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Bostrom J, Searcy R, Walia A, Rzucidlo J, Banco D, Quien M, Sweeney G, Pierre A, Tang Y, Mola A, Xia Y, Whiteson J, Dodson JA. Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease. J Cardiopulm Rehabil Prev 2020; 40:E26-E30. [PMID: 32084031 DOI: 10.1097/hcr.0000000000000495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF). METHODS We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression). RESULTS Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31). CONCLUSIONS Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
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Affiliation(s)
- John Bostrom
- Departments of Medicine (Drs Bostrom, Rzucidlo, Banco, and Quien) and Rehabilitation Medicine (Drs Sweeney, Pierre, Mola, and Whiteson and Ms Tang), New York University School of Medicine, New York; University of North Carolina School of Medicine, Chapel Hill (Mr Searcy); Northeast Ohio Medical University, Rootstown (Ms Walia); Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York (Ms Xia and Dr Dodson); and Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York (Dr Dodson)
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Taylor C, Tsakirides C, Moxon J, Moxon JW, Dudfield M, Witte K, Ingle L, Carroll S. Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study. Open Heart 2017; 4:e000623. [PMID: 28878950 PMCID: PMC5574458 DOI: 10.1136/openhrt-2017-000623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/28/2017] [Accepted: 06/20/2017] [Indexed: 01/10/2023] Open
Abstract
Aims To investigate the relationship between exercise participation, exercise ‘dose’ expressed as metabolic equivalent (MET) hours (h) per week, and prognosis in individuals attending an extended, community-based exercise rehabilitation programme. Methods Cohort study of 435 participants undertaking exercise-based cardiac rehabilitation (CR) in Leeds, West Yorkshire, UK between 1994 and 2006, followed up to 1 November 2013. MET intensity of supervised exercise was estimated utilising serial submaximal exercise test results and corresponding exercise prescriptions. Programme participation was routinely monitored. Cox regression analysis including time-varying and propensity score adjustment was applied to identify predictors of long-term, all-cause mortality across exercise dose and programme duration groups. Results There were 133 events (31%) during a median follow-up of 14 years (range, 1.2 to 18.9 years). The significant univariate association between exercise dose and all-cause mortality was attenuated following multivariable adjustment for other predictors, including duration in the programme. Longer-term adherence to supervised exercise training (>36 months) was associated with a 33% lower mortality risk (multivariate-adjusted HR: 0.67; 95% CI: 0.47 to 0.97; p=0.033) compared with all lesser durations of CR (3, 12, 36 months), even after adjustment for baseline fitness, comorbidities and survivor bias. Conclusion Exercise dose (MET-h per week) appears less important than long-term adherence to supervised exercise for the reduction of long-term mortality risk. Extended, supervised CR programmes within the community may play a key role in promoting long-term exercise maintenance and other secondary prevention therapies for survival benefit.
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Affiliation(s)
- Claire Taylor
- Carnegie School of Sport,Leeds Beckett University, Leeds, UK
| | | | | | | | | | - Klaus Witte
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Sean Carroll
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
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Gill L, Sullivan KA. Boosting Exercise Beliefs and Motivation Through a Psychological Intervention Designed for Poststroke Populations. Top Stroke Rehabil 2015; 18:470-80. [DOI: 10.1310/tsr1805-470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bentley D, Khan S, Oh P, Grace S, Thomas S. Physical activity behavior two to six years following cardiac rehabilitation: a socioecological analysis. Clin Cardiol 2012; 36:96-102. [PMID: 23280429 DOI: 10.1002/clc.22084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) promotes long-term positive health behaviours, such as physical activity (PA), in patients following a cardiovascular event. We have limited knowledge of long-term PA and its correlates. Therefore, this research examined both PA behaviour and socioecological correlates among elderly graduates 2-6 years following CR. HYPOTHESIS CR graduates will have a moderate PA level in the long term. Greater PA will be associated with various multilevel correlates. METHODS This was a retrospective, cross-sectional study which quantified PA using the Physical Activity Scale for the Elderly (PASE) and collected information about socioecological correlates at the intrapersonal, interpersonal and health service levels. Both univariate and multivariate analyses assessed PA and PA correlates. RESULTS The majority of the 584 participants were older (69.8 ± 9.8), male (80.3%), and well educated (75.4% ≥ some post-secondary). Average time since CR graduation was 41.5 ± 11.5 months. Seventy five percent of CR graduates reported current weekly PA levels that met, or exceeded, Canadian PA guidelines (>150 minutes of moderate-vigorous PA). Univariate analyses identified 13 PASE score correlates. Multivariate analyses identified age, PA enjoyment, current work status, CR staff support, location of primary residence, and perceived health as significantly associated with higher PASE scores (p < 0.001). CONCLUSIONS Three and a half years post-CR graduates had high PA levels. Greater PA was associated with several modifiable multilevel correlates at all levels of influence. Understanding correlates of long-term PA behaviour among CR graduates will help identify groups at risk for nonadherence and assist with continued program development.
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Affiliation(s)
- Danielle Bentley
- Department of Exercise Science, University of Toronto, Toronto, Canada.
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Madsen W. 'This is a forever project': supporting lifestyle changes in a regional Queensland community-based cardiac rehabilitation program. Aust J Prim Health 2012; 19:178-83. [PMID: 22950845 DOI: 10.1071/py11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 05/22/2012] [Indexed: 11/23/2022]
Abstract
Cardiac rehabilitation programs throughout the world have struggled for several years to attract more participants and facilitate behaviour changes in these clients. Over the past few years, there has been an increased level of attention in the role that self-efficacy and social support may play in this respect. The main aim of this study was to explore self-efficacy and social support within a regional, community-based cardiac rehabilitation program that does not adhere to traditional cardiac rehabilitation structures. Twelve participants were interviewed and two major themes emerged from the thematic analysis of the interview transcripts: making personal lifestyle changes; and supportive environment for lifestyle changes. Although this study is exploratory in nature, it has highlighted the significance of social support from within a program as opposed to participants' friends and family, the subject of most social-support research. It also contributes to the challenges others are starting to make regarding the limited timeframes associated with traditional cardiac rehabilitation programs, suggesting more time may be needed to build firmer psychosocial foundations for behaviour change after cardiac events.
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Affiliation(s)
- Wendy Madsen
- CQUniversity, Locked Bag 3333, Bundaberg, Qld 4670, Australia.
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Conraads VM, Deaton C, Piotrowicz E, Santaularia N, Tierney S, Piepoli MF, Pieske B, Schmid JP, Dickstein K, Ponikowski PP, Jaarsma T. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2012; 14:451-8. [PMID: 22499542 DOI: 10.1093/eurjhf/hfs048] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly recommended by the recent guidelines issued by the European Society of Cardiology, but it is still severely underutilized in this particular patient population. This position paper addresses the problem of non-adherence, currently recognized as a main obstacle to a wide implementation of physical training. Since the management of chronic heart failure and, even more, of training programmes is a multidisciplinary effort, the current manuscript intends to reach cardiologists, nurses, physiotherapists, as well as psychologists working in the field.
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Affiliation(s)
- Viviane M Conraads
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium.
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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Wittmer M, Volpatti M, Piazzalonga S, Hoffmann A. Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation. Eur J Prev Cardiol 2011; 19:1082-8. [DOI: 10.1177/1741826711418163] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Melanie Wittmer
- Institute of Sports Sciences, University of Basel, Switzerland
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Nigg CR, Geller KS, Motl RW, Horwath CC, Wertin KK, Dishman RK. A Research Agenda to Examine the Efficacy and Relevance of the Transtheoretical Model for Physical Activity Behavior. PSYCHOLOGY OF SPORT AND EXERCISE 2011; 12:7-12. [PMID: 21113323 PMCID: PMC2990961 DOI: 10.1016/j.psychsport.2010.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Regular physical activity (PA) decreases the risk of several chronic diseases including some cancers, type II diabetes, obesity, and cardiovascular disease; however, the majority of US adults are not meeting the recommended levels to experience these benefits. To address this public health concern, the underlying mechanisms for behavior change need to be understood, translated and disseminated into appropriately tailored interventions. The Transtheoretical Model (TTM) provides a framework for both the conceptualization and measurement of behavior change, as well as facilitating promotion strategies that are individualized and easily adapted. The purpose of this manuscript is to present the constructs of the TTM as they relate to PA behavior change. We begin with a brief synopsis of recent examinations of the TTM constructs and their application. Subsequent to its introduction, we specifically present the TTM within the PA context and discuss its application and usefulness to researchers and practitioners. Criticisms of the TTM are also noted and presented as opportunities for future research to enhance the valid application of the TTM. We offer general study design recommendations to appropriately test the hypothesized relationships within the model. With further examinations using appropriate study design and statistical analyses, we believe the TTM has the potential to advance the public health impact of future PA promotion interventions.
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Affiliation(s)
- Claudio R Nigg
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, 1960 East-West Road, Honolulu, HI 96822. Tel: (808) 956-2862, ,
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