1
|
Gallo G, Volterrani M, Fini M, Sposato B, Autore C, Tocci G, Volpe M. Position Statement of the Italian Society of Cardiovascular Prevention (SIPREC) and Italian Heart Failure Association (ITAHFA) on Cardiac Rehabilitation and Protection Programs as a Cornerstone of Secondary Prevention after Myocardial Infarction or Revascularization. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00663-z. [PMID: 39060868 DOI: 10.1007/s40292-024-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the remarkable and progressive advances made in the prevention and management of cardiovascular diseases, the recurrence of cardiovascular events remains unacceptably elevated with a notable size of the residual risk. Indeed, in patients who suffered from myocardial infarction or who underwent percutaneous or surgical myocardial revascularization, life-style changes and optimized pharmacological therapy with antiplatelet drugs, lipid lowering agents, beta-blockers, renin angiotensin system inhibitors and antidiabetic drugs, when appropriate, are systematically prescribed but they might be insufficient to protect from further events. In such a context, an increasing body of evidence supports the benefits of cardiac rehabilitation (CR) in the setting of secondary cardiovascular prevention, consisting in the reduction of myocardial oxygen demands, in the inhibition of atherosclerotic plaque progression and in an improvement of exercise performance, quality of life and survival. However, prescription and implementation of CR programs is still not sufficiently considered.The aim of this position paper of the Italian Society of Cardiovascular Prevention (SIPREC) and of the Italian Heart Failure Association (ITAHFA) is to examine the reasons of the insufficient use of this strategy in clinical practice and to propose some feasible solutions to overcome this clinical gap.
Collapse
Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | | | | | | | - Camillo Autore
- Cardio-Pulmonary Department, San Raffaele Cassino, Cassino (FR), 03043, Italy
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | | |
Collapse
|
2
|
Drugescu A, Roca M, Zota IM, Costache AD, Gavril OI, Gavril RS, Vasilcu TF, Mitu O, Esanu IM, Roca IC, Ghiciuc CM, Mitu F. Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060814. [PMID: 35744077 PMCID: PMC9229341 DOI: 10.3390/medicina58060814] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.
Collapse
Affiliation(s)
- Andrei Drugescu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Mihai Roca
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Ioana Mădălina Zota
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Alexandru-Dan Costache
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Oana Irina Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Radu Sebastian Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Teodor Flaviu Vasilcu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Ovidiu Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Irina Mihaela Esanu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Iulia-Cristina Roca
- Surgery II Department, Faculty of Medicine, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Cristina Mihaela Ghiciuc
- Morpho-Functional Sciences II Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Florin Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| |
Collapse
|
3
|
Deljanin-Ilić M, Kocić G, Lazarević G, Simonović D, Stojanović M, Ilić S, Đorđević B, Petrović D, Stojanović S. Exercise training and inflammatory markers in coronary artery disease patients. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-36545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aim. To evaluate the influence of exercise training on inflammatory markers and exercise tolerance in coronary artery disease (CAD) patients. Patients and methods. A total of 54 subjects were enrolled in the present study, including 34 CAD patients (CAD group: 59.2 ± 8.2 years) and 20 healthy controls (C group: 54.2 ± 8.0 years). C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and placental growth factor (PIGF) were determined, and an exercise test was performed in both groups at baseline and once again in CAD group after the supervised 3 weeks of aerobic exercise training. Results. At baseline, CRP, ESR and PIGF were significantly higher in the CAD group compared to the C group (p = 0.038, p = 0.019 and p = 0.002), while exercise capacity was significantly higher in the C group (p ˂ 0.01). After 3 weeks of exercise training, CRP, ESR, WBC count and PIGF significantly decreased (p = 0.048, p ˂ 0.001, p = 0.002 and p ˂ 0.001 respectively), while exercise capacity significantly increased (p ˂ 0.001) in the CAD group. In the CAD group, CRP decrease significantly correlated with WBC and PIGF decrease (r = 0.816, p = 0.002 and r = 0.988, p ˂ 0.001), as well as with exercise capacity increase (r = 0.834, p ˂ 0.001). Also, WBC decrease significantly correlated both with PIGF decrease (r = 0.768, p ˂ 0.001) and exercise capacity increase (r = 0.548, p = 0.012), while PIGF decrease significantly correlated with exercise capacity increase (r = 0.548, p = 0.013). Conclusion. Residential exercise training in CAD patients reduces inflammation, expressed through a significant decrease in CRP, ESR, WBC count and PIGF levels. Those positive changes in inflammatory markers are associated with significant improvement in exercise capacity.
Collapse
|
4
|
Hap K, Biernat K, Konieczny G. Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions. J Diabetes Res 2021; 2021:5122494. [PMID: 34056006 PMCID: PMC8131145 DOI: 10.1155/2021/5122494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.
Collapse
Affiliation(s)
- Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Konieczny
- Faculty of Health Sciences and Physical Education, Witelon State University of Applied Sciences in Legnica, Poland
| |
Collapse
|
5
|
Alterations in the Properties of Red Blood Cells in Men with Coronary Artery Diseases after Comprehensive Cardiac Rehabilitation. Cardiol Res Pract 2020; 2020:6478785. [PMID: 33294220 PMCID: PMC7718067 DOI: 10.1155/2020/6478785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/27/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Comprehensive cardiac rehabilitation (CCR) is a complex program aimed at improving the health status of patients with coronary artery disease (CAD), especially those who have been subjected to cardiac interventions (PCI and CABG).The aim of this study was to measure the changes in the properties of red blood cells (RBCs) in men with CAD after cardiac intervention and after participation in CCR program. Methods In this study, we have investigated the influence of the physical training-based CCR program in 12 men with CAD, after PCI or CABG. The characteristics of RBCs including the basic morphology of RBCs, the conformational state of RBC membrane protein and hemoglobin, acetylcholinesterase activity, membrane fluidity, the osmotic fragility, and thiol concentration in membrane and in hemolysate were measured. Ascorbate concentration and reduced glutathione were also determined. The analysis was performed in men, before and after participation in CCR. The properties of RBCs were observed in connection with the exercise test, and parameters were evaluated before, immediately after, and 1 hour after the exercise test. Results After CCR, a decrease in the mobility of erythrocyte membrane proteins was observed, which was accompanied by a decrease in lipid fluidity. In addition, immediately after the exercise test and 1 hour later, we measured a decrease in thiol level in hemolysate, but not in the plasma membrane. Unexpectedly, an increase in reduced glutathione concentration one hour after the exercise test after completing comprehensive cardiac rehabilitation was observed. Conclusion CCR in men with CAD after cardiac intervention is connected with decreased membrane fluidity and decreased membrane protein mobility, which indicates that reduction of oxidative changes in these components occurs.
Collapse
|
6
|
Soltani M, Aghaei Bahmanbeglou N, Ahmadizad S. High-intensity interval training irrespective of its intensity improves markers of blood fluidity in hypertensive patients. Clin Exp Hypertens 2020; 42:309-314. [PMID: 31362531 DOI: 10.1080/10641963.2019.1649687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: The present study examined and compared the effects of two different HIIT (High-intensity interval training) protocols on markers of blood fluidity in hypertensive patients.Methods: Thirty hypertensive (stage 1, systolic BP >140 and diastolic BP>90 mmHg) patients (age, 47.96 ± 3.20 yrs), were randomly allocated to short-duration HIIT (SDHIIT, n = 10), long-duration HIIT (LDHIIT, n = 10), and control (n = 10) groups. After 2 weeks of continuous mild training, patients in SDHIIT group performed 8 weeks of HIIT included 27 min HIIT that encompassed 27 repetitions of 30 s activity at 80%-100% of VO2peak interspersed by 30 s passive/active (10%-20% of VO2peak) recovery, while, patients in LDHIIT group performed 8 weeks of HIIT (32 min per session) included 4 repetitions of 4 min activity at 75%-90% of VO2peak interspersed by 4 min passive/active (15%-30% of VO2peak) recovery. Two blood samples were taken before and after training and were analyzed for hemorheological variables.Results: Significant (P < .05) reductions in systolic blood pressure (SBP), blood and plasma viscosity, fibrinogen concentration and red blood cell (RBC) aggregation (8-12%) were found following two training protocols (P < .05), though, the differences between adaptations were not statistically significant (P > .05). In addition, HIIT protocols increased RBC deformability significantly (P < .05), with no significant differences being observed between two protocols.Conclusion: It is concluded that HIIT training reduces SBP and markers of blood fluidity in patients with stage 1 hypertension irrespective of the HIIT intensity and duration. Therefore, this type of exercise training could be prescribed for improving the blood fluidity markers in hypertensive patients.
Collapse
Affiliation(s)
- Mohammad Soltani
- Department of Biological Sciences in Sport, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Neda Aghaei Bahmanbeglou
- Faculty of Physical Education and Sport Sciences, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran
| | - Sajad Ahmadizad
- Department of Biological Sciences in Sport, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
| |
Collapse
|
7
|
The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with coronary artery disease. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp200810126s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background / Aim. Well-organized cardiovascular rehabilitation (CVR) reduces
cardiovascular burden by influencing cardiovascular risk factors, improving
the quality of life and reducing mortality and hospital readmission.
However, its effects on hemodynamic status are largely unknown. The aim of
our study was to evaluate the influence of three-week CVR program on
hemodynamic status and to investigate if there is a correlation between
physical strain tolerance and hemodynamic parameters measured by impedance
cardiography (ICG) before and after CVR program in patients with coronary
artery disease. Methods. Fifty-two patients attended a three-week CVR
program. At the beginning and at the end of rehabilitation program
laboratory tests, exercise stress tests (EST) and ICG measurements were
taken. Results. Patients showed better strain tolerance on the second
exercise stress test (EST2) by achieving higher strain level (Z=2,315;
p=0,021) and longer duration of test (Z=2,305; p=0,021). There was a strong
positive correlation between the level of EST2 and cardiac output (CO)
(r=0,538; p<0,001) and stroke volume (SV) (r=0,380; p=0,017) on the second
ICG (ICG2). Also, there was a strong negative correlation between EST2 level
and systemic vascular resistance (SVR) (r=-0,472; p=0,002) and SVR index
(SSVRI) (r=-0,407; p=0,010) on ICG2. There was a strong positive correlation
between EST2 duration and CO (r=0.517; p=0.001) as well as between EST2
duration and SV (r=0.340; p=0.034), and a strong negative correlation
between EST2 duration and SVR (r=-0.504; p=0.001) as well as between EST2
duration and SVRI (r=-0.448; p=0.004), according to ICG2. Conclusion. Our
study showed that a well-designed CVR program can lead to better physical
strain tolerance. Furthermore, CVR led to a significant positive correlation
between EST and cardiac output as well as between EST and stroke volume
measured by ICG. On the other hand, there was a significant negative
correlation between EST and vascular related parameters according to ICG at
the end of the CVR program.
Collapse
|
8
|
O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
Collapse
Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
| |
Collapse
|
9
|
Ivanova OА, Kuklin SG. THE RATE OF CARDIAC RHYTHM RECOVERY POST EXERTION IN PHYSICAL REHABILITATION OF CARDIOLOGICAL PATIENTS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-2-95-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Taken the rising mortality and morbidity of the population due to cardiovascular diseases (CVD), rehabilitation of cardiovascular patients remains actual. Regular exercises are the leading components of cardiorehabilitation, that is evidently beneficial. Taken this, the question raises on the adequacy and efficacy of training regimens. Utilization of the parameter representing the velocity of heart rate decline by every minute of recovery phase after the exertion, is quite informative. The borderline set for heart rate, with increasing cardiovascular risk if below. Dynamics of such parameter during the programs of physical rehabilitation might be a marker of the events efficacy. Recently, there is a deficiency of information on the normal parameters of heart rate recovery rate in CVD patients. Hence a question raises, on the unification of approaches in evaluation of recovery period and data collection on the influence of long term exercises on CVD prognosis.
Collapse
Affiliation(s)
- O. А. Ivanova
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
| | - S. G. Kuklin
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
| |
Collapse
|
10
|
Marcucci R, Gori A, Burgisser C, Francini S, Roberts A, Sofi F, Gensini G, Abbate R, Fattirolli F, Cesari F. Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells. Thromb Haemost 2017; 112:196-204. [DOI: 10.1160/th13-10-0869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/13/2014] [Indexed: 11/05/2022]
Abstract
SummaryAn increase of endothelial progenitor cells (EPCs) among acute myo-cardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0–10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.
Collapse
|
11
|
Toth A, Sandor B, Marton Z, Kesmarky G, Szabados E, Kehl D, Juricskay I, Czopf L, Toth K. Comparison of hemorheological changes in patients after acute coronary events, intervention and ambulatory rehabilitation. Clin Hemorheol Microcirc 2016; 64:565-574. [PMID: 27791999 DOI: 10.3233/ch-168038] [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] [Indexed: 01/14/2023]
Abstract
During the past decades, our group have investigated the hemorheological parameters (HPs) of more than 1,000 patients with various forms of ischemic heart disease (IHD). Our data indicate that HPs are altered in patients with IHD and the extent of the alterations is in good correlation with the clinical severity of the disease. Our findings have also proven that HPs play a critical role in the pathogenesis of myocardial ischemia.The lack of regular exercise is an important cardiovascular risk factor. Regular physical activity - as part of the cardiovascular rehabilitation training program (CRP) - is recommended for the treatment of IHD and the prevention of first or further cardiovascular events. To estimate the beneficial hemorheological effects of CRP, compared to patients after a coronary event or intervention and not participating in CRP, the data of four of our prospective studies (three non-CRP and one CRP-participating) were evaluated.Hematocrit (Hct), plasma and whole blood viscosity (WBV), Hct/WBV ratio significantly (p < 0.05) increased in the non-CRP groups during the 6-12 months follow-up, while in the CRP group they significantly decreased (p < 0.05). Red blood cell aggregation decreased in a much greater manner in the CRP group.Our results indicate that CRP has beneficial hemorheological effects and is able to reverse the deterioration of HPs after coronary events or intervention.
Collapse
Affiliation(s)
- Andras Toth
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary.,Department of Radiology, Medical School, University of Pecs, Pecs, Hungary
| | - Barbara Sandor
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Zsolt Marton
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Gabor Kesmarky
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Eszter Szabados
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Daniel Kehl
- Institute of Economics and Econometrics, Faculty of Business and Economics, University of Pecs, Pecs, Hungary
| | - Istvan Juricskay
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Laszlo Czopf
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Kalman Toth
- 1st Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| |
Collapse
|
12
|
Lavie CJ, Menezes AR, De Schutter A, Milani RV, Blumenthal JA. Impact of Cardiac Rehabilitation and Exercise Training on Psychological Risk Factors and Subsequent Prognosis in Patients With Cardiovascular Disease. Can J Cardiol 2016; 32:S365-S373. [DOI: 10.1016/j.cjca.2016.07.508] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022] Open
|
13
|
Gwoździński K, Pieniążek A, Czepas J, Brzeszczyńska J, Jegier A, Pawlicki L. Cardiac rehabilitation improves the blood plasma properties of cardiac patients. Exp Biol Med (Maywood) 2016; 241:1997-2006. [PMID: 27407099 DOI: 10.1177/1535370216658143] [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: 03/08/2016] [Accepted: 05/31/2016] [Indexed: 12/11/2022] Open
Abstract
Cardiac rehabilitation (CR) improves exercise tolerance and general function. However, its effects on blood plasma in cardiac patients remain uncertain. Our aim was to examine the effect of comprehensive CR on the oxidative stress parameters and antioxidant plasma status in patients with coronary artery disease (CAD) after cardiac interventions. Exercise-based rehabilitation was established as ergometer training, adjusted for individual patients' physical efficiency. Training was repeated three times a week for two months. The standard biochemical (total cholesterol, HDL, LDL, triglycerides and erythrocyte sedimentation rate) and metabolic parameters (peak oxygen uptake [VO2] and peak workload) were determined. We assessed plasma viscosity, lipid peroxidation, carbonyl compounds levels, glutathione (GSH) and ascorbate (ASC) levels and the non-enzymatic antioxidant capacity of plasma in 12 patients with CAD before and after CR. Parameters were examined before exercise, immediately after exercise, and 1 h later. We also compared morphological and biochemical parameters of blood, as well as other parameters such as heart rate and blood pressure (resting and exercise), VO2max and peak workload (W) before and after CR. Before CR, a significant decrease in GSH concentration was observed 1 h after exercise. Conversely, after CR, GSH, and ASC levels remained unchanged immediately after exercise. However, ASC increased after CR after exercise and 1 h later in comparison to before CR. There was a significant increase in ferric reduction ability of plasma immediately after exercise after CR, when compared with before CR. CR improved several blood biochemical parameters, peak VO2, induced an increase in systolic blood pressure peak, and patients' peak workload. After CR, improvements were detected in oxidative stress parameters, except in the level of carbonyls. These changes may contribute to the increased functional heart capacity and better tolerance to exercise and functional capacity of the patients. These improvements could indicate better prognosis of future cardiac events and hospitalization and better quality of life.
Collapse
Affiliation(s)
- Krzysztof Gwoździński
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
| | - Anna Pieniążek
- Department of Medical Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
| | - Jan Czepas
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
| | - Joanna Brzeszczyńska
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland
| | - Lucjan Pawlicki
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-647 Lodz, Poland
| |
Collapse
|
14
|
Buono MJ, Krippes T, Kolkhorst FW, Williams AT, Cabrales P. Increases in core temperature counterbalance effects of haemoconcentration on blood viscosity during prolonged exercise in the heat. Exp Physiol 2016; 101:332-42. [PMID: 26682653 PMCID: PMC4738148 DOI: 10.1113/ep085504] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
NEW FINDINGS What is the central question of this study? The purpose of the present study was to determine the effects of exercise-induced haemoconcentration and hyperthermia on blood viscosity. What is the main finding and its importance? Exercise-induced haemoconcentration, increased plasma viscosity and increased blood aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell (RBC) deformability (e.g. RBC membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat. Previous studies have reported that blood viscosity is significantly increased following exercise. However, these studies measured both pre- and postexercise blood viscosity at 37 °C even though core and blood temperatures would be expected to have increased during the exercise. Consequently, the effect of exercise-induced hyperthermia on mitigating change in blood viscosity may have been missed. The purpose of this study was to isolate the effects of exercise-induced haemoconcentration and hyperthermia and to determine their combined effects on blood viscosity. Nine subjects performed 2 h of moderate-intensity exercise in the heat (37 °C, 40% relative humidity), which resulted in significant increases from pre-exercise values for rectal temperature (from 37.11 ± 0.35 to 38.76 ± 0.13 °C), haemoconcentration (haematocrit increased from 43.6 ± 3.6 to 45.6 ± 3.5%) and dehydration (change in body weight = -3.6 ± 0.7%). Exercise-induced haemoconcentration significantly (P < 0.05) increased blood viscosity by 9% (from 3.97 to 4.33 cP at 300 s(-1)), whereas exercise-induced hyperthermia significantly decreased blood viscosity by 7% (from 3.97 to 3.69 cP at 300 s(-1)). When both factors were considered together, there was no overall change in blood viscosity (from 3.97 to 4.03 cP at 300 s(-1)). The effects of exercise-induced haemoconcentration, increased plasma viscosity and increased red blood cell aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell deformability (e.g. red blood cell membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat.
Collapse
Affiliation(s)
- Michael J. Buono
- Department of Biology, San Diego State University, San Diego, CA 92182
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182
| | - Taylor Krippes
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182
| | - Fred W. Kolkhorst
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182
| | - Alexander T. Williams
- Department of Bioengineering, University of California, San Diego, San Diego, CA 92093
| | - Pedro Cabrales
- Department of Bioengineering, University of California, San Diego, San Diego, CA 92093
| |
Collapse
|
15
|
Pabisiak A, Bromboszcz J, Kmiec S, Dendura M, Dabrowski Z, Smolenski O. Changes in the complete blood count and blood rheology in patients after myocardial infarction participating in the rehabilitation programme. Clin Hemorheol Microcirc 2016; 61:541-7. [DOI: 10.3233/ch-151954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A. Pabisiak
- University School of Physical Education, 31-571 Krakow, Al. Jana Pawła II 78, Poland
- Center of Diagnostics and Cardiac Rehabilitation REMED, 31-148 Krakow, ul. Wroblewskiego, Poland
| | - J. Bromboszcz
- Physiotherapy Faculty, Administration University School in Bielsko-Biala, 43-300 Bielsko-Biala, ul. Frycza-Modrzewskiego, Poland
| | - S. Kmiec
- University School of Physical Education, 31-571 Krakow, Al. Jana Pawła II 78, Poland
| | - M. Dendura
- Center of Diagnostics and Cardiac Rehabilitation REMED, 31-148 Krakow, ul. Wroblewskiego, Poland
| | - Z. Dabrowski
- University School of Physical Education, 31-571 Krakow, Al. Jana Pawła II 78, Poland
| | - O. Smolenski
- University School of Physical Education, 31-571 Krakow, Al. Jana Pawła II 78, Poland
| |
Collapse
|
16
|
Sandor B, Nagy A, Toth A, Rabai M, Mezey B, Csatho A, Czuriga I, Toth K, Szabados E. Effects of moderate aerobic exercise training on hemorheological and laboratory parameters in ischemic heart disease patients. PLoS One 2014; 9:e110751. [PMID: 25347067 PMCID: PMC4210208 DOI: 10.1371/journal.pone.0110751] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/24/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND DESIGN In this study we set out to determine the effects of long-term physical training on hemorheological, laboratory parameters, exercise tolerability, psychological factors in cardiac patients participating in an ambulatory rehabilitation program. METHODS Before physical training, patients were examined by echocardiography, tested on treadmill by the Bruce protocol, and blood was drawn for laboratory tests. The enrolled 79 ischemic heart disease patients joined a 24-week cardiac rehabilitation training program. Blood was drawn to measure hematocrit (Hct), plasma and whole blood viscosity (PV, WBV), red blood cell (RBC) aggregation and deformability. Hemorheological, clinical chemistry and psychological measurements were repeated 12 and 24 weeks later, and a treadmill test was performed at the end of the program. RESULTS After 12 weeks Hct, PV, WBV and RBC aggregation were significantly decreased, RBC deformability exhibited a significant increase (p<0.05). Laboratory parameters (triglyceride, uric acid, hsCRP and fibrinogen) were significantly decreased (p<0.05). After 24 weeks the significant results were still observed. By the end of the study, IL-6 and TNF-α levels displayed decreasing trends (p<0.06). There was a significant improvement in MET (p<0.001), and the BMI decrease was also significant (p<0.05). The vital exhaustion parameters measured on the fatigue impact scale indicated a significant improvement in two areas of the daily activities (p<0.05). CONCLUSIONS Regular physical training improved the exercise tolerability of patients with ischemic heart disease. Previous publications have demonstrated that decreases in Hct and PV may reduce cardiovascular risk, while a decrease in RBC aggregation and an increase in deformability improve the capillary flow. Positive changes in laboratory parameters and body weight may indicate better oxidative and inflammatory circumstances and an improved metabolic state. The psychological findings point to an improvement in the quality of life.
Collapse
Affiliation(s)
- Barbara Sandor
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Alexandra Nagy
- Department of Behavioural Sciences, University of Pecs, School of Medicine, Pecs, Hungary
| | - Andras Toth
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Miklos Rabai
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Bela Mezey
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Arpad Csatho
- Department of Behavioural Sciences, University of Pecs, School of Medicine, Pecs, Hungary
| | - Istvan Czuriga
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Kalman Toth
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| | - Eszter Szabados
- 1 Department of Medicine, University of Pecs, School of Medicine, Pecs, Hungary
| |
Collapse
|
17
|
Jin YZ, Zheng DH, Duan ZY, Lin YZ, Zhang XY, Wang JR, Han S, Wang GF, Zhang YJ. Relationship Between Hematocrit Level and Cardiovascular Risk Factors in a Community-Based Population. J Clin Lab Anal 2014; 29:289-93. [PMID: 24849556 DOI: 10.1002/jcla.21767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/17/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to determine the relationship between hematocrit (HCT) levels and cardiovascular risk factors in a community-based population of middle-aged adults. METHODS From April 2011 to February 2012, a total of 1,884 middle-aged adults were selected from a community-based population in China. Blood and urine samples were collected for routine blood and urine tests, and measurement of plasma glucose and lipid levels. Baseline information including traditional cardiovascular risk factors was obtained by standard questionnaire to analyze. We evaluated the distribution of the HCT values for middle-aged adults with or without cardiovascular risk factors. There were 548 males and 1,336 females in this study. The mean age of all subjects was 54.7 ± 6.7 years. There were 1,209 subjects with risk factors and 675 without risk factors. RESULTS The HCT levels in subjects with risk factors were higher than those without risk factors (P = 0.005). According to a simplified tool for evaluation of the 10-year risk of ischemic cardiovascular diseases (CVDs) in Chinese populations, all subjects were divided into four groups: the ultralow-risk group (1,367, 72.6%), low-risk group (232, 12.3%), intermediate-risk group (201, 10.7%), and high-risk/ultrahigh-risk group (84, 4.4%). Compared with HCT levels in the ultralow-risk group, significant differences were found in the low-risk, intermediate-risk, and high-risk/ultrahigh-risk groups (all P < 0.05). CONCLUSION Our results indicate that elevated HCT levels may be positively associated with cardiovascular risk factors. Thus, the combination of HCT values and cardiovascular risk factors may enable early diagnosis of CVDs.
Collapse
Affiliation(s)
- Yuan-Ze Jin
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Dong-Han Zheng
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Zhi-Ying Duan
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Ying-Zi Lin
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Xue-Ying Zhang
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Jing-Ru Wang
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Shuo Han
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Guo-Feng Wang
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Yi-Jing Zhang
- Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| |
Collapse
|
18
|
|
19
|
Nwose EU, Jelinek HF, Richards RS, Tinley P, Kerr PG. Atherothrombosis and oxidative stress: the connection and correlation in diabetes. Redox Rep 2013; 14:55-60. [DOI: 10.1179/135100009x392458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
20
|
Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2013; 33:77-83. [DOI: 10.1097/hcr.0b013e31828254fc] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
21
|
Lavie CJ, Church TS, Milani RV, Earnest CP. Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev 2011; 31:137-45. [PMID: 21427600 DOI: 10.1097/hcr.0b013e3182122827] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Physical activity and exercise training (ET) enhance overall cardiorespiratory fitness (ie, fitness), thus producing many benefits in the primary and secondary prevention of cardiovascular diseases. Substantial evidence also indicates that acute and chronic inflammation is involved in the development and progression of atherosclerosis and major cardiovascular events. The most commonly utilized marker of inflammation is C-reactive protein (CRP). In this review, we discuss the importance of inflammation, especially CRP, as a cardiovascular risk marker by reviewing an abundant cross-sectional and clinical intervention literature providing evidence that physical activity, enhanced fitness, and ET are inversely associated with CRP and that being overweight or obese is directly related with inflammation/CRP. Although we discuss the controversy regarding whether or not ET reduces CRP independent of weight loss, clearly physical activity, improved fitness, and ET are associated with reductions in inflammation and overall cardiovascular risk in both primary and secondary prevention.
Collapse
Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
| | | | | | | |
Collapse
|
22
|
Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis 2011; 53:397-403. [PMID: 21545925 DOI: 10.1016/j.pcad.2011.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs.
Collapse
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
| | | |
Collapse
|
23
|
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
| | | | | | | |
Collapse
|
24
|
Hansen D, Dendale P, van Loon LJC, Meeusen R. The impact of training modalities on the clinical benefits of exercise intervention in patients with cardiovascular disease risk or type 2 diabetes mellitus. Sports Med 2011; 40:921-40. [PMID: 20942509 DOI: 10.2165/11535930-000000000-00000] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise training intervention represents an effective means to reduce adipose tissue mass, improve glycaemic control and increase whole-body oxygen uptake capacity (VO(2peak)) in obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM) and heart disease patients. In this manuscript, we review the impact of different exercise training modalities on clinical benefits of prolonged exercise intervention in these patient (sub)populations. By changing training modalities, significantly greater clinical benefits can be obtained. Greater training frequency and longer programme duration is associated with greater reduction in adipose tissue mass in obesity patients. A greater training frequency (up to 2 days/week) and a longer programme duration (up to 38 weeks) seems to be associated with greater improvements in VO(2peak) in heart disease patients. Longer programme duration and addition of resistance-type exercise further improve glycaemic control in T2DM patients. The first line of evidence seems to indicate that high-intensity interval exercise training has a greater impact on VO(2peak) in heart disease patients and insulin sensitivity in subjects with metabolic syndrome, but not on adipose tissue mass in obese subjects. However, it remains unclear whether addition of resistance-type exercise and continuous higher-intensity endurance-type exercise training are accompanied by greater improvements in VO(2peak) in heart disease patients. Furthermore, the impact of training session duration/volume on adipose tissue mass loss and glycaemic control in obesity and T2DM patients, respectively, is currently unknown. The impact of training frequency on glycaemic control remains to be investigated in T2DM patients.
Collapse
|
25
|
Lavie CJ, Milani RV, Artham SM, Patel DA, Ventura HO. The obesity paradox, weight loss, and coronary disease. Am J Med 2009; 122:1106-14. [PMID: 19682667 DOI: 10.1016/j.amjmed.2009.06.006] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 05/06/2009] [Accepted: 06/02/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE Because obesity is a cardiovascular risk factor but is associated with a more favorable prognosis among cohorts of cardiac patients, we assessed this "obesity paradox" in overweight and obese patients with coronary heart disease enrolled in a cardiac rehabilitation and exercise training (CRET) program, making this assessment in patients classified as overweight/obese using both traditional body mass index (BMI) and percent body fat assessments. Additionally, we assessed the efficacy and safety of purposeful weight loss in overweight and obese coronary patients. PATIENTS AND METHODS We retrospectively studied 529 consecutive CRET patients following major coronary events before and after CRET, and compared baseline and post program data in 393 overweight and obese patients (body mass index [BMI] > or =25 kg/m(2)) divided by median weight change (median=-1.5%; mean +2% vs -5%, respectively). In addition, we assessed 3-year total mortality in various baseline BMI categories as well as compared mortality in those with high baseline percent fat (>25% in men and >35% in women) versus those with low baseline fat. RESULTS Following CRET, the overweight and obese with greater weight loss had improvements in BMI (-5%; P <.0001), percent fat (-8%; P <.0001), peak oxygen consumption (+16%; P <.0001), low-density lipoprotein cholesterol (-5%; P <.02), high-density lipoprotein cholesterol (+10%; P <.0001), triglycerides (-17%; P <.0001), C-reactive protein (-40%; P <.0001), and fasting glucose (-4%; P=.02), as well as marked improvements in behavioral factors and quality-of-life scores. Those with lower weight loss had no significant improvements in percent fat, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, and fasting glucose. During 3-year follow-up, overall mortality trended only slightly lower in those with baseline overweightness/obesity who had more weight loss (3.1% vs 5.1%; P=.30). However, total mortality was considerably lower in the baseline overweight/obese (BMI > or =25 kg/m(2)) than in 136 CRET patients with baseline BMI <25 kg/m(2) (4.1% vs 13.2%; P <.001), as well as in those with high baseline fat compared with those with low fat (3.8% vs 10.6%; P <.01). CONCLUSIONS Purposeful weight loss with CRET in overweight/obese coronary patients is associated with only a nonsignificant trend for lower mortality but is characterized by marked improvements in obesity indices, exercise capacity, plasma lipids, and inflammation, as well as behavioral factors and quality of life. Although an "obesity paradox" exists using either baseline BMI or baseline percent fat criteria, these results support the safety and potential long-term benefits of purposeful weight loss in overweight and obese patients with coronary heart disease.
Collapse
Affiliation(s)
- Carl J Lavie
- Cardiac Rehabilitation, Exercise Laboratories, Ochsner Health System, New Orleans, LA 70121-2483, USA.
| | | | | | | | | |
Collapse
|
26
|
Bronas UG. Exercise training and reduction of cardiovascular disease risk factors in patients with chronic kidney disease. Adv Chronic Kidney Dis 2009; 16:449-58. [PMID: 19801135 DOI: 10.1053/j.ackd.2009.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Observational studies have reported a significant inverse association between physical function/aerobic capacity and mortality in patients with CKD. Several randomized controlled trials have provided evidence of a cardioprotective effect of exercise training via multiple mechanisms, which may result in a reduction of cardiovascular disease risk factors in patients with CKD. This review focuses on the available evidence for the role of exercise training in the reduction of cardiovascular disease risk factors as classified into antiatherosclerotic, anti-ischemic, antiarrhythmic, and antithrombotic protective effects. Preliminary evidence, primarily from studies in patients requiring hemodialysis, suggests that exercise training improves arterial compliance, cardiac autonomic control, and left ventricular systolic function while decreasing inflammation, oxidative stress, and blood pressure levels. It is concluded that these studies have provided preliminary evidence that exercise training may result in a reduction of cardiovascular disease risk factors. The available evidence supports the use of therapeutic exercise training as an adjunct component of a comprehensive treatment program for patients with CKD. However, it is clear that much additional research is required to confirm the apparent, multiple, cardioprotective effects of exercise training and to identify additional mechanisms, especially in patients with predialysis CKD.
Collapse
|
27
|
Milani RV, Lavie CJ. Reducing psychosocial stress: a novel mechanism of improving survival from exercise training. Am J Med 2009; 122:931-8. [PMID: 19682669 DOI: 10.1016/j.amjmed.2009.03.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/18/2009] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exercise training reduces mortality in patients with coronary artery disease. Behavioral characteristics, including depression, hostility, and overall psychosocial stress, have been shown to be independent risk factors for recurrent myocardial infarction and death in these patients. Exercise training can reduce these high-risk behaviors, but it remains uncertain as to what extent the health benefits of exercise training can be attributed to improving these behaviors. METHODS We evaluated the impact of exercise training during cardiac rehabilitation on mortality in 53 patients with coronary artery disease with high levels of psychosocial stress and in 469 patients with coronary artery disease with low levels of psychosocial stress and compared them with 27 control patients with high psychosocial stress who did not undergo formal cardiac rehabilitation and exercise training. RESULTS Mortality was approximately 4-fold greater in patients with high psychosocial stress than in those with low psychosocial stress (22% vs 5%; P = .003). Exercise training decreased the prevalence of psychosocial stress from 10% to 4% (P<.0001) and similarly improved peak oxygen uptake in patients with high and low psychosocial stress. Mortality in patients who improved exercise capacity by>or=10% (high exercise change) was 60% lower than in patients who had<10% improvement in exercise capacity (low exercise change) (P=.009). Mortality was lower in patients with high psychosocial stress with high exercise change compared with patients with high psychosocial stress with low exercise change (0% vs 19%; P=.009). In contrast, there was no significant improvement in mortality in patients with high versus low exercise change with low psychosocial stress (4% vs 8%; P=.14). CONCLUSION Psychosocial stress is an independent risk factor for mortality in patients with coronary artery disease, and exercise training can effectively reduce its prevalence. Exercise training reduces mortality in patients with coronary artery disease, and this effect seems to be mediated in part because of the salutary effects of exercise on psychosocial stress.
Collapse
Affiliation(s)
- Richard V Milani
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
28
|
Leon AS, Bronas UG. Pathophysiology of Coronary Heart Disease and Biological Mechanisms for the Cardioprotective Effects of Regular Aerobic Exercise. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609338145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atherosclerosis, the underlying cause of coronary heart disease (CHD), is a chronic inflammatory condition involving the subendothelial layer of coronary as well as other large-and medium-sized arteries. This disease process is initiated early in life by multiple risk factors. Endothelial dysfunction and lipid infiltration are fundamental for the initiation and progression of the atherosclerotic process. After many asymptomatic decades, acute coronary syndromes are generally triggered by a coronary occlusion, caused by a thrombosis initiated by disruption of a vulnerable lipid-laden plaque with a thin, noncalcified fibrosis cap. Epidemiology studies over the past 50 years have consistently observed an inverse association between CHD and regular physical activity and/or cardiorespiratory fitness. Supporting evidence of causative relationships has been provided by exercise training studies demonstrating multiple, plausible, cardioprotective, biological mechanisms. These pleotropic effects may be classified as (1) direct antiatherosclerotic effects and indirect effects via reduction of other risk factors, (2) anti-ischemic effects by decreasing myocardial oxygen demands and increasing its vascular supply and by decreasing the severity of ischemic injuries by direct conditioning effects on cardiomyocytes, (3) antiarrhythmic effects by improving electrical stability of the heart, and (4) antithrombotic (and prothrombolytic) effects, reducing risk of a coronary thrombotic occlusion. It is concluded based on an impressive body of evidence that regular aerobic exercise attenuates the risk of CHD at all stages of the atherothrombotic process.
Collapse
Affiliation(s)
- Arthur S. Leon
- Laboratory of Physiological Hygiene and Exercise Science, School of Kinesiology, University of Minnesota, Minneapolis,
| | - Ulf G. Bronas
- School of Nursing and School of Kinesiology, Minneapolis, Minnesota
| |
Collapse
|
29
|
Scrutinio D, Temporelli PL, Passantino A, Giannuzzi P. Long-term secondary prevention programs after cardiac rehabilitation for the reduction of future cardiovascular events: focus on regular physical activity. Future Cardiol 2009; 5:297-314. [DOI: 10.2217/fca.09.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease, and as such are recommended in most contemporary clinical practice guidelines. The interventions are aimed at reducing disability, optimizing cardiovascular risk reduction by drug therapy and promoting healthy behavior. Healthy lifestyle habits must be recognized as capable of substantially reducing the risk for cardiovascular events in patients with coronary heart disease. This review highlights the recommended components of cardiac rehabilitation/secondary prevention programs, with special emphasis on regular physical activity.
Collapse
Affiliation(s)
- Domenico Scrutinio
- Fondazione ‘S. Maugeri’, IRCCS, Istituto di Cassano Murge, 70020 Cassano Murge (Bari), Italy
| | - Pier Luigi Temporelli
- ‘Salvatore Maugeri’ Foundation, IRCCS, Department of Cardiac Rehabilitation, Scientific Institutes of Veruno (NO), Italy
| | - Andrea Passantino
- Fondazione ‘S. Maugeri’, IRCCS, Istituto di Cassano Murge, 70020 Cassano Murge (Bari), Italy
| | - Pantaleo Giannuzzi
- ‘Salvatore Maugeri’ Foundation, IRCCS, Department of Cardiac Rehabilitation, Scientific Institutes of Veruno (NO), Italy
| |
Collapse
|
30
|
Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc 2009; 84:373-83. [PMID: 19339657 PMCID: PMC2665984 DOI: 10.1016/s0025-6196(11)60548-x] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Substantial data have established a sedentary lifestyle as a major modifiable risk factor for coronary heart disease (CHD). Increased levels of physical activity, exercise training, and overall cardiorespiratory fitness have provided protection in the primary and secondary prevention of CHD. This review surveys data from observational studies supporting the benefits of physical activity, exercise training, and overall cardiorespiratory fitness in primary prevention. Clearly, cardiac rehabilitation/secondary prevention (CRSP) programs have been greatly underused by patients with CHD. We review the benefits of CRSP programs on CHD risk factors, psychological factors, and overall CHD morbidity and mortality. These data support the routine referral of patients with CHD to CRSP programs. Patients should be vigorously encouraged to attend these programs.
Collapse
Affiliation(s)
- Carl J Lavie
- Cardiac Rehabilitation and Exercise Laboratories, Ochsner Medical Center, New Orleans, LA 70121-2483, USA.
| | | | | | | | | |
Collapse
|
31
|
Lavie CJ, Morshedi-Meibodi A, Milani RV. Impact of Cardiac Rehabilitation on Coronary Risk Factors, Inflammation, and the Metabolic Syndrome in Obese Coronary Patients. ACTA ACUST UNITED AC 2008; 3:136-40. [DOI: 10.1111/j.1559-4572.2008.00002.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Abstract
Peripheral arterial disease (PAD) is currently a major health problem affecting 8-12 million Americans, 15-40% of whom will have intermittent claudication that can lead to substantial impairment in their ability to carry out normal daily activities as well as perform the recommended cardiovascular exercise. Supervised exercise training is an effective tool in the treatment of claudication and is currently a recommended first-line therapy for patients with this condition. In addition to improving pain-free walking distance and quality of life, supervised exercise training can improve many cardiovascular risk factors, possibly reducing the risk for subsequent myocardial infarction, stroke, and death. This paper will review the benefits of supervised exercise training in patients with PAD.
Collapse
Affiliation(s)
- Richard V Milani
- Department of Cardiovascular Disease, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | | |
Collapse
|
33
|
Cardiac Rehabilitation Programs Markedly Improve High-Risk Profiles in Coronary Patients with High Psychological Distress. South Med J 2008; 101:262-7. [DOI: 10.1097/smj.0b013e318164dfa8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Alterations of blood rheology during and after exercise are both consequences and modifiers of body's adaptation to muscular activity. Sci Sports 2007. [DOI: 10.1016/j.scispo.2007.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
35
|
|
36
|
Casillas JM, Gremeaux V, Damak S, Feki A, Pérennou D. Exercise training for patients with cardiovascular disease. ACTA ACUST UNITED AC 2007; 50:403-18, 386-402. [PMID: 17445931 DOI: 10.1016/j.annrmp.2007.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/09/2007] [Indexed: 01/19/2023]
Abstract
This review surveys effort training, a validated and recommended therapy, in patients with atheromatous cardiovascular disease. This true therapy reduces mortality by 25-35%, reduces clinical manifestations and complications (rhythm problems, thrombosis) and improves physical capacity, reintegration and quality of life. The effects are essentially linked to improved metabolic performance of muscles and reduced endothelial dysfunction, insulin resistance and neurohormonal abnormalities. Training also has an impact on the evolution of major risk factors, especially diabetes and arterial hypertension. The risks are limited as long as the contraindications are respected and the programmes supervised. The indications (stable angina, chronic heart failure, peripheral arterial disease) should be described more precisely by taking into account functional criteria: physical deconditioning, exclusion, compliance, mood swings, and seriousness of risk factors. The training programme should be tailor made and based on evaluation of the patient's adaptation to effort, in terms of frequency, intensity and duration of the exercises. Various types of exercise include overall or segmental physical training; concentric, eccentric, even isokinetic muscle contraction exercises; and proprioceptive rehabilitation. However, knowledge is lacking about the molecular mechanisms of the effects of training, the most effective intensity of effort, and strategies to develop physical activity in this ever-growing population for both primary and secondary prevention.
Collapse
Affiliation(s)
- J M Casillas
- Pôle rééducation-réadaptation, Inserm U887, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon cedex, France.
| | | | | | | | | |
Collapse
|
37
|
Lee KW, Blann AD, Jolly K, Lip GYH. Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study. Heart 2006; 92:1732-8. [PMID: 16807272 PMCID: PMC1861270 DOI: 10.1136/hrt.2006.092163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D-dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P-selectin (an index of platelet activation)), vasomotor function (using flow-mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown. METHODS 81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital-based (n = 40) or home-based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D-dimer, fibrinogen, soluble P-selectin and plasma viscosity, as well as FMD and 24-h ABP, were measured at baseline and after 3 months of cardiac rehabilitation. RESULTS In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D-dimer were significantly lower and FMD improved (all p<or=0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24-h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital-based and home-based cardiac rehabilitation programmes on these indices. CONCLUSIONS Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home-based and hospital-based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes.
Collapse
Affiliation(s)
- K W Lee
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
| | | | | | | |
Collapse
|
38
|
Turchetti V, Boschi L, Donati G, Trabalzini L, Forconi S. Impact of Hemorheological and Endothelial Factors on Microcirculation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 578:107-12. [PMID: 16927678 DOI: 10.1007/0-387-29540-2_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Previous studies showed that endothelial alterations caused by physical stress worsened the hemorheological parameters mainly in patients affected by ischemic vascular diseases: major vascular alterations have been found in patients with very high endothelial dysfunction indexes: these indexes are given by the various substances produced by the endothelium, but it is very difficult to have a value which clearly identifies the real state of the endothelial alteration. The function of the NO, an endogenous vasodilator whose synthesis is catalyzed by NOs, can be determined by the Citrulline/Arginine ratio, which represents the level of activity of the enzyme. A very good index of the endothelial dysfunction is asymmetric dimethylarginine (ADMA), a powerful endogenous inhibitor of NOs; in fact several studies have demonstrated a strong relationship between ischemic vascular disease and high levels of plasmatic ADMA. Our recent studies on heart failure and on ischemic cerebrovascular diseases evaluate endothelial dysfunctions and hemorheological parameters.
Collapse
Affiliation(s)
- Vera Turchetti
- Dipartimento di Medicina Interna, Cardiovascolare e Geriatrica, Universith degli Studi di Siena, Policlinico Santa Maria alle Scotte, 53100 Siena, Italy.
| | | | | | | | | |
Collapse
|
39
|
Giovannelli F, Rubattu S. The Role of Cardiac Rehabilitation in the Treatment and Secondary Prevention of Cardiovascular Disease. High Blood Press Cardiovasc Prev 2006. [DOI: 10.2165/00151642-200613010-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
40
|
Casillas JM, Deley G, Salmi-Belmihoub S. Indices de mesure de l'activité physique dans le domaine des affections cardiovasculaires. ACTA ACUST UNITED AC 2005; 48:404-10. [PMID: 15932778 DOI: 10.1016/j.annrmp.2005.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify the more useful among many methods available for the measurement of physical activity in patients with cardiovascular disease. For practical and financial reasons only questionnaires and mechanical monitoring, which are appropriate for use in large studies, were assessed. METHODS To select tools valuable for clinical and epidemiological measurement of physical activity, with sufficient validity, reproducibility and sensitivity, we reviewed the literature in Medline with use of keywords: accelerometry, ambulatory accelerometry, ambulatory monitoring, cardiovascular diseases, daily activity, heart disease, pedometer, physical activity, questionnaire. RESULTS Considering appropriate level of reproducibility and validity, 15 questionnaires are available. For measuring postures and motions during daily life, activity monitor seems to be more valid than pedometers or single accelerometers. CONCLUSION At present the preferred method is a questionnaire, provided it is valid, repeatable, easy to use and inexpensive. In the future mechanical monitoring (especially activity monitor) will be probably a good alternative.
Collapse
Affiliation(s)
- J M Casillas
- Inserm ERITm 0207, pôle rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 2079 Dijon cedex, France.
| | | | | |
Collapse
|
41
|
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111:369-76. [PMID: 15668354 DOI: 10.1161/01.cir.0000151788.08740.5c] [Citation(s) in RCA: 606] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article updates the 1994 American Heart Association scientific statement on cardiac rehabilitation. It provides a review of recommended components for an effective cardiac rehabilitation/secondary prevention program, alternative ways to deliver these services, recommended future research directions, and the rationale for each component of the rehabilitation/secondary prevention program, with emphasis on the exercise training component.
Collapse
|
42
|
Lavie CJ, Milani RV. Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training. Mayo Clin Proc 2005; 80:335-42. [PMID: 15757014 DOI: 10.4065/80.3.335] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the prevalence of hostility symptoms in young patients with coronary artery disease (CAD), the associated risk factor profile in these patients, and the effects of a formal phase 2 cardiac rehabilitation and exercise training program. PATIENTS AND METHODS Our study included consecutive CAD patients referred for cardiac rehabilitation from May 1999 through December 2000. At baseline and after rehabilitation, behavioral factors and quality of life were assessed by validated questionnaires, and standard CAD risk factors were measured, including exercise capacity. We specifically evaluated detailed data for young patients. RESULTS A total of 500 patients were included in the study. Hostility scores were 2.5 times higher (P<.001) in the 81 young patients (< 50 years; mean +/- SD age, 45 +/- 5 years) than in the 268 elderly patients (> or = 65 years; mean +/- SD age, 70 +/- 4 years), and the prevalence of hostility symptoms was 3.5 times higher in young patients (28% vs 8%; P<.001). Young patients with hostility symptoms also had more adverse CAD risk profiles, including higher total cholesterol levels, triglyceride levels, total cholesterol/high-density lipoprotein cholesterol ratios, fasting glucose levels, and glycosylated hemoglobin levels and lower quality-of-life scores compared with young patients with low hostility scores. After cardiac rehabilitation, young patients with hostility symptoms had marked improvements in CAD risk factors, behavioral characteristics (including hostility), and quality of life, and a nearly 50% (P=.005) reduction in the prevalence of hostility symptoms occurred. CONCLUSIONS Young CAD patients have a high prevalence of hostility symptoms and adverse CAD risk profiles. Reducing hostility symptoms and other parameters of psychological distress in young CAD patients should be emphasized, and the potential benefits of cardiac rehabilitation programs in the secondary prevention of CAD should be highlighted.
Collapse
Affiliation(s)
- Carl J Lavie
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
43
|
Lavie CJ, Milani RV. Cardiac Rehabilitation and Exercise Training Programs in Metabolic Syndrome and Diabetes. ACTA ACUST UNITED AC 2005; 25:59-66. [PMID: 15818190 DOI: 10.1097/00008483-200503000-00001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Carl J Lavie
- Exercise LaboratoriesDepartment of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
| | | |
Collapse
|
44
|
Dendale P, Berger J, Hansen D, Vaes J, Benit E, Weymans M. Cardiac rehabilitation reduces the rate of major adverse cardiac events after percutaneous coronary intervention. Eur J Cardiovasc Nurs 2004; 4:113-6. [PMID: 15904881 DOI: 10.1016/j.ejcnurse.2004.11.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 11/01/2004] [Accepted: 11/18/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite multiple publications on effects of rehabilitation in cardiac patients, rehabilitation is not fully known to be of value in post-percutaneous coronary intervention (PCI) patients. AIMS To investigate the influence of cardiac rehabilitation on the incidence of major adverse cardiac events (MACEs) in post-PCI patients. METHODS Retrospectively and nonrandomized 140 post-PCI patients (107 males, mean age 62 (7) years) participated in a 3-month rehabilitation program, starting 2 weeks post-PCI, while 83 post-PCI patients (54 males, mean age 68 (8) years) did not and were all followed up for 15 months. Data on cardiac medication prescription and incidence of MACE (including angina pectoris with or without reintervention, restenosis, myocardial infarction, revascularisation with re-PCI or CABG, and death) were collected. The relationship with cardiovascular risk factors including sex, smoking behaviour, obesity, diabetes mellitus, hypertension, familiar predisposition, and hypercholesterolemia was analysed. RESULTS The incidence of total MACE in the rehabilitation group is significantly lower than in the control group (24% vs. 42%, respectively; P<0.005). The incidence of documented restenosis, angina pectoris with resulting reintervention, all revascularisations, and death is significantly lower in the rehabilitation group, compared with the control group. CONCLUSION The incidence of MACE and restenosis is significantly lower when PCI patients are included in a cardiac rehabilitation program.
Collapse
Affiliation(s)
- Paul Dendale
- Rehabilitation and Health Centre, Virga Jesse Hospital, Hasselt, Belgium.
| | | | | | | | | | | |
Collapse
|
45
|
Lavie CJ, Milani RV. Impact of aging on hostility in coronary patients and effects of cardiac rehabilitation and exercise training in elderly persons. ACTA ACUST UNITED AC 2004; 13:125-30. [PMID: 15133415 DOI: 10.1111/j.1076-7460.2004.03285.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hostility is a coronary artery disease (CAD) risk factor affecting recovery after major CAD events. Yet, few data exist on the impact of aging on hostility in CAD patients or the effects of cardiac rehabilitation on elderly patients with high hostility. The authors studied 500 consecutive patients following CAD events to determine the impact of aging on hostility scores, the prevalence of hostility symptoms, and the response of elderly persons with hostility symptoms to cardiac rehabilitation programs. Overall hostility scores (p<0.01) and prevalence of hostility symptoms (8% in 268 elderly vs. 28% in 81 younger patients [aged <50 years]) were inversely related to age (p<0.01). Elderly persons with hostility symptoms had greater weight (p=0.02), four times higher anxiety and depression scores (p<0.0001), two times higher scores for somatization (p<0.0001), and 17% lower scores for quality of life (p<0.001) compared with elderly persons without hostility symptoms. Marked reduction in hostility and improvements in other risk factors occurred following rehabilitation. These results demonstrate the inverse relationship between age and hostility symptoms in patients with CAD. Although hostility symptoms are relatively uncommon in elderly persons with CAD, these patients have more adverse CAD risk profiles and still have marked improvements following cardiac rehabilitation and exercise training programs.
Collapse
Affiliation(s)
- Carl J Lavie
- Ochsner Heart and Vascular Institute, New Orleans, LA 70121, USA.
| | | |
Collapse
|