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Jansson AK, Schumacher TL, Kocanda L, Whatnall M, Fenwick M, Betts D, Bauman A, Kerr J, Duncan MJ, Collins CE, Boyle A, Inder KJ, Plotnikoff RC. A Systematic Review of the Completion of Cardiac Rehabilitation Programs for Adults Aged 18-50 Years. J Cardiopulm Rehabil Prev 2024; 44:E30-E51. [PMID: 39185913 DOI: 10.1097/hcr.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50 yr and describe how core components were reported, measured, and tailored to those under 50 yr. REVIEW METHODS Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50 yr) who had participated in a CR program. SUMMARY Out of the articles screened (n = 24,517), 33 reports across 31 independent studies were considered eligible (n = 1958 patients aged ≤50 yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7 d to 20 wk, with most (65%) ranging between 6 and 12 wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.
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Affiliation(s)
- Anna K Jansson
- Author Affiliations: Centre for Active Living and Learning, School of Education, The University of Newcastle, Newcastle, New South Wales, Australia (Drs Jansson and Plotnikoff); Active Living Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia (Dr Jansson, Mr Fenwick, and Drs Duncan and Plotnikoff); Department of Rural Health, The University of Newcastle, Tamworth, New South Wales, Australia (Drs Schumacher and Kocanda); School of Health Science, College of Health and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia (Drs Whatnall and Collins); Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia (Drs Kocanda, Whatnall, and Collins); School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia (Mr Fenwick and Drs Duncan and Boyle); Cancer Council NSW, Sydney, New South Wales, Australia (Mrs Betts); School of Public Health, University of Sydney, Sydney, New South Wales, Australia (Dr Bauman); Hunter New England Health, Newcastle, New South Wales, Australia (Ms Kerr and Dr Inder); and School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia (Dr Inder)
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Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2022; 42:331-337. [PMID: 35362694 DOI: 10.1097/hcr.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group. METHODS A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs. RESULTS There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression. CONCLUSIONS Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.
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Marzuca-Nassr GN, Seron P, Román C, Gálvez M, Navarro R, Latin G, Marileo T, Molina JP, Sepúlveda P, Oliveros MJ. A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease. Front Physiol 2022; 13:948273. [PMID: 35991183 PMCID: PMC9389047 DOI: 10.3389/fphys.2022.948273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary heart disease is the most common cause of death worldwide. Standard cardiac rehabilitation (face-to-face sessions) has shown benefits in increasing muscle strength and functional exercise capacity in adults and older people. However, it is unknown whether hybrid cardiac rehabilitation (a first face-to-face phase + a second remote monitoring phase) will have similar benefits in adults versus older subjects. The aim of this study was to compare the effects of a hybrid exercise-based cardiac rehabilitation program on muscle strength and functional exercise capacity in “adult” versus “older” people with coronary artery disease. We hypothesized that a hybrid exercise-based cardiac rehabilitation program would improve muscle strength and functional exercise capacity, but the impact would be smaller in the older group than the adult individuals. This study is part of a larger project (The Hybrid Cardiac Rehabilitation Trial-HYCARET). We subjected 22 adult (<60 y) females and males (ADULT; n = 5/17 (f/m); 52 ± 5 y; 28.9 ± 3.4 kg·m-2) and 20 older (≥60 y) females and males (OLDER; n = 6/14 (f/m); 66 ± 4 y; 27.4 ± 3.9 kg·m-2) with coronary artery disease to 12 weeks of hybrid exercise-based cardiac rehabilitation program. Prior to and after 12 weeks of a hybrid exercise-based cardiac rehabilitation program, grip strength (handgrip), leg strength (chair stand test), and functional exercise capacity (6-minute walk test, 6MWT) were assessed. The hybrid exercise-based cardiac rehabilitation program resulted in a 9.4 ± 14.6% and a 6.2 ± 12.1% grip strength increase, a 14.4 ± 39.4% and a 28.9 ± 48.1% legs strength increase, and a 14.6 ± 26.4% and a 6.8 ± 14.0% functional exercise capacity improvement in ADULT and OLDER, respectively (p < 0.05) with no differences between groups. In conclusion, a hybrid exercise-based cardiac rehabilitation program could increase muscle strength and improve functional exercise capacity in adults and older people with coronary artery disease. More future studies comparing effectiveness among these age groups are needed to strengthen this conclusion.
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Affiliation(s)
- Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Pamela Seron
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- *Correspondence: Pamela Seron,
| | - Claudia Román
- Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Complejo Hospitalario San José, Santiago, Chile
| | | | - Rocío Navarro
- Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gonzalo Latin
- Hospital Clínico San Borja-Arriarán, Santiago, Chile
| | - Tania Marileo
- Hospital Regional de Antofagasta, Antofagasta, Chile
| | | | - Pablo Sepúlveda
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - María José Oliveros
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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A Half-Century of Evidence-Based Cardiac Rehabilitation: A Historical Review. Clin J Sport Med 2022; 32:e96-e103. [PMID: 32932364 DOI: 10.1097/jsm.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the achievements of cardiac exercise rehabilitation programs retrospectively and to identify continuing challenges to their success. METHODS A review of files accumulated while working with the Toronto Rehabilitation Center, updated by articles identified by PUB-MED, OVID, and Google Scholar through February 2019. RESULTS After the early lead of Israeli physicians, cardiac rehabilitation began in Ontario during the 1960s and quickly attracted a large case load. Recurrence rates of the patients recruited were low relative to those receiving standard medical treatment, even after allowing for differences in risk factors at entry to programs. Controlled trials began but were individually of insufficient in size to show a significant reduction in recurrences or mortality. Subsequently, multiple meta-analyses demonstrated a 20% to 25% reduction of all-cause and cardiac mortality over the first few years of follow-up in patients who persisted with their rehabilitation. Compliance continued a problem at many centers, but special features of the Toronto cardiac rehabilitation program sustained a compliance of 82.8% over 3 years. Although vigorous exercise increased the immediate risks of a recurrence 5- to 10-fold, this was more than offset by the long-term benefits of enhanced physical condition, and cardiac deaths were a rarity during either supervised or home-based exercise sessions. About a half of patients developed a depression immediately after infarction, but if encouraged to persist with prescribed exercise, their quality of life progressively improved. Among the wide variety of mechanisms underlying the benefits of exercise, gains of aerobic power seemed particularly important. With sustained training, the physical condition of some younger patients progressed to the point of participating successfully in marathon events. Older patients also benefited from sustained training, but for them, optimal results were likely associated with less rigorous physical demands. CONCLUSIONS Research conducted in Toronto and elsewhere has established the benefits of exercise-centered cardiac rehabilitation. However, there remains a need to define the optimum timing of program onset, and the frequency, intensity, and duration of supervised training sessions. Return to blue-collar occupations also needs to be boosted, and the limited participation of eligible patients in available programs remains a continuing challenge.
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Lutz AH, Forman DE. Cardiac rehabilitation in older adults: Apropos yet significantly underutilized. Prog Cardiovasc Dis 2022; 70:94-101. [PMID: 35016915 PMCID: PMC8930627 DOI: 10.1016/j.pcad.2022.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 01/12/2023]
Abstract
Cardiac Rehabilitation (CR) is a comprehensive disease management program that utilizes exercise training, behavioral modification, education, and psychosocial counseling to optimize outcomes and functionality in patients with cardiovascular disease (CVD)1). While CR was initially designed as an exercise training and fitness program for younger patients, usually men, after debilitating hospitalizations for myocardial infarction or cardiac surgery, evidence has expanded to also include other types of CVD in women as well as men, including heart failure, valvular disease, and peripheral arterial disease2-4). As the population of older adults continues to expand, age-related CVD is endemic and is commonly associated with exercise decline, diminished quality of life, and dependence. CR has the potential to counterbalance these patterns, and therefore stands out as a particularly important consideration for older adults with CVD. Nevertheless, CR remains highly underutilized5,6). Novel approaches to CR including home-based and hybrid CR programs show promise for enhanced outreach to patients who may not otherwise participate. This review summarizes the current data available regarding CR in older adults with CVD with a focus on geriatric-specific complexities, current barriers to utilization, and approaches to enhance participation and effectiveness.
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Affiliation(s)
- Andrew H Lutz
- University of Maryland School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Baltimore, MD, Baltimore VA Healthcare System, Baltimore, MD, United States of America
| | - Daniel E Forman
- University of Pittsburgh, Department of Medicine, Divisions of Geriatrics and Cardiology, Pittsburgh Geriatrics Research, Education and Clinical Center, VA Pittsburgh Healthcare System, United States of America.
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Marcin T, Eser P, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Peña Gil C, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. PLoS One 2021; 16:e0255477. [PMID: 34343174 PMCID: PMC8330933 DOI: 10.1371/journal.pone.0255477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO2) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (≥65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy. Trial registration Netherlands Trial Register, Trial NL5166.
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Affiliation(s)
- Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Santiago, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P. Meindersma
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Deng B, Shou X, Ren A, Liu X, Wang Q, Wang B, Wang Y, Yan T, Zhao X, Zhu L. Effect of aerobic training on exercise capacity and quality of life in patients older than 75 years with acute coronary syndrome undergoing percutaneous coronary intervention. Physiother Theory Pract 2020; 38:1135-1144. [PMID: 32991232 DOI: 10.1080/09593985.2020.1825580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Limited clinical studies are available on early exercise-based cardiac rehabilitation in elderly acute coronary syndrome (ACS) patients. OBJECTIVE To evaluate the effect of aerobic exercise on exercise capacity and quality of life (QoL) in such patients. METHODS Seventy elderly patients with ACS undergoing percutaneous coronary intervention in Zhejiang Hospital during August 2016-June 2017 were randomly divided into the control (n = 35) or cardiac rehabilitation group (CR, n = 35). The control group was treated with standard medical treatments without exercise, whereas the CR group was treated with standard medical treatments and exercise-based cardiac rehabilitation. General information, cardiopulmonary exercise test (CPET) results, responses to QoL and mental health questionnaires, and clinical outcomes and safety were collected. RESULTS The CR group safely finished CPET and the 12-week exercise-based cardiac rehabilitation. After the 12-week intervention, the CR group showed significant differences in maximal oxygen uptake (VO2max) and greater improvements in VO2max, compared with the control group. The CR group showed statistically significant differences in QoL and mental health compared with the control group. CONCLUSION CPET-based exercise in cardiac rehabilitation can safely increase exercise capacity and QoL in such patients.
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Affiliation(s)
- Bingying Deng
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Xiaoling Shou
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Aihua Ren
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Xinwen Liu
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Qinan Wang
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Bozhong Wang
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Yan Wang
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Ting Yan
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Xiaoxia Zhao
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
| | - Liyue Zhu
- Rehabilitation Center, Zhejiang Hospital, Hangzhou City, Zhejiang Province, China
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Grote V, Unger A, Böttcher E, Muntean M, Puff H, Marktl W, Mur E, Kullich W, Holasek S, Hofmann P, Lackner HK, Goswami N, Moser M. General and Disease-Specific Health Indicator Changes Associated with Inpatient Rehabilitation. J Am Med Dir Assoc 2020; 21:2017.e10-2017.e27. [PMID: 32736990 DOI: 10.1016/j.jamda.2020.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Rehabilitation plays a vital role in the mitigation and improvement of functional limitations associated with aging and chronic conditions. Moderating factors such as sex, age, the medical diagnosis, and rehabilitation timing for admission status, as well as the expected change related to inpatient rehabilitation, are examined to provide a valid basis for the routine assessment of the quality of medical outcomes. DESIGN An observational study was carried out, placing a focus on general and disease-specific health measurements, to assess representative results of multidisciplinary inpatient rehabilitation. Aspects that were possibly confounding and introduced bias were controlled based on data from a quasi-experimental (waiting) control group. MEASURES Existing data or general health indicators were extracted from medical records. The indicators included blood pressure, resting heart rate, self-assessed health, and pain, as well as more disease-specific indicators of physical function and performance (eg, activities of daily living, walking tests, blood lipids). These are used to identify moderating factors related to health outcomes. SETTING AND PARTICIPANTS A standardized collection of routine data from 16,966 patients [61.5 ± 12.5 years; 7871 (46%) women, 9095 (54%) men] with different medical diagnoses before and after rehabilitation were summarized using a descriptive evaluation in terms of a content and factor analysis. RESULTS Without rehabilitation, general health indicators did not improve independently and remained stable at best [odds ratio (OR) = 0.74], whereas disease-specific indicators improved noticeably after surgery (OR = 3.20). Inpatient rehabilitation was shown to reduce the risk factors associated with certain lifestyles, optimize organ function, and improve well-being in most patients (>70%; cutoff: z-difference >0.20), with a standardized mean difference (SMD) seen in overall medical quality outcome of -0.48 ± 0.37 [pre- vs post-rehabilitation: ηp2 = 0.622; dCohen = -1.22; 95% confidence interval (95% CI) -1.24 to -1.19]. The baseline medical values obtained at the beginning of rehabilitation were influenced by indication, age, and sex (all P < .001); however, these factors have less significant effects on improvements in general health indicators (ηp2 < 0.01). According to the disease-specific results, the greatest improvements were found in older patients (SMD for patients >60 vs ≤60 years: 95% CI 0.08-0.11) and during the early rehabilitation stage (ηp2 = 0.063). CONCLUSIONS AND IMPLICATIONS Compared with those who received no inpatient rehabilitation, patients who received rehabilitation showed greater improvements in 2 independent areas, general and disease-specific health measures, regardless of their diagnosis, age, and sex. Due to the study design and the use of a nonrandomized waiting group, causal conclusions must be drawn with caution. However, the comparability and stability of the presented results strongly support the validity of the observed improvements associated with inpatient rehabilitation.
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Affiliation(s)
- Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.
| | - Alexandra Unger
- University College of Teacher Education Carinthia, Viktor Frankl University College, Klagenfurt, Austria
| | | | | | | | - Wolfgang Marktl
- GAMED & Karl Landsteiner Institut für Traditionelle Medizin, Vienna, Austria
| | - Erich Mur
- Univ.-Klinik Innsbruck & Research Unit f. Orthopädische Physiotherapie (UMIT), Hall in Tirol, Austria
| | - Werner Kullich
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Department for Rehabilitation, Saalfelden, Austria
| | - Sandra Holasek
- Otto Loewi Research Center, Immunology and Pathophysiology, Medical University of Graz, Graz, Austria
| | - Peter Hofmann
- Institute of Sports Sciences, Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Helmut K Lackner
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Maximilian Moser
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria; Human Research Institute, Weiz, Austria
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Harb SC, Bhat P, Cremer PC, Wu Y, Cremer LJ, Berger S, Cho L, Menon V, Gulati M, Jaber WA. Prognostic Value of Functional Capacity in Different Exercise Protocols. J Am Heart Assoc 2020; 9:e015986. [PMID: 32578479 PMCID: PMC7670526 DOI: 10.1161/jaha.119.015986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Functional capacity is associated with mortality, although the prognostic value of achieved estimated metabolic equivalents (METs) across various exercise protocols is not established. We sought to determine whether achieved METs had different prognostic implications according to the protocol employed. Methods and Results From 1991 to 2015, we identified 120 705 consecutive patients from a stress testing registry who underwent the following 7 different standardized exercise protocols: Bruce, modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The primary outcome was all‐cause mortality. There were 74 953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20 425 Cornell 10%, 1226 Naughton, and 3113 modified Naughton protocols. During a mean follow‐up of 8.7 years, a total of 8426 deaths (6.9%) occurred. When compared with the Bruce protocol, after multivariable adjustment for clinical risk factors, medications, and functional capacity, test protocol was independently associated with mortality (modified Naughton [hazard ratio (HR), 2.51; 95% CI, 2.26–2.8], Naughton [HR, 1.79; 95% CI, 1.57–2.04], Cornell 0% [HR, 1.79; 95% CI, 1.59–2.01], modified Bruce [HR, 1.62; 95% CI, 1.48–1.76], Cornell 5% [HR, 1.61; 95% CI, 1.47–1.75], and Cornell 10% [HR, 1.32; 95% CI, 1.22–1.42]). Across all protocols, higher estimated METs were associated with lower mortality, although the equivalent METs achieved were associated with a worse prognosis in less‐demanding protocols. Conclusions Higher estimated METs are reliably associated with lower mortality in all exercise protocols, although the prognostic value is not transferable across different tests. Consequently, the prognostic value of METs achieved during a stress test should be considered protocol dependent.
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Affiliation(s)
- Serge C Harb
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Pavan Bhat
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Paul C Cremer
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Yuping Wu
- Department of Mathematics and Statistics Cleveland State University Cleveland OH
| | | | | | - Leslie Cho
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Venu Menon
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Martha Gulati
- Division of Cardiology University of Arizona College of Medicine Phoenix AZ
| | - Wael A Jaber
- Heart and Vascular Institute Cleveland Clinic Cleveland OH
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Kim KH, Jang YC, Song MK, Park HK, Choi IS, Han JY. Changes in Aerobic Capacity Over Time in Elderly Patients With Acute Myocardial Infarction During Cardiac Rehabilitation. Ann Rehabil Med 2020; 44:77-84. [PMID: 32130841 PMCID: PMC7056327 DOI: 10.5535/arm.2020.44.1.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/25/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients. METHODS We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (METmax) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity. RESULTS The younger group showed improvement in METmax between T0 and T1. However, METmax of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with METmax, of all groups showed improvement between T0 and T2. CONCLUSION Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.
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Affiliation(s)
- Ki-Hong Kim
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yun-Chol Jang
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - In-Sung Choi
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol 2020; 43:108-117. [PMID: 31825137 PMCID: PMC7021659 DOI: 10.1002/clc.23311] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.
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Affiliation(s)
| | - Daniel E. Forman
- Professor of MedicineUniversity of Pittsburgh University of Pittsburgh Medical Center and VA Pittsburgh Healthcare SystemPittsburghPennsylvania
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Abstract
Coronary artery disease (CAD) can be obstructive or nonobstructive. Patients with nonobstructive and stable angina pectoris are usually women. Nonobstructive CAD is caused by endothelial dysfunction at the microvascular level, such as cardiac syndrome X and coronary slow flow syndrome. Even if coronary anatomy is nonobstructive, the presence of myocardial ischemia is a major determinant for the exercise program. CAD is a chronic inflammatory disease, and the progression of the disease can lead to a rapid change in the functional capacity of CAD patients. Exercise training is a major component of cardiac rehabilitation and reduces cardiovascular mortality, morbidity, and rehospitalization as well as improves psychological stress and controls risk factors of CAD, such as diabetes mellitus, hypertension, and obesity. It is possible that the quality of life of patients with CAD can be improved by using appropriate exercise therapy. However, the exercise programs among CAD patients are highly underutilized. This chapter will summarize the research progress of exercise in the prevention and treatment of CAD as well as how to create safe exercise programs and the importance of exercise for patients with CAD. In addition, exercise training has fundamental beneficial effects on ischemic and nonischemic heart failure.
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Affiliation(s)
- Aydin Akyuz
- Faculty of Medicine, Department of Cardiology, University Hospital, Namık Kemal University, Tekirdag, Turkey.
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Effects of a Cardiac Rehabilitation Program Versus Usual Care on Cardiopulmonary Function in Patients With Cardiac Syndrome X. J Cardiopulm Rehabil Prev 2019; 40:41-47. [PMID: 31869312 DOI: 10.1097/hcr.0000000000000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Because of uncertainty in the pathophysiological process, the treatment of cardiac syndrome X (CSX) is still under study. Addressing the effects of cardiac rehabilitation (CR) can help promote the prescription of this modality as an adjuvant therapy for these patients. METHODS This study was performed on 30 patients with effort-induced angina pectoris using a positive exercise test and/or myocardial perfusion scan in the absence of obvious stenosis or a stenosis of <50% on coronary angiography. The patients were divided into the CR and usual care (UC) groups and underwent cardiopulmonary exercise testing with gas exchange analysis before and after the study. The Duke Treadmill Score was used to compare prognosis and survival estimates of patients. RESULTS An increase in peak oxygen uptake ((Equation is included in full-text article.)O2) was significantly higher in the CR group than in the control group (P = .017). Resting (Equation is included in full-text article.)O2 was also increased in the CR group, but its difference with the UC group was not statistically significant. Resting O2 pulse was increased in the CR group, which significantly differed between groups (P = .041). Exercise test duration and the Duke Treadmill Score significantly increased in the CR group as compared with the UC group (P = .003 and P = .002, respectively). Also, recovery heart rate in the first minute was significantly improved in CR group. CONCLUSION Adding a 4-wk course of CR to UC for patients with CSX not only increased the Duke Treadmill Score and exercise test duration but also improved the resting O2 pulse, peak (Equation is included in full-text article.)O2, and first-minute recovery heart rate.
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Kumar KR, Pina IL. Cardiac rehabilitation in older adults: New options. Clin Cardiol 2019; 43:163-170. [PMID: 31823400 PMCID: PMC7021654 DOI: 10.1002/clc.23296] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home‐based CR and the utilization of technology.
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Affiliation(s)
- Kartik R Kumar
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Ileana L Pina
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
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Functional Capacity but Not Early Uptake of Cardiac Rehabilitation Predicts Readmission in Patients With Metabolic Syndrome. J Cardiovasc Nurs 2019; 33:306-312. [PMID: 29303869 DOI: 10.1097/jcn.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phase II cardiac rehabilitation reduces hospital readmissions and cardiovascular disease risk factors and improves functional capacity. Cardiovascular disease risk factors double with patients with metabolic syndrome, a population less likely to adhere to cardiac rehabilitation. PURPOSE The aim of this study was to determine relationships between cardiac rehabilitation uptake timing, demographic variables and functional capacity, and readmission in patients with metabolic syndrome. METHODS This retrospective, medical records study involved 353 patients with metabolic syndrome who subsequently received cardiac rehabilitation. Logistic regression was used to examine relationships between time from discharge to cardiac rehabilitation uptake and readmission. Unordered categorical factors were compared between readmission groups using Pearson χ tests. Multivariable logistic regression was used to identify predictors of readmission. RESULTS Patients readmitted within 30 and 90 days of hospitalization were more often women (P ≤ .018) and nonwhite (P ≤ .002) and had lower functional capacity (P < .001). In multivariable analysis, white race (odds ratio [OR], 0.50 [95% confidence interval (CI), 0.25-0.99]; P = .045) and higher functional capacity (OR, 0.80 [95% CI, 0.68-0.93]; P = .005) were protective against hospital readmission within the first 90 days. Race, sex, and functional capacity remained significant predictors of readmission at 1 year. In multivariable analysis, only race (OR, 0.41 [95% CI, 0.22-0.79]; P = .007) and functional capacity (OR, 0.83 [95% CI, 0.73-0.95]; P = .007) were significant. Early cardiac rehabilitation was not associated with readmission at any time point (P > .05). CONCLUSIONS Sex, race, and functional capacity were important predictors of readmission for metabolic syndrome, even when cardiac rehabilitation intake was delayed. Results raise questions about the unique traits of patients with metabolic syndrome and need for novel approaches to improve cardiac rehabilitation utilization and functional capacity in metabolic syndrome.
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Abstract
Prevalence of cardiovascular disease (CVD) increases with age and is endemic in the burgeoning population of older adults. Older adults with CVD are susceptible not only to high mortality but also to increased likelihood of disability, dependency, functional decline, and poor quality of life. Cardiac rehabilitation (CR) is a multidimensional and comprehensive treatment program that can potentially address many of the distinctive challenges of older adults with CVD. In this review, the wide range of potential benefits of CR for older adults with CVD is summarized.
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Affiliation(s)
- Deirdre O'Neill
- Department of Medicine and Mazankowski Heart Institute, Division of Cardiology, University of Alberta Hospital, 11220 83 Avenue, Edmonton, AB T6G 2J2, Canada
| | - Daniel E Forman
- Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Haeny T, Nelson R, Ducharme J, Zuhl M. The Influence of Exercise Workload Progression Across 36 Sessions of Cardiac Rehabilitation on Functional Capacity. J Cardiovasc Dev Dis 2019; 6:jcdd6030032. [PMID: 31489917 PMCID: PMC6787655 DOI: 10.3390/jcdd6030032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022] Open
Abstract
Defining time frames throughout cardiac rehabilitation (CR) to progress exercise workloads may lead to improve functional capacity outcomes. The purpose of this study was to investigate the role of exercise progression on functional capacity among cardiac patients enrolled in CR. This was a retrospective database analysis study. Extracted data included: Demographic, functional capacity (in METs), and exercise intensity during exercise sessions 2, 12, 24, and 36 of CR from 150 patients who completed a 36-session program. Progression of exercise was determined by calculating percent change in treadmill exercise workload within predefined time frames of CR. The time frames were percent change from exercise session 2 to 12 (“%ΔS2–S12), 12 to 24 (%ΔS12–S24), and 24 to 36 (%ΔS24–S36). A multiple linear regression model was developed to predict change in functional capacity (ΔMETs). A significant proportion (21%) of total variation in ΔMETs was predicted by %ΔS2–12, %ΔS12–24, %ΔS24–36, age, sex, and body mass index (BMI). Percent changes between sessions 12 to 24 (%ΔS12–24; β = 0.17, p = 0.03) and 24 to 36 (%ΔS24–36; β = 0.23, p < 0.01) were significant predictors. Progressing patients between sessions 12 to 24 and 24 to 36 predicted significant changes in functional capacity and reinforced the importance of exercise progression across all 36 sessions of CR.
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Affiliation(s)
- Truman Haeny
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Rachael Nelson
- School of Health Sciences, Central Michigan University, Mt. Pleasant, MI 48859, USA.
| | - Jeremy Ducharme
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
| | - Micah Zuhl
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA.
- School of Health Sciences, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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Caru M, Curnier D, Bousquet M, Kern L. Evolution of depression during rehabilitation program in patients with cardiovascular diseases. Disabil Rehabil 2018; 42:378-384. [PMID: 30299991 DOI: 10.1080/09638288.2018.1499824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.
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Affiliation(s)
- M Caru
- Department of Psychology, University of Paris Nanterre, Nanterre, France.,Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France
| | - D Curnier
- Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - M Bousquet
- Saint-Orens Cardiovascular and Pulmonary Rehabilitation Center, Saint-Orens-de-Gameville, France
| | - L Kern
- Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France.,Department of Science and Technology of Physical Activities and Sports, University of Paris Nanterre, Nanterre, France.,Laboratoire EA 2931 - Centre de recherches sur le sport et le mouvement (CeRSM), UFR STAPS, University of Paris Nanterre, Nanterre, France
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Butter C, Groß J, Haase-Fielitz A, Sims H, Deutsch C, Bramlage P, Neuss M. Impact of Rehabilitation on Outcomes after TAVI: A Preliminary Study. J Clin Med 2018; 7:jcm7100326. [PMID: 30301135 PMCID: PMC6210128 DOI: 10.3390/jcm7100326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
The benefit of rehabilitation in elderly patients undergoing transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is unknown. The impact of declining rehabilitation programs on mortality has also not been described. In a longitudinal cohort study of 1056 patients undergoing elective TAVI between 2008 and 2016, logistic regression analysis was used to assess the relationship between treatment modality and outcome according to whether or not patients participated in a three-week rehabilitation program after TAVI. Subgroup analyses included patient outcome separated according to cardiac, geriatric, or no rehabilitation. A total of 1017 patients survived until hospital discharge (96.3%) and were offered rehabilitation, 366 patients (36.0%) declined to undergo rehabilitation, with the remaining patients undergoing either cardiac (n = 435; 42.8%) or geriatric rehabilitation (n = 216; 21.2%). Mortality at six months was lower for patients receiving rehabilitation compared with those who had not (adjusted odds ratio (OR): 0.49; 95% confidence interval (confidence interval [CI]: 0.25–0.94; p = 0.032). Sub-analysis showed the benefit of cardiac (adjusted OR: 0.31; 95% CI 0.14–0.71, p = 0.006), but not geriatric rehabilitation (adjusted OR 0.83; 95% CI 0.37–1.85, p = 0.65). A program of rehabilitation after TAVI has the potential to reduce mortality. Future studies should focus on health-orientated behavior and identifying risk factors for declining rehabilitation programs.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Jessica Groß
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Helen Sims
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
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Cardiac Rehabilitation in Older Persons with Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0569-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pieters K, Utens EMWJ, Ter Hoeve N, van Geffen M, Dulfer K, Sunamura M, van Domburg RT. Age does matter: Younger pPCI patients profit more from cardiac rehabilitation than older patients. Int J Cardiol 2017; 230:659-662. [PMID: 28077225 DOI: 10.1016/j.ijcard.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended as secondary prevention in primary percutaneous coronary intervention (pPCI) patients. This study was conducted to expand the knowledge about age-effects of CR in pPCI patients. The aim of this study was to compare changes in subjective health status (SHS) during and after CR between patients <60years and patients ≥60years, who underwent pPCI after myocardial infarction. METHODS Between 2009 and 2011, in total 282 pPCI patients who participated in CR were included. Patients completed the Short Form 12 (SF-12) questionnaire at baseline (pre-CR), 3months (post-CR) and 12months follow-up. Patients were divided into two age-groups, <60years versus ≥60years. To compare improvements in SHS between groups, Generalized Estimating Equations (GEE) analyses were performed. RESULTS The mean physical component summary (PCS) score improved over time in both groups and even reached mean levels of the normative Dutch population. The improvement on the PCS score was equal in both age groups. The mental component summary (MCS) score also improved in both groups. Patients <60years reported on average more improvement on the MCS score than patients ≥60years (Exp(B) 1.019; 95%CI 1.009-1.030; P<0.001). However, mean levels of the normative Dutch population were not reached by patients <60years. CONCLUSION Even though pPCI patients <60years reported more improvement on the MCS score, mean levels of the normative Dutch population were not reached. Therefore, a tailored CR program with more focus on their mental status, may be beneficial in younger patients.
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Affiliation(s)
- Kimberley Pieters
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Myrna van Geffen
- Capri Cardiac Rehabilitation Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands.
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Compostella L, Compostella C, Truong LVS, Russo N, Setzu T, Iliceto S, Bellotto F. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol 2017; 24:460-467. [PMID: 28067536 DOI: 10.1177/2047487316686434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Erectile dysfunction may predict future cardiovascular events and indicate the severity of coronary artery disease in middle-aged men. The aim of this study was to evaluate whether erectile dysfunction (expression of generalized macro- and micro-vascular pathology) could predict reduced effort tolerance in patients after an acute myocardial infarction. Patients and methods One hundred and thirty-nine male patients (60 ± 12 years old), admitted to intensive cardiac rehabilitation 13 days after a complicated acute myocardial infarction, were evaluated for history of erectile dysfunction using the International Index of Erectile Function questionnaire. Their physical performance was assessed by means of two six-minute walk tests (performed two weeks apart) and by a symptom limited cardiopulmonary exercise test (CPET). Results Patients with erectile dysfunction (57% of cases) demonstrated poorer physical performance, significantly correlated to the degree of erectile dysfunction. After cardiac rehabilitation, they walked shorter distances at the final six-minute walk test (490 ± 119 vs. 564 ± 94 m; p < 0.001); at CPET they sustained lower workload (79 ± 28 vs. 109 ± 34 W; p < 0.001) and reached lower oxygen uptake at peak effort (18 ± 5 vs. 21 ± 5 ml/kg per min; p = 0.003) and at anaerobic threshold (13 ± 3 vs.16 ± 4 ml/kg per min; p = 0.001). The positive predictive value of presence of erectile dysfunction was 0.71 for low peak oxygen uptake (<20 ml/kg per min) and 0.69 for reduced effort capacity (W-max <100 W). Conclusions As indicators of generalized underlying vascular pathology, presence and degree of erectile dysfunction may predict the severity of deterioration of effort tolerance in post-acute myocardial infarction patients. In the attempt to reduce the possibly associated long-term risk, an optimization of type, intensity and duration of cardiac rehabilitation should be considered.
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Affiliation(s)
- Leonida Compostella
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Caterina Compostella
- 3 Department of Medicine, School of Emergency Medicine, University of Padua, Italy
| | - Li Van Stella Truong
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Nicola Russo
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Tiziana Setzu
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy
| | - Sabino Iliceto
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Fabio Bellotto
- 1 Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy.,2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Nesello PFT, Tairova O, Tairova M, Graciolli L, Baroni A, Comparsi E, Marchi TD. Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs. Open Access Maced J Med Sci 2016; 4:654-660. [PMID: 28028408 PMCID: PMC5175516 DOI: 10.3889/oamjms.2016.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 10/30/2016] [Accepted: 10/31/2016] [Indexed: 11/05/2022] Open
Abstract
AIM This paper aims to assess the dropout rate in different age groups through the example of the large cardiac rehabilitation centre affiliated with the Institute of Sports Medicine, University of Caxias do Sul. MATERIAL AND METHODS A historic cohort study comprising the following groups: Non-Old < 65 (n = 141); Young-Old 65-74 (n = 128); and Middle-Old 75-84 years old (n = 57). The exercise program lasted 48 sessions and dropout was defined as attendance of 50% of sessions or less. Logistic binominal regression was performed to assess the risk of dropout. For all analyses, a two-tailed P value of < 0.05 was used. RESULTS The total dropout rate was 38.6%. The Young-Old and Middle-Old groups showed lower dropouts compared to Non-Old patients (p = 0.01). Young-Old has 96% less risk for dropout compared to Non-Old group (adjusted odds ratios = 1.96 [1.16-3.29]). Furthermore, patients underwent the Coronary Artery Bypass Graft showed a lower rate of dropout (p = 0.001). The absence of CABG involved three times more risk of dropout (p = 0.001). CONCLUSION The Non-Old and the Middle-Old patients showed higher dropout rates compared to Young-Old. To ensure the best possible rehabilitation and to improve patients´ participation in CR, these programs should be adjusted to the needs of patients in terms of their age.
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Affiliation(s)
| | - Olga Tairova
- University of Caxias do Sul, Cardiac Rehabilitation Service, Caxias do Sul, Brazil
| | - Maria Tairova
- University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul, Brazil
| | - Lucas Graciolli
- University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul, Brazil
| | - Allan Baroni
- University of Caxias do Sul, Sports Medicine Institute, Caxias do Sul, Brazil
| | - Eduardo Comparsi
- University of Caxias do Sul, Cardiac Rehabilitation Service, Caxias do Sul, Brazil
| | - Thiago De Marchi
- Faculdade Cenetista, Physiotherapy Undergraduate Coordinator, Bento Gonçalves, Brazil
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Cardiac Rehabilitation in Older Adults. Can J Cardiol 2016; 32:1088-96. [DOI: 10.1016/j.cjca.2016.03.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/26/2016] [Accepted: 03/05/2016] [Indexed: 02/02/2023] Open
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Vanhees L, Stevens A, Schepers D, Defoor J, Rademakers F, Fagard R. Determinants of the effects of physical training and of the complications requiring resuscitation during exercise in patients with cardiovascular disease. ACTA ACUST UNITED AC 2016; 11:304-12. [PMID: 15292764 DOI: 10.1097/01.hjr.0000136458.44614.a2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Benefits of cardiac rehabilitation with exercise therapy are well-established, although individual reactions are heterogeneous. The identification of determinants of training effects is useful from a prognostic point of view, but data regarding this are scarce. Furthermore, limited data exist on the determinants of complications during exercise in cardiac patients. This study aimed to investigate the determinants (1) of training effects in cardiac rehabilitation and (2) of complications requiring resuscitation during exercise activities at the hospital and during continued exercise at a sports club for cardiac patients. DESIGN Clinical association study. METHODS Determinants of changes in peak oxygen uptake (VO2) after 3 months of cardiac rehabilitation were determined by multiple regression analysis (n=1909). Determinants of events requiring resuscitation (n=21) were assessed by logistic regression analysis. RESULTS Improvements in peak VO2 and exercise duration averaged 26%. Eighteen per cent of the variance in absolute improvements of peak VO2 was explained, with age and training characteristics as the strongest determinants. Twenty-one per cent of the variation in relative improvements was explained, with baseline exercise performance and training characteristics being the strongest determinants. The intake of anti-arrhythmics (odds ratio=5.5; P<0.001) and the presence of ST-segment depression (> or =1 mm) at baseline exercise testing (odds ratio=1.6; P<0.001) were predictive for serious complications. The occurrence of events requiring resuscitation was higher at the sports club (1/16,533 versus 1/29,214 patient-hours). CONCLUSIONS Age, baseline exercise performance and training characteristics were predictive for training effects in cardiac rehabilitation. Anti-arrhythmics and ST-segment depression at baseline exercise testing were predictive for complications.
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Affiliation(s)
- Luc Vanhees
- Cardiovascular Rehabilitation Unit, Dept. of Rehabilitation Sciences, Faculty of Physical Education and Physical Therapy, Leuven, Belgium.
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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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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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Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease: A POPULATION-BASED COHORT STUDY IN TAIWAN. J Cardiopulm Rehabil Prev 2016; 36:250-7. [PMID: 26959494 DOI: 10.1097/hcr.0000000000000168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of cardiac rehabilitation (CR) provided within the first 3 months of revascularization on reducing recurrent revascularization in patients with coronary heart disease in Taiwan. METHODS In this population-based cohort study, we used the claims data of 1 million beneficiaries who were randomly selected from all beneficiaries enrolled in Taiwan's National Health Insurance program from 1996 to 2000. Between 2000 and 2007, 2838 patients underwent a first-event revascularization. Of these patients, 442 (15.6%) underwent CR within the first 3 months of admission for revascularization. The remaining 84.4% (n = 2396) served as the non-CR group. All the study patients were followed-up until the end of 2008 for any recurrent revascularization. A propensity score-adjusted Cox proportional hazard model was used to estimate the relative risk of recurrent revascularization associated with CR. RESULTS During the 1- to 9-year follow-up, 69 patients (15.6%) in the CR group and 840 (35.1%) patients in the non-CR group experienced recurrent revascularization. The results of the propensity score-adjusted Cox proportional hazard regression analysis showed that CR was significantly associated with a reduced risk of recurrent revascularization with a hazard ratio of 0.48 (95% CI, 0.37 to -0.62). CONCLUSIONS Cardiac rehabilitation within the first 3 months of revascularization is significantly associated with a reduced risk of recurrent revascularization. This preventive effect was more pronounced in men compared with other subgroups of patients.
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Wittboldt S, Cider Å, Bäck M. Reliability of two questionnaires on physical function in patients with stable coronary artery disease. Eur J Cardiovasc Nurs 2015; 15:142-9. [PMID: 26156784 DOI: 10.1177/1474515115593840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation is highly recommended for patients with coronary artery disease, as it improves physical fitness and reduces mortality and morbidity. Physical fitness per se does not always correlate with the patient's physical function. For this reason, additional measurements of physical function could be included in cardiac rehabilitation programmes to further tailor interventions to suit the individual patient. As a result, reliable measurements to assess physical function are required for patients with coronary artery disease. AIM The aim of this study was to evaluate the reliability of the Patient-Specific Functional Scale (PSFS) and the Disability Rating Index (DRI) in patients with stable coronary artery disease. MATERIAL Fifty-one patients (11 women), age 63.9 (SD 7.6) years, with stable coronary artery disease and coronary-angiographic changes indicating an elective percutaneous coronary intervention, were recruited at the Cardiology Department at Sahlgrenska University Hospital, Gothenburg. METHODS The reliability tests included stability over time, evaluated with a test-retest procedure using the intraclass correlation coefficient (ICC), and internal consistency, measured with Cronbach's alpha and item-total correlation coefficients. RESULTS Both questionnaires were stable over time (DRI, ICC=0.74, and PSFS, ICC=0.72). The internal consistency for the DRI was good, with a Cronbach's alpha value of > 0.85 for all items. The item-total correlation coefficients presented acceptable values of > 0.40, apart from two items. CONCLUSION We have provided introductory support for the reliability of the DRI and PSFS questionnaires in patients with stable CAD. These questionnaires can be used to assess physical function and to evaluate the effect of interventions in addition to measuring physical fitness.
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Affiliation(s)
- Susanna Wittboldt
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Åsa Cider
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden Institute of Neuroscience and Physiology/Physiotherapy, University of Gothenburg, Sweden
| | - Maria Bäck
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden
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Clennin MN, Payne JPW, Rienzi EG, Lavie CJ, Blair SN, Pate RR, Sui X. Association between Cardiorespiratory Fitness and Health-Related Quality of Life among Patients at Risk for Cardiovascular Disease in Uruguay. PLoS One 2015; 10:e0123989. [PMID: 25901358 PMCID: PMC4406735 DOI: 10.1371/journal.pone.0123989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/25/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To examine the association between objectively measured CRF and physical and mental components of HRQoL in a Uruguayan cohort at risk for developing CVD. METHODS Patient data records from 2002-2012 at the Calidad de Vida Center were examined. To assess CRF, participants performed a submaximal exercise test. During the evaluation, participants also completed the SF-36, a HRQoL measure comprised of eight dimensions that are summarized by physical and mental component scores (PCS and MCS, respectively). ANCOVA was used to examine the relationship between HRQoL dimensions and CRF. Logistic regression was then used to compare the odds of having a HRQoL component score above the norm across CRF. All analyses were performed separately for males and females with additional stratified analyses across age and BMI conducted among significant trends. RESULTS A total of 2,302 subjects were included in the analysis. Among females, a significant relationship was observed between CRF and vitality, physical functioning, physical role, bodily pain, and general health dimensions. However, for males the only dimension found to be significantly associated with CRF was physical health. After adjusting for potential confounders, a significant linear trend (p<0.001) for PCS scores above the norm across CRF levels was observed for females only. CONCLUSION Among females with one or more risk factors for developing CVD, higher levels of CRF were positively associated with the vitality and physical dimensions of HRQoL, as well as the overall PCS. However, among males the only dimension associated with CRF was physical functioning. Future studies should examine this relationship among populations at risk for developing CVD in more detail and over time.
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Affiliation(s)
- Morgan N. Clennin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Jonathan P. W. Payne
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Edgardo G. Rienzi
- Especialista en Medicina del Deporte, Centro Calidad de Vida, Asociación Española, Montevideo, Uruguay
| | - 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, Louisiana, United States
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, United States
| | - Steven N. Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
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Abstract
There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.
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Affiliation(s)
- Wendy Day
- Faculty of Health, Science and Technology, Universal College of Learning, Palmerston North, New Zealand
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Sonati JG, Vilarta R, Maciel ÉDS, Modeneze DM, Vilela Junior GDB, Lazari VO, Muciacito B. Análise comparativa da qualidade de vida de adultos e idosos envolvidos com a prática regular de atividade física. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2014. [DOI: 10.1590/1809-9823.2014.13122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Identificar diferenças na qualidade de vida de adultos e idosos, ambos praticantes de atividade física. MÉTODOS: Foram estudados 117 sujeitos praticantes de atividade física, com idade entre 40 e 80 anos. Para a caracterização da amostra, foram analisadas as variáveis idade, sexo, renda familiar e escolaridade. Para a comparação entre os grupos de adultos e idosos, foram analisadas as variáveis peso, estatura, índice de massa corporal, domínios e facetas da qualidade de vida (Whoqol-Bref). O teste de Kolmogorov-Smirnov foi aplicado para análise da normalidade e o teste de Mann-Whitney, para a comparação de medidas contínuas ou ordenáveis entre dois grupos independentes; adotou-se valor de p<0,05. RESULTADOS: Foram encontradas diferenças significantes para os domínios psicológico, relações sociais e qualidade de vida geral, sendo que os idosos apresentaram os maiores valores médios. CONCLUSÃO: Idosos ativos, comparados aos adultos ativos, percebem melhor qualidade de vida nos aspectos da vida ativa, do desempenho das atividades da vida diária, da aceitação da aparência física, satisfação financeira e disponibilidade de tempo para as atividades de lazer.
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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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Reichkendler MH, Rosenkilde M, Auerbach PL, Agerschou J, Nielsen MB, Kjaer A, Hoejgaard L, Sjödin A, Ploug T, Stallknecht B. Only minor additional metabolic health benefits of high as opposed to moderate dose physical exercise in young, moderately overweight men. Obesity (Silver Spring) 2014; 22:1220-32. [PMID: 24339390 DOI: 10.1002/oby.20226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 11/19/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The dose-response effects of exercise training on insulin sensitivity, metabolic risk, and quality of life were examined. METHODS Sixty-one healthy, sedentary (VO₂max: 35 ± 5 ml/kg/min), moderately overweight (BMI: 27.9 ± 1.8), young (age: 29 ± 6 years) men were randomized to sedentary living (sedentary control group; n = 18), moderate (moderate dose training group [MOD]: 300 kcal/day, n = 21), or high (high dose training group [HIGH]: 600 kcal/day, n = 22) dose physical exercise for 11 weeks. RESULTS The return rate for post-intervention testing was 82-94% across groups. Weekly exercise amounted to 2,004 ± 24 and 3,774 ± 68 kcal, respectively, in MOD and HIGH. Cardiorespiratory fitness increased (P < 0.001) 18 ± 3% in MOD and 17 ± 3% in HIGH, and fat percentage decreased (P < 0.001) similarly in both exercise groups (MOD: 32 ± 1 to 29 ± 1%; HIGH: 30 ± 1 to 27 ± 1%). Peripheral insulin sensitivity increased (P < 0.01) (MOD: 28 ± 7%; HIGH: 36 ± 8%) and the homeostasis model assessment of insulin resistance decreased (P < 0.05) (MOD: -17 ± 7%; HIGH: -18 ± 10%). The number of subjects meeting the criteria of the metabolic syndrome decreased by 78% in MOD (P < 0.01) and by 80% in HIGH (P < 0.05). General health assessed by questionnaire increased similarly in MOD (P < 0.05) and HIGH (P < 0.01). CONCLUSIONS Only minor additional health benefits were found when exercising ∼3,800 as opposed to ∼2,000 kcal/week in young moderately overweight men. This finding may have important public health implications.
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Affiliation(s)
- M H Reichkendler
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Outcomes in people after stroke attending an adapted cardiac rehabilitation exercise program: does time from stroke make a difference? J Stroke Cerebrovasc Dis 2014; 23:1648-56. [PMID: 24709146 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/15/2013] [Accepted: 01/09/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes. METHODS The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4±42.3 (mean±standard deviation) months after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration. RESULTS After adjusting for multiple comparisons, participants demonstrated significant improvements (all P<.001) in 6MWD (283.2±126.6 to 320.7±141.8 m), sit-to-stand performance (16.3±9.5 to 13.3±7.1 seconds), affected-side IKES (25.9±10.1 to 30.2±11 kg as a percentage of body mass), and VO2peak (15.2±4.5 to 17.2±4.9 mL·kg·min(-1)). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P<.001), and bilateral step lengths (P<.04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (β=-42.1; P=.002) independent of baseline factors. CONCLUSIONS A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation.
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Lavie CJ, Johannsen N, Swift D, Sénéchal M, Earnest C, Church T, Hutber A, Sallis R, Blair SN. Exercise is Medicine - The Importance of Physical Activity, Exercise Training, Cardiorespiratory Fitness and Obesity in the Prevention and Treatment of Type 2 Diabetes. EUROPEAN ENDOCRINOLOGY 2014; 10:18-22. [PMID: 29872459 PMCID: PMC5983092 DOI: 10.17925/ee.2014.10.01.18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/26/2013] [Indexed: 01/22/2023]
Abstract
Type 2 diabetes has reached epidemic proportions worldwide and is associated with increased risk of cardiovascular diseases and premature mortality. Diet and physical activity (PA)-based lifestyle interventions have been shown to prevent progression to type 2 diabetes in patients at high risk. Regular PA substantially reduces the risk of type 2 diabetes and a high level of PA is associated with a substantial reduction in type 2 diabetes risk. In addition, there is strong evidence suggesting a steep inverse relationship between both PA and cardiorespiratory fitness (CRF) and mortality in patients with type 2 diabetes. Of particular concern is the dramatic, steep increase in mortality among patients with low CRF. An important point is that obese individuals who are at least moderately fit have a lower mortality risk than those who are normal weight but unfit. A large body of evidence demonstrates that exercise improves glycaemic control in type 2 diabetes; the greatest improvements are achieved with combined aerobic and resistance training. A primary goal of public health strategies is to promote PA and move patients out of the least fit, highrisk cohort by increasing PA among the least active. Any plan to deal with the global epidemic of type 2 diabetes must give major attention to low PA and how this can be reversed in the general population.
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Affiliation(s)
- Carl J Lavie
- Professor of Medicine, Medical Director, Cardiac Rehabilitation and Prevention Director, Stress Testing Laboratory, Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US
| | - Neil Johannsen
- Assistant Professor, School of Kinesiology, Louisiana State University and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US
| | - Damon Swift
- Postdoctoral Researcher, Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US
| | - Martin Sénéchal
- Postdoctoral Researcher, Manitoba Institute of Child Health, Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Conrad Earnest
- Professor, Department for Health, University of Bath, UK and Pennington Biomedical Research Center, Baton Rouge, Louisiana, US
| | - Timothy Church
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, US
| | - Adrian Hutber
- Vice President, Exercise is Medicine, American College of Sports Medicine, Indianapolis, Indiana, US
| | - Robert Sallis
- Department of Family Medicine, Fontana Medical Center, Kaiser Permanente, Southern California, California, US
| | - Steven N Blair
- Professor, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, US
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Nakayama N, Negi K, Watanabe K, Hirai M. Life activities improve heart rate variability in patients with mild hypertension and/or the initial stage of heart failure. J Clin Nurs 2013; 23:367-73. [PMID: 23534614 DOI: 10.1111/jocn.12120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To determine the effects on heart rate variability of home-based daily activity in patients with mild hypertension and/or stable angina pectoris and to clarify the relationship between daily activity and sympathovagal balance. BACKGROUND Several prior studies have assessed the ability of exercise training to improve functional capacity and produce beneficial effects on mortality and physical capacity in patients with cardiovascular disease. DESIGN A non-randomised six-month prospective longitudinal study. METHODS This study consisted of 41 patients (59-83 years old) with mild hypertension and/or stable angina pectoris. The home-based daily activity and heart rate variability were measured at the start of the study (BASE) and six months after the start of the study (6MoA). At 6MoA, the active mass increased in 23 patients (the IC group), while it decreased in the remaining 18 patients (the DC group). RESULTS There were significant increases in the high-frequency component in the IC group between the data at BASE and 6MoA. There were significant decreases in the low frequency to high-frequency ratio (low frequency/high-frequency) during sleep in the IC group between the data at BASE and 6MoA. The active mass was classified into life activities and walk activities in terms of intensity of activity. In a multivariate model, increased life activitiesrevealed a trend towards an association with increased high-frequency. CONCLUSIONS In patients with mild hypertension and/or stable angina pectoris, an increase in active mass improved heart rate variability outcomes with increased high-frequency and decreased low frequency/high-frequency during sleep. To increase life activitiesmight improve heart rate variability and prognosis in patients. RELEVANCE TO CLINICAL PRACTICE This study demonstrated that the potential importance of low-intensity daily activities in patients with mild hypertension and/or stable angina pectoris.
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Affiliation(s)
- Natsuki Nakayama
- Department of Nursing, College of Life and Health Sciences, Chubu University, Kasugai, Japan
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Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O'Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77:281-92. [PMID: 23328449 DOI: 10.1253/circj.cj-13-0007] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Marzolini S, Oh P, McIlroy W, Brooks D. The effects of an aerobic and resistance exercise training program on cognition following stroke. Neurorehabil Neural Repair 2012; 27:392-402. [PMID: 23161865 DOI: 10.1177/1545968312465192] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive benefits obtained from exercise in healthy populations support the idea that aerobic and resistance training (AT+RT) would confer benefit for poststroke recovery. However, there is little evidence regarding the effectiveness of such programs. OBJECTIVE To evaluate the effects of a 6-month exercise program of AT+RT on cognition in consecutively enrolled patients with motor impairments ≥10 weeks poststroke. METHODS Outcomes were measured before and after 6 months of AT+RT on 41 patients. Cognition was measured by the Montreal Cognitive Assessment (MoCA). Secondary measures included evaluation of gas exchange anaerobic threshold (ATge), body composition by dual energy X-ray absorptiometry, and depressive symptoms by questionnaire. RESULTS There were significant improvements in overall MoCA scores (22.5 ± 4.5 to 24.0 ± 3.9, P < .001) as well as in the subdomains of attention/concentration (4.7 ± 1.7 to 5.2 ± 1.3, P = .03) and visuospatial/executive function (3.4 ± 1.1 to 3.9 ± 1.1, P = .002). There was a significant reduction in the proportion of patients meeting the threshold criteria for mild cognitive impairment (MCI) at baseline compared with posttraining (65.9% vs 36.6%, P < .001). In a linear regression model, there was a positive association between change in cognitive function and change in fat-free mass of the nonaffected limbs (β = .002; P = .005) and change in attention/concentration and change in ATge (β = .383; P ≤ .001), independent of age, sex, time from stroke, and change in fat mass and depression score. CONCLUSION A combined training model (AT+RT) resulted in improvements in cognitive function and a reduction in the proportion of patients meeting the threshold criteria for MCI. Change in cognition was positively associated with change in fat-free mass and ATge.
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Affiliation(s)
- Susan Marzolini
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Menezes AR, Lavie CJ, Milani RV, Arena RA, Church TS. Cardiac rehabilitation and exercise therapy in the elderly: Should we invest in the aged? J Geriatr Cardiol 2012; 9:68-75. [PMID: 22783325 PMCID: PMC3390101 DOI: 10.3724/sp.j.1263.2012.00068] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 12/16/2022] Open
Abstract
Coronary heart disease (CHD) is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older. Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, especially compared to their younger counterparts. The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation (CR) and exercise therapy on mortality, exercise capacity, psychological risk factors, inflammation, and obesity among patients with CHD. Unfortunately, a significant portion of the available data in this field pertains to younger patients. A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician. In this article, we will review the benefits of CR programs among the elderly, as well as some of the barriers that hinder their participation.
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Affiliation(s)
- Arthur R Menezes
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute Ochsner Clinical School, The University of Queensland School of Medicine, 1514, Jefferson Highway, New Orleans, LA 70121, USA
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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.
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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.
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Lavie CJ, Milani RV. Depression, autonomic function, and cardiorespiratory fitness: comment on Hughes, et al. (2010). Percept Mot Skills 2011; 112:319-21. [PMID: 21466105 DOI: 10.2466/02.06.15.20.pms.112.1.319-321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A recent paper by Hughes and colleagues suggested that dysfunction of the autonomic nervous system in depressed cardiac patients was partly explained by reduced physical activity and fitness. Other data demonstrate that exercise training and improvements in fitness not only lead to improvements in autonomic function in coronary patients but also reduce depression and depression-related increased mortality.
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Affiliation(s)
- Carl J Lavie
- Division of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
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Retracted Article: Association of physical fitness with health-related quality of life in Finnish young men. Qual Life Res 2010; 19:611. [DOI: 10.1007/s11136-010-9595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2010] [Indexed: 11/27/2022]
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Onishi T, Shimada K, Sato H, Seki E, Watanabe Y, Sunayama S, Ohmura H, Masaki Y, Nishitani M, Fukao K, Kume A, Sumide T, Mokuno H, Naito H, Kawai S, Daida H. Effects of phase III cardiac rehabilitation on mortality and cardiovascular events in elderly patients with stable coronary artery disease. Circ J 2010; 74:709-14. [PMID: 20208382 DOI: 10.1253/circj.cj-09-0638] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has numerous benefits, including reduction of mortality and cardiovascular events, in patients with coronary artery disease (CAD). However, the long-term effect of phase III CR in elderly patients with stable CAD is still unknown. METHODS AND RESULTS The 111 elderly male CAD patients (>or=65 years), including 37 subjects participating in supervised CR for 6 months and 74 age-matched controls, were analyzed. The patients were followed for up to 3,500 days, until the occurrence of death or 1 of the following major adverse cardiovascular events (MACE): cardiovascular death, acute coronary syndrome, refractory angina requiring revascularization, admission for congestive heart failure, or stroke. All-cause mortality tended to be lower in the CR group than in the Control group (14% vs 28%, P=0.081). The MACE incidence was significantly lower in the CR group than in the Control group (30% vs 62%, P=0.001). Multivariate Cox proportional hazard analysis showed that the MACE incidence was significantly lower in the CR group than in the Control group [adjusted hazard ratio 0.43 (95% confidence interval 0.20-0.91), P=0.027]. CONCLUSIONS Phase III CR has the beneficial effect of reducing cardiovascular events even in elderly patients with stable CAD.
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Affiliation(s)
- Tomo Onishi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
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Häkkinen A, Rinne M, Vasankari T, Santtila M, Häkkinen K, Kyröläinen H. Association of physical fitness with health-related quality of life in Finnish young men. Health Qual Life Outcomes 2010; 8:15. [PMID: 20109241 PMCID: PMC2835678 DOI: 10.1186/1477-7525-8-15] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 01/29/2010] [Indexed: 11/24/2022] Open
Abstract
Background Currently, there is insufficient evidence available regarding the relationship between level of physical fitness and health-related quality of life (HRQoL) in younger adults. Therefore, the aim of the present study was to investigate the impact of measured cardiovascular and musculoskeletal physical fitness level on HRQoL in Finnish young men. Methods In a cross-sectional study, we collected data regarding the physical fitness index, including aerobic endurance and muscle fitness, leisure-time physical activity (LTPA), body composition, health, and HRQoL (RAND 36) for 727 men [mean (SD) age 25 (5) years]. Associations between HRQoL and the explanatory parameters were analyzed using the logistic regression analysis model. Results Of the 727 participants who took part in the study, 45% were in the poor category of the physical fitness, while 37% and 18% were in the satisfactory and good fitness categories, respectively. A higher frequency of LTPA was associated with higher fitness (p < 0.001). Better HRQoL in terms of general health, physical functioning, mental health, and vitality were associated with better physical fitness. When the HRQoL of the study participants were compared with that of the age- and gender-weighted Finnish general population, both the good and satisfactory fitness groups had higher HRQoL in all areas other than bodily pain. In a regression analysis, higher LTPA was associated with three dimensions of HRQoL, higher physical fitness with two, and lower number of morbidities with all dimensions, while the effect of age was contradictory. Conclusions Our study of Finnish young men indicates that higher physical fitness and leisure-time physical activity level promotes certain dimensions of HRQoL, while morbidities impair them all. The results highlight the importance of health related physical fitness while promoting HRQoL.
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Affiliation(s)
- Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Hospital, Jyväskylä, Finland.
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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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Lavie CJ, Milani RV, Ventura HO. Exercise Training and Heart Failure in Older AdultsâDismal Failure or Not Enough Exercise? J Am Geriatr Soc 2009; 57:2148-50. [DOI: 10.1111/j.1532-5415.2009.02520.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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