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Lakhani F, Racette SB, Park LK, Deych E, Williams D, McKenzie KM, Stranczek NA, McKenzie EJ, Lenze EJ, Durbin D, Jonagan J, Carson T, Talpade N, Rich MW, Fuentes LDL, Peterson LR. Prospective Study of the Impact of Outpatient Intensive Cardiac Rehabilitation on Diet Quality, Health-related Quality of Life, and Cardiovascular Health Indices. Am J Cardiol 2023; 192:60-66. [PMID: 36736014 PMCID: PMC10200263 DOI: 10.1016/j.amjcard.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/05/2022] [Accepted: 01/02/2023] [Indexed: 02/04/2023]
Abstract
Intensive cardiac rehabilitation (ICR) programs are approved by the Centers for Medicare & Medicaid Services on the basis of their expected benefits for cardiovascular disease (CVD) risk factors and health outcomes. However, the impact of outpatient ICR on diet quality, quality of life (QOL), and CVD risk factors has not been prospectively assessed. The aim of this cohort study was to test the hypothesis that patients enrolled in a Pritikin outpatient ICR program would show improved diet quality, QOL, and CVD health indexes, and that the improvements would be greater than those of patients in traditional cardiac rehabilitation (CR). Patients enrolled in ICR (n = 230) or CR (n = 62) were assessed at baseline and at visit 24. Diet quality was assessed using the Rate Your Plate questionnaire, and QOL was assessed through the Dartmouth COOP Functional Health Assessment questionnaire. Secondary end points included anthropometrics, CVD biomarkers, hemodynamics, and fitness. Patients in ICR programs displayed significant improvements at visit 24 versus baseline in Rate Your Plate and Dartmouth COOP Functional Health Assessment scores, weight, body mass index (BMI), waist circumference, fat mass, total and low-density lipoprotein cholesterol, 6-minute walk distance, and grip strength. Patients in ICR had greater improvements in diet quality (p = 0.001), weight (p = 0.001), and BMI (p <0.001) than did those in CR. In summary, this prospective study of Pritikin outpatient ICR revealed significant improvements in diet quality, QOL, adiposity, and other CVD risk factors. The improvements in diet quality, body weight, and BMI were greater than those observed with traditional CR.
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Affiliation(s)
| | - Susan B Racette
- Department of Medicine; Program in Physical Therapy; College of Health Solutions, Arizona State University, Phoenix, Arizona
| | | | - Elena Deych
- Department of Medicine, Cardiovascular Division
| | | | | | | | | | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Physical and Psychological Outcomes of Patients Undergoing Traditional Cardiac Rehabilitation and Intensive Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2023; 43:31-38. [PMID: 35836336 DOI: 10.1097/hcr.0000000000000707] [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: 12/31/2022]
Abstract
PURPOSE Both traditional cardiac rehabilitation (TCR) and intensive cardiac rehabilitation (ICR) have proven benefits for patients with cardiovascular disease. The aim of this study was to compare ICR versus TCR on cardiac rehabilitation (CR) outcomes in patients with cardiovascular disease. METHODS In a retrospective cohort study of 970 patients (n = 251, ICR; n = 719, TCR) who were referred for CR between January 2018 and December 2019, 693 (71.4%) patients completed it. The TCR sessions were 90 min (60-min exercise) three times/wk for 12 wk, while ICR sessions were 4 hr (60-min exercise) two times/wk for 9 wk. Primary endpoints were change in cardiorespiratory fitness (CRF) (by difference in exercise prescription metabolic equivalents [METs] between the last session and the average of the second and third sessions), anxiety (Generalized Anxiety Disorder-7) scores, percent depression (Patient Health Questionnaire-9 or Center for Epidemiologic Studies Depression Scale) scores, and health status (36-item Short Form Health Survey physical and mental composite scores). Linear regression adjusted for imbalanced baseline characteristics (age, race, and diagnosis of angina). RESULTS Of the 693 patients who completed CR (ICR = 204/251 [81%] vs TCR = 489/719 [68%], P < .01), mean age was 66 yr and 31% were female. Patients in TCR had a higher improvement in CRF (CR session METs: ICR +1.5 ± 1.2 vs TCR +1.9 ± 1.5, P < .01) but no difference in health status scores. Conversely, patients in ICR had more reduction in anxiety scores (-2 ± 4 vs -1 ± 3, P < .01) and percent reduction in depression scores (-8.3 ± 13.7% vs -5.0 ± 11.7%, P < .01) than patients in TCR. CONCLUSIONS Patients in TCR had higher improvement in CRF while patients in ICR had higher improvement in anxiety and depression scores.
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Abstract
PURPOSE Intensive cardiac rehabilitation (ICR) is a comprehensive, medically supervised exercise treatment program covered by Medicare for patients with approved cardiac diagnoses. The aim of this study was to determine the benefits of the first Pritikin outpatient ICR program. METHODS This retrospective analysis included patients referred to ICR or traditional cardiac rehabilitation (CR) during the first 7 yr (2013-2019) at the first facility to implement Pritikin ICR. Intensive cardiac rehabilitation is composed of 36 education sessions on nutrition, exercise, and a healthy mindset, in addition to 36 monitored exercise sessions that comprise traditional CR. Assessments included anthropometrics (weight, body mass index, and waist circumference), dietary patterns, physical function (6-min walk test, [6MWT] Short Physical Performance Battery [SPPB: balance, 4-m walk, chair rise], handgrip strength), and health-related quality of life (Dartmouth COOP, 36-item Short Form Survey). Baseline and follow-up measures were compared within and between groups. RESULTS A total of 1963 patients enrolled (1507 ICR, 456 CR, 66.1 ± 11.4 yr, 68% male, 82% overweight or obese); 1141 completed the program (58%). The ICR patients completed 22 exercise and 18 education sessions in 9.6 wk; CR patients completed 19 exercise sessions in 10.3 wk. ICR resulted in improvements ( P < .001 pre vs post) in all anthropometric measures, dietary patterns, 6MWT distance, all SPPB components, grip strength, and health-related quality of life. The improvements in anthropometrics and dietary patterns were greater in ICR than in CR. CONCLUSIONS The Pritikin outpatient ICR program promoted improvements in several cardiovascular health indices. Critical next steps are to assess long-term health outcomes after ICR, including cardiac events and mortality.
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Hama T, Ushijima A, Goto T, Nagamatsu H, Morita N, Yoshimachi F, Ikari Y, Kobayashi Y. Effect of Cardiac Rehabilitation on Glomerular Filtration Rate Using Serum Cystatin C Concentration in Patients With Cardiovascular Disease and Renal Dysfunction. J Cardiopulm Rehabil Prev 2022; 42:E15-E22. [PMID: 34793359 PMCID: PMC8884179 DOI: 10.1097/hcr.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD. METHODS We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.73 m2) who participated in our CR program for cardiovascular disease. First, the patients were divided into three groups according to the baseline severity of the eGFRcys: G3a, G3b, and G4 groups. We compared the eGFRcys before and after the CR in each group. Second, to determine the association of baseline eGFRcys with the effect of CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome. RESULTS Of the 203 patients, 122 were in G3a, 60 were in G3b, and 21 were in G4 groups. The mean improvement of eGFRcys in each group was 1.3, 3.1, and 4.8 mL/min/1.73 m2, respectively. The %ΔeGFRcys was larger among patients with lower baseline eGFRcys (0.47% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.23-0.72%). This association remained significant after adjustment for potential confounders (0.63% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.35-0.91%). CONCLUSIONS The effect of CR on renal function was greater in patients with worse renal dysfunction measured by eGFRcys. A CR program could be useful for patients with severe renal dysfunction and it might have a beneficial effect on their renal function.
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Affiliation(s)
- Tomoaki Hama
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Akiko Ushijima
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Tadahiro Goto
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Hirofumi Nagamatsu
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Norishige Morita
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Fuminobu Yoshimachi
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Yuji Ikari
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
| | - Yoshinori Kobayashi
- The Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan (Drs Hama, Ushijima, Nagamatsu, Morita, Yoshimachi, and Kobayashi); TXP Medical Co Ltd, Tokyo, and Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan (Dr Goto); and The Division of Cardiology, Department of Medicine, Tokai University Hospital, Shibuya City, Tokyo, Japan (Dr Ikari)
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Alhumaid W, Small SD, Kirkham AA, Becher H, Pituskin E, Prado CM, Thompson RB, Haykowsky MJ, Paterson DI. A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging. Front Cardiovasc Med 2022; 9:753652. [PMID: 35265675 PMCID: PMC8898950 DOI: 10.3389/fcvm.2022.753652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/17/2022] [Indexed: 12/26/2022] Open
Abstract
Exercise is a commonly prescribed therapy for patients with established cardiovascular disease or those at high risk for de novo disease. Exercise-based, multidisciplinary programs have been associated with improved clinical outcomes post myocardial infarction and is now recommended for patients with cancer at elevated risk for cardiovascular complications. Imaging studies have documented numerous beneficial effects of exercise on cardiac structure and function, vascular function and more recently on the cardiovascular risk profile. In this contemporary review, we will discuss the effects of exercise training on imaging-derived cardiovascular outcomes. For cardiac imaging via echocardiography or magnetic resonance, we will review the effects of exercise on left ventricular function and remodeling in patients with established or at risk for cardiac disease (myocardial infarction, heart failure, cancer survivors), and the potential utility of exercise stress to assess cardiac reserve. Exercise training also has salient effects on vascular function and health including the attenuation of age-associated arterial stiffness and thickening as assessed by Doppler ultrasound. Finally, we will review recent data on the relationship between exercise training and regional adipose tissue deposition, an emerging marker of cardiovascular risk. Imaging provides comprehensive and accurate quantification of cardiac, vascular and cardiometabolic health, and may allow refinement of risk stratification in select patient populations. Future studies are needed to evaluate the clinical utility of novel imaging metrics following exercise training.
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Affiliation(s)
- Waleed Alhumaid
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Amy A. Kirkham
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
| | - Harald Becher
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Edith Pituskin
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mark J. Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - D. Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- *Correspondence: D. Ian Paterson
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