The role of exercise training and dietary sodium restriction in heart failure rehabilitation: A systematic review

Heart failure (HF) rehabilitation seeks to enhance the entire well-being and quality of life of those with HF by focusing on both physical and mental health. Non-pharmacological measures, particularly exercise training, and dietary salt reduction, are essential components of heart failure rehabilitation. This study examines the impact of these components on the recovery of patients with heart failure. By conducting a comprehensive analysis of research articles published from 2010 to 2024, we examined seven relevant studies collected from sources that include PubMed and Cochrane reviews. Our findings indicate that engaging in physical activity leads to favorable modifications in the heart, including improved heart contractility, vasodilation, and cardiac output. These alterations enhance the delivery of oxygen to the peripheral tissues and reduce symptoms of heart failure, such as fatigue and difficulty breathing. Nevertheless, decreasing the consumption of salt in one's diet to less than 1500 mg per day did not have a substantial impact on the frequency of hospitalizations, visits to the emergency room, or overall mortality when compared to conventional treatment. The combination of sodium restriction and exercise training can have synergistic effects due to their complementary modes of action. Exercise improves cardiovascular health and skeletal muscle metabolism, while sodium restriction increases fluid balance and activates neurohormonal pathways. Therefore, the simultaneous usage of both applications may result in more significant enhancements in HF symptoms and clinical outcomes compared to using each program alone.

Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial

BACKGROUND

Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format.

OBJECTIVE

This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome.

METHODS

A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability.

RESULTS

The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [≤1/week]: 141/143, 97.9% vs 96/141, 68.1%; industrial pastries [<2/week]: 129/143, 89.6% vs 80/141, 56.8%; oily fish [≥2/week]: 124/143, 86.1% vs 64/141, 41.4%; vegetables [≥2/day]: 130/143, 90.3% vs 78/141, 55.3%; fruit [≥2/day]: 128/143, 88.9% vs 85/141, 60.2%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points).

CONCLUSIONS

With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606.

Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme.

METHODS

This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined.

RESULTS

Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns.

CONCLUSIONS

Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.

Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study

INTRODUCTION

Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management.

EVIDENCE ACQUISITION

A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events.

EVIDENCE SYNTHESIS

Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients.

CONCLUSIONS

The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.

Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis

Background

Home-based exercise (HBE) represents an alternative to increase the accessibility of rehabilitation programs and relieve the burden on the health care system for people with knee osteoarthritis.

Objectives

To summarize for the first time the effectiveness of HBE as compared to center-based exercise (CBE), both with and without HBE, on patient-reported and performance-based outcomes in people with KOA.

Methods

Searches were conducted on PubMed, Cochrane, Embase, Web of Science, and Scopus until March 10, 2023, without date or language restrictions. Randomized controlled trials investigating HBE versus CBE or HBE combined with CBE for people with KOA were eligible. The primary outcomes were patient-reported: pain, physical disability, and quality of life. The secondary outcomes were performance-based: walking ability, lower limb muscle strength, and balance function. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to the GRADE.

Results

Eleven trials involving 956 participants were included. There was no difference in short-term pain (SMD, 0.22 [95% CI, -0.04 to 0.47], p = 0.09; I2 = 0%), physical disability (SMD, 0.17 [95% CI, -0.19 to 0.54], p = 0.35; I2 = 0%), walking ability (SMD, -0.21 [95% CI, -0.64 to 0.22], p = 0.33; I2 = 35%) and lower limb muscle strength (SMD, -0.24 [95% CI, -0.88 to 0.41], p = 0.47; I2 = 69%) between HBE and CBE. HBE combined with CBE has better benefits compared with HBE alone in short-term pain (SMD, 0.89 [95% CI, 0.60 to 1.17], p < 0.001; I2 = 11%) and physical disability (SMD, 0.25 [95% CI, 0.00 to 0.50], p = 0.05; I2 = 0%).

Conclusion

Based on limited evidence, HBE is as effective as CBE on short-term pain, physical disability, walking ability, and lower limb muscle strength in people with knee osteoarthritis. Furthermore, combining HBE with CBE may enhance the overall efficacy of the intervention.

Systematic review registration

PROSPERO, CRD42023416548.

Utility of Cardiac Rehabilitation for Long-Term Outcomes in Patients with Hospital-Acquired Functional Decline after Cardiac Surgery: A Retrospective Study

Hospital-acquired functional decline is an important outcome that affects the long-term prognosis of patients after cardiac surgery. Phase II cardiac rehabilitation (CR) for outpatients is expected to improve prognosis; however, this is not clear in patients with hospital-acquired functional decline after cardiac surgery. Therefore, this study evaluated whether phase II CR improved the long-term prognosis of patients with hospital-acquired functional decline after cardiac surgery. This single-center, retrospective observational study included 2371 patients who required cardiac surgery. Hospital-acquired functional decline occurred in 377 patients (15.9%) after cardiac surgery. The mean follow-up period was 1219 ± 682 days in all patients, and there were 221 (9.3%) cases with major adverse cardiovascular events (MACE) after discharge during the follow-up period. The Kaplan-Meier survival curves indicated that hospital-acquired functional decline and non-phase II CR was associated with a higher incidence of MACE than other groups (log-rank, p < 0.001), additionally exhibiting prognosticating MACE in multivariate Cox regression analysis (HR, 1.59; 95% CI, 1.01-2.50; p = 0.047). Hospital-acquired functional decline after cardiac surgery and non-phase II CR were risk factors for MACE. The participation in phase II CR in patients with hospital-acquired functional decline after cardiac surgery could reduce the risk of MACE.

Feasibility and Potential Effectiveness of a Smartphone Zero-Time Exercise Intervention for Promoting Physical Activity and Fitness in Patients With Coronary Heart Disease: A Pilot Randomized Controlled Trial

Background

Zero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD).

Methods

A parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group.

Results

One hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group (n = 70) or control group (n = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), P = 0.04, Cohen's d = 0.34] than the control group.

Conclusions

This pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes.

Trial Registration

The research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.

Exercise Training and Interventions for Coronary Artery Disease

Coronary artery disease (CAD) may be considered a main cause of mortality and the prevalence of CAD is increasing nowadays, leading to high health costs in many countries. Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance. Thus, the present narrative review aimed to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training. Exercise attenuates certain pathophysiological processes of this disease, such as endothelial dysfunction or the vulnerability of atherosclerotic plaques, and produces improvements in functional capacity and muscle strength, among others. Within the different exercise modalities, the most important parameter to be considered seems to be the total caloric expenditure, and not so much the modality itself. As such, in cardiac rehabilitation, when prescribing exercise, we should possibly focus on the modality that obtains more adherence in patients. To conclude, it must be highlighted that total caloric expenditure is not being taken into account when comparing interventions and this relevant information should be considered in future studies.

Cardiac rehabilitation in women, challenges and opportunities

Cardiac rehabilitation(CR) has known proven benefits in reducing mortality related to cardiovascular disease (CVD), improving quality of life (QoL), and preventing CVD-related readmissions. Despite these known benefits, CR remains underutilized among women relative to men. Disparities exist at the level of referral, enrollment, and program completion. Much is left to be understood regarding the utility of CR in female-predominant CVD such as postpartum cardiomyopathy and Spontaneous Coronary Artery Dissection. This review identifies the benefits of CR for specific populations of women and elucidates on the barriers to CR. We also describe current recommendations to overcome barriers to CR in women.

Determinants of Virtual Exercise Equipment Use: An Integrated Model Investigation

BACKGROUND

Given the limited research on behavioral determinants of using virtual exercise machines to engage in exercise during the COVID-19 pandemic, this study applied an integrated behavior change model to identify behavioral determinants using these machines.

METHOD

Adult owners of livestreaming virtual exercise equipment (N = 123) completed measures of social cognition, planning, motivation, virtual exercise machine features, and sociostructural variables at an initial occasion (T1) and 4 weeks later (T2). Hypothesized relations among model constructs were tested using a cross-lagged structural equation model with past behavior and sociostructural variables as covariates.

RESULTS

Autonomous motivation predicted intentions and habit indirectly via attitudes and perceived behavioral control at T1; virtual exercise machine features predicted intention and habit indirectly via social cognition constructs at T1; and intention and habit at T1 predicted exercise behavior at T2.

CONCLUSIONS

This study supports social cognition constructs and virtual features as predictors of exercise using virtual exercise machines.

Gym and home-based combined training in men with primary hypertension: are they equally effective on functional fitness profile, body composition components, and biochemical parameters of hypertension?

OBJECTIVE

This study aimed to compare the effects of 10 weeks of gym versus home-based combined training on the functional fitness, body composition, and biochemical parameters of hypertension in primary hypertensive men.

METHODS

Forty-six patients (age 48 ± 9 years, BMI 30 ± 4 kg/m²) assigned into three groups: a gym-based combined training (GBCTr: n = 16; resistance at 60-80% of 1RM, using pin-loaded resistance equipment, aerobic at 40-60% HRR, and stretching), home-based combined training (HBCTr: n = 15; resistance at 12-15 RPE, using an elastic exercise band, aerobic at 40-60% HRR, and stretching), and control (CTR, n = 15).

RESULTS

Following GBCTr and HBCTr, the functional aerobic capacity (P = .005 and P = .004, respectively), flexibility (P = .01 and P = .004, respectively), and lower limb muscle strength (P = .01 and P = .02, respectively) was increased significantly compared with the CTR group. The body weight (P = .02), body mass index (P = .008), hip circumference (P = .02), and nitric oxide level in GBCTr and HBCTr group (P = .002 and P = .02, respectively) was decreased significantly compared with the CTR group. No significant changes found in the plasma levels of NADPH oxidase 5, thioredoxin-2, thioredoxin reductase-2, and resting blood pressure after GBCTr and HBCTr compared with the CTR group.

CONCLUSION

These results suggest that in hypertensive men, HBCTr equally to GBCTr improved functional fitness and body composition remarkably without necessarily reducing resting blood pressure. Therefore, they can be advisable substitutes for gaining health benefits.

Long-term exercise effects after cardiac telerehabilitation in patients with coronary artery disease: 1-year follow-up results of the randomized study

BACKGROUND

Home-based cardiac telerehabilitation (HBCT) is a feasible and effective alternative to traditional center-based cardiac rehabilitation (CBCR). Currently, there are only limited studies focusing on a long-term effect of HBCT, which means it is essential to do more research in this study field.

AIM

This study aimed at investigating a 1-year effect of a randomized controlled study using Cardiac Rehabilitation through the Global Position System (CR-GPS) compared to outpatient cardiac rehabilitation. Study focused on cardiorespiratory fitness (CRF) and health-related quality of life (HRQL) in patients with coronary heart disease (CAD).

DESIGN

A long-term follow-up of a randomized study.

SETTING

Patients were enrolled, and the intervention was performed in an outpatient or home-based model. The results were obtained and evaluated in a hospital.

POPULATION

Patients who participated in the CR-GPS study were diagnosed with CAD with low to moderate cardiovascular risk.

METHODS

Patients enrolled in the study were eligible participants who had previously completed a 12-week HBCT program using a wrist heart rate (HR) monitor or attended a traditional CBCR. Primary outcome was the change in CRF expressed in peak oxygen uptake (pVO<inf>2</inf>), and the secondary outcomes were self-reported HRQL, objectively measured anthropometric characteristics, and mortality and hospitalization rates.

RESULTS

Forty-four patients (76%) completed the long-term follow-up. The average peak of pVO<inf>2</inf> was higher after 1-year follow-up in the telerehabilitation group (HBCT 25.5 mL/kg/min compared to the active control group CBCR 23.6 mL/kg/min P=0.047). No statistically significant difference between the two groups was found after long-term follow-up for the parameter HRQL. For both groups, there was a significant improvement in the range of perceptions of general health. There was no death case and no difference in hospitalization rate between the groups.

CONCLUSIONS

This study supports the HBCT model. It has been demonstrated that it induces satisfactory long-term effects in pVO<inf>2</inf>, exercise performance, and perceived general health in CAD patients with low to moderate cardiovascular risk.

CLINICAL REHABILITATION IMPACT

Cardiovascular telerehabilitation using wrist HR monitors is a feasible and effective rehabilitation method that can help patients eliminate barriers that prevent them from using CBCR programs. Especially in the current global situation with the COVID-19 pandemic, this topic is becoming increasingly important.

The Effects Of Exercise Training On Physical, Physiological And Psychological Risk Factors Of Patients With Cardiovascular Disease

Background — Exercise training is an important component of wellness for individuals diagnosed with cardiovascular disease (CVD). Exercise may have an effect on cardiovascular risk factors such as hypertension, lipid levels, and other associated physical, psychological, and physiological risk factors. Exercise intensity may further impact those risk factors. Aim — This narrative review of the literature aims to identify the effect of regular physical exercise on modifying risk factors for CVD and increased morbidity and mortality related to CVD. Methods — Published English-language papers from 2011 to 2020, available in Scopus, PubMed, Cochrane, Google Scholar, and Thompson were included in this review. Keywords for this search were exercise training, cardiovascular disease, hypertension, physical function, physiological, and psychological risk factors. Conclusions — Exercise training may be a cost-effective intervention that improves the physical, physiological, and psychological risk factors and the motor function of patients with cardiovascular disease.

Is It Really Home-Based? A Commentary on the Necessity for Accurate Definitions across Exercise and Physical Activity Programmes

Background: There is wide discrepancy in how published research defines and reports home-based exercise programmes. Studies consisting of fundamentally different designs have been labelled as home-based, making searching for relevant literature challenging and time consuming. This issue has been further highlighted by an increased demand for these programmes following the COVID-19 pandemic and associated government-imposed lockdowns. Purpose: To examine what specifically constitutes home-based exercise by: (1) developing definitions for a range of terms used when reporting exercise and physical activity programmes and (2) providing examples to contextualise these definitions for use when reporting exercise and physical activity programmes. Methods: A literature search was undertaken to identify previous attempts to define home-based exercise programmes. A working document, including initial definitions and examples were developed, which were then discussed between six experts for further refinement. Results: We generated definitions for universal key terms within three domains (and subdomains) of programme design: location (home-based, community/centre-based, or clinical setting), prescription (structured or unstructured) and delivery (supervised, facilitated, or unsupervised). Examples for possible combinations of design terms were produced. Conclusions: Definitions will provide consistency when using reporting tools and the intention is to discuss the issues presented as part of a Delphi study. This is of paramount importance due to the predicted increase in emerging research regarding home-based exercise.

Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review

The availability of wearable devices (WDs) to collect biometric information and their use during activities of daily living is significantly increasing in the general population. These small electronic devices, which record fitness and health-related outcomes, have been broadly utilized in industries such as medicine, healthcare, and fitness. Since they are simple to use and progressively cheaper, they have also been used for numerous research purposes. However, despite their increasing popularity, most of these WDs do not accurately measure the proclaimed outcomes. In fact, research is equivocal about whether they are valid and reliable methods to specifically evaluate physical activity and health-related outcomes in older adults, since they are mostly designed and produced considering younger subjects' physical and mental characteristics. Additionally, their constant evolution through continuous upgrades and redesigned versions, suggests the need for constant up-to-date reviews and research. Accordingly, this article aims to scrutinize the state-of-the-art scientific evidence about the usefulness of WDs, specifically on older adults, to monitor physical activity and health-related outcomes. This critical review not only aims to inform older consumers but also aid researchers in study design when selecting physical activity and healthcare monitoring devices for elderly people.

Social Cognition and Socioecological Predictors of Home-Based Physical Activity Intentions, Planning, and Habits during the COVID-19 Pandemic

'Shelter in place' and 'lockdown' orders implemented to minimize the spread of COVID-19 have reduced opportunities to be physically active. For many, the home environment emerged as the only viable option to participate in physical activity. Previous research suggests that availability of exercise equipment functions as a determinant of home-based physical activity participation among the general adult population. The purpose of this study was to use a socioecological framework to investigate how the availability of exercise equipment at home predicts behavioral decisions, namely, intention, planning, and habits with respect to participation in physical activity. Participants (n = 429) were adults recruited in U.S. states subject to lockdown orders during the pandemic who completed measures online. A structural equation model indicated that availability of cardiovascular and strength training equipment predicted physical activity planning. Social cognition constructs mediated the relationship between each type of exercise equipment and intentions. Autonomous motivation and perceived behavioral control were found to mediate the relationship between each type of exercise equipment and habit. The availability of large cardiovascular and strength training equipment demonstrated significant predictive effects with intention, planning, habit, and autonomous motivation. Facilitating these constructs for home-based physical activity interventions could be efficacious for promoting physical activity.

Mobile health and cardiac rehabilitation in older adults

With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility-based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth-CR) and evidence being generated in this field.

Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness?

BACKGROUND

Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce.

OBJECTIVE

The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life.

METHODS

Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year.

RESULTS

Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups (P_time > 0.05 for all), irrespective of the intervention (P_interaction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity (P_time < 0.05). No interaction effect was found for physical activity.

CONCLUSION

Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942.

Physical Exercise and Selective Autophagy: Benefit and Risk on Cardiovascular Health

Physical exercise promotes cardiorespiratory fitness, and is considered the mainstream of non-pharmacological therapies along with lifestyle modification for various chronic diseases, in particular cardiovascular diseases. Physical exercise may positively affect various cardiovascular risk factors including body weight, blood pressure, insulin sensitivity, lipid and glucose metabolism, heart function, endothelial function, and body fat composition. With the ever-rising prevalence of obesity and other types of metabolic diseases, as well as sedentary lifestyle, regular exercise of moderate intensity has been indicated to benefit cardiovascular health and reduce overall disease mortality. Exercise offers a wide cadre of favorable responses in the cardiovascular system such as improved dynamics of the cardiovascular system, reduced prevalence of coronary heart diseases and cardiomyopathies, enhanced cardiac reserve capacity, and autonomic regulation. Ample clinical and experimental evidence has indicated an emerging role for autophagy, a conservative catabolism process to degrade and recycle cellular organelles and nutrients, in exercise training-offered cardiovascular benefits. Regular physical exercise as a unique form of physiological stress is capable of triggering adaptation while autophagy in particular selective autophagy seems to be permissive to such cardiovascular adaptation. Here in this mini-review, we will summarize the role for autophagy in particular mitochondrial selective autophagy namely mitophagy in the benefit versus risk of physical exercise on cardiovascular function.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

BACKGROUND

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.

METHODS

This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.

RESULTS

CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR.

CONCLUSION

Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis

BACKGROUND

Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM.

METHODS

A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis.

RESULTS

Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64-2.66]; p = 0.001; I2 = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; - 0.17-1.07] p = 0.15; I2 = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54-1.02]; p < 0.001; I2 = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits.No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties.

CONCLUSIONS

Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however further research would strengthen this conclusion.

TRIAL REGISTRATION

PROSPERO Registration Number: CRD42019106591.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

OBJECTIVE

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.

METHODS

This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.

PRINCIPAL CONCLUSIONS

CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

High-intensity interval training increase GATA4, CITED4 and c-Kit and decreases C/EBPβ in rats after myocardial infarction

AIM

Myocardial infarction (MI), an important cause of morbidity and mortality, can be followed by left ventricular dysfunction and cardiomyocyte loss. Cardiac repair mechanisms may subsequently improve left ventricular function. Exercise training has been suggested to have cardioprotective effects against MI damage, but detailed knowledge is lacking on the effects of different types and intensities of exercise training on molecular targets of cardiomyocyte regeneration.

MAIN METHODS

MI was induced in male Wistar rats by ligating the left anterior descending coronary artery. After MI induction, the rats were randomly assigned to one of five groups: sham operated, and experimental MI followed by no exercise, or low, moderate or high intensity exercise Cardiac function and infarct size were assessed by echocardiography and Evans blue/TTC staining, respectively. The expression of mRNA markers and proteins associated with myocardial regeneration was measured with RT-PCR and western blotting.

KEY FINDINGS

Exercise training at different intensities improved cardiac function and levels of stem cell and cardiomyocyte markers, and reduced infarct size. mRNA levels of GATA4, Nkx2.5 and c-Kit and protein expression of Nkx2.5 and c-Kit were significantly increased in all MI-exercise groups. The high-intensity exercise group had greater increases than the low and moderate intensity exercise groups. In the high-intensity exercise group, Sca-1 and CITED4 increased more than in the low-intensity exercise group. C/EBPβ mRNA and protein levels decreased after exercise training, with greater reductions in the high-intensity exercise group than the low- or moderate-intensity groups.

SIGNIFICANCE

The findings suggest that by targeting cardiogenesis, high-intensity training can exert cardioprotective effects against cardiac dysfunction in an experimental model of MI.

The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial

Background

Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low.

Design and methods

The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone.

Results

The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of –5.7 points (95% confidence interval –10.6 to –0.7) in favour of the REACH-HF intervention group (p = 0.025). With the exception of patient self-care (p < 0.001) there was no significant difference in other secondary outcomes, including clinical events (p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant.

Conclusions

The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.

Rationale and design of randomized controlled trial protocol of cardiovascular rehabilitation based on the use of telemedicine technology in the Czech Republic (CR-GPS)

BACKGROUND

Cardiovascular diseases remain the most common causes of death in the world. Instructions for secondary prevention recommend multifaceted approach in cardiovascular diseases risk management. Center-based physical exercise training is considered as an important integral part of cardiac rehabilitation (CR). Despite all recognized benefits CR brings, active interest of patients remains low in many countries, including the Czech Republic. That is why there is a need to focus on more effective patients' participation in CR with respect to their preferences and needs. One of possible approaches is using telemonitoring guidance based on obtaining data via technological equipment during home exercise training. The aim of this study is to compare effectiveness of both center- and home-based exercise training with focus on participants' physical fitness and quality of life.

METHODS/DESIGN

This randomized control trial intends to monitor cardiorespiratory health indicators and quality of life of patients diagnosed with a coronary artery disease (CAD) at the University Hospital Brno, Czech Republic. These patients will be randomly separated into 2 groups-a regular outpatient group (ROT) and an intervention training group (ITG). Both groups undergo a 12-week rehabilitation training program. The ROT group will undergo center-based exercise trainings in the hospital and receive feedback and support directly by their coach. The ITG group will be telemonitored during exercise training in their home environment via a wrist sport tester and Internet application.All patients will be supposed to exercise at 70% to 80% of their heart rate reserve obtained from cardiopulmonary exercise test (CPX). The primary outcome is to measure and compare physical fitness values assessed at baseline and after 12 weeks of training. Physical fitness is expressed as peak oxygen uptake assessed by the CPX test. The secondary outcomes are patients, training adherence, and their quality of life.

DISCUSSION

This trial focuses on an up-to-date topic. As there have not been any similar trials in the Czech Republic yet, we expect it to bring great benefits not only for our hospital in Brno. In the long term, this method seems to be low-cost for all participants and brings a lot of benefits for those patients, who are for many reasons unable to participate in center-based CR provided by hospitals and other health care centers. Physical exercise therapy brings good results in reducing cardiovascular risk factors and improves its global impact. Thanks to its simplicity, it is expected to increase patients' training adherence as well.

Do Depressive Symptoms Moderate the Effects of Exercise Self-efficacy on Physical Activity Among Patients With Coronary Heart Disease?

BACKGROUND

Exercise self-efficacy is an important predictor of physical activity. Patients with coronary heart disease are at risk of developing depressive symptoms that could further weaken their self-efficacy and interfere with their ability to engage in physical activity.

OBJECTIVE

The aim of this study was to examine the relationship between depressive symptoms, exercise self-efficacy, and physical activity among patients with coronary heart disease and how the efficacy-activity relationship is affected by the patient's level of depression.

METHODS

A survey was conducted on 149 participants at the time of discharge from the emergency and in-patient medical wards at 2 regional hospitals.

RESULTS

The sample was mostly male, married, living with families, and of lower socioeconomic status. The mean exercise self-efficacy was 4.26 ± 2.73, and the median physical activity was 12 (interquartile range, 6-21). Approximately 26% of participants had high depressive symptoms. Those with more depressive symptoms reported lower self-efficacy scores and lower physical activity. In multivariate regressions, self-efficacy was an independent predictor of physical activity (b = 1.48, P < .001). After including depressive symptoms as the interaction term, exercise self-efficacy had a significantly stronger and positive relationship with physical activity (b = 0.14, P = .043).

CONCLUSION

Exercise self-efficacy had a positive association with physical activity, and this relationship was stronger among coronary heart disease patients with depressive symptoms. This finding suggests that self-efficacy might be important in encouraging individuals with depressive symptoms to participate in physical activity. More efforts should target the development of effective strategies to improve exercise self-efficacy as a way of promoting physical activity among depressed coronary heart disease patients.

Quality of life improvement with rehabilitation according to constitution of the World Health Organization for coronary artery bypass graft surgery patients: A descriptive review

This is a descriptive review focusing on trends of treatments required for postoperative coronary artery bypass graft surgery (CABG) patients to improve the quality of life (QOL).

METHODOLOGY

The sources of literary research to understand the concepts of coronary artery disease according to Indian scriptures are Ayurveda texts, Bhagavad Gita, Patanjali Yoga Sutra. The data was typed in Sanskrit using Devanagari script and explanation in English was given. As per new research techniques, surgery, physiotherapy rehabilitation and Yoga are serving CABG patient's medical and psychological health better. The World Health Organization (WHO) defines health as physical, mental and social well-being later redefined with additional terms like environmental and spiritual health. This definition is similar to the Panchakosha concept in Yoga and Pancha Mahabhutas in Ayurveda. In cases of emergency or passive treatment, medication serves as a better option for physical health. In circumstances where the person is able to move in daily activities (just after discharge), rehabilitation serves as a better option for physical, mental and social health. Travel and reactions to climatic change serve environmental health. Last strategy, belief, cultural and traditional methods with scientific background serves as the spiritual health. These step-wise treatments are required for CABG patients to get the overall health or QOL. However, surgery and physiotherapy rehabilitation are advanced as per modern era which serves physical, mental, and social health also, but environmental health and spiritual health have yet to be addressed. As an ancient system of medicine, Yoga combines physical, mental, social, environmental and spiritual practices and it should be added as treatment along with surgery and physiotherapy rehabilitation. If all of these therapies were in the treatment protocol for CABG surgery patients, we would observe the changes of QOL and fulfill the requirements of constitution of the WHO. Integrating concepts of Yoga, Ayurveda, modern rehabilitation, surgery and patient cooperation with lifestyle change are the key to QOL improvements after CABG.