Factors influencing physical activity after cardiac surgery: An integrative review

Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors

BACKGROUND

Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery.

OBJECTIVE

This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined.

METHODS

Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights.

RESULTS

The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity.

CONCLUSIONS

Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.

Effects of daily sleep on physical activity after cardiac surgery

BACKGROUND

Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients.

OBJECTIVES

This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery.

METHODS

Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses.

RESULTS

Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time.

CONCLUSIONS

Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.

Feasibility of early digital health rehabilitation after cardiac surgery in the elderly: a qualitative study

BACKGROUND

Increasing numbers of elderly patients experience prolonged decreased functional capacity and impaired quality of life after seemingly successful cardiac surgery. After discharge from hospital, these patients experience a substantial gap in care until centre-based cardiac rehabilitation commences. They may benefit from immediate coaching by means of mobile health technology to overcome psychological and physiological barriers to physical activity. The aim of this study was to explore the usability, acceptability, and relevance of a mobile health application designed to support remote exercise-based cardiac rehabilitation of elderly patients early after cardiac surgery from the perspective of patients, their relatives, and physiotherapists.

METHODS

We adapted a home-based mobile health application for use by elderly patients early after cardiac surgery. Semi-structured dyadic interviews were conducted with a purposive sample of patients (n = 9), their spouses (n = 5), and physiotherapists (n = 2) following two weeks of the intervention. The transcribed interviews were analysed thematically.

RESULTS

Three themes were identified: 1) creating an individual fit by tailoring the intervention; 2) prioritizing communication and collaboration; and 3) interacting with the mobile health application. Overall, the findings indicate that the mobile health intervention has the potential to promote engagement, responsibility, and motivation among elderly patients to exercise early after surgery. However, the intervention can also be a burden on patients and their relatives when roles and responsibilities are unclear.

CONCLUSION

The mobile health intervention showed potential to bridge the intervention gap after cardiac surgery, as well as in fostering engagement, responsibility, and motivation for physical activity among elderly individuals. Nevertheless, our findings emphasize the necessity of tailoring the intervention to accommodate individual vulnerabilities and capabilities. The intervention may be improved by addressing a number of organizational and communicational issues. Adaptions should be made according to the barriers and facilitators identified in this study prior to testing the effectiveness of the intervention on a larger scale. Future research should focus on the implementation of a hybrid design that supplements or complements face-to-face and centre-based cardiac rehabilitation.

TRIAL REGISTRATION

Danish Data Protection Agency, Central Denmark Region (1-16-02-193-22, 11 August 2022).

A cross-sectional examination of post-myocardial infarction physical activity levels among US rural and urban residents: Findings from the 2017-2019 Behavioral Risk Factor Surveillance System

BACKGROUND

This study sought to examine the relationship between rural residence and physical activity levels among US myocardial infarction (MI) survivors.

METHODS

We conducted a cross-sectional study using nationally representative Behavioral Risk Factor Surveillance System surveys from 2017 and 2019. We determined the survey-weighted percentage of rural and urban MI survivors meeting US physical activity guidelines. Logistic regression models were used to examine the relationship between rural/urban residence and meeting physical activity guidelines, accounting for sociodemographic factors.

RESULTS

Our study included 22,732 MI survivors (37.3% rural residents). The percentage of rural MI survivors meeting physical activity guidelines (37.4%, 95% CI: 35.1%-39.7%) was significantly less than their urban counterparts (45.6%, 95% CI: 44.0%-47.2%). Rural residence was associated with a 28.8% (95% CI: 20.0%-36.7%) lower odds of meeting physical activity guidelines, with this changing to a 19.3% (95% CI: 9.3%-28.3%) lower odds after adjustment for sociodemographic factors.

CONCLUSIONS

A significant rural/urban disparity in physical activity levels exists among US MI survivors. Our findings support the need for further efforts to improve physical activity levels among rural MI survivors as part of successful secondary prevention in US high-MI burden rural areas.

An exploration of proactive health oriented symptom patterns in patients undergoing percutaneous coronary intervention with stent implantation: A mixed-methods study protocol

BACKGROUND

Coronary Heart Disease (CHD) is one of the most prevalent chronic diseases worldwide. Currently, percutaneous coronary intervention (PCI) with stent implantation is the main clinical treatment for CHD, and patients can achieve better outcomes after stenting. However, adverse cardiovascular events continue to recur, ultimately failing to yield good results. Several symptoms exist after stenting and are associated with health outcomes. Little is known about the symptom patterns of patients during the different postoperative periods. Therefore, this study aims to explore the dynamics of symptoms and clarify the experiences of post-stenting in patients during different periods, which may help the delivery of more specific patient management and improve survival outcomes in the future.

METHODS

A mixed method (quantitative/qualitative) design will be adopted. Longitudinal research, including surveys regarding three different periods, will be sued to describe the symptom patterns of patients undergoing PCI with stent implantation, clarifying their focused symptom problems during different time periods or in populations with different features. Qualitative individual interviews aim to understand the feelings, experiences, opinions, and health conditions of patients post-stenting, which can explain and supplement quantitative data. Quantitative data will be analyzed using descriptive statistics, latent class analysis (LCA), and latent translation analysis (LTA). Qualitative data will be analyzed using content analysis.

DISCUSSION

This study is the first study to explore the symptom patterns and experiences of patients in various domains after stent implantation using a novel design including quantitative and qualitative methods, which will help the delivery of more specific patient management, reduce the recurrence of adverse cardiovascular events, and improve survival outcomes in the future. It is also meaningful to use PROMIS profile-57 to help patients to proactively focus on their health problems, promote health literacy, and incorporate active patient participation into health management, which is a successful transition from passive medical treatment to active management.

The effect of preoperative rehabilitation on the prevention of postoperative ileus in colorectal cancer patients

PURPOSE

Previous research suggests that the preoperative rehabilitation of colorectal cancer patients can reduce postoperative ileus. However, the evidence is insufficient and further research is warranted. This study aimed to investigate whether short-term preoperative rehabilitation, both on an outpatient and inpatient basis, can reduce the incidence of postoperative ileus after colorectal cancer surgery.

METHODS

This was a retrospective cohort study that drew on data from multicenter electronic medical records. Patients with stage 1-3 colorectal cancer who underwent surgery and postoperative rehabilitation were included. The incidence of postoperative ileus was compared between patients who received short-term preoperative rehabilitation and those who did not. Propensity score adjustment using inverse probability weighting and subgroup analysis by type of surgery was performed.

RESULTS

Four thousand seventy-six eligible patients (43.4% female; mean age 75.1 ± 10.9 years) were included; 1914 (47.0%) received short-term preoperative rehabilitation. The preoperative rehabilitation group had a significantly lower incidence of postoperative ileus than the no preoperative rehabilitation group (pre-adjustment: 5.5% vs. 9.9%, p < 0.001; post-adjustment: 5.2% vs. 9.0%, p < 0.001). Therefore, preoperative rehabilitation was significantly associated with a lower incidence of postoperative ileus (OR: 0.554, 95% CI: 0.415-0.739, p < 0.001). In an adjusted analysis of surgery type subgroups, the incidence of postoperative ileus was significantly lower in the preoperative rehabilitation group for all types of surgery.

CONCLUSION

Our study showed that short-term preoperative rehabilitation for patients with stage 1-3 colorectal cancer, both with inpatients and outpatients, significantly reduces the incidence of postoperative ileus.

Mediating effect of kinesiophobia between self-efficacy and physical activity levels in post-CABG patients: protocol for a prospective, multicentre, cross-sectional study in China

INTRODUCTION

Physical activity (PA) can improve cardiac function, exercise capacity, and quality of life, in addition to reducing mortality by 20%-30% and preventing the recurrence of adverse cardiovascular events in patients following coronary artery bypass graft (CABG). However, PA levels are low in patients after CABG. This study intends to explore the mediating effect of kinesiophobia between self-efficacy and PA levels in patients following CABG.

METHODS AND ANALYSIS

The proposed study constitutes a prospective, multicentre and cross-sectional study comprising 413 patients. Four teaching hospitals with good reputations in CABG will be included in the study. All of them are located in Beijing, China, and provide medical service to the whole country. This study will assess the following patient-reported outcome measures: demographic information, International Physical Activity Questionnaire-Long, Social Support Rating Scale, Cardiac Exercise Self-Efficacy Instrument, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and Tampa Scale for Kinesiophobia Heart.

ETHICS AND DISSEMINATION

This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of The Sixth Medical Centre of PLA General Hospital (approval number: HZKY-PJ-2022-2). All study participants will provide written informed consent. Findings from this study will be published in Chinese or English for widespread dissemination of the results.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Register, ChiCTR2100054098.

Impact of minimally invasive mitral valve surgery on sexual dysfunction in male patients

Background

Sexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations.

Methods

Patients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire.

Results

There were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health.

Conclusions

In our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.

Factors influencing physical activity engagement following coronary artery bypass graft surgery: A mixed methods systematic review

BACKGROUND

Engagement in physical activity during the initial months following coronary artery bypass graft (CABG) surgery is important in order to improve health, quality of life and functional outcomes. There are, however, many potential barriers to physical activity engagement during the recovery period. No review studies have focused on barriers and facilitators to engagement in physical activity during the early stages of recovery following CABG surgery.

OBJECTIVE

To explore the factors that influence engagement in physical activity during the first three months following CABG surgery.

METHODS

Four electronic databases were searched. Extracted data from selected studies were synthesised using the Joanna Briggs Institute convergent integrated approach.

RESULTS

Nineteen studies met the inclusion criteria. Four main themes that influenced engagement were identified: sociodemographic variables; physical symptoms; psychosocial factors; and environmental factors. More barriers were identified than facilitating factors. Psychosocial factors were the most commonly reported barriers in the literature.

CONCLUSIONS

The findings of this review provide insights into factors that inhibit and facilitate engagement in physical activity following CABG surgery. Further research specifically exploring factors that influence engagement, especially facilitators, is required.