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Zhu R, Niu Y, Xu H, Wang S, Mao J, Lei Y, Xiong X, Zhou W, Guo L. Traditional Chinese Exercises for Cardiovascular Diseases: A Bibliometric Analysis. Percept Mot Skills 2024; 131:514-536. [PMID: 38349750 DOI: 10.1177/00315125241230599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Traditional Chinese exercises (TCEs) have great value in the prevention and effective treatment of cardiovascular diseases (CVD). Our purpose in this study was to summarize present research trends and future directions regarding the link between TCEs and CVD by bibliometrics analysis. We searched the Web of Science Core Collection (WoSCC) for all original articles and reviews on TCEs for CVD published in English before August 7, 2022 using CiteSpace 5.8.R3 and Microsoft Excel 2019 software, and we displayed the results in the form of network maps, line graphs, and tables. We initially obtained 725 articles. Our results showed that the United States was the most influential country in this line of research, with Harvard University the most prolific institution in the field, and, Evidence-Based Complementary and Alternative Medicine was the most productive journal for these articles. The highest-frequency keywords in this research area were Tai Chi, exercise, blood pressure, quality of life, and older adult. Additionally, important research topics included heart rate variability, quality of life, meta-analysis, Baduanjin exercise, and breathing exercise. In addition, our results revealed that among all the TCEs, Tai Chi, Baduanjin, and Qigong emerged as the most extensively studied. However, it's important to note our exclusive focus on literature published in English may have led to our missing important results. Future investigators should broaden their search to include other databases and languages to present a still more comprehensive overview of this field.
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Affiliation(s)
- Ruiting Zhu
- School of Nursing, Jilin University, Changchun, China
| | - Yirou Niu
- School of Nursing, Jilin University, Changchun, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, China
| | - Saikun Wang
- School of Nursing, Jilin University, Changchun, China
| | - Jing Mao
- School of Nursing, Jilin University, Changchun, China
| | - Yangyang Lei
- School of Nursing, Jilin University, Changchun, China
| | - Xuance Xiong
- Medical College, Beihua University, Jilin, China
| | - Wei Zhou
- Department of Clinical Laboratory, The First Hospital of Jilin University, Changchun, China
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, China
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Smith L, Yon DK, Butler L, Kostev K, Brayne C, Barnett Y, Underwood BR, Shin JI, Rahmati M, Neufeld SAS, Ragnhildstveit A, López Sánchez GF, Koyanagi A. Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries. J Phys Act Health 2024; 21:247-255. [PMID: 38154018 DOI: 10.1123/jpah.2023-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown. METHODS Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations. RESULTS Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%). CONCLUSIONS Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.
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Affiliation(s)
- Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine,Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Sharon A S Neufeld
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anya Ragnhildstveit
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
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Sun YL, Yao YL, Jia MJ, Sun YY, Li HL, Ruan XF, Wang XL. Evaluation of the efficacy and safety of Suxiao Jiuxin Pill in the treatment of stable angina: A randomized, double-blind, placebo-controlled, multi-center clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116959. [PMID: 37487965 DOI: 10.1016/j.jep.2023.116959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Suxiao Jiuxin Pill (SJP) has been used for treating chronic stable angina (SA) for more than 40 years in China. SJP is composed of two Chinese herbs and has the effect of activating blood and promoting qi, according to traditional Chinese medicine (TCM) theory. AIM OF THE STUDY The study aims to determine the effects of adjunct SJP on conventional therapy in patients with SA which provides a complementary choice and its evidence for clinical medication for treating SA. MATERIALS AND METHODS Participants with SA were recruited and randomized 1:1 to either the SJP group or the control group for 24 weeks. Both groups received conventional treatment according to local tertiary hospital protocols, and the participants received additional SJP (composed of Ligusticum wallichii and Borneol) or placebo in treatment and control groups respectively. The primary outcome was the curative efficacy rate at week 4. Secondary outcomes are the curative efficacy rate, the total score of angina pectoris symptoms, CCS Angina Classification improvement, Seattle Angina Questionnaire (SAQ) score, TCM syndrome scores (TCMSS), and the curative efficacy rate of TCMSS. Adverse events and adverse drug reactions were observed and recorded for safety analysis. RESULTS A total of 324 participants with SA from 13 hospitals in China were enrolled in this trial. Compared with the control group, the curative efficacy rate of SA, the curative efficacy rate of TCMSS significantly increased, and the total score of angina pectoris symptoms and TCMSS significantly reduced in the SJP group at week 4, 12, and 24, accompanied by the statistically significant improvement in the curative efficacy rate based on CCS grade reduction (all P < 0.05). Furthermore, the SAQ score (physical limitation, angina stability, and treatment satisfaction) was evaluated as the quality of life significantly improved after treatment (P < 0.05). The medication compliance, concomitant medication, and rates of adverse events were similar between the two groups (P > 0.05). CONCLUSION The present prospective, multicenter, randomized, double-blind, placebo-controlled, clinical trial confirms that adjunct SJP to conventional treatment increased the curative efficacy and life quality of SA patients with no significant adverse drug reactions during the clinical application. CLINICAL TRIAL REGISTRATION (ID, ChiCTR1900021876, URL = http://www.chictr.org.cn/showproj.aspx?proj=34955).
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Affiliation(s)
- Yuan-Long Sun
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yi-Li Yao
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Mei-Jun Jia
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yuan-Yuan Sun
- Cardiovascular Disease Drug Research Committee, China Association of Traditional Chinese Medicine, China
| | - He-Lin Li
- Beijing Yaohai Ningkang Pharmaceutical Technology Co., LTD, China
| | - Xiao-Fen Ruan
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Xiao-Long Wang
- Cardiovascular Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China; Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Wang F, Cai J, Liu J, Duan B, Yang Y, Yang Q. Effects of traditional Chinese exercise on physiological indicators and quality of life in patients with coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34233. [PMID: 37390231 PMCID: PMC10313288 DOI: 10.1097/md.0000000000034233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of physiological indicators and quality of life in patients with coronary heart disease (CHD) is controversial. METHOD Five databases were systematically searched for relevant articles published from inception to February 2023. Controlled trials examining TCE intervention in patients with CHD. The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges g). The categorical and continuous variables were used to conduct moderator analyses. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence based on the Grading of Recommendations Assessment, Development and Evaluation approach. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023401934). RESULT Ten studies involving a total of 718 participants were included in the final analysis. In the physiological indicators outcomes, the meta-analytic findings revealed large and significant improvements in systolic blood pressure (g = 0.78, 95% confidence interval [CI] = 0.51-1.05, P = .00, I2 = 98%), diastolic blood pressure (g = 0.90, 95% CI = 0.61-1.20, P = .00, I2 = 98%) and body mass index (g = 1.05, 95% CI = 0.75-1.34, P = .00, I2 = 99%), small and significant improvements in heart rate (g = 0.28, 95% CI = 0.01-0.54, P = .04, I2 = 98%) and ventilatory equivalents/carbon dioxide (g = -1.10, 95% CI = -1.47 to -0.74, P = .00, I2 = 96%).In the quality of life outcomes, the findings revealed small and significant improvements in physical functioning (g = -3.01, 95% CI = -3.45 to -2.57, P = .00, I2 = 96%), bodily pain (g = -2.16, 95% CI = -2.57 to -1.74, P = .00, I2 = 98%), vitality (g = -3.67, 95% CI = -4.16 to -3.16, P = .00, I2 = 97%) and mental health (g = -1.23, 95% CI = -1.771 to -0.692, P = .00, I2 = 99%). The moderator shows that the effects of TCE on physiological indicators and quality of life were moderated by PEDro score, type of exercise, exercise frequency, exercise duration, and number of sessions. CONCLUSION TCE intervention is a beneficial nonpharmacological approach to improving physiological indicators in patients with CHD, especially in systolic blood pressure, diastolic blood pressure, and body mass index. However, there was no significant effect on quality of life. Our findings require broader clinical trials and higher-quality study designs to strengthen the evidence.
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Affiliation(s)
- Fan Wang
- Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingjing Cai
- Shiyan Hospital of Integrated Traditional Chinese and Western Medicine, Shiyan, Hubei Province, China
| | - Jihong Liu
- Shiyan Hospital of Integrated Traditional Chinese and Western Medicine, Shiyan, Hubei Province, China
| | - Banyan Duan
- Shiyan Hospital of Integrated Traditional Chinese and Western Medicine, Shiyan, Hubei Province, China
| | - Yingying Yang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qianfang Yang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang Province, China
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Han S, Hu S, Li K. Influence of Taijiquan Exercise on Mentality and Emotion Regulation by Intelligent Medical Big Data Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5468317. [PMID: 36304773 PMCID: PMC9578829 DOI: 10.1155/2022/5468317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
Taijiquan training emphasizes the relaxation of the mind and the body, pay attention to maintain the peace of mind, and minimize the impact of external interference on the body so as to make the mind more comfortable. This study mainly explores the influence of Taijiquan practice on emotion regulation based on intelligent medical health big data analysis. The significance of Taijiquan in developing and improving the positive emotions of middle-aged people and maintaining physical and mental health is expounded. There are two methods of data collection: full collection and incremental collection. In this study, when the psychological testing equipment was launched, a full amount of historical data was collected; after the psychological testing equipment was online, the collection method was generally carried out in the way of incremental collection. The subjects exercised Taijiquan three times a week, one hour each time, and the exercise content was the 24-style Taijiquan designated by the workstation. At the same time, the subjects were asked not to engage in other regular physical exercise projects in their spare time. By longitudinal tracking and comparison of the Taijiquan intervention group after participating in the Taijiquan exercise intervention, the differences in the state of mind and emotion regulation strategies, and 12 subjects were selected voluntarily to participate in the emotional Stroop (the color words used in the classic Stroop paradigm were replaced with emotional and nonemotional words written in different colors, and the subjects were still tasked with responding to colors) experimental paradigm. In this paper, the moderate-intensity Taijiquan project is selected, which is in line with the effective value threshold theory of exercise load. It studies the effects of exercise on the body shape, cardiopulmonary function, flexibility, and balance ability of the body according to the metabolism theory and the movement balance theory of the human body adapting to the environment. Before the experiment, there was no significant difference between the Taijiquan training group and the control group, but after the experiment, there was a significant difference between the Taijiquan training group and the control group (P<0.05). Taijiquan has a significant effect on improving students' body shape, cardiopulmonary function, flexibility, balance, and mood.
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Affiliation(s)
- Shuaiju Han
- Department of Physical Education, Graduate School, Sejong University, Seoul 04989, Republic of Korea
| | - Shaohui Hu
- Beijing Sport University China Wushu School, Beijing 100084, China
| | - Kang Li
- Physical Education Department, Tianjin Vocational and Technical Normal University, Tianjin 300222, China
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Postoperative Cognitive Behavioral Intervention in Patients with Coronary Heart Disease Based on the Effect of Nursing Process Reengineering. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6974909. [PMID: 36164450 PMCID: PMC9509227 DOI: 10.1155/2022/6974909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 11/18/2022]
Abstract
With the development of society and economy, patients with coronary heart disease increasingly hope to receive more humanized services after surgery, and the reengineering of the nursing process is precisely based on humanized management. In order to create a nursing intervention that helps in boosting total nursing gains and lowering disasters, the primary element of the nursing business process reengineering is to reintegrate or condense the creative work flow that was fragmented by specialization into a whole job. The “patient” is positioned in the center of nursing process reengineering, with service quality as the main guiding principle. It follows the management principles of continuous regulation and innovation, and cultivates and promotes the development of the nursing field from the perspective of “sublation.” In the method part, this article introduces and supplements related information on nursing process reengineering, coronary heart disease, and postoperative cognitive behavioral intervention. Algorithmically, this paper proposes 3D RPN structure, loss function, capsule network, and improved activation function algorithm for coronary heart disease region extraction. In the part of experiment and results, this article collects general data of patients and compares memory ability, grades of self-management behaviors of patients treated with coronary heart disease, scores of quality control standards before and after nursing process reengineering, scores of patients' mental state, and comparison of postoperative physical indicators. According to the test results, the test group's diastolic and systolic blood pressure declined by more than 20, their total cholesterol dropped from 6.23 to 5.28, and their triglyceride levels dropped from 1.82 to 1.39 after the stent was implanted. Triglycerides reduced from 1.82 to 1.39, and total cholesterol dropped from 6.15 to 5.98. It indicates postoperative memory in patients with coronary heart disease. Abilities, including recognition, number, touch memory, and associative memory, decline significantly, but it can be improved after receiving the nursing process reengineering. It can be seen that nursing process reengineering can play a positive role in the postoperative cognitive behavior of patients with coronary heart disease.
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Smith L, Shin JI, Haro JM, Jacob L, López Sánchez GF, Tully MA, Oh H, Carvalho AF, Barnett Y, Butler L, Koyanagi A. Physical multimorbidity and wish to die among adults aged ≥65 years: A cross-sectional analysis of the Irish Longitudinal Study on Ageing. J Affect Disord 2022; 313:263-269. [PMID: 35764230 DOI: 10.1016/j.jad.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/21/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical multimorbidity (i.e., ≥2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults. METHODS Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" Multivariable logistic regression and mediation analyses were conducted. RESULTS Data on 2941 adults aged ≥65 years [mean (SD) age 73.2 (5.2) years; 45.0 % males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1 %), followed by depression (19.4 %), sleep problems (18.4 %), perceived stress (13.0 %), loneliness (10.4 %), anxiety (8.1 %), and disability (7.2 %). CONCLUSIONS Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity.
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Affiliation(s)
- Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 8044, 120-752 Seoul, Seoul, Republic of Korea
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Mark A Tully
- School of Health Sciences, Institute of Mental Health Sciences, Ulster University, Newtownabbey BT15 1ED, Newtownabbey, UK
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA 90007, USA
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Yvonne Barnett
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Laurie Butler
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
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Ma M, Zhang B, Yan X, Ji X, Qin D, Pu C, Zhao J, Zhang Q, Lowis H, Li T. Adaptive Posture-Balance Cardiac Rehabilitation Exercise Significantly Improved Physical Tolerance in Patients with Cardiovascular Diseases. J Clin Med 2022; 11:jcm11185345. [PMID: 36142993 PMCID: PMC9504163 DOI: 10.3390/jcm11185345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
Cardiac rehabilitation (CR) requires more professional exercise modalities to improve the efficiency of treatment. Adaptive posture-balance cardiac rehabilitation exercise (APBCRE) is an emerging, balance-based therapy from clinical experience, but lacks evidence of validity. Our study aimed to observe and assess the rehabilitation effect of APBCRE on patients with cardiovascular diseases (CVDs). All participants received one-month APBCRE therapy evenly three times per week and two assessments before and after APBCRE. Each assessment included cardiopulmonary exercise testing (CPET), resting metabolic rate (RMR) detection, and three questionnaires about general health. The differences between two assessments were analyzed to evaluate the therapeutic effects of APBCRE. A total of 93 participants (80.65% male, 53.03 ± 12.02 years) were included in the analysis. After one-month APBCRE, oxygen uptake (VO2, 11.16 ± 2.91 to 12.85 ± 3.17 mL/min/kg, p < 0.01) at anaerobic threshold (AT), ventilation (VE, 28.87 ± 7.26 to 32.42 ± 8.50 mL/min/kg, p < 0.01) at AT, respiratory exchange ratio (RER, 0.93 ± 0.06 to 0.95 ± 0.05, p < 0.01) at AT and oxygen uptake efficiency slope (OUES, 1426.75 ± 346.30 to 1547.19 ± 403.49, p < 0.01) significantly improved in CVD patients. The ≤55-year group had more positive improvements (VO2 at AT, 23% vs. 16%; OUES, 13% vs. 6%) compared with the >55-year group. Quality of life was also increased after APBCRE (47.78 ± 16.74 to 59.27 ± 17.77, p < 0.001). This study proved that APBCRE was a potentially available exercise rehabilitation modality for patients with CVDs, which performed significant increases in physical tolerance and quality of life, especially for ≤55-year patients.
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Affiliation(s)
- Mei Ma
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin 300192, China
| | - Bowen Zhang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Xinxin Yan
- Department of Cardiology, Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiang Ji
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Deyu Qin
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin 300192, China
| | - Chaodong Pu
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin 300192, China
| | - Jingxiang Zhao
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin 300192, China
| | - Qian Zhang
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin 300192, China
| | - Heinz Lowis
- Drei-Burgen-Klinik of German Pension Insurance of Rhineland-Palatinate, 55583 Bad Kreuznach, Germany
| | - Ting Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
- Correspondence: ; Tel.: +86-180-0212-7296
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Platz K, Zelle H, Howie-Esquivel J. Prevalence of US Adults With Cardiovascular Disease Reporting Barriers to Clinician Office Visits: IMPLICATIONS FOR ACCESSIBLE MODELS FOR CARDIAC REHABILITATION. J Cardiopulm Rehabil Prev 2022; 42:148-155. [PMID: 35135965 DOI: 10.1097/hcr.0000000000000669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite known health benefits of cardiac rehabilitation (CR) for patients with cardiovascular disease (CVD), only a quarter of eligible patients attend. Among CR barriers are physical (eg, walking) and in-person attendance limitations. The purpose of this study was to determine the prevalence of difficulty walking and dependence on another person to attend medical appointments among people with and without CVD using national survey data. METHODS We compared the prevalence of difficulty walking and difficulty attending medical appointments alone among adults with and without CVD using national survey data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2015-2019. We used logistic regression and Rao-Scott χ2 analysis while controlling for several social determinants of health as covariates. RESULTS Of 2 212 973 respondents, 200 087 (9.04%) had CVD. The odds of individuals with CVD experiencing either difficulty walking or difficulty attending medical appointments alone were >3 times greater than the odds for individuals without CVD. In all adults with CVD, 42% reported difficulty walking and 20% reported dependence on another person to attend medical appointments. In all adults with CVD, 46% reported difficulty with one or both difficulties compared with 14% of adults without CVD. CONCLUSIONS We estimate that 11.9 million Americans with self-reported CVD have difficulty walking, or are dependent on another person to attend medical appointments, or both. Alternative models of CR that adapt to these limitations are needed to increase attendance of CR so that all adults with CVD can improve their health outcomes.
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Affiliation(s)
- Katherine Platz
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville (Ms Platz and Dr Howie-Esquivel) and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville (Dr Zelle)
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Liu T, Chan AWK, Chair SY. Group- plus home-based Tai Chi program improves functional health among patients with coronary heart disease: a randomized controlled trial. Eur J Cardiovasc Nurs 2022; 21:597-611. [PMID: 35022661 DOI: 10.1093/eurjcn/zvab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/05/2021] [Accepted: 12/12/2021] [Indexed: 11/13/2022]
Abstract
AIMS Tai Chi is a promising exercise option in cardiac rehabilitation to manage coronary heart disease (CHD). Increasing attention was paid on home-based cardiac rehabilitation to improve participation rate, but no study has yet emphasized the effect of home-based Tai Chi. A single-blinded randomized controlled trial is used to examine the effects of a group- plus home-based Tai Chi program on functional health. METHODS AND RESULTS Ninety-eight community-dwelling patients with CHD were randomly assigned to the Tai Chi and control groups. Participants in the Tai Chi group attended 6-week group- plus 6-week home-based Tai Chi program. Outcome measures included physical functions, cardiovascular risk factors, and exercise self-efficacy. Data were collected at baseline, 6-week, 12-week, and 24-week. Intervention effects were analysed using the generalized estimating equation model. Compared with changes in the control group, the intervention group achieved significant improvements in aerobic endurance, lower-body strength, agility and dynamic balance, diastolic blood pressure, and exercise self-efficacy over the 24-week study period (all Ps < 0.05). Intervention adherence was high (79.6% of participants attending >75% of all Tai Chi sessions). CONCLUSIONS This Tai Chi program significantly improved the functional health of patients with CHD, indicating that Tai Chi could be taught in group sessions and then continued independently as a home exercise routine for health promotion.
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Affiliation(s)
- Ting Liu
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China
| | - Aileen Wai Kiu Chan
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China
| | - Sek Ying Chair
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China
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Vilela EM, Ladeiras-Lopes R, Joao A, Braga J, Torres S, Viamonte S, Ribeiro J, Teixeira M, Nunes JP, Fontes-Carvalho R. Current role and future perspectives of cardiac rehabilitation in coronary heart disease. World J Cardiol 2021; 13:695-709. [PMID: 35070112 PMCID: PMC8716974 DOI: 10.4330/wjc.v13.i12.695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/08/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
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Affiliation(s)
- Eduardo M Vilela
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ana Joao
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Joana Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Susana Torres
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Sofia Viamonte
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4405-565, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
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Fazekas C, Linder D, Matzer F, Jenewein J, Hanfstingl B. Interpreting physical sensations to guide health-related behavior : An introductory review on psychosomatic competence. Wien Klin Wochenschr 2021; 134:3-10. [PMID: 34893940 PMCID: PMC8825406 DOI: 10.1007/s00508-021-01988-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
From a biopsychosocial perspective, maintaining health requires sufficient autoregulatory and self-regulatory capacity to both regulate somatic physiology and manage human-environment interactions. Increasing evidence from neuroscientific and psychological research suggests a functional link between so called interoceptive awareness and self-regulatory behavior. Self-regulation can, again, influence autoregulatory patterns as it is known from biofeedback training or meditation practices. In this review, we propose the psychosomatic competence model that provides a novel framework for the interrelation between interoceptive and self-regulatiory skills and health behavior. The term psychosomatic competence refers to a set of mind- and body-related abilities which foster an adequate interpretation of interoceptive signals to drive health-related behavior and physical well-being. Current related empirical findings and future directions of research on interoception and self-regulation are discussed.
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Affiliation(s)
- Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria.
| | - Dennis Linder
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Franziska Matzer
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
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Effects of Cardiac Rehabilitation Training in Patients with Heart Failure Based on Traditional Chinese Exercise: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1068623. [PMID: 34819979 PMCID: PMC8608508 DOI: 10.1155/2021/1068623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/01/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Methods PubMed, Embase, Cochrane Library, and three Chinese databases, namely, China National Knowledge Network, Wanfang, and China Biomedical Network, were searched from the time of their inceptions through August, 2021. We retrieved the studies on the application of TCE-based cardiac rehabilitation in patients with HF. Based on the standard evaluation methods of Cochrane Reviewer's Handbook 5.1.0, two authors independently assessed the risk of bias and evaluated the methodological quality of the studies included. The RevMan 5.3 software was used for further meta-analysis. Additionally, the GRADEpro GDT web version was used to assess the quality of the evidence in these studies. Results Nine randomized controlled trials involving 721 patients were included in this analysis. The meta-analysis revealed that the TCE (experimental group) effectively improved the patient's motor function and endurance compared to walking or other activities (control group) (mean difference, MD = 68.23, 95% CI [54.55, 81.91]; P < 0.00001). From each subgroup analysis, the exercising ability of the experimental group was higher than that of the control group. The quality of life's score in the experimental group was lower than that of the control group (MD = −9.51, 95%CI [−17.84, −1.18]; P=0.03). The plasma B-type natriuretic peptide content in the experimental group was lower than that in the control group (MD = −59.77, 95%CI [−82.85, −36.7]; P < 0.00001). The number of hospitalizations (MD = −0.83, 95%CI [−0.98, −0.68]; P < 0.00001) and hospital costs in the experimental group (MD = −1.6, 95%CI [−1.89, −1.31]; P < 0.00001) were lower than those in the control group. However, no significant differences were observed in the left ventricular ejection fraction and maximal oxygen consumption between the two groups (MD = 1.38, 95%CI [−3.08, 5.84] and P=0.54; MD = −0.04, 95%CI [−1.62, 1.54] and P=0.96, respectively). From the current analysis, TCE can be considered a relatively safe exercise method. According to the GRADE evaluation results on the evidence level, the studies included were of moderate quality, low quality, or very low quality. Conclusions Our systematic review showed that TCE had potential benefits in improving patients' cardiac function, motor function, and quality of life. Therefore, TCE might be an effective adjuvant therapy in patients with HF. However, given the inclusion of the low-quality elucidations, further rigorous studies are urgently needed to confirm these results.
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Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
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15
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Gilliam EA, Cheung T, Kraemer K, Litrownik D, Wayne PM, Moy ML, Yeh GY. The impact of Tai Chi and mind-body breathing in COPD: Insights from a qualitative sub-study of a randomized controlled trial. PLoS One 2021; 16:e0249263. [PMID: 33831022 PMCID: PMC8031883 DOI: 10.1371/journal.pone.0249263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control. METHODS We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached. RESULTS A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains. CONCLUSIONS Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD. TRIAL REGISTRATION This trial is registered in Clinical Trials.gov, ID number NCT01551953.
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Affiliation(s)
- Elizabeth A. Gilliam
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Tina Cheung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Kristen Kraemer
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Daniel Litrownik
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Peter M. Wayne
- Harvard Medical School, Boston, MA, United States of America
| | - Marilyn L. Moy
- Harvard Medical School, Boston, MA, United States of America
- Pulmonary and Critical Care Medicine Section, Department of Medicine, Veterans Administration Boston Healthcare System, Boston, MA, United States of America
| | - Gloria Y. Yeh
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
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16
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Huang J, Qin X, Shen M, Xu Y, Huang Y. The Effects of Tai Chi Exercise Among Adults With Chronic Heart Failure: An Overview of Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:589267. [PMID: 33816570 PMCID: PMC8012482 DOI: 10.3389/fcvm.2021.589267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/26/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Tai chi (TC) is a popular form of exercise among adults with chronic heart failure (CHF), yet services are greatly underutilized. The aim of the current study was to identify and summarize the existing evidence and to systematically determine the clinical effectiveness of Tai Chi in the management of CHF using a systematic overview. Methods: Both English and Chinese databases were searched for systematic reviews (SRs)/meta-analyses (MAs) on TC for CHF from their inception to June 2020. The methodological quality, reporting quality, and risk of bias of SRs/MAs were assessed using Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and Risk of Bias in Systematic reviews (ROBIS), respectively. The evidence quality of outcome measures was assessed by the Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Results: Six SRs/MAs using a quantitative synthesis to assess various outcomes of TC in CHF were included in this overview. The methodological quality, reporting quality and risk of bias of the SRs/MAs and the evidence quality of the outcome measures are generally unsatisfactory. The limitations of the past SRs/MAs included the lack of either the protocol or registration, the list of excluded studies, and the computational details of meta-analysis were inadequately reported. The critical problems were that qualitative data synthesis relied on trials with small sample sizes and critical low quality. Conclusions: TC may be a promising complementary treatment for CHF. However, further rigorous and comprehensive SRs/MAs and RCTs are required to provide robust evidence for definitive conclusions.
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Affiliation(s)
- Jinke Huang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohui Qin
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Min Shen
- Department of Neurology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Yanjuan Xu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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The Specific and Nonspecific Effects of Tai Chi and Its Possible Central Responses: A Protocol of Neuroimaging Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8883460. [PMID: 33680067 PMCID: PMC7910056 DOI: 10.1155/2021/8883460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Tai Chi has been proven to be a safe and effective assistant therapy for healthcare and disease treatment. However, whether the adjuvant therapeutic effect of Tai Chi is general or disease-oriented remains uncertain. This trial focuses on exploring the specific and nonspecific effects of Tai Chi and its potential central responses. The results will deepen our understanding of the characteristics of Tai Chi exercise for adjuvant therapeutic effects and promote its application in the clinic. In this neuroimaging trial, 40 functional constipation (FC) patients and 40 healthy subjects (HS) will be recruited and will receive 10 weeks of Tai Chi exercise. The motor function, respiratory function, stool-related symptoms, quality of life, and emotional state of the participants will be evaluated at the baseline, the 5-week Tai Chi practice, and the end of practice. The potential changes in the heart rate variability and the cerebral function will be recorded by the 24 h dynamic electrocardiogram at the baseline and the functional magnetic resonance imaging at the end of practice. The possible correlations among the clinical variables, the heart rate variability, and the cerebral activity alterations in FC patients and HS will be analyzed. The healthcare and therapeutic effects of Tai Chi exercise might consist of the specific and nonspecific effects. This study provides not only a new perspective for understanding Tai Chi but also a new approach for investigating the mind-body exercise. This trial was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=33243) on 28 November 2018 (registration number: ChiCTR1800019781; protocol version number: V1.0). This trial is currently in the stage of recruiting patients. The first patient was included on 1 December 2018. To date, 18 FC patients and 20 HS have been included. Recruitment will be completed in December 2020.
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Prabhakaran D, Chandrasekaran AM, Singh K, Mohan B, Chattopadhyay K, Chadha DS, Negi PC, Bhat P, Sadananda KS, Ajay VS, Singh K, Praveen PA, Devarajan R, Kondal D, Soni D, Mallinson P, Manchanda SC, Madan K, Hughes AD, Chathurvedi N, Roberts I, Ebrahim S, Reddy KS, Tandon N, Pocock S, Roy A, Kinra S. Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial. J Am Coll Cardiol 2020; 75:1551-1561. [PMID: 32241371 PMCID: PMC7132532 DOI: 10.1016/j.jacc.2020.01.050] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). OBJECTIVES This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. METHODS The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks. RESULTS MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). CONCLUSIONS Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).
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Affiliation(s)
- Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | | | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Kaushik Chattopadhyay
- London School of Hygiene and Tropical Medicine, London, United Kingdom; The University of Nottingham, Nottingham, United Kingdom
| | | | | | - Prabhavathi Bhat
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | | | - Vamadevan S Ajay
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Pradeep A Praveen
- Centre for Chronic Disease Control, New Delhi, India; All India Institute of Medical Sciences, New Delhi, India
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Divya Soni
- Centre for Chronic Disease Control, New Delhi, India
| | - Poppy Mallinson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Nishi Chathurvedi
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Ian Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ambuj Roy
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Yeh GY, Litrownik D, Wayne PM, Beach D, Klings ES, Reyes Nieva H, Pinheiro A, Davis RB, Moy ML. BEAM study (Breathing, Education, Awareness, Movement): a randomised controlled feasibility trial of tai chi exercise in patients with COPD. BMJ Open Respir Res 2020; 7:7/1/e000697. [PMID: 33219007 PMCID: PMC7682460 DOI: 10.1136/bmjresp-2020-000697] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite therapeutic advances, the management of chronic obstructive pulmonary disease (COPD) remains complex. There is growing interest in multidimensional, mind-body exercises to improve both physical and psychosocial aspects of COPD burden. Few US data are available in this population on tai chi (TC) a mind-body exercise incorporating physical activity, breathing and mindful awareness. We explored feasibility and preliminary efficacy of TC in COPD in an US academic medical setting. METHODS Patients with COPD Global Obstructive Lung Disease (GOLD) stages 2-4 were randomised to a 12-week TC programme or education control. At 12 weeks, those in TC were randomised again to continue in maintenance classes or not to further explore optimal duration. All groups were followed to 24 weeks. Feasibility/safety parameters were analysed descriptively. Preliminary between-group differences were estimated in symptoms (dyspnoea, fatigue), health-related quality-of-life (Chronic Respiratory Questionnaire CRQ), cognitive-emotional measures (mood, COPD self-efficacy) and functional status (6 min walk test, lower body strength, flexibility, physical activity). RESULTS Ninety-two subjects were randomised (N=61 TC, N=31 education). Mean age was 68±8 years, 66% male, mean forced expiratory volume in 1 s % predicted 57±13, 28% were GOLD stage 3-4. Overall retention was 85%. Nineteen adverse events occurred, most being study-unrelated COPD exacerbations. From baseline to 12 weeks, there were between-group improvements favouring TC, in CRQ-total (Cohen's d effect size (ES)=0.46; adj mean diff (AMD)=0.31), CRQ-emotion (ES=0.54; AMD=0.49), Centre for Epidemiologic Studies Depression (ES=-0.37; AMD=2.39) and Patient-Reported Outcome Measurement Information System (PROMIS)-fatigue (ES=-0.34; AMD=-0.17). From baseline to 24 weeks, there was an improvement favouring TC in CRQ-dyspnoea (ES=0.41; AMD=0.46). Among TC participants, there was a positive effect of maintenance classes on self-efficacy (ES=-0.69; AMD=-0.40), 6 min walk (ES=0.56; AMD=49.26 feet), PROMIS-fatigue (ES=-0.41; AMD=-0.28) and chair stand (0.43; AMD=0.56). CONCLUSION TC in patients with COPD is feasible and safe. Preliminary analyses support a potential modest role in improving quality-of-life, cognitive-emotional health and function that should be further studied. TRIAL REGISTRATION NUMBER NCT01551953. IRB REFERENCE BIDMC 2010P-000412; VA 2540.
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Affiliation(s)
- Gloria Y Yeh
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Litrownik
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Beach
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth S Klings
- Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Adlin Pinheiro
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger B Davis
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marilyn L Moy
- Harvard Medical School, Boston, Massachusetts, USA.,Pulmonary and Critical Care Section, Department of Medicine, Veterans Administration Boston Healthcare System, Boston, Massachusetts, USA
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Salmoirago-Blotcher E, Trivedi D, Dunsiger S. Tai Chi practice and change in exercise habits in survivors of acute coronary syndromes: Is mindfulness a possible mechanism? Explore (NY) 2020; 17:475-478. [PMID: 32978061 DOI: 10.1016/j.explore.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mechanisms by which mind-body practice may improve exercise behaviors in patients with coronary heart disease (CHD) are unknown. PURPOSE To identify predictors of exercise behaviors developed in response to a tai chi intervention. METHODS We conducted an exploratory analysis using data from a pilot study of tai chi for physically inactive patients with CHD. We used Latent Class Analysis to identify patterns of moderate to vigorous physical activity (MVPA) (accelerometry-assessed, average min/week) over the 9-month study period. Logistic regression was used to evaluate associations between MVPA patterns and changes in exercise self-efficacy (Self-efficacy for exercise scale), social support (Multidimensional Scale of Perceived Social Support), resilience (Brief Resilience Survey), and mindfulness (Five Facets of Mindfulness) at 6 months. RESULTS Data supported a 3-class model over time: 31% of participants were in class 1 (high and sustained MVPA, > 200 min/week), 21% were in class 2 (low and decreasing MVPA, < 100 > 50 min/week), and 48% in class 3 (low and stable MVPA, < 50 min/week). Higher mindfulness scores at 6 months were associated with a high and sustained MVPA pattern (b = 1.89, SE = 0.15, p = .01). Social support was inversely associated with low and decreasing MVPA (b = -0.72, SE = 0.34, p = .04). No associations were noted with the other factors. CONCLUSIONS Improvements in mindfulness were associated with a distinct high and sustained MVPA pattern. Although only hypothesis-generating, these findings suggest that improvements in mindfulness skills could be a mechanism for the possible effect of Tai Chi in the promotion of MVPA.
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Affiliation(s)
- Elena Salmoirago-Blotcher
- The Miriam Hospital, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | | | - Shira Dunsiger
- School of Public Health, Brown University, United States
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Zhao Z, Wang X, Wang S, Zhou R, Liu Y, Su L, Li C, Lin S, Liu H, Zhao L, Mao J. Study on the clinical assessment of integrated rehabilitation of Traditional Chinese Medicine and western medication for acute myocardial infarction. Medicine (Baltimore) 2020; 99:e21592. [PMID: 32846768 PMCID: PMC7447369 DOI: 10.1097/md.0000000000021592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This trial aims to evaluate the efficacy and safety of the Baduanjin exercise in patients with acute myocardial infarction (AMI). METHODS A single-center, open, randomized controlled clinical trial will be conducted to evaluate the effectiveness of the Baduanjin exercise on the rehabilitation of AMI patients. It plans to enroll 64 patients. Patients will be divided evenly into 2 groups using a random number table method. There will be 32 cases in each group. Patients in the experimental group will be treated with standardized drug therapy combined with Baduanjin exercise, while patients in the control group will be treated with standardized drug therapy combined with routine exercise. The primary outcome is the peak oxygen consumption (Peak VO2) during cardiopulmonary exercise test (CPET). The secondary outcomes include CPET, echocardiography, Seattle angina pectoris scale, hospital depression and anxiety scale, Pittsburgh Sleep Quality Index scale, scores of 4 examinations, and diagnostic methods of traditional Chinese medicine and composite endpoint events, etc. DISCUSSION:: This study will be the first to evaluate the effect of the Baduanjin exercise on the Peak VO2 in patients with AMI. STUDY REGISTRATION This study has been registered on the Chinese Clinical Trial Registry (No: ChiCTR1800016209, protocol version 1.2).
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Does Tai Chi improve antioxidant and anti-inflammatory abilities via the KEAP1-NRF2 pathway and increase blood oxygen level in lung cancer patients: A randomized controlled trial? Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ma J, Zhang JW, Li H, Zhao LS, Guo AY, Chen ZH, Yuan W, Gao TM, Li YM, Li CH, Wang HW, Song B, Lu YL, Cui MZ, Wei QY, Lyu SJ, Yin HC. Safety and effectiveness of a Tai Chi-based cardiac rehabilitation programme for chronic coronary syndrom patients: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036061. [PMID: 32624473 PMCID: PMC7337900 DOI: 10.1136/bmjopen-2019-036061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Preliminary evidence from clinical observations suggests that Tai Chi exercise may offer potential benefits for patients with chronic coronary syndrom (CCS). However, the advantages for CCS patients to practice Tai Chi exercise as rehabilitation have not been rigorously tested and there is a lack of consensus on its benefits. This study aims to develop an innovative Tai Chi Cardiac Rehabilitation Program (TCCRP) for CCS patients and to assess the efficacy, safety and acceptability of the programme. METHODS AND ANALYSIS We propose to conduct a multicentre randomised controlled clinical trial comprising of 150 participants with CCS. The patients will be randomly assigned in a 1:1 ratio into two groups. The intervention group will participate in a supervised TCCRP held three times a week for 3 months. The control group will receive supervised conventional exercise rehabilitation held three times a week for 3 months. The primary and secondary outcomes will be assessed at baseline, 1 month, 3 months after intervention and after an additional 3-month follow-up period. Primary outcome measures will include a score of 36-Item Short Form Survey and Chinese Perceived Stress Scale. The secondary outcome measures will include body composition, cardiopulmonary exercise test, respiratory muscle function, locomotor skills, echocardiogram, New York Heart Association classification, heart rate recovery time and laboratory examination. Other measures also include Seattle Angina Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Berg Balance Scale. All adverse events will be recorded and analysed. ETHICS AND DISSEMINATION This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of Chinese People's Libration Army General Hospital (approval number: S2019-060-02). Findings from this study will be published and presented at conferences for widespread dissemination of the results. TRIAL REGISTRATION NUMBER NCT03936504.
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Affiliation(s)
- Jing Ma
- Department of Cardiology, First Medical Center of Chinese People's Libration Army General Hospital, Beijing, China
| | - Jian Wei Zhang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Hua Li
- Department of Cardiovascular Medicine, Anzhen Community Health Service Center, Chaoyang District, Beijing, China
| | - Lian Shan Zhao
- Department of Cardiovascular Medicine, Beijing Shuili Hospital, Beijing, China
| | - Ai Ying Guo
- Department of Cardiovascular Medicine, Anzhen Community Health Service Center, Chaoyang District, Beijing, China
| | - Zai Hao Chen
- College of Wushu, Beijing Sport University, Beijing, China
| | - Wen Yuan
- College of Wushu, Beijing Sport University, Beijing, China
| | - Tian Ming Gao
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Ya Meng Li
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Cui Han Li
- College of Wushu, Beijing Sport University, Beijing, China
| | - Hong Wei Wang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Bo Song
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yu Long Lu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Mei Ze Cui
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Qiu Yang Wei
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Shao Jun Lyu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Heng Chan Yin
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
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Cheng D, Wang B, Li Q, Guo Y, Wang L. Research on Function and Mechanism of Tai Chi on Cardiac Rehabilitation. Chin J Integr Med 2020; 26:393-400. [PMID: 32350802 DOI: 10.1007/s11655-020-3262-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
With the increasing number of cardiovascular patients, more and more people are living with diseases. Cardiac rehabilitation (CR) is an effective treatment and prevention measure for cardiovascular disease (CVD), which aims to relieve both psychological and physiological stress of CVD, reduce risk of death from CVD, improve cardiovascular function and patients' quality of life. Tai Chi is popular in China and mainly used as a daily leisure activity for the elderly to strengthen their bodies. This review discusses whether Tai Chi could be taken as a positive intervention in CR and what is the exact role and its mechanisms as exercise therapy for CVD. The authors detail the role of Tai Chi on CR from the aspects of exercise capacity, risk factors of CVD and psychological factors, etc., as well as highlight the limitation of Tai Chi research at present.
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Affiliation(s)
- Duan Cheng
- Department of Rehabilitation, Acupuncture and Moxibustion and Massage College • Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Bo Wang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Qian Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yan Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Lei Wang
- Department of Rehabilitation, Acupuncture and Moxibustion and Massage College • Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR-126. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4565438. [PMID: 32382289 PMCID: PMC7199556 DOI: 10.1155/2020/4565438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/29/2020] [Accepted: 04/04/2020] [Indexed: 01/20/2023]
Abstract
Background Tai Chi is effective in preventing heart disease (CHD) risk, but the molecular mechanism remains unclear. Mitogen-activated protein kinase (MAPK) signaling plays a critical role in the pathogenesis of CHD and can be activated by miR-126. Tai Chi may exert its protective function through the miR-126-modulated MAPK pathway. Methods The CHD patients after PCI were randomized into the CG group (CG) (n = 19, normal care) and Tai Chi group (TG) (Tai Chi intervention, n = 17). Epicardial adipose tissue volume (EATV) (one main adverse cardiovascular event of CHD), HR (heart rate), QoL (quality of life) scores, and balance performance were measured in the two groups. The body fat content, abdominal subcutaneous fat, and visceral fat were measured to reflect the improvement of adipose tissue dysfunction. The levels of miR-126 and MAPK-associated molecules were measured in peripheral blood leukocytes. Meanwhile, the effects of miR-126 silence and mimic on MAPK-associated molecules were also explored in cardiac cell H9C2. Results After the 3-month intervention, Tai Chi reduced EATV and HR and increased QoL scores and balance performance, respectively (P < 0.05). The fat percentage, body fat mass, and BMI were also significantly reduced after Tai Chi intervention (P < 0.05). The levels of miR-126, MAPK, JNK, and ERK in the TG group were lower than those in the CG group (P < 0.05). The miR-126 levels had a strong relationship with the values of EATV, HR, and QoL scores (P < 0.05). miR-126 silence or mimic inactivated or activated MAPK-associated molecules in the cardiac cell lines. Conclusions Tai Chi improved CHD risk by inactivating the MAPK/ERK pathway via serum miR-126.
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Zhu D, Jiang M, Xu D, Schöllhorn WI. Long-Term Effects of Mind-Body Exercises on the Physical Fitness and Quality of Life of Individuals With Substance Use Disorder-A Randomized Trial. Front Psychiatry 2020; 11:528373. [PMID: 33391039 PMCID: PMC7775308 DOI: 10.3389/fpsyt.2020.528373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Mind-body exercises (MBE) are sequences of low to medium-intensity activities that benefit healthy performers physically and mentally. In contrast to the unmodified application of traditional tai chi, qi gong, or yoga in the healthy population, MBEs are typically tailored for individuals with substance abuse disorder (SUD). Despite numerous applications in practice, the detailed effects of tailor-made MBEs for SUD are unclear. Objectives: This study aimed to analyze and compare changes in the physical fitness and quality of life of individuals with SUD that underwent conventional or tailor-made MBEs. Methods: A total of 100 subjects obtained from the Shanghai Mandatory Detoxification and Rehabilitation Center with SUD were randomly assigned into two groups. The subjects in the experimental group (n = 50) practiced tailored MBE for 60 min a day, five times a week, for 3 months. The subjects (n = 50) in the control group were treated with conventional rehabilitation exercises with the same intervention protocol. The outcomes of fitness and quality of life for drug addiction were measured at the beginning and after 3 and 6 months by a questionnaire (QOL-DA). A two-way repeated measure analysis of variance was applied to compare the difference of treatments in the two groups. Results: Statistically significant differences for the experimental group were found in systolic (p < 0.01, η2 = 0.124) and diastolic blood pressure (p < 0.01, η2 = 0.097), pulse (p < 0.01, η2 = 0.086), vital capacity (p < 0.05, η2 = 0.036), flexibility (p < 0.01, η2 = 0.143), and aerobic endurance (p < 0.01, η2 = 0.165). Results of the QOL-DA showed statistically significant differences between the experimental and control groups in total score (p < 0.01, η2 = 0.158) with greater effects on the former. Conclusions: This study provided evidence that tailored MBE could lead to remarkable effects with regard to blood pressure, vital capacity, flexibility, and aerobic endurance in comparison with conventional rehabilitation methods. Clinical Trial Registration: ChiCTR-IPR-14005343.
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Affiliation(s)
- Dong Zhu
- School of International Education, Shanghai University of Sport, Shanghai, China
| | - Mei Jiang
- School of International Education, Shanghai University of Sport, Shanghai, China
| | - Ding Xu
- Shanghai Drug Administration, Shanghai, China
| | - Wolfgang I Schöllhorn
- School of International Education, Shanghai University of Sport, Shanghai, China.,Institute for Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
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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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Thomas RJ, Huang HH. Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Disease: 2019 Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:56. [PMID: 31486974 DOI: 10.1007/s11936-019-0759-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW To provide updated information on the science and practice of cardiac rehabilitation (CR). RECENT FINDINGS Evidence continues to mount that supports the many benefits of CR as well as the important gap in delivering CR to all eligible patients. Recent studies have identified center-based and home-based strategies to improve the reach and impact of CR. Cardiac rehabilitation is a systematic, evidence-based approach to deliver effective secondary CVD preventive therapies to individuals with cardiovascular conditions. Because of a number of benefits that have been associated with CR, clinical practice guidelines strongly endorse CR services for eligible patients. Research supports CR as a high value service, with evidence of favorable clinical outcomes and costs. Unfortunately, a significant gap exists in CR participation due to a number of patient-, provider-, and system-level barriers. Solutions to most of these barriers have been identified and involve systematic approaches to CR delivery. The future is bright for CR as new strategies, new policies, and new methods of delivery continue to develop to help provide CR services to all eligible patients.
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Affiliation(s)
- Randal J Thomas
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Hsu-Hang Huang
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
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Cha NH, Jeon GE, Cho Y, Sok SR. Effects of Tai Chi therapy on body mass index and physical index of intellectual disability. Jpn J Nurs Sci 2019; 17:e12292. [PMID: 31465156 DOI: 10.1111/jjns.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/22/2019] [Accepted: 07/06/2019] [Indexed: 11/27/2022]
Abstract
AIM Continuous program development and application are necessary in order to manage the health and address the problems of secondary metabolic disorders for people with intellectual disabilities. This study examines the effects of Tai Chi therapy on body mass index (BMI) and physical index among people with intellectual disabilities. METHODS A quasi-experimental study using a pretest-post-test control group, non-synchronized design was employed. Samples were in total 104 people with intellectual disabilities (experimental: n = 67, control: n = 37) in two facilities in South Korea. They were randomly allocated using a coin toss into the two groups. Tai Chi therapy as an experimental intervention was the Sun style Tai Chi exercise, which consists of the warm-up (5 min), main exercise (45 min), and finishing (meditation, 10 min). Tai Chi therapy was conducted twice a week for a total of 40 sessions for 5 months (1 hour each) by one professional instructor. Measures were general characteristics of study participants, BMI as degree of obesity, and physical index. Data were analyzed using the SPSS 21.0 program (descriptive statistics, χ2 test, independent t test). A P value of less than .05 was considered statistically significant. RESULTS There were statistically significant differences on fasting blood glucose (t = 4.351, P < .001) and high-density lipoprotein (t = -2.052, P = .043) in the physical index between the two groups. CONCLUSIONS Tai Chi therapy was an effective intervention for decreasing fasting blood glucose and for increasing high-density lipoprotein in those with intellectual disabilities. Tai Chi therapy can be implied as a nursing intervention for intellectual disabilities in nursing practice.
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Affiliation(s)
- Nam-Hyun Cha
- Department of Nursing, Andong National University, Andong-si, South Korea
| | - Ga-Eul Jeon
- Department of Nursing, Cheongam College, Suncheon-si, South Korea
| | - Youngmi Cho
- Department of Nursing, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Sohyune R Sok
- Department of Nursing, College of Nursing Science, Kyung Hee University, Seoul, South Korea
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Gao L, Si D, Bao H, Yu M, Sun H, Damchaaperenlei D, Yan Y, Shi Q, Li Y. Tai Chi for the treatment of chronic obstructive pulmonary disease: A systematic review protocol. Medicine (Baltimore) 2019; 98:e16097. [PMID: 31261524 PMCID: PMC6617485 DOI: 10.1097/md.0000000000016097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increasing morbidity and mortality that cause huge social and economic loss. Although recommended by guidelines, pulmonary rehabilitation has not been widely applied in clinics because of its inherent limitations. Free from restrictions of specific training venues and equipment, Tai Chi, as a kind of pulmonary rehabilitation, has been used to cure the COPD, yet the efficacy and safety of Tai Chi remains to be assessed. In this study, we aim to draw up a protocol for systematic review to evaluate the efficacy and safety of Tai Chi for COPD. METHODS We will search the following electronic databases from inception to December 31, 2018: PubMed, Web of Science, Medline, Cochrane Central Register of Controlled Trials, Springer, EMBASE, the China National Knowledge Infrastructure Database, Wan Fang Database, the Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Clinical trial registrations, potential gray literatures, relevant conference abstracts and reference list of identified studies will also be searched. The literature selection, data extraction, and quality assessment will be completed by 2 independent authors. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. Changes in lung function will be evaluated as the primary outcome. Symptom assessment, quality of life (SGRQ), medication usage, exacerbations, and adverse events will be assessed as the secondary outcomes. The RevMan V.5.3.5 will be used for Meta-analysis. RESULTS This study will provide a synthesis of current evidence of Tai Chi for COPD from several aspects, such as lung function, SGRQ, medication usage, exacerbations, and adverse events. CONCLUSION The conclusion of our study will provide updated evidence to judge whether Tai Chi is an effective solution to COPD patients. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019122791.
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Affiliation(s)
- Longxia Gao
- Beijing University of Chinese Medicine, Beijing
| | - Dongxu Si
- Beijing University of Chinese Medicine, Beijing
| | - Haipeng Bao
- Inner Mongolia Autonomous Region Hospital of Traditional Chinese Medicine, Hohhot
| | - MingXia Yu
- Beijing University of Chinese Medicine, Beijing
| | - Huizhuo Sun
- Beijing University of Chinese Medicine, Beijing
| | | | - Yue Yan
- The 2nd Department of Pulmonary Disease in TCM, The Key Unit of SATCM Pneumonopathy Chronic Cough and Dyspnea, Beijing Key Laboratory of Prevention and Treatment of Allergic Diseases with TCM (No. BZ0321), Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Qi Shi
- The 2nd Department of Pulmonary Disease in TCM, The Key Unit of SATCM Pneumonopathy Chronic Cough and Dyspnea, Beijing Key Laboratory of Prevention and Treatment of Allergic Diseases with TCM (No. BZ0321), Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Youlin Li
- The 2nd Department of Pulmonary Disease in TCM, The Key Unit of SATCM Pneumonopathy Chronic Cough and Dyspnea, Beijing Key Laboratory of Prevention and Treatment of Allergic Diseases with TCM (No. BZ0321), Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
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Li Y, Zhang H, Wang Y. Tai Chi Ameliorates Coronary Heart Disease by Affecting Serum Levels of miR-24 and miR-155. Front Physiol 2019; 10:587. [PMID: 31191331 PMCID: PMC6548805 DOI: 10.3389/fphys.2019.00587] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 04/26/2019] [Indexed: 12/17/2022] Open
Abstract
The protective role of Tai Chi in coronary heart disease (CHD) has been widely reported. However, the exact molecular mechanism remains unclear. Serum levels of miR-24 and miR-155 have been found to potentially be involved with CHD risk. Thus, the effects of Tai Chi on CHD risk were explored by measuring serum levels of miR-24 and miR-155. A total of 326 CHD patients were evenly divided into the Tai Chi (TG) and control (CG) groups. The activities of daily living ability (ADL) and exercise of self-care agency (ESCA) scores were compared between the two groups. Left ventricular ejection fraction (LVEF), SF-36 life quality, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate subjects’ cardiac function, quality of life, anxiety, and depression. Serum levels of miR-24 and miR-155 were measured by a real-time quantitative polymerase chain reaction (RT-qPCR). After a 6-month Tai Chi intervention, the ESCA, ADL, LVEF, and SF-36 scores in the TG group were higher than those in the CG group (p < 0.05). The time of arrhythmia and atrioventricular block recovery and hospital stay, and the scores of SAS and SDS in the TG group were lower than in the CG group (p < 0.05). Serum levels of miR-24 and miR-155 in the TG group were also lower than in the CG group (p < 0.05). In addition, serum levels of miR-24 and miR-155 were negatively associated with the ESCA, ADL, LVEF and SF-36 scores, and had adverse effects on life quality. Altogether, these present findings demonstrate that Tai Chi improves CHD prognosis, by affecting serum levels of the miR-24 and miR-155.
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Affiliation(s)
- Yang Li
- Department of Cardiovascular Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Haiyang Zhang
- Department of Cardiovascular Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Yushi Wang
- Department of Cardiovascular Center, The First Bethune Hospital of Jilin University, Changchun, China
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Conboy L, Krol J, Tomas J, Yeh GY, Wayne P, Salmoirago-Blotcher E. Tai Chi for heart attack survivors: qualitative insights. BMJ Support Palliat Care 2019; 10:e44. [PMID: 30948446 DOI: 10.1136/bmjspcare-2018-001685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR. METHODS A semistructured focus group agenda was used to assess three key domains of feasibility: (1) patients' experiences, (2) reasons/barriers for not having attended CR and (3) any improvements in physical activity and other secondary outcomes (quality of life, weight, sleep). A thematic analysis was used to better understand the key concepts. RESULTS This high-risk group of patients reported that they enjoyed TC exercise, and felt confident and safe doing it. TC practice was reported to support other types of physical activity allowing for a generalisation of positive effects. DISCUSSION This analysis is consistent with published reports of TC practice improving mood and psychological well-being. Qualitative methods allowed us to find emergent experiential reports of behaviour change factors found in established behaviour change theories.
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Affiliation(s)
- Lisa Conboy
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, USA
| | - Julie Krol
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jose Tomas
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Gloria Y Yeh
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Bei Y, Shi C, Zhang Z, Xiao J. Advance for Cardiovascular Health in China. J Cardiovasc Transl Res 2018; 12:165-170. [PMID: 30535628 DOI: 10.1007/s12265-018-9852-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023]
Abstract
As the most populous country worldwide, China has ≈ 290 million patients with cardiovascular diseases (CVDs), representing the leading cause of death in Chinese population. The morbidity and mortality of CVDs are continuously rising. Here, we will first summarize the recent advance in the management of CVDs such as coronary arterial disease, arrhythmia, and heart failure in China. In particular, we will introduce the development of chest pain centers and indicate the novel techniques and methods applied for the management of CVDs. Then, we will discuss and point out the importance of improving the clinical and basic research for Traditional Chinese medicine in the treatment of CVDs. Finally, we will emphasize the efforts made to promote cardiac rehabilitation and cardiovascular prevention system in China. We are striving to establish a practical prevention-treatment-rehabilitation system and looking forward to a bright future with reduced morbidity and mortality from CVDs in China.
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Affiliation(s)
- Yihua Bei
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Chao Shi
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Zhongrong Zhang
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Junjie Xiao
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China.
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Pearson MJ, King N, Smart NA. Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis. Open Heart 2018; 5:e000819. [PMID: 30018779 PMCID: PMC6045761 DOI: 10.1136/openhrt-2018-000819] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022] Open
Abstract
Background Biomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy. Methods A systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included. Results Forty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements. Conclusion Pooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.
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Affiliation(s)
- Melissa J Pearson
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | - Nicola King
- School of Biomedical and Healthcare Sciences, University of Plymouth, Plymouth, UK
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
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Pirruccello JP, Traynor K, Aragam KG. "Road Map" to Improving Enrollment in Cardiac Rehabilitation: Identifying Barriers and Evaluating Alternatives. J Am Heart Assoc 2017; 6:e007468. [PMID: 29021269 PMCID: PMC5721899 DOI: 10.1161/jaha.117.007468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- James P Pirruccello
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kathleen Traynor
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Krishna G Aragam
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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