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Marçal IR, Vidal-Almela S, Blanchard C, Prince SA, Way KL, Reed JL. Sex Differences in Physical Activity Levels and Sitting Time in Patients With Atrial Fibrillation. J Cardiopulm Rehabil Prev 2024; 44:280-288. [PMID: 38836648 DOI: 10.1097/hcr.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE While research demonstrates low levels of physical activity (PA) among adults living with atrial fibrillation (AF), there is limited evidence investigating sex differences in moderate to vigorous intensity physical activity (MVPA) and sedentary time in this population. The primary aim was to examine sex differences in MVPA levels and sitting time between women and men with AF. Secondary aims explored sex differences in sociodemographic factors, outcome expectations, and task self-efficacy toward PA levels. METHODS This was a subanalysis of the CHAMPLAIN-AF cohort study. Women and men with AF completed a survey, including the Short-Form International Physical Activity Questionnaire. RESULTS A total of 210 women (median = 66.0 yr: 95% CI, 63.5-68.0) and 409 men (median = 66.0 yr: 95% CI, 64.0-67.0) were included. No sex differences were observed in median weekly MVPA (60 min/wk: 95% CI, 0-120 in women vs 120 min/wk: 95% CI, 85-150 in men) and daily sitting time (5.5 hr/d: 95% CI, 5.0-6.0 in women vs 6.0 hr/d: 95% CI, 5.0-6.0 in men). Women engaged in significantly less vigorous-intensity PA than men ( P = .03) and demonstrated significantly lower task self-efficacy ( P < .01). Significant positive correlations in PA levels with outcome expectations (mostly weak) and task self-efficacy (mostly strong) were observed in both sexes. CONCLUSION Most women and men with AF did not meet the global MVPA guidelines but met the sitting time recommendation. Women presented with lower vigorous-intensity physical activity levels and confidence than men. Strategies to increase physical activity behavior, considering sociodemographic factors and task self-efficacy, are needed and may differ between sexes.
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Affiliation(s)
- Isabela R Marçal
- Author Affiliations: Exercise Physiology and Cardiovascular Health Laboratory, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, (Mss Marçal and Vidal-Almela, and Drs Way and Reed); Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, (Ms Marçal and Dr Reed); Faculty of Medicine, Dalhousie University, Halifax, Canada (Dr Blanchard); Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada (Dr Prince); Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia (Dr Way); and Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada (Dr Reed)
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Vonk T, Maessen MFH, Hopman MTE, Snoek JA, Aengevaeren VL, Franklin BA, Eijsvogels TMH, Bakker EA. Temporal Trends in Cardiac Rehabilitation Participation and Its Core Components: A Nationwide Cohort Study From the Netherlands. J Cardiopulm Rehabil Prev 2024; 44:180-186. [PMID: 38373064 DOI: 10.1097/hcr.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
PURPOSE Patient- and disease-specific data on cardiac rehabilitation (CR) participation and changes over time are limited. The objective of this study was to describe time trends in CR participation between 2013 and 2019 and provides insights into the utilization of CR components. METHODS Patients with cardiovascular disease (CVD) with an indication for CR were enrolled between 2013 and 2019. Dutch health insurance claims data were used to identify CR participation and its components. RESULTS In total, 106 212 patients with CVD were included of which 37% participated in CR. Participation significantly increased from 28% in 2013 to 41% in 2016 but remained unchanged thereafter. Participation was highest in the youngest age groups (<50 yrs 52%; 50-65 yrs 50%), men (48%), patients with ST-segment elevation myocardial infarction (73%), non-ST-segment elevation myocardial infarction (59%), and coronary artery bypass grafting (82%). In contrast, it was the lowest in the oldest age group (≥85 yrs 8%), women (30%), and in patients with heart failure (11%). Most participants in CR received referral plus an admission session (97%) and exercise training (82%), whereas complementary services related to dietary (14%) and mental health counseling (10%) had a low utilization. CONCLUSIONS CR participation rates increased to 41% in 2016 but remained unchanged thereafter. Participation modulators included age, sex, CVD diagnosis, and undergoing a cardiothoracic procedure. Education and exercise sessions were frequently adopted, but dietary and mental health counseling had a low utilization rate. These findings suggest the need for reinvigorated referral and novel enrollment strategies in specific CVD subgroups to further promote CR participation and its associated underutilized adjunctive services.
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Affiliation(s)
- Thijs Vonk
- Author Affiliations: Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands (Mr Vonk and Drs Hopman, Aengevaeren, Eijsvogels, and Bakker); Customer Intelligence, Coöperatie VGZ, Arnhem, The Netherlands (Dr Maessen); Isala Heart Center, Zwolle, The Netherlands (Dr Snoek); Department of Preventive Cardiology, Beaumont Health & Wellness Center, Royal Oak, Michigan, USA (Dr Franklin); and PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (Dr Bakker)
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Vanzella LM, Cotie LM, Flores-Hukom M, Marzolini S, Konidis R, Ghisi GLDM. Patients' Perceptions of Hybrid and Virtual-Only Care Models During the Cardiac Rehabilitation Patient Journey: A Qualitative Study. J Cardiovasc Nurs 2024:i. [PMID: 38206327 DOI: 10.1097/jcn.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic initially led to discontinuation of the "traditional" center-based cardiac rehabilitation (CR) model. Virtual models emerged as an opportunity to deliver care, with many programs continuing to offer these models. OBJECTIVE The aim of this study was to explore patients' perceptions of virtual models of either hybrid (combining center-based and virtual) or virtual-only CR since the pandemic. METHODS Men and women who chose to participate in hybrid or virtual CR models between January 2022 and January 2023 were invited to attend 1 of 8 focus group sessions. Focus groups were conducted online until thematic saturation was reached. Transcripts were analyzed using thematic analysis. RESULTS Twenty-three patients (48% female; 83% attending hybrid CR) participated in the study. Analysis revealed 12 overarching themes associated with the CR patient journey: pre-CR, namely, (1) importance of endorsement from healthcare providers and (2) need for education/communication while waiting for program initiation; during CR, namely, (3) preference for class composition/structure, (4) need to enhance peer support in the virtual environment, (5) convenience and concerns with virtual sessions, (6) necessity of on-site sessions, (7) safety of the exercise prescription, (8) requirement/obligation for allied health offerings, (9) satisfaction with virtual education, and (10) use of technology to facilitate CR participation; and post-CR, namely, (11) acknowledgment of program completion and (12) need for support/education after program graduation. CONCLUSIONS Patients require ongoing support from time of referral to beyond CR program completion. Physical, psychosocial, nutritional, and educational supports are needed. Perceptions expressed by patients related to the program model are modifiable, and strategies to address these perceptions should be explored.
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Albalak G, Stijntjes M, van Bodegom D, Jukema JW, Atsma DE, van Heemst D, Noordam R. Setting your clock: associations between timing of objective physical activity and cardiovascular disease risk in the general population. Eur J Prev Cardiol 2023; 30:232-240. [PMID: 36372091 DOI: 10.1093/eurjpc/zwac239] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
AIMS Little is known about the impact of daily physical activity timing (here referred to as 'chronoactivity') on cardiovascular disease (CVD) risk. We aimed to examined the associations between chronoactivity and multiple CVD outcomes in the UK Biobank. METHODS AND RESULTS physical activity data were collected in the UK-Biobank through triaxial accelerometer over a 7-day measurement period. We used K-means clustering to create clusters of participants with similar chronoactivity irrespective of the mean daily intensity of the physical activity. Multivariable-adjusted Cox-proportional hazard models were used to estimate hazard ratios (HRs) comparing the different clusters adjusted for age and sex (model 1), and baseline cardiovascular risk factors (model 2). Additional stratified analyses were done by sex, mean activity level, and self-reported sleep chronotype. We included 86 657 individuals (58% female, mean age: 61.6 [SD: 7.8] years, mean BMI: 26.6 [4.5] kg/m2). Over a follow-up period of 6 years, 3707 incident CVD events were reported. Overall, participants with a tendency of late morning physical activity had a lower risk of incident coronary artery disease (HR: 0.84, 95%CI: 0.77, 0.92) and stroke (HR: 0.83, 95%CI: 0.70, 0.98) compared to participants with a midday pattern of physical activity. These effects were more pronounced in women (P-value for interaction = 0.001). We did not find evidence favouring effect modification by total activity level and sleep chronotype. CONCLUSION Irrespective of total physical activity, morning physical activity was associated with lower risks of incident cardiovascular diseases, highlighting the potential importance of chronoactivity in CVD prevention.
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Affiliation(s)
- Gali Albalak
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Marjon Stijntjes
- Department of Rehabilitation Medicine, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (building 34), 2628 CD Delft, The Netherlands
| | - David van Bodegom
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
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Proença T, Pinto RA, Carvalho MM, Rocha A, Dias P, Macedo F. Sex disparities and dyslipidemic control in a coronary rehabilitation program. Int J Cardiol 2023; 370:72-74. [PMID: 36410542 DOI: 10.1016/j.ijcard.2022.11.025] [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: 08/04/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
Lipid control is one of the most important secondary cardiovascular prevention targets. Although cardiovascular disease is the most common cause of death in both sexes, women are less likely to receive guideline-recommended secondary prevention medications. To compare sex disparities in dyslipidemia control in a secondary prevention population, we retrospectively analysed all patients who participated in a Coronary Rehabilitation Program (CRP) after an acute coronary syndrome (ACS) from January 2011 to October 2019. Of a total of 881 patients enrolled, mean age 55.0-year-old, 16.1% were female. At hospital admission, females and males had similar mean LDL-levels. Female patients received more high intensity therapy during follow-up (67.8% vs 53.9% at baseline, p = 0.015; 75.6% vs 59.0% after CRP, p = 0.003; and 79.8% vs 65.1% at 1-year-follow-up, p = 0.007). At the end of the CRP, male patients exhibit a better control of LDL [82.0 vs 75.6 mg/dL, t(597) = 2.4, p = 0.016)] with 12.8% vs 16.4% below 55 mg/dL and 29.8% vs 44.5% below 70 mg/dL (p = 0.008). At 1-year follow-up, both sexes exhibited similar LDL-control thanks to a worsening control of the male population (81.9 vs 80.6 mg/dL, t(540) = 0.52, p = 0.605). Only 13.3% of females had LDL below 55 mg/dL (vs 12.9%, p = 0.921) and 32.5% below 70 mg/dL (vs 37.0%, p = 0.432). This real-life study showed that guideline recommended LDL target is not achieved in the majority of patients. Unlike other reports, there were more women receiving more potent anti-dyslipidemic therapy. Nevertheless, women showed a poor control of LDL-concentration after three months of ACS and a similar control after 1-year.
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Affiliation(s)
- Tânia Proença
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Ricardo Alves Pinto
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Miguel Martins Carvalho
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Afonso Rocha
- Serviço de Medicina Física e da Reabilitação, Centro Hospitalar Universitário de São João, Portugal
| | - Paula Dias
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipe Macedo
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Liu J, Wang L, Fang H, Wang X, Wu L, Zhang J. Home-based cardiac rehabilitation: A review of bibliometric studies and visual analysis of CiteSpace (2012-2021). Medicine (Baltimore) 2022; 101:e31788. [PMID: 36626492 PMCID: PMC9750688 DOI: 10.1097/md.0000000000031788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Home-based cardiac rehabilitation has been a major area in cardiac rehabilitation research for a long time. However, there are few systematic studies in this field using bibliometric analysis. We collected articles and reviews for home-based cardiac rehabilitation from the Web of Science Core Collection. Our objectives were to perform a bibliometric analysis and visualization study to determine hotspots and trends of home-based cardiac rehabilitation, identify collaboration and influence among authors, countries, institutions, and journals, and assess the knowledge base to develop clinical research in the future. This study will provide a valuable reference for researchers concerned with HBCR.
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Affiliation(s)
- Jingyu Liu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Lingyu Wang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Haiyan Fang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
- * Correspondence: Haiyan Fang, College of Nursing, Anhui University of Chinese Medicine, Hefei 230012, China (e-mail: )
| | - Xiang Wang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Lingsha Wu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Jing Zhang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
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Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Digitally enabled cardiac rehabilitation following coronary revascularization: results from a single centre feasibility study. Eur Heart J Suppl 2022; 24:H25-H31. [DOI: 10.1093/eurheartjsupp/suac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Wearable activity monitors, together with smartphone-based health and fitness applications (apps), are becoming more accessible and their widespread use provides an additional opportunity for the recording of cardiovascular metrics in patients with cardiovascular disease. The use of selected metrics by cardiac rehabilitation (CR) programmes allows the facilitation of individualized and tailored positive lifestyle changes to patients and places the patient at the centre of their recovery programme. To investigate the role of such devices on outcomes with patients on a CR programme, a cohort/case–control study was conducted. Patients post-myocardial infarction who were treated with either percutaneous coronary intervention or surgical coronary revascularisation at a single centre were invited to use a physical activity monitor linked to a customized app at their initial assessment for the rehabilitation programme. Those who accepted were allocated to the treatment group. The control group was selected from a larger pool of 400 historical and concurrent patients. Propensity matching was used to associate each case with their closest control. The changes in self-reported physical activity were similar for both groups at the end of the CR programme (EOP). The digitally monitored group tended to achieve greater METS (metabolic equivalent of task - a measure of exercise intensity) at 12 weeks (P < 0.059); however, no difference was observed in the overall change in METS at EOP (P < 0.333). Although no difference was noted in diastolic blood pressure, a statistically significant drop in the systolic blood pressure in the digitally monitored group (P < 0.004) was detected. In this study, the innovative combination of technology and face-to-face CR showed promising results and assisted the individualization of delivered content. This intervention could easily be replicated and expanded. Challenges are the recruitment of the elderly population, those who may be less engaged with or have less access to technology, and the underrepresentation of women in the study sample.
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Reed JL, Terada T, Vidal-Almela S, Tulloch HE, Mistura M, Birnie DH, Wells GA, Nair GM, Hans H, Way KL, Chirico D, O’Neill CD, Pipe AL. Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2239380. [PMID: 36315143 PMCID: PMC9623436 DOI: 10.1001/jamanetworkopen.2022.39380] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE Patients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF. OBJECTIVE To compare the effects of 12 weeks of HIIT and MICT-based cardiovascular rehabilitation (CR) on functional capacity and general QOL in patients with persistent and permanent AF. Disease-specific QOL, resting heart rate (HR), time in AF, and physical activity (PA) levels were also assessed. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial, conducted between November 17, 2015, and February 4, 2020, at a tertiary-care cardiovascular health center in Ottawa, Canada, recruited 94 patients with persistent and permanent AF. INTERVENTIONS High-intensity interval training (23 minutes: two 8-minute interval training blocks of 30-second work periods at 80%-100% of peak power output interspersed with 30-second recovery) or CR (60 minutes: continuous aerobic conditioning within 67%-95% of peak HR and 12-16 of 20 ratings of perceived exertion) twice weekly for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcomes were changes in functional capacity (6-minute walk test [6MWT] distance) and general QOL (Short Form 36) from baseline to 12 weeks' follow-up. Secondary outcomes included changes in disease-specific QOL (Atrial Fibrillation Severity Scale), resting HR, time in AF, and PA levels. An intention-to-treat analysis was used to compare changes between groups. RESULTS Of the 94 patients who consented, 86 participated (mean [SD] age, 69 [7] years; 57 [66.3%] men). No significant differences in improvements in 6MWT distance (mean [SD], 21.3 [34.1] vs 13.2 [55.2] m; P = .42) and general QOL (Physical Component Summary, 0.5 [6.1] vs 1.1 [4.9] points; P = .87) between HIIT and CR were observed. No significant differences in improvements in disease-specific QOL (AF symptoms: -1.7 [4.3] vs -1.5 [4] points, P = .59), resting HR (-3.6 [10.6] vs -2.9 [12.4] beats per minute, P = .63), and moderate to vigorous PA levels (37.3 [93.4] vs 14.4 [125.7] min/wk; P = .35) between HIIT and CR were detected. Participants attended a mean (SD) of 18.3 (6.1) (75.1%) HIIT sessions and 20.0 (4.5) (83.4%) CR sessions (P = .36). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, twice-weekly 23-minute HIIT was as efficacious as twice-weekly 60-minute CR in improving functional capacity, general and disease-specific QOL, resting HR, and PA levels in patients with persistent and permanent AF. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02602457.
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Affiliation(s)
- Jennifer L. Reed
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Tasuku Terada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sol Vidal-Almela
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
- Research Unit on Nutrition and Metabolism, Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Heather E. Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Matheus Mistura
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David H. Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - George A. Wells
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Girish M. Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Harleen Hans
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kimberley L. Way
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deakin University, School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Daniele Chirico
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrew L. Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Deprtment of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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Singh U, Ramachandran AK, Ramirez-Campillo R, Perez-Castilla A, Afonso J, Manuel Clemente F, Oliver J. Jump rope training effects on health- and sport-related physical fitness in young participants: A systematic review with meta-analysis. J Sports Sci 2022; 40:1801-1814. [PMID: 36121177 DOI: 10.1080/02640414.2022.2099161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of this systematic review with meta-analysis was to assess the available body of published peer-reviewed articles related on the effects of jump rope training (JRT) compared with active/passive controls on health- and sport-related physical fitness outcomes. Searches were conducted in three databases, including studies that satisfied the following criteria: i) healthy participants; ii) a JRT programprogramme; iii) active or traditional control group; iv) at least one measure related to health- and sport-related physical fitness; v) multi-arm trials. The random-effects model was used for the meta-analyses. Twenty-one moderate-high quality (i.e., PEDro scale) studies were meta-analysed, involving 1,021 participants (male, 50.4%). Eighteen studies included participants with a mean age <18 years old. The duration of the JRT interventions ranged from 6 to 40 weeks. Meta-analyses revealed improvements (i.e., p = 0.048 to <0.001; ES = 0.23-1.19; I2 = 0.0-76.9%) in resting heart rate, body mass index, fat mass, cardiorespiratory endurance, lower- and upper-body maximal strength, jumping, range of motion, and sprinting. No significant JRT effects were noted for systolic-diastolic blood pressure, waist-hip circumference, bone or lean mass, or muscle endurance. In conclusion, JRT, when compared to active and passive controls, provides a range of small-moderate benefits that span health- and sport-related physical fitness outcomes.
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Affiliation(s)
- Utkarsh Singh
- Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Akhilesh Kumar Ramachandran
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory. School of Physical Therapy. Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | | | - José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal
| | - Filipe Manuel Clemente
- Escola Superior Desporto E Lazer, Instituto Politécnico de Viana Do Castelo, Rua Escola Industrial E Comercial de Nun'álvares, Viana do Castelo, Portugal.,Instituto de Telecomunicações, Delegação da Covilhã, Lisboa, Portugal
| | - Jon Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
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11
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Pitchalard K, Wimolphan P, Singkhorn O, Purkey E, Moonpanane K. Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study. Health Equity 2022; 6:629-637. [PMID: 36081879 PMCID: PMC9448522 DOI: 10.1089/heq.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand. Methods: In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model. Results: Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model. Conclusion: The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.
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Affiliation(s)
| | | | | | - Eva Purkey
- School of Medicine, Queen's University, Kingston, Ontario, Canada
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12
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Adedinsewo DA, Pollak AW, Phillips SD, Smith TL, Svatikova A, Hayes SN, Mulvagh SL, Norris C, Roger VL, Noseworthy PA, Yao X, Carter RE. Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools. Circ Res 2022; 130:673-690. [PMID: 35175849 PMCID: PMC8889564 DOI: 10.1161/circresaha.121.319876] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Affiliation(s)
- Demilade A. Adedinsewo
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Amy W. Pollak
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Sabrina D. Phillips
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Taryn L. Smith
- Division of General Internal Medicine (T.L.S.), Mayo Clinic, Jacksonville, FL
| | - Anna Svatikova
- Department of Cardiovascular Diseases (A.S.), Mayo Clinic, Phoenix, AZ
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada (S.L.M.)
| | - Colleen Norris
- Cardiovascular Health and Stroke Strategic Clinical Network, Edmonton, Canada (C.N.)
| | - Veronique L. Roger
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences (V.L.R.), Mayo Clinic, Rochester, MN
- Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences (R.E.C.), Mayo Clinic, Jacksonville, FL
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13
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Alexander S, Li S, Tracy M. Cardiac rehabilitation - The answer for the second chance. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100108. [PMID: 38560078 PMCID: PMC10978207 DOI: 10.1016/j.ahjo.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 04/04/2024]
Abstract
In the United States and worldwide, the leading cause of death in females is cardiovascular disease (CVD). However, compared to males, females have overall higher mortality rates, especially within the first few years of having an acute myocardial infarction (AMI). Despite the increased awareness of CVD in females and established benefits of cardiac rehabilitation (CR) programs, there is still delayed initiation of care, under-recognition of atypical presentations of angina in females, under referral of females to CR, and under-representation of females in CVD trials. In this paper, we will investigate the barriers to female participation in CR, explore the fundamental differences in physiology between males and females, and current limitations in CVD trials where females are under-represented. Finally, we aim to provide potential methods to increase enrollment of females in CR and CR related trials.
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Affiliation(s)
- Sarah Alexander
- Community Care Network, Inc., Munster, IN, United States of America
| | - Shannon Li
- RUSH University Medical Center, Chicago, IL, United States of America
| | - Melissa Tracy
- RUSH University Medical Center, Chicago, IL, United States of America
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14
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Cabrera-Aguilera I, Ivern C, Badosa N, Marco E, Salas-Medina L, Mojón D, Vicente M, Llagostera M, Farré N, Ruiz-Bustillo S. Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry. Front Physiol 2021; 12:768199. [PMID: 34899392 PMCID: PMC8654103 DOI: 10.3389/fphys.2021.768199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background and Aims: Exercise training (ET) is a critical component of cardiac rehabilitation (CR), but it remains underused. The aim of this study was to compare clinical outcomes between patients who completed ET (A-T), those who accepted ET but did not complete it (A-NT), and those who did not accept to undergo it (R-NT), and to analyze reasons for rejecting or not completing ET. Methods and Results: A unicenter ambispective observational registry study of 497 patients with acute coronary syndrome (ACS) was carried out in Barcelona, Spain, from 2016 to 2019. The primary endpoint was a composite of all-cause mortality, hospitalization for ACS, or need for revascularization during follow-up. Multivariable analysis was carried out to identify variables independently associated with the primary outcome. Initially, 70% of patients accepted participating in the ET, but only 50.5% completed it. The A-T group were younger and had fewer comorbidities. Baseline characteristics in A-NT and R-NT groups were very similar. The main reason for not undergoing or completing ET was rejection (reason unknown) or work/schedule incompatibility. The median follow-up period was 31 months. Both the composite primary endpoint and mortality were significantly lower in the A-T group compared to the A-NT and R-NT (primary endpoint: 3.6% vs. 23.2% vs. 20.4%, p < 0.001, respectively; mortality: 0.8% vs. 9.1% vs. 8.2%, p < 0.001; respectively). During multivariable analysis, the only variables that remained statistically significant with the composite endpoint were ET completion, previous ACS, and anemia. Conclusion: Completion of ET after ACS was associated with improved prognosis. Only half of the patients completed the ET program, with the leading reasons for not completing it being refusal (reason unknown) and work/schedule incompatibility. These results highlight the need to focus on the needs of patients in order to guarantee that structural barriers to ET no longer exist.
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Affiliation(s)
- Ignacio Cabrera-Aguilera
- Facultat de Medicina i Ciències de la Salut, Unitat de Biofísica i Bioenginyeria, Universitat de Barcelona, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Human Movement Sciences, Faculty of Health Sciences, School of Kinesiology, Universidad de Talca, Talca, Chile
| | - Consolació Ivern
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Neus Badosa
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Ester Marco
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luís Salas-Medina
- Cardiac Rehabilitation Unit, Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain
| | - Diana Mojón
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Miren Vicente
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Marc Llagostera
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Nuria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Ruiz-Bustillo
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
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15
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Effects of Supervised Cardiac Rehabilitation Programmes on Quality of Life among Myocardial Infarction Patients: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8120166. [PMID: 34940521 PMCID: PMC8703932 DOI: 10.3390/jcdd8120166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.
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16
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review. BMC Cardiovasc Disord 2021; 21:459. [PMID: 34556036 PMCID: PMC8458788 DOI: 10.1186/s12872-021-02267-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception to May 2020. Primary studies of any design were included. Adult females with any cardiac diseases, participating in women-focused CR (i.e., program or sessions included ≥ 50% females, or was 1-1 and tailored to women’s needs) were considered. Two authors rated citations for inclusion. One extracted data, including study quality rated as per the Mixed-Methods Assessment Tool (MMAT), which was checked independently by a second author. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results 3498 unique citations were identified, with 28 studies (53 papers) included (3697 women; ≥ 10 countries). Globally, women-focused CR is offered by 40.9% of countries that have CR, with 32.1% of programs in those countries offering it. Thirteen (46.4%) studies offered women-focused sessions (vs. full program), 17 (60.7%) were women-only, and 11 (39.3%) had gender-tailoring. Five (17.9%) programs offered alternate forms of exercise, and 17 (60.7%) focused on psychosocial aspects. With regard to utilization, women-focused CR cannot be offered as frequently, so could be less accessible. Adherence may be greater with gender-tailored CR, and completion effects are not known. Satisfaction was assessed in 1 trial, and results were equivocal. Conclusions Women-focused CR involves tailoring of content, mode and/or sex composition. Availability is limited. Effects on utilization require further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02267-0.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gabriela L M Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,Peter Munk Cardiac Centre, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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17
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Vidal-Almela S, Way KL, Terada T, Tulloch HE, Keast ML, Pipe AL, Chirico D, Reed JL. Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation. Appl Physiol Nutr Metab 2021; 47:1-9. [PMID: 34375540 DOI: 10.1139/apnm-2021-0265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).
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Affiliation(s)
- Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Institut du savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kimberley L Way
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Heather E Tulloch
- School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marja-Leena Keast
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Andrew L Pipe
- School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- TotalCardiologyTM Rehabilitation and Risk Reduction, Calgary, AB, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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18
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Abstract
PURPOSE OF REVIEW Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Canada. .,KITE-Toronto Rehabilitation Institute, Toronto, ON, Canada. .,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Mary A Whooley
- US Department of Veterans Affairs Quality Enhancement Research Initiative, San Francisco, USA.,University of California, San Francisco, USA
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19
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Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS. J Cardiopulm Rehabil Prev 2021; 41:207-213. [PMID: 34158454 PMCID: PMC8243714 DOI: 10.1097/hcr.0000000000000629] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite the known benefits of cardiac rehabilitation (CR), it remains underutilized particularly among women. The aim of this review was to provide an overview regarding women in CR, addressing barriers that may affect enrollment and attendance as well as to discuss the training response and methods to optimize exercise-related benefits of CR. REVIEW METHODS The review examines original studies and meta-analyses regarding women in CR. SUMMARY Women are less likely to engage in CR compared with men, and this may be attributed to lack of referral or psychosocial barriers on the part of the patient. Furthermore, despite having lower levels of fitness, women do not improve their fitness as much as men in CR. This review summarizes the current literature and provides recommendations for providers regarding participation and adherence as well as optimal methods for exercise training for women in CR.
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Affiliation(s)
- Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
| | - Diann E. Gaalema
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Patrick Savage
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
| | - Philip A. Ades
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
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20
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Halasz G, Piepoli MF. Editor comments: Focus on Cardiac rehabilitation and exercise training. Eur J Prev Cardiol 2021; 28:687-689. [PMID: 34089585 DOI: 10.1093/eurjpc/zwab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo F Piepoli
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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21
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Way KL, Vidal-Almela S, Keast ML, Hans H, Pipe AL, Reed JL. The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis. BMC Sports Sci Med Rehabil 2020; 12:38. [PMID: 32612840 PMCID: PMC7325048 DOI: 10.1186/s13102-020-00186-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022]
Abstract
Background Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interval training (HIIT) has received specific attention as an emerging exercise-training paradigm that addresses frequently cited barriers to CR (i.e. lack of motivation/enjoyment and time, perceiving exercise regime as tiring/boring) and improves cardiovascular risk factors. Previous studies have examined the safety of HIIT in CR; there is little evidence on the feasibility of HIIT in CR. The aims of this study were to evaluate the feasibility of HIIT within a CR setting and examine the sex differences regarding the feasibility of such programming. Methods Patients attended an on-site HIIT CR program (10-min warm-up, 25 min of interspersed high-intensity [HI - 4 min at 85–95% HRpeak] and lower intensity [LO - 3 min at 60–70% HRpeak] intervals, 10-min cool-down) twice weekly for 10 weeks. Heart rate (HR) and the Borg rating of perceived exertion (RPE) scale (6–20 points) were recorded at each session. Feasibility was assessed by: [1] attendance and compliance: the number of sessions attended and the compliance to the prescribed HI and LO HR ranges; [2] the patient experience: patients’ perceived effort, program difficulty, if the program was challenging and satisfying; and, [3] safety. Descriptive statistics were used to report the means and their variations. Mann-Whitney U tests and Chi-square analyses were performed to examine sex-differences. Results A total of 151 patients (33% women, 57.5 ± 9.1 years) attended the HIIT program and completed 16 ± 5 classes with a low attrition rate (11.3%). Most patients met or exceeded the prescribed target HR for the HI (80%) and LO (84%) intervals, respectively. Patients reported a “somewhat hard” RPE for HI (14 ± 2 points) and “very light” for LO (10 ± 2 points) intervals. All patients were satisfied with the program and found it challenging. Most patients found HIIT to be difficult (7 ± 2 points, scale range 0–10 points), yet safe (97%). Three vasovagal episodes occurred and more women dropped-out of the program than men (p < 0.01). Conclusions HIIT is a feasible, safe and well-received exercise paradigm in a CR setting.
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Affiliation(s)
- Kimberley L Way
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Marja-Leena Keast
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Harleen Hans
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Forsyth F, Deaton C. Women and cardiac rehabilitation: Moving beyond barriers to solutions? Eur J Prev Cardiol 2020; 28:758-760. [PMID: 33611477 DOI: 10.1177/2047487320911843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Faye Forsyth
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK
| | - Christi Deaton
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK.,Cambridge University Hospitals NHS Foundation Trust, UK
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