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Levitan EB, Goyal P, Ringel JB, Soroka O, Sterling MR, Durant RW, Brown TM, Bowling CB, Safford MM. Myocardial infarction and physical function: the REasons for Geographic And Racial Differences in Stroke prospective cohort study. BMJ PUBLIC HEALTH 2023; 1:e000107. [PMID: 37920711 PMCID: PMC10618954 DOI: 10.1136/bmjph-2023-000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Objective To examine associations between myocardial infarction (MI) and multiple physical function metrics. Methods Among participants aged ≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities of daily living (IADL), activities of daily living (ADL), gait speed, chair stands, and Short Form-12 physical component summary (PCS) were assessed after approximately 10 years of follow-up. We examined associations between MI and physical function (no MI [n = 9,472], adjudicated MI during follow-up [n = 288, median 4.7 years prior to function assessment], history of MI at baseline [n = 745], history of MI at baseline and adjudicated MI during follow-up [n = 70, median of 6.7 years prior to function assessment]). Models were adjusted for sociodemographic characteristics, health behaviours, depressive symptoms, cognitive impairment, body mass index, diabetes, hypertension, and urinary albumin to creatinine ratio. We examined subgroups defined by age, gender, and race. Results The average age at baseline was 62 years old, 56% were women, and 35% Black. MI was significantly associated with worse IADL and ADL scores, IADL dependency, chair stands, and PCS, but not ADL dependency or gait speed. For example, compared to participants without MI, IADL scores (possible range 0-14, higher score represents worse function) were greater for participants with MI during follow-up (difference: 0.37 [95% CI 0.16, 0.59]), MI at baseline (0.26 [95% CI 0.12, 0.41]), and MI at baseline and follow-up (0.71 [95% CI 0.15, 1.26]), p < 0.001. Associations tended to be greater in magnitude among participants who were women and particularly Black women. Conclusion MI was associated with various measures of physical function. These decrements in function associated with MI may be preventable or treatable.
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Affiliation(s)
- Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Madeline R. Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Raegan W. Durant
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C. Barrett Bowling
- Department of Veterans Affairs, Durham Geriatrics Research Education and Clinical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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Barrett KV, Savage PD, Ades PA. Effects of Behavioral Weight Loss and Weight Loss Goal Setting in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2020; 40:383-387. [PMID: 32694455 PMCID: PMC7647951 DOI: 10.1097/hcr.0000000000000510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Obesity is prevalent among participants in cardiac rehabilitation (CR). Establishing a weight loss goal is an important strategy for promoting weight loss. We evaluate the association between a pre-program weight loss goal and change in weight during CR. METHODS Body weight was measured at CR entry and at exit from CR. Overweight/obese participants were categorized as having: (1) established a weight loss goal and attended behavioral weight loss sessions (G + BWL); (2) set a weight loss goal but did not attend BWL (G); (3) and neither set a weight loss goal nor attended BWL (NoG). RESULTS The cohort consisted of 317 overweight/obese participants; 52 of whom set a weight loss goal and attended BWL, 227 patients set a goal but did not attend BWL, and 38 did neither. The G + BWL group lost more weight than the G group (-6.8 + 4.3 vs -1.1 + 3.5) (P < .0001). Both groups that established a weight loss goal lost more weight than the NoG group. CONCLUSIONS For overweight/obese individuals in CR, participating in BWL classes and setting a weight loss goal leads to more weight loss than G alone. Setting a weight loss goal alone leads to greater weight loss than not setting a weight loss goal.
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Affiliation(s)
- Kaitlyn V Barrett
- Divisions of Endocrinology, University of Vermont Medical Center, and Larner College of Medicine, University of Vermont, Burlington (Dr Barrett); and Divisions of Cardiology, University of Vermont Medical Center, and Larner College of Medicine, University of Vermont, Burlington (Mr Savage and Dr Ades)
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome. Korean Circ J 2019; 49:1066-1111. [PMID: 31646772 PMCID: PMC6813162 DOI: 10.4070/kcj.2019.0194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine-Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine-Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine-Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman's University, Seoul, Korea
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:248-285. [PMID: 31404368 PMCID: PMC6687042 DOI: 10.5090/kjtcs.2019.52.4.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/29/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul,
Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan,
Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine,
Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam,
Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon,
Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang,
Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong,
Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju,
Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju,
Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon,
Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon,
Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon,
Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon,
Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan,
Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan,
Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul,
Korea
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. Ann Rehabil Med 2019; 43:355-443. [PMID: 31311260 PMCID: PMC6637050 DOI: 10.5535/arm.2019.43.3.355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital. College of Medicine, The Catholic university of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine Kyungpook National University, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul, Korea
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Association of cognitive impairment and grip strength trajectories with mortality among middle-aged and elderly adults. Int Psychogeriatr 2019; 31:723-734. [PMID: 30298800 DOI: 10.1017/s1041610218001175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED ABSTRACTBackground:This study investigates whether maintaining high levels of cognitive impairment and weak grip strength will predict a higher risk for mortality. METHODS Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using longitudinal data analysis and included 5,812 research subjects. Our modeling approach jointly estimated multi-period trajectories of grip strength and cognitive impairment, and the primary analysis was based on Cox proportional hazards models. RESULTS A four-class linear solution fit the data best in both cognitive impairment and grip strength based on the model fitness, respectively. The hazard ratio (HR) of mortality in group 1 (consistently low) of cognitive impairment and of grip strength were 2.114 times higher (p-value 0.001) and 3.405 times higher (p-value <.0001) compared with group 3 (consistently high) and group 4 (consistently high), respectively. CONCLUSION This study provides insightful scientific evidence into the specificity of longitudinal changes in grip strength and cognitive impairment on mortality. Our findings suggest that declined cognitive ability and weak grip strength are predictors of mortality in older Korean people.
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Price KJ, Gordon BA, Gray K, Gergely K, Bird SR, Benson AC. Is Exercise Prescription in Cardiac Rehabilitation Influenced by Physical Capacity or Cardiac Intervention? J Aging Phys Act 2019; 27:633–641. [PMID: 30676215 DOI: 10.1123/japa.2018-0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation.
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Association Between Depressive Symptoms and Exercise Capacity in Patients With Heart Disease: A META-ANALYSIS. J Cardiopulm Rehabil Prev 2018; 37:239-249. [PMID: 27428818 DOI: 10.1097/hcr.0000000000000193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Depression and reduced exercise capacity are risk factors for poor prognosis in patients with heart disease, but the relationship between the 2 is unclear. We assessed the relationship between depressive symptoms and exercise capacity in patients with heart disease. METHODS PubMed, Cochrane Library, Google Scholar, and ProQuest databases were browsed for English-language studies published from January 2000 to September 2013. Studies including adult patients with coronary artery disease, heart failure, congenital heart disease, and implantable cardioverter defibrillator, reporting correlation between a depression scale and exercise capacity ((Equation is included in full-text article.)O2peak, peak watts, estimated metabolic equivalents, and incremental shuttle walk test distance), as well as studies from which such a correlation could be calculated and provided by the authors, were included. Correlation coefficients (CCs) were converted to Fischer z values, and the analysis was performed using a random-effects model. Then, summary effects and 95% CIs were converted back to CCs. RESULTS Fifty-nine studies (25 733 participants) were included. Depressive symptoms were inversely correlated to exercise capacity (CC = -0.15; 95% CI, -0.17 to -0.12). Heterogeneity was significant (I = 64%; P < .001). There was no evidence of publication bias (Fail-safe N = 4681; Egger test: P = .06; Kendall test: P = .29). CONCLUSIONS Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.
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Costa Filho AM, Mambrini JVDM, Malta DC, Lima-Costa MF, Peixoto SV. Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013). CAD SAUDE PUBLICA 2018; 34:e00204016. [DOI: 10.1590/0102-311x00204016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/25/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract: This study’s objective was to assess the contribution of selected chronic diseases to the prevalence of disability in elderly Brazilians, based on data from the National Health Survey (PNS 2013). Disability was defined as some degree of difficulty in performing ten activities, considering three levels: (i) without disability; (ii) disabled only in some instrumental activity of daily living (IADL); and (iii) disabled in some basic activity of daily living (BADL). The multinomial additive hazards model was the attribution method used to assess the contribution of each self-reported chronic condition (hypertension, diabetes, arthritis, stroke, depression, heart disease, and lung disease) to the prevalence of disability in this population, stratified by sex and age bracket (60 to 74 years and 75 or older). Study participants included 10,537 elderly Brazilians with a mean age of 70.0 years (SD = 7.9 years) and predominance of women (57.4%). Prevalence rates for disability in at least one IADL and at least one BADL were 14% (95%CI: 12.9; 15.1) and 14.9% (95%CI: 13.8; 16.1), respectively. In general, the contribution of chronic diseases to prevalence of disability was greater in younger elderly (60 to 74 years) and in the group with greatest severity (disabled in BADL), highlighting the relevance of stroke and arthritis in men, and arthritis, hypertension, and diabetes in women. This knowledge can help orient health services to target specific groups, considering age, sex, and current illnesses, aimed at preventing disability in the elderly.
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Dudzińska-Griszek J, Szuster K, Szewieczek J. Grip strength as a frailty diagnostic component in geriatric inpatients. Clin Interv Aging 2017; 12:1151-1157. [PMID: 28794619 PMCID: PMC5538538 DOI: 10.2147/cia.s140192] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients. PATIENTS AND METHODS The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination. RESULTS Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (β=0.239; P=0.001) and statin use (β=0.213; P=0.002) - and four independent measures were negatively associated with grip strength - female sex (β=-0.671; P<0.001), C-reactive protein (β=-0.253; P<0.001), prior myocardial infarction (β=-0.190; P=0.006) and use of an antidepressant (β=-0.163; P=0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; P=0.018). CONCLUSION Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.
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Affiliation(s)
- Joanna Dudzińska-Griszek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Karolina Szuster
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Bjarnason-Wehrens B, Grande G, Loewel H, Völler H, Mittag O. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes? ACTA ACUST UNITED AC 2016; 14:163-71. [PMID: 17446793 DOI: 10.1097/hjr.0b013e3280128bce] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ischaemic heart disease (IHD) has changed from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Most clinical studies during the past three decades have been conducted with men. Cardiac rehabilitation programmes were also developed with special regard to improving the rate of return to work in middle-aged men. The rehabilitation needs of older patients and women in particular have been largely neglected. The aim of this review is briefly to outline our present knowledge on gender issues in cardiac rehabilitation, and to specify barriers with regard to physical activities especially in (older) women. Coping with a cardiac event, women tend to minimize or play down the impact of their health situation and avoid burdening their social contacts. After a first cardiac event, women report greater psychological distress and lower self-efficacy and self-esteem. In addition, older age, lower exercise levels and reduced functional capacity or co-morbid conditions such as osteoporosis and urinary incontinence are barriers to physical activities in women with IHD. Recent studies on psychosocial intervention revealed less favourable results in women compared with men. These findings have not yet been well explained. This emphasizes our current lack of knowledge about the processes and determinants of successful psychosocial interventions in men and women with IHD. A large (European) trial on gender-specific coping styles, needs, and preferences of older women, and the effects of psychosocial intervention is proposed.
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Affiliation(s)
- Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany.
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Kirchberger I, Heier M, Amann U, Kuch B, Thilo C, Meisinger C. Variables associated with disability in male and female long-term survivors from acute myocardial infarction. Results from the MONICA/KORA Myocardial Infarction Registry. Prev Med 2016; 88:13-9. [PMID: 27002251 DOI: 10.1016/j.ypmed.2016.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
Abstract
Increasing attention is paid on functional limitations and disability among people with chronic diseases. However, only few studies have explored disability in persons with acute myocardial infarction (AMI). The objective of this study was to provide a description of disability and to identify determinants of disability in a population-based sample of long-term AMI survivors. The sample consisted of 1943 persons (35-85years) with AMI from the German population-based MONICA/KORA Myocardial Infarction Registry, who responded to a postal follow-up survey in 2011. Disability was assessed with the 12-item version of the World Health Organization Disability Schedule (WHODAS). Multivariate linear regression models were established in order to identify socioeconomic and clinical factors, risk factors and comorbidities which are associated with disability. The mean WHODAS score for the total sample was 7.86±9.38. The regression model includes 26 variables that explained 37.2% of the WHODAS variance. Most of the explained variance could be attributed to the presence of depression, female sex, joint disorders, digestive disorders, and stroke. Depression was the most important determinant of disability in both sexes. Replacement of single comorbidities by the total number of comorbidities resulted in a model with 15 variables explaining 31.9% of the WHODAS variance. Most of the variance was explained by the number of comorbidities. Further significant determinants of disability were female sex, low education level, angina pectoris, and no revascularization therapy. In AMI patients, the number of comorbidities and particularly the presence of depression are important determinants of disability and should be considered in post-AMI health care.
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Affiliation(s)
- Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
| | - Margit Heier
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Ute Amann
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Bernhard Kuch
- Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720 Nördlingen, Germany; Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156 Augsburg, Germany
| | - Christian Thilo
- Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156 Augsburg, Germany
| | - Christa Meisinger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
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Stefanick ML, Brunner RL, Leng X, Limacher MC, Bird CE, Garcia DO, Hogan PE, LaMonte MJ, Mackey RH, Johnson KC, LaCroix A, Robinson JG, Seguin RA, Tindle HA, Wassertheil-Smoller S. The Relationship of Cardiovascular Disease to Physical Functioning in Women Surviving to Age 80 and Above in the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2016; 71 Suppl 1:S42-53. [PMID: 26858324 DOI: 10.1093/gerona/glv087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is highly prevalent at ages 80 and above. The association of physical functioning (PF), a key to an optimal aging trajectory, with CVD and specific CVD diagnosis in women who survive to age 80 and above has not been described previously and has important public health significance given our aging population. METHODS Women's Health Initiative participants aged 80 years or older at the time of self-reporting PF (RAND SF-36) were studied in relationship to CVD diagnosis, whether present at study baseline (1993-1998) or diagnosed during follow-up through 2012. Cross-sectional analyses utilized demographic, medical, lifestyle, and psycho-social questionnaire data from baseline or updated at the time of self-reported PF. RESULTS Among 27,145 older Women's Health Initiative participants, 22.0% (N = 5,959) had been diagnosed with CVD, specifically: 11.3% (N = 3,071) with coronary heart disease; 4.7% (N = 1,279), stroke; 5.2% (N = 1,397), venous thromboembolism; 2.7% (N = 737), peripheral arterial disease; and 2.7% (N = 725), congestive heart failure. PF scores (mean ± SE) were significantly (p < .0001) higher without CVD (60.0 ± 26.9), compared with any CVD (47.9 ± 27.3), and for each specific CVD diagnosis: coronary heart disease (48.8 ± 27.1); stroke (44.8 ± 27.9); venous thromboembolism (48.9 ± 27.4); peripheral arterial disease (41.9 ± 2.2); and congestive heart failure (38.8 ± 26.1). Regardless of CVD diagnosis, higher PF was associated with: younger age at the time of PF assessment; lower body mass index; higher recreational physical activity; better self-reported general health; fewer hip fractures after age 55; no history of arthritis; and no recent use of non-steroidal anti-inflammatory drugs. CONCLUSIONS Older women with any CVD, and particularly women with congestive heart failure or peripheral arterial disease, reported significantly lower PF compared to women with no CVD. Regardless of CVD diagnosis, higher PF was strongly associated with a more active lifestyle and lower body mass index, suggesting potential intervention targets for more optimal aging.
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Affiliation(s)
- Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center and Department of Obstetrics & Gynecology, School of Medicine, Stanford University, California.
| | - Robert L Brunner
- Department of Family and Community Medicine, University of Nevada School of Medicine, Reno
| | - X Leng
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Marian C Limacher
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville
| | | | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson
| | - Patricia E Hogan
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo - SUNY, New York
| | - Rachel H Mackey
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea LaCroix
- Department of Family and Preventative Medicine, University of California San Diego, La Jolla, California
| | | | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithica, New York
| | - Hilary A Tindle
- Center for Research on Health Care, University of Pittsburgh, Pennsylvania
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Branco C, Viamonte S, Matos C, Magalhães S, Cunha I, Barreira A, Fernandes P, Torres S. Predictors of changes in functional capacity on a cardiac rehabilitation program. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Branco CFB, Viamonte S, Matos C, Magalhães S, Cunha I, Barreira A, Fernandes P, Torres S. [Predictors of changes in functional capacity on a cardiac rehabilitation program]. Rev Port Cardiol 2016; 35:215-24. [PMID: 27006062 DOI: 10.1016/j.repc.2015.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/20/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The effectiveness of cardiac rehabilitation programs (CRP) strongly influences the recovery of functional capacity (FC), resulting in improved prognosis and survival. OBJECTIVE To determine the cardiovascular risk factors that predict changes in FC in patients on CRP. METHODS We performed a cross-sectional descriptive retrospective study of patients who began a CRP between January 2008 and December 2013. The dependent variable was changes in FC estimated in metabolic equivalents (METs) achieved in stress testing at the beginning and end of the phase II program. The independent variables were age, gender, dyslipidemia, diabetes, smoking, body mass index, physical activity level and reason for referral to the CRP. RESULTS The sample included 1399 patients, of whom 1125 (80.4%) completed the program. FC improved in most patients (93%), with a mean gain of 1.45 ± 1.19 METs. Patients aged 45 -65 and over 65 years achieved a greater increase in FC compared with other age groups. Patients admitted to the CRP after coronary artery bypass graft surgery obtained a greater improvement in FC compared to patients with acute coronary syndrome. Non-diabetic patients benefited more than diabetic patients. No significant differences were seen between the groups in the other variables. CONCLUSION This study highlights the need for new and individualized approaches in certain subgroups of patients on CRP.
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Affiliation(s)
| | - Sofia Viamonte
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal.
| | - Carlos Matos
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
| | - Sandra Magalhães
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Cunha
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Barreira
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
| | - Preza Fernandes
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
| | - Severo Torres
- Unidade de Prevenção e Reabilitação Cardiovascular, Centro Hospitalar do Porto, Porto, Portugal
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Abstract
The field of quality-of-life (QOL) measurement grew out of attempts in the 1960s and 1970s to connect the ever-increasing levels of public expenditure on technology-based health care for chronic diseases with evidence of the benefits and harms to patients. Most of the concepts, methods, and standards for measuring QOL were derived from psychometrics, but the degree to which current tools adhere to these methods varies greatly. Despite the importance of QOL, patient-reported outcomes are not measured in most cardiovascular clinical trials. Lack of familiarity with QOL measures and their interpretation, and unrealistic expectations about the information these measures can provide, are obstacles to their use. Large clinical trials of revascularization therapy for coronary artery disease and medical treatments for heart failure show small-to-moderate QOL effects, primarily detected with disease-specific instruments. Larger treatment effects, seen in trials of device therapy for heart failure and ablation therapy for atrial fibrillation, have been detected with both generic and disease-specific instruments. A large gap remains between the parameters currently being measured in clinical research and the data needed to incorporate the 'patient's voice' into therapeutic decision-making.
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Affiliation(s)
- Daniel B Mark
- Duke Clinical Research Institute, 2400 Pratt Avenue, Room 0311, PO Box 17969, Durham, North Carolina 27715, USA
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Abstract
PURPOSE Exercise maintenance after completing phase II cardiac rehabilitation (CR) is challenging for many patients. A telephone-based maintenance intervention improved exercise participation compared with a control group at 12 months post-CR discharge. We examined the 6-month mediators of intervention effects on exercise. METHODS In a randomized controlled trial, 130 patients who had completed CR (mean age: 63.6 [SD = 9.7] years, 20.8% female) were randomized to Maintenance Counseling (n = 64) or Contact Control (n = 66). Putative mediators examined the following: self-efficacy, behavioral processes of change, decisional balance index, social support for exercise, and enjoyment of exercise. RESULTS Multiple mediation analyses showed that the intervention significantly increased social support from friends at 6 months but not the other constructs. Decreasing support from friends mediated greater exercise participation in Maintenance Counseling than in Contact Control at 12 months. CONCLUSIONS Social support from friends functioned as a suppressor mediator for exercise maintenance among cardiac patients.
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Affiliation(s)
- Bernardine M Pinto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and W. Alpert Medical School of Brown University, Providence, Rhode Island
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Skaggs BG, Yates BC. Functional Status and Search for Meaning After Percutaneous Coronary Intervention. West J Nurs Res 2014; 38:248-61. [PMID: 25512267 DOI: 10.1177/0193945914561129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine the differences in the search for meaning and functional status (psychological and physical) between persons who undergo percutaneous coronary intervention and have recurrent angina symptoms and those who do not have recurrent symptoms. Participants (224; 147 male, 77 female) who underwent PCI completed the following study materials: Meaning in Heart Disease instrument, Hospital Anxiety and Depression Scale, and SF36v2™. Persons with recurrent angina symptoms (40% of the sample) were more likely to have higher disrupted meaning, greater anxiety, greater depression, lower physical functioning, and greater use of meaning-based coping (searching for answers and refocusing global meaning) compared with individuals without recurrent symptoms. Interventions are needed to identify the risk of recurrent symptoms after percutaneous coronary intervention and provide coping and cognitive behavioral interventions focused on managing the psychological and physical disruptions.
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Affiliation(s)
- Brenda G Skaggs
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
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Effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes: a randomized clinical trial. Phys Ther 2014; 94:1720-30. [PMID: 25082918 DOI: 10.2522/ptj.20140097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Exercise training is effective for improving physical fitness and physical function in people with type 2 diabetes. However, limited research has been conducted on the optimal exercise training intensity for this population. OBJECTIVE The primary study objective was to investigate the effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes. DESIGN This was a randomized clinical trial. SETTING The setting was a university campus. PARTICIPANTS Twenty-one people with type 2 diabetes were randomly allocated to receive either moderate-intensity training (MOD group) or high-intensity training (HIGH group). INTERVENTION The MOD group performed resistance training at an intensity of 75% of the 8-repetition maximum (8-RM) and aerobic training at an intensity of 30% to 45% of the heart rate reserve (HRR). The HIGH group performed resistance training at an intensity of 100% of the 8-RM and aerobic training at an intensity of 50% to 65% of the HRR. MEASUREMENTS Muscle strength (peak torque [newton-meters]), exercise capacity (graded exercise test duration [minutes]), and physical function (Patient-Specific Functional Scale questionnaire) were measured at baseline and 3 months later. Acute exercise-induced changes in glucose levels were assessed immediately before exercise, immediately after exercise, and 1 hour after exercise during the first exercise training session. RESULTS Although both groups showed improvements in physical fitness and physical function, the between-group effect sizes were not statistically significant (exercise capacity estimated marginal mean [EMM] difference=2.1, 95% confidence interval [95% CI]=-0.2, 4.5; muscle strength EMM difference=20.8, 95% CI=-23.3, 65.0; and physical function EMM difference=0.1, 95% CI=-0.6, 0.9). Mean percent changes in glucose levels measured immediately before exercise and immediately after exercise, immediately after exercise and 1 hour after exercise, and immediately before exercise and 1 hour after exercise for the MOD group were -11.4%, -5.0%, and -15.8%, respectively; those for the HIGH group were -21.5%, 7.9%, and -15.3%, respectively. LIMITATIONS Sample size, lack of outcome assessor masking, and physical function measurement subjectivity were limitations. CONCLUSIONS Moderate- and high-intensity exercise training, as defined in this study, may lead to similar improvements in physical fitness and physical function in people with type 2 diabetes.
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Kirchberger I, Braitmayer K, Coenen M, Oberhauser C, Meisinger C. Feasibility and psychometric properties of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0) in a population-based sample of patients with myocardial infarction from the MONICA/KORA myocardial infarction registry. Popul Health Metr 2014. [DOI: 10.1186/s12963-014-0027-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chen CH, Chen YJ, Tu HP, Huang MH, Jhong JH, Lin KL. Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease. Kaohsiung J Med Sci 2014; 30:521-30. [PMID: 25438684 DOI: 10.1016/j.kjms.2014.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/06/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022] Open
Abstract
Cardiopulmonary exercise training is beneficial to people with coronary artery disease (CAD). Nevertheless, the correlation between aerobic capacity, and functional mobility and quality of life in elderly CAD patients is less addressed. The purpose of the current study is to investigate the beneficial effects of exercise training in elderly people with CAD, integrating exercise stress testing, functional mobility, handgrip strength, and health-related quality of life. Elderly people with CAD were enrolled from the outpatient clinic of a cardiac rehabilitation unit in a medical center. Participants were assigned to the exercise training group (N = 21) or the usual care group (N = 15). A total of 36 sessions of exercise training, completed in 12 weeks, was prescribed. Echocardiography, exercise stress testing, the 6-minute walking test, Timed Up and Go test, and handgrip strength testing were performed, and the Short-Form 36 questionnaire (SF-36) was administered at baseline and at 12-week follow-up. Peak oxygen consumption improved significantly after training. The heart rate recovery improved from 13.90/minute to 16.62/minute after exercise training. Functional mobility and handgrip strength also improved after training. Significant improvements were found in SF-36 physical function, social function, role limitation due to emotional problems, and mental health domains. A significant correlation between dynamic cardiopulmonary exercise testing parameters, the 6-minute walking test, Timed Up and Go test, handgrip strength, and SF-36 physical function and general health domains was also detected. Twelve-week, 36-session exercise training, including moderate-intensity cardiopulmonary exercise training, strengthening exercise, and balance training, is beneficial to elderly patients with CAD, and cardiopulmonary exercise testing parameters correlate well with balance and quality of life.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mao-Hsiung Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jing-Hui Jhong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Quinones PA, Seidl H, Holle R, Kuch B, Meisinger C, Hunger M, Kirchberger I. New potential determinants of disability in aged persons with myocardial infarction: results from the KORINNA-study. BMC Geriatr 2014; 14:34. [PMID: 24645907 PMCID: PMC3994968 DOI: 10.1186/1471-2318-14-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 03/14/2014] [Indexed: 11/13/2022] Open
Abstract
Background Elderly individuals with coronary heart disease are a population particularly burdened by disability. However, to date many predictors of disability established in general populations have not been considered in studies examining disability in elderly acute myocardial infarction (AMI) survivors. Our study explores factors associated with the ability to perform basic activities of daily living in elderly patients with AMI. Methods Baseline data from 333 AMI-survivors older than 64 years included within the randomized controlled KORINNA-study were utilized to examine disability assessed by the Stanford Health Assessment Questionare Disability Index (HAQ-DI). Numerous potential determinants including demographic characteristics, clinical parameters, co-morbidities, interventions, lifestyle, behavioral and personal factors were measured. Disability was defined as a HAQ-DI ≥ 0.5. After bi-variate testing the probability of disability was modeled with logistic regression. Missing covariate values were imputed using a Markov Chain Monte Carlo method. Results Disability was significantly more frequent in older individuals (Odds Ratio (OR): 1.10, 95% Confidence Interval (CI): 1.05-1.16), patients with deficient nutrition (OR: 3.38, 95% CI: 1.60-7.15), coronary artery bypass graft (CABG) (OR: 3.26, 95% CI: 1.29-8.25), hearing loss in both ears (OR: 2.85, 95% CI: 1.41-5.74), diabetes mellitus (OR: 2.56, 95% CI: 1.39-4.72), and heart failure (OR: 3.32, 95% CI: 1.79-6.16). It was reduced in patients with percutaneous transluminal coronary angioplasty (PTCA) (OR: 0.41, 95% CI: 0.21-0.80) and male sex (OR: 0.48, 95% CI: 0.27-0.85). Conclusions Effects of nutrition, hearing loss, and diametrical effects of PTCA and CABG on disability were identified as relevant for examination of causality in longitudinal trials. Trial registration ISRCTN02893746.
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Affiliation(s)
- Philip Andrew Quinones
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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Psychosocial outcomes of an exercise maintenance intervention after phase II cardiac rehabilitation. J Cardiopulm Rehabil Prev 2013; 33:91-8. [PMID: 23422351 DOI: 10.1097/hcr.0b013e3182825531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Maintenance of exercise after completing phase II cardiac rehabilitation (CR) is challenging for many patients. We offered a telephone-based maintenance intervention and found improvement in exercise participation in the intervention group at 12 months post-CR discharge. We examined the effects of the intervention on psychosocial outcomes. METHODS The effects of a home-based exercise maintenance intervention on psychosocial outcomes among patients who had completed phase II CR versus contact control were evaluated in a randomized controlled trial. Data were collected in 2005 to 2010 and analyzed in 2011. One hundred thirty patients (mean age = 63.6 [SD = 9.7] years, 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n = 64) or contact control (Contact Control group, n = 66). Maintenance Counseling group participants received exercise counseling (based on the transtheoretical model and social-cognitive theory) delivered via telephone for 6 months, as well as print materials and feedback reports. Assessments of depression, quality of life, and mental health were conducted at baseline, 6 months, and 12 months. RESULTS The Maintenance Counseling group reported statistically significant higher quality of life than the Contact Control group at 6 months (b = 0.29, SE = 0.08, P < .001) and 12 months (b = 0.27, SE = 0.09, P = .002). Intervention effects on depressive symptoms were significant at 12 months (b = -6.42, SE = 2.43, P = .009). Effects on overall mental health were nonsignificant at both followups. No significant moderators of treatment effects were found. CONCLUSION A telephone-based intervention that helped maintain exercise showed statistically significant improvements in quality of life and reduced depressive symptoms in this patient population.
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Marsh AP, Janssen JA, Ambrosius WT, Burdette JH, Gaukstern JE, Morgan AR, Nesbit BA, Paolini JB, Sheedy JL, Rejeski WJ. The Cooperative Lifestyle Intervention Program-II (CLIP-II): design and methods. Contemp Clin Trials 2013; 36:382-93. [PMID: 23974035 DOI: 10.1016/j.cct.2013.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 12/15/2022]
Abstract
A complication of cardiovascular disease (CVD) and the metabolic syndrome (MetS) among older adults is loss of mobility. The American Heart Association has identified weight management as a core component of secondary prevention programs for CVD and is an important risk factor for physical disability. The American Society for Nutrition and the Obesity Society have highlighted the need for long-term randomized clinical trials to evaluate the independent and additive effects of diet-induced weight loss (WL) and physical activity in older persons on outcomes such as mobility, muscle function, and obesity related diseases. Here we describe the rationale, design, and methods of a translational study, the Cooperative Lifestyle Intervention Program-II (CLIP-II). CLIP-II will randomize 252 obese, older adults with CVD or MetS to a weight loss only treatment (WL), aerobic exercise training (AT)+WL, or resistance exercise training (RT)+WL for 18 months. The dual primary outcomes are mobility and knee extensor strength. The interventions will be delivered by YMCA community partners with our staff as trainers and advisers. This study will provide the first large scale trial to evaluate the effects of diet-induced WL on mobility in obese, older adults with CVD or MetS as compared to WL combined with two different modes of physical activity (AT and RT). Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and RT+WL on muscle strength.
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Affiliation(s)
- Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA.
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Effects of community-based cardiac rehabilitation on body composition and physical function in individuals with stable coronary artery disease: 1.6-year followup. BIOMED RESEARCH INTERNATIONAL 2013; 2013:903604. [PMID: 23865071 PMCID: PMC3707214 DOI: 10.1155/2013/903604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/24/2013] [Indexed: 12/25/2022]
Abstract
Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR). Design. Thirty-four individuals (69.7 ± 8.2 years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance. Results. Participants attended 38.5 ± 30.3% sessions during 1.6 ± 0.2 year followup. A significant increase in 30-second chair stands (17.0 ± 4.7 to 19.6 ± 6.4, P < 0.001), body weight (75.8 ± 11.1 to 77.2 ± 12.1 kg, P = 0.001), and body fat (27.0 ± 9.5 to 29.1 ± 9.6%, P < 0.001) and a decline in handgrip strength (36.4 ± 9.4 to 33.0 ± 10.6 kg·f, P < 0.001) and muscle mass (40.8 ± 5.6 to 39.3 ± 5.8%, P < 0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes. Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.
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Kamiya K, Mezzani A, Hotta K, Shimizu R, Kamekawa D, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T. Quadriceps isometric strength as a predictor of exercise capacity in coronary artery disease patients. Eur J Prev Cardiol 2013; 21:1285-91. [DOI: 10.1177/2047487313492252] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kentaro Kamiya
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Kitasato University Hospital, Sagamihara, Japan
| | | | - Kazuki Hotta
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Ryosuke Shimizu
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Daisuke Kamekawa
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Chiharu Noda
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Kitasato University, Sagamihara, Japan
| | - Takashi Masuda
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Kitasato University, Sagamihara, Japan
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Social cognitive changes following weight loss and physical activity interventions in obese, older adults in poor cardiovascular health. Ann Behav Med 2013; 44:353-64. [PMID: 22773225 DOI: 10.1007/s12160-012-9390-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The study objectives were to determine (a) the effects of group-mediated cognitive-behavioral interventions on change in performance self-efficacy, satisfaction with function, and with appearance among older, overweight/obese adults in poor cardiovascular health and (b) whether self-efficacy mediated change in 400-m walk time. METHODS This translational, randomized controlled trial of physical activity and weight loss was conducted within community Cooperative Extension Centers. Participants were randomized to three intervention arms: Physical Activity, Weight Loss + Physical Activity, or a Successful Aging education control. RESULTS Across 18 months, the Weight Loss + Physical Activity intervention demonstrated greater improvements in self-efficacy, satisfaction with function, and appearance versus other trial arms. Physical Activity intervention participants also experienced significant improvements in self-efficacy and satisfaction with function versus those in Successful Aging. Self-efficacy mediated 400-m walk time at 18 months. CONCLUSIONS Both group-mediated cognitive-behavioral interventions yielded desirable improvements in social cognitions and preserved mobility improvements post-intervention.
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Mandic S, Walker R, Stevens E, Nye ER, Body D, Barclay L, Williams MJA. Estimating exercise capacity from walking tests in elderly individuals with stable coronary artery disease. Disabil Rehabil 2013; 35:1853-8. [DOI: 10.3109/09638288.2012.759629] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Busch JC, Lillou D, Wittig G, Bartsch P, Willemsen D, Oldridge N, Bjarnason-Wehrens B. Resistance and Balance Training Improves Functional Capacity in Very Old Participants Attending Cardiac Rehabilitation After Coronary Bypass Surgery. J Am Geriatr Soc 2012; 60:2270-6. [DOI: 10.1111/jgs.12030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John C. Busch
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
| | - Dorothea Lillou
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | - Godehard Wittig
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | - Petra Bartsch
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | | | - Neil Oldridge
- School of Medicine and Public Health; University of Wisconsin; Milwaukee Wisconsin
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Center; Milwaukee Wisconsin
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
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Lee DTF, Choi KC, Chair SY, Yu DSF, Lau ST. Psychological distress mediates the effects of socio-demographic and clinical characteristics on the physical health component of health-related quality of life in patients with coronary heart disease. Eur J Prev Cardiol 2012; 21:107-16. [DOI: 10.1177/2047487312451541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diana Tze Fan Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Doris Sau Fung Yu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Dodson JA, Arnold SV, Reid KJ, Gill TM, Rich MW, Masoudi FA, Spertus JA, Krumholz HM, Alexander KP. Physical function and independence 1 year after myocardial infarction: observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry. Am Heart J 2012; 163:790-6. [PMID: 22607856 PMCID: PMC3359897 DOI: 10.1016/j.ahj.2012.02.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) may contribute to health status declines including "independence loss" and "physical function decline." Despite the importance of these outcomes for prognosis and quality of life, their incidence and predictors have not been well described. METHODS We studied 2,002 patients with AMI enrolled across 24 sites in the TRIUMPH registry who completed assessments of independence and physical function at the time of AMI and 1 year later. Independence was evaluated by the EuroQol-5D (mobility, self-care, and usual activities), and physical function was assessed with the Short Form-12 physical component score. Declines in ≥1 level on EuroQol-5D and >5 points in PCS were considered clinically significant changes. Hierarchical, multivariable, modified Poisson regression models accounting for within-site variability were used to identify predictors of independence loss and physical function decline. RESULTS One-year post AMI, 43.0% of patients experienced health status declines: 12.8% independence loss alone, 15.2% physical function decline alone, and 15.0% both. After adjustment, variables that predicted independence loss included female sex, nonwhite race, unmarried status, uninsured status, end-stage renal disease, and depression. Variables that predicted physical function decline were uninsured status, lack of cardiac rehabilitation referral, and absence of pre-AMI angina. Age was not predictive of either outcome after adjustment. CONCLUSIONS >40% of patients experience independence loss or physical function decline 1 year after AMI. These changes are distinct but can occur simultaneously. Although some risk factors are not modifiable, others suggest potential targets for strategies to preserve patients' health status.
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Affiliation(s)
- John A Dodson
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Affiliation(s)
- Mireille Landry
- Physiotherapist and Exercise Coordinator Women's Cardiovascular Health Initiative, Women's College Hospital; Lecturer (status-only), Department of Physical Therapy, University of Toronto Toronto, ON
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Pinto BM, Goldstein MG, Papandonatos GD, Farrell N, Tilkemeier P, Marcus BH, Todaro JF. Maintenance of exercise after phase II cardiac rehabilitation: a randomized controlled trial. Am J Prev Med 2011; 41:274-83. [PMID: 21855741 PMCID: PMC3160619 DOI: 10.1016/j.amepre.2011.04.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/10/2011] [Accepted: 04/05/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events. PURPOSE The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated. DESIGN An RCT was used to evaluate the intervention. Data were collected in 2005-2010 and analyzed in 2010. SETTING/PARTICIPANTS One hundred thirty patients (mean age=63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66). INTERVENTION Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the transtheoretical model and social cognitive theory) delivered via telephone, as well as print materials and feedback reports. MAIN OUTCOME MEASURES Assessments of physical activity (7-Day Physical Activity Recall), motivational readiness for exercise, lipids, and physical functioning were conducted at baseline, 6 months, and 12 months. Objective accelerometer data were collected at the same time points. Fitness was assessed via maximal exercise stress tests at baseline and 6 months. RESULTS The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months (difference of 80 minutes, 95% CI=22, 137). Group differences in exercise at 6 months were nonsignificant. The intervention significantly increased the probability of participants' exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months. Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months. No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months. CONCLUSIONS A telephone-based intervention can help maintain exercise, prevent regression in motivational readiness for exercise, and improve physical functioning in this patient population.
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Affiliation(s)
- Bernardine M Pinto
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, One Hoppin Street, Providence RI 02903, USA.
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Rejeski WJ, Mihalko SL, Ambrosius WT, Bearon LB, McClelland JW. Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program. J Gerontol B Psychol Sci Soc Sci 2011; 66:279-86. [PMID: 21292809 PMCID: PMC3078758 DOI: 10.1093/geronb/gbq104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 12/09/2010] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Using the weight efficacy lifestyle questionnaire (WEL), we examined whether a group-mediated intervention for weight loss among older, obese adults resulted in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss. METHODS This was a randomized controlled design, and 288 older adults received 1 of 3 treatments for 6 months: physical activity only (PA), weight loss + physical activity (WL + PA), or a successful aging (SA) health education program. The WEL was administered prior to randomization and again at the 6-month follow-up visit. RESULTS A significant treatment effect was observed for the WEL, F (2249) = 15.11, p < .0001, partial eta2 = .11, showing that improvement occurred only in the WL + PA group as compared with PA and SA. Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss. DISCUSSION These results illustrate that WL + PA can be effective in improving older adults' self-efficacy for the self-regulation of eating behavior and that these changes are prospectively related to the amount of weight loss. Further research is warranted on an expanded concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults.
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Affiliation(s)
- W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, P.O. Box 7868, Winston-Salem, NC 27109, USA.
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Impact of Cardiac Rehabilitation on the Ability of Elderly Cardiac Patients to Perform Common Household Tasks. J Cardiopulm Rehabil Prev 2011; 31:100-4. [DOI: 10.1097/hcr.0b013e3181f1fd8c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Tu C. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung 2010; 38:364-76. [PMID: 19755186 DOI: 10.1016/j.hrtlng.2009.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group). METHODS A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS. RESULTS Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use. CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, Lincoln, 68588-0220, USA
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Giallauria F, Vigorito C, Tramarin R, Fattirolli F, Ambrosetti M, De Feo S, Griffo R, Riccio C, Piepoli M. Cardiac rehabilitation in very old patients: data from the Italian Survey on Cardiac Rehabilitation-2008 (ISYDE-2008)--official report of the Italian Association for Cardiovascular Prevention, Rehabilitation, and Epidemiology. J Gerontol A Biol Sci Med Sci 2010; 65:1353-61. [PMID: 20667934 DOI: 10.1093/gerona/glq138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Using data from the Italian SurveY on carDiac rEhabilitation-2008 (ISYDE-2008), this study provides insight into the level of implementation of cardiac rehabilitation (CR) in very old cardiac patients. METHODS Data from 165 CR units were collected online from January 28 to February 10, 2008. RESULTS The study cohort consisted of 2,281 patients (66.9 ± 11.8 years): 1,714 (62.4 ± 9.6 years, 78% male) aged<75 years and 567 aged ≥ 75 years (80.8 ± 4.5 years, 59% male). Compared with adults, a higher percentage of older patients were referred to CR programs after cardiac surgery or acute heart failure and showed more acute phase complications and comorbidity. Older patients were less likely discharged to home, more likely transferred to nursing homes, or discharged with social networks activation. Older patients had higher death rate during CR programs (odds ratio = 4.6; 95% confidence interval = 1.6-12.9; p = .004). CONCLUSION The ISYDE-2008 survey provided a detailed snapshot of CR in very old cardiac patients.
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Affiliation(s)
- Francesco Giallauria
- Department of Clinical Medicine, Cardiovascular, and Immunological Sciences, Cardiac Rehabilitation Unit, University of Naples Federico II, Naples, Italy.
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Dolansky MA, Stepanczuk B, Charvat JM, Moore SM. Women's and men's exercise adherence after a cardiac event. Res Gerontol Nurs 2010; 3:30-8. [PMID: 20128541 PMCID: PMC2897096 DOI: 10.3928/19404921-20090706-03] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 03/17/2009] [Indexed: 01/11/2023]
Abstract
The purpose of this secondary analysis was to determine whether age affects women's and men's exercise adherence after a cardiac event. In a convenience sample of 248 adults ages 38 to 86 who had a cardiac event, exercise adherence (three exercise sessions per week) was compared between men and women in three age groups (younger than 60, 61 to 70, and older than 70). Exercise patterns were recorded by heart rate monitors worn during exercise. No differences were found in adherence between the age groups for women; older men were nonadherent sooner than younger men when controlling for fitness level, pain, comorbidity, self-efficacy, depressed mood, and social support. Exercise adherence after a cardiac event was higher for younger men compared with older men. For all age groups, less than 37% of the total sample adhered to a three-times-per-week exercise regimen after 1 year, suggesting that interventions to maintain exercise adherence are needed.
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Affiliation(s)
- Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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Tolmie EP, Lindsay GM, Kelly T, Tolson D, Baxter S, Belcher PR. Are older patients' cardiac rehabilitation needs being met? J Clin Nurs 2009; 18:1878-88. [PMID: 19638048 PMCID: PMC3787784 DOI: 10.1111/j.1365-2702.2009.02798.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Design. Mixed methods. Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. Results.Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’. Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.
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Barnason S, Zimmerman L, Schulz P, Tu C. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. Heart Lung 2009; 38:459-68. [PMID: 19944870 DOI: 10.1016/j.hrtlng.2009.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 01/05/2009] [Accepted: 01/28/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden. METHODS A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years). RESULTS There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time. CONCLUSION The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, Nebraska, USA
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Whooley MA, de Jonge P, Vittinghoff E, Otte C, Moos R, Carney RM, Ali S, Dowray S, Na B, Feldman MD, Schiller NB, Browner WS. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300:2379-88. [PMID: 19033588 PMCID: PMC2677371 DOI: 10.1001/jama.2008.711] [Citation(s) in RCA: 628] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown. OBJECTIVE To determine why depressive symptoms are associated with an increased risk of cardiovascular events. DESIGN AND PARTICIPANTS The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years. SETTING Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008. MAIN OUTCOME MEASURES Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators. RESULTS A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score > or = 10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16-1.95; P = .002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00-1.71; P = .04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94-1.63; P = .12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79-1.40; P = .75). CONCLUSION In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.
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Pettersen KI, Kvan E, Rollag A, Stavem K, Reikvam A. Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction. BMC Cardiovasc Disord 2008; 8:28. [PMID: 18847506 PMCID: PMC2576460 DOI: 10.1186/1471-2261-8-28] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 10/12/2008] [Indexed: 11/10/2022] Open
Abstract
Background The objective was to explore the relationship between left ventricular ejection fraction (LVEF) assessed during hospitalization for acute myocardial infarction (MI) and later health-related quality of life (HRQoL). Methods We used multivariable linear regression to assess the relationship between LVEF and HRQoL in 256 MI patients who responded to the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ-5D Index, and the EuroQol Visual Analogue Scale (EQ-VAS) 2.5 years after the index MI. Results 167 patients had normal LVEF (>50%), 56 intermediate (40%–50%), and 33 reduced (<40%). The mean (SD) KCCQ clinical summary scores were 85 (18), 75 (22), and 68 (21) (p <0.001) in the three groups, respectively. The corresponding EQ-5D Index scores were 0.83 (0.18), 0.72 (0.27), and 0.76 (0.14) (p = 0.005) and EQ-VAS scores were 72 (18), 65 (21), and 57 (20) (p = 0.001). In multivariable linear regression analysis age ≥ 70 years, known chronic obstructive pulmonary disease (COPD), subsequent MI, intermediate LVEF, and reduced LVEF were independent determinants for reduced KCCQ clinical summary score. Female sex, medication for angina pectoris at discharge, and intermediate LVEF were independent determinants for reduced EQ-5D Index score. Age ≥ 70 years, COPD, and reduced LVEF were associated with reduced EQ-VAS score. Conclusion LVEF measured during hospitalization for MI was a determinant for HRQoL 2.5 years later.
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Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev 2008; 28:163-73. [PMID: 18496314 DOI: 10.1097/01.hcr.0000320066.58599.e5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Older patients have high rates of physical function impairment and disability following a cardiac event. Exercise training has been shown to favorably affect such limitations, as well as cardiovascular risk factors, symptoms, and mortality post coronary event in middle-aged patients. Aerobic capacity, body strength, quality of life, and physical function are improved with exercise-based cardiac rehabilitation (CR) in patients older than 65 years. However, there have been relatively few studies of the effects of exercise-based CR on physical function recovery in the very old patients (> or =75 years), despite the continuous growth of this segment of the population. After hospitalization for a cardiac event, postacute inpatient CR serves as a bridge between acute care and independent home living for the most disabled older patients. It plays an important role in the physical recovery process, particularly after cardiac surgery. Exercise-based outpatient (phase II) CR, starting early after hospital discharge, is safe in very old patients and studies demonstrate that these patients derive similar benefits from CR, compared with younger patients, regarding physical function improvement. Older patients, however, are less likely than younger cardiac patients to participate in outpatient CR programs. There is a need to find protocols that could increase the referral and participation rates of the frailer and older cardiac patient to exercise-based CR.
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Geldman M, Moore A, Cheek L. The effect of pre-injury physical fitness on the initial severity and recovery from whiplash injury, at six-month follow-up. Clin Rehabil 2008; 22:364-76. [PMID: 18390979 DOI: 10.1177/0269215507081966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of pre-injury physical fitness on the initial severity and recovery of motor vehicle-induced neck injury (whiplash injury). DESIGN A quantitative experimental design using both retrospective and prospective data. SETTING Metropolitan Police physiotherapy and rehabilitation department in the UK. SUBJECTS One-hundred and two patients with neck pain following whiplash injury. INTERVENTIONS Patients were divided into three groups based on pre-injury physical fitness (low, medium and high). Recovery was compared between the three groups initially then again at three and six months. MAIN MEASURES Three measurement scales were used: the Neck Disability Index, the Problem Percentage, and the Physical Activity Scale. RESULTS Pre-injury physical fitness had a marked effect on recovery at three and six months, with the medium and high fitness groups having significantly better recovery than the low fitness group. At three months the Neck Disability Index score for the low fitness group was 12 compared with 7 and 7.5 for the medium and high fitness groups respectively (P = 0.009). At six months the Neck Disability Index score was 9 for the low fitness group compared with 0 and 3 for the medium and high fitness groups (P = 0.002). In addition, the return to work rate was almost twice as high for individuals with medium/high fitness. CONCLUSION Early recovery from whiplash injury was significantly more likely for individuals with medium to high levels of pre-injury physical fitness than for individuals with low levels of pre-injury physical fitness.
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Affiliation(s)
- Mark Geldman
- Physiotherapist, Musculoskeletal Specialist, Nottingham, UK.
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Alboni P, Favaron E, Paparella N, Sciammarella M, Pedaci M. Is there an association between depression and cardiovascular mortality or sudden death? J Cardiovasc Med (Hagerstown) 2008; 9:356-62. [PMID: 18334889 DOI: 10.2459/jcm.0b013e3282785240] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The results of many studies and recent meta-analyses strongly suggest that depression is a risk factor for total and cardiovascular mortality, both in the general population and in patients with known heart disease. By contrast, the association between depression and sudden death or cardiac arrest has received little attention. This issue has been investigated in three recent studies; two were carried out in the general population and showed depression to be a independent risk factor for sudden death. The other study was carried out in patients with acute myocardial infarction (AMI); the adjusted relative risk (RR) of sudden death was significantly increased in depressed patients but, after adjustment for dyspnea/fatigue (a common symptom for heart disease and depression), the RR was no longer statistically significant. However, when the cognitive-affective depressive symptoms were examined separately from the somatic ones (dyspnea/fatigue, etc.), there was a clear trend for an association between cognitive-affective symptoms and sudden death. Because a risk factor can be defined as 'independent' only in a multivariate analysis in which variables are dichotomized, the presence of common symptoms between heart disease and depression represents a very difficult problem. However, taken together, the results of studies carried out in the general population and in patients with AMI strongly suggest that depression is a significant risk factor for sudden death.
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Affiliation(s)
- Paolo Alboni
- Division of Cardiology and Arrhythmologic Centre, Ospedale Civile, Cento (FE), Italy.
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Abstract
Using the disablement model, the authors examined the following questions in adults 70 years of age and older during the 6 weeks following hospitalization for a cardiac event: (a) What are the patterns in physical performance, self-report of functional limitations, and disability, and (b) to what extent does physical performance in the hospital and self-report of functional limitations pre-event predict 6-week disability? Data were collected before discharge and 3 and 6 weeks later on a sample of 60 older adults after a cardiac event. Results show that although the majority of participants improved in their objective physical performance, 70% self-reported no improvement or worsening. Physical performance during hospitalization is a better predictor of disability than a pre-event self-report of functional limitations, even when controlling for depression, gender, and comorbidity. Assessment of objective physical performance prior to discharge will help to identify older adults at risk for progressive disability.
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Mroszczyk-McDonald A, Savage PD, Ades PA. Handgrip strength in cardiac rehabilitation: normative values, interaction with physical function, and response to training. J Cardiopulm Rehabil Prev 2008; 27:298-302. [PMID: 17885508 DOI: 10.1097/01.hcr.0000291297.70517.9a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine normative values for handgrip (HG) strength at entry into cardiac rehabilitation (CR) and to examine the relationship of HG strength with self-reported physical function and the response of HG strength to exercise training. METHODS HG strength was measured in 1,960 patients with coronary heart disease. Other measures obtained included oxygen consumption/ unit time (peak VO2), body composition, physical function and depression questionnaires, and assessment of comorbid conditions. Subsequently, HG strength and other measures were obtained in 666 participants who completed 36 sessions of CR exercise training. RESULTS HG strength was significantly greater in men than in women (40.6 +/- 10.1 kg vs 22.6 +/- 6.5 kg, P < .0001), but diminished with age in both men and women from the third to the eight decade. Factors most strongly correlated with HG strength were gender (r = 0.40, P < .0001), height (r = 0.37, P < .0001), peak VO2 (r = 0.32, P < .0001), and age (r = -0.23, P < .0001). Baseline HG strength was correlated with physical function capacity in patients older than 65 years but not in younger patients. Following CR, HG strength increased overall by 4.6% in comparison with baseline values (34.9 +/- 11.4 to 36.5 +/- 11.6 kg, P < .0001). For the entire cohort, the increase in HG strength was associated with an increase in physical function score (P < .05). CONCLUSIONS In patients with coronary heart disease, HG strength decreases with age and is lower in women, patients with diabetes, and patients with lower peak Vo2. It remains to be determined whether a training protocol that specifically focuses on increasing HG strength would have a greater impact on overall functional status.
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Affiliation(s)
- Alex Mroszczyk-McDonald
- Division of Cardiology, Department of Medicine, University of Vermont College of Medicine, Fletcher-Allen Health Care, Burlington, Vermont, USA
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Physical activity and reducing the risk of cardiovascular morbidity and mortality in older men and women: Lessons learned in 2006. CURRENT CARDIOVASCULAR RISK REPORTS 2007. [DOI: 10.1007/s12170-007-0041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thombs BD, Magyar-Russell G, Bass EB, Stewart KJ, Tsilidis KK, Bush DE, Fauerbach JA, McCann UD, Ziegelstein RC. Performance characteristics of depression screening instruments in survivors of acute myocardial infarction: review of the evidence. PSYCHOSOMATICS 2007; 48:185-94. [PMID: 17478586 DOI: 10.1176/appi.psy.48.3.185] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Authors conducted a systematic review to assess performance characteristics of depression screening instruments after acute myocardial infarction (AMI). Among the seven studies identified, the Beck Depression Inventory (BDI) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) were used most frequently. Studies were generally of low quality, and no screening instrument performed notably better than others. Future research should compare the BDI and the HADS-D with instruments such as the Patient Health Questionnaire (PHQ-9 and PHQ-2) in post-AMI patients, should attend to important elements of the screening process, including when, where, and how often to screen patients, and should evaluate serial screening.
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Affiliation(s)
- Brett D Thombs
- Johns Hopkins University Evidence-Based Practice Center, the Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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