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk. RECENT FINDINGS Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors. SUMMARY Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
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Hickman IJ, Coran D, Wallen MP, Kelly J, Barnett A, Gallegos D, Jarrett M, McCoy SM, Campbell KL, Macdonald GA. ‘Back to Life’—Using knowledge exchange processes to enhance lifestyle interventions for liver transplant recipients: A qualitative study. Nutr Diet 2019; 76:399-406. [DOI: 10.1111/1747-0080.12548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Ingrid J. Hickman
- Department of Nutrition and DieteticsPrincess Alexandra Hospital Brisbane Queensland Australia
- Mater Research InstituteUniversity of Queensland Brisbane Queensland Australia
- Faculty of MedicineUniversity of Queensland Brisbane Queensland Australia
| | - Donna Coran
- School of Exercise and Nutrition SciencesQueensland University of Technology Brisbane Queensland Australia
| | - Matthew P. Wallen
- School of Human Movement and Nutrition SciencesUniversity of Queensland Brisbane Queensland Australia
| | - Jaimon Kelly
- Faculty of Health Sciences and MedicineBond University Gold Coast Queensland Australia
| | - Amandine Barnett
- Faculty of Health Sciences and MedicineBond University Gold Coast Queensland Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition SciencesQueensland University of Technology Brisbane Queensland Australia
| | - Maree Jarrett
- Queensland Liver Transplant ServicePrincess Alexandra Hospital Brisbane Queensland Australia
| | - Simone M. McCoy
- Department of Nutrition and DieteticsPrincess Alexandra Hospital Brisbane Queensland Australia
| | - Katrina L. Campbell
- Department of Nutrition and DieteticsPrincess Alexandra Hospital Brisbane Queensland Australia
- Faculty of Health Sciences and MedicineBond University Gold Coast Queensland Australia
| | - Graeme A. Macdonald
- Queensland Liver Transplant ServicePrincess Alexandra Hospital Brisbane Queensland Australia
- Faculty of MedicineUniversity of Queensland Brisbane Queensland Australia
- Department of Hepatology and GastroenterologyPrincess Alexandra Hospital Brisbane Queensland Australia
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Psychokardiologische Rehabilitation – interdisziplinäre Behandlung als Pilotprojekt. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-018-0292-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zhao F, Lin Y, Zhai L, Gao C, Zhang J, Ye Q, Zaslawski CJ, Ma F, Wang Y, Liang C. Effects of cardiac rehabilitation qigong exercise in patients with stable coronary artery disease undergoing phase III rehabilitation: A randomized controlled trial (with video). JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2018. [DOI: 10.1016/j.jtcms.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Olsen SJS, Schirmer H, Wilsgaard T, Bønaa KH, Hanssen TA. Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention. Eur J Prev Cardiol 2018; 25:1017-1025. [DOI: 10.1177/2047487318778088] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Anxiety and depression are related to coronary heart disease, and psychological support is recommended in cardiac rehabilitation. Purpose The aims of this study were: to compare the prevalence of anxiety and depression with respect to cardiac rehabilitation participation among patients who have been treated with percutaneous coronary intervention; to examine prevalence of anxiety and depression among percutaneous coronary intervention patients compared to the general population; and to identify predictors of symptomatic anxiety and depression among percutaneous coronary intervention patients. Methods We included 9013 patients undergoing first-time percutaneous coronary intervention. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale in a representative sample of 775 patients at baseline and after three years of follow-up, and in the entire cohort at three-year follow-up. Results Cardiac rehabilitation participants had more anxiety and depression than cardiac rehabilitation non-participants at baseline, and both groups had a more anxiety than the general population. The levels of anxiety and depression fell significantly during three years of follow-up, but the changes did not differ between cardiac rehabilitation participants and cardiac rehabilitation non-participants. Three years after percutaneous coronary intervention the prevalence of anxiety was 32% ( p < 0.001), higher among cardiac rehabilitation participants compared to cardiac rehabilitation non-participants. Female gender and younger age were associated with anxiety, whereas older age, lower levels of education and cardiovascular morbidity were associated with depression. Conclusion The levels of anxiety and depression were prevalent among percutaneous coronary intervention patients and the levels were not affected by cardiac rehabilitation participation. Anxiety is prevalent among female and younger patients, whereas depression is related to older age and cardiovascular co-morbidity.
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Affiliation(s)
- Siv JS Olsen
- Division of Internal Medicine, University Hospital of North Norway, Norway
- Cardiovascular Research Group, The Arctic University of Norway, Norway
| | - Henrik Schirmer
- Cardiovascular Research Group, The Arctic University of Norway, Norway
- Akershus University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, The Arctic University of Norway, Norway
| | - Kaare H Bønaa
- Department of Community Medicine, The Arctic University of Norway, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Clinic for Heart Disease, St Olavs University Hospital, Norway
| | - Tove A Hanssen
- Cardiovascular Research Group, The Arctic University of Norway, Norway
- Department of Heart Disease, University Hospital of North Norway, Norway
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