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Ozasa N, Kaneda K, Washida K, Umeda Shiozaki Y, Imai S, Kitta K, Higuchi Y, Yoshiuchi S, Yoshida T, Nakatsuma K, Kimura T, Ono K. Online Intensive Cardiac Rehabilitation Program for Japanese Patients With Coronary Artery Disease - A Pilot Study Protocol. Circ Rep 2024; 6:401-405. [PMID: 39262643 PMCID: PMC11383542 DOI: 10.1253/circrep.cr-24-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024] Open
Abstract
Background A comprehensive cardiac rehabilitation (CR) program is recommended for coronary artery disease (CAD). However, many facilities do not have established programs for dietary guidance and patient education, resulting in an exercise-based CR program and limited efficacy for secondary prevention. Methods and Results A pilot study will be conducted to develop an online Japanese-style intensive cardiac rehabilitation (J-ICR) program for Japanese patients with CAD and will examine adherence, safety, and efficacy. Twenty-four patients diagnosed with stable CAD will be randomly assigned in a 1 : 1 ratio to either an early or late-phase group. The program will comprise the following four parts: exercise sessions; dietary education centered on "the Japan diet"; mindfulness; and group support, with a frequency of 3 h per session, once a week for 12 weeks (a total of 36 h). The primary endpoint will be program feasibility, determined by examining its adherence. Physical examination and function, stress-coping skills, risk of classic CAD (e.g., lipid profile, glucose tolerance, and blood pressure), and dietary changes will be assessed as secondary endpoints. Conclusions The online J-ICR program is designed as a comprehensive CR program for Japanese patients with CAD. If this program shows high adherence and an improvement in CAD risk factors, its secondary prevention effect should be verified with appropriately powered randomized trials at multiple centers.
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Affiliation(s)
- Neiko Ozasa
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Cardiology, Kansai Heart Center, Takanohara Central Hospital Nara Japan
| | - Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Koichi Washida
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | | - Saeko Imai
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Kaoru Kitta
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Yuki Higuchi
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Sawako Yoshiuchi
- Health Science Center, Kansai Medical University Hospital Osaka Japan
| | - Toshiko Yoshida
- Graduate School of Nursing Science, St. Luke's International University Tokyo Japan
| | - Kenji Nakatsuma
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
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Murphy BE, Card PD, Ramirez-Kelly L, Xaysuda AM, Heidel RE. Effects of the Strong Hearts program after a major cardiovascular event in patients with cardiovascular disease. J Osteopath Med 2023; 123:279-285. [PMID: 36958944 DOI: 10.1515/jom-2022-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
CONTEXT Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions. OBJECTIVES This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event. METHODS One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures. RESULTS One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86). CONCLUSIONS The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.
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Affiliation(s)
| | | | | | | | - R Eric Heidel
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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3
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Abstract
PURPOSE Intensive cardiac rehabilitation (ICR) is a comprehensive, medically supervised exercise treatment program covered by Medicare for patients with approved cardiac diagnoses. The aim of this study was to determine the benefits of the first Pritikin outpatient ICR program. METHODS This retrospective analysis included patients referred to ICR or traditional cardiac rehabilitation (CR) during the first 7 yr (2013-2019) at the first facility to implement Pritikin ICR. Intensive cardiac rehabilitation is composed of 36 education sessions on nutrition, exercise, and a healthy mindset, in addition to 36 monitored exercise sessions that comprise traditional CR. Assessments included anthropometrics (weight, body mass index, and waist circumference), dietary patterns, physical function (6-min walk test, [6MWT] Short Physical Performance Battery [SPPB: balance, 4-m walk, chair rise], handgrip strength), and health-related quality of life (Dartmouth COOP, 36-item Short Form Survey). Baseline and follow-up measures were compared within and between groups. RESULTS A total of 1963 patients enrolled (1507 ICR, 456 CR, 66.1 ± 11.4 yr, 68% male, 82% overweight or obese); 1141 completed the program (58%). The ICR patients completed 22 exercise and 18 education sessions in 9.6 wk; CR patients completed 19 exercise sessions in 10.3 wk. ICR resulted in improvements ( P < .001 pre vs post) in all anthropometric measures, dietary patterns, 6MWT distance, all SPPB components, grip strength, and health-related quality of life. The improvements in anthropometrics and dietary patterns were greater in ICR than in CR. CONCLUSIONS The Pritikin outpatient ICR program promoted improvements in several cardiovascular health indices. Critical next steps are to assess long-term health outcomes after ICR, including cardiac events and mortality.
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Wulsin LR, Sagui-Henson SJ, Roos LG, Wang D, Jenkins B, Cohen BE, Shah AJ, Slavich GM. Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study. Psychosom Med 2022; 84:267-275. [PMID: 35067657 PMCID: PMC8976751 DOI: 10.1097/psy.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. METHOD In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. RESULTS On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. CONCLUSIONS Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
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Affiliation(s)
- Lawson R Wulsin
- From the Departments of Psychiatry and Family Medicine, University of Cincinnati, and Cincinnati Veterans Administration Medical Center (Wulsin), Cincinnati, Ohio; Osher Center for Integrative Medicine (Sagui-Henson), University of California, San Francisco, San Francisco, California; Health Psychology PhD Program (Roos), University of North Carolina at Charlotte, Charlotte, North Carolina; Center for Economic and Social Research (Wang), University of Southern California, Los Angeles; Department of Psychology, Chapman University, Center on Stress & Health, and Department of Anesthesiology and Perioperative Care (Jenkins), University of California, Irvine; Department of Medicine, University of California, San Francisco, and San Francisco Veterans Affairs Healthcare System (Cohen), San Francisco, California; Department of Epidemiology (Shah), Rollins School of Public Health, Emory University; Department of Medicine, Division of Cardiology (Shah), Emory University School of Medicine, Atlanta; and Atlanta Veterans Affairs Healthcare System (Shah), Decatur, Georgia; and Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences (Slavich), University of California, Los Angeles, Los Angeles, California
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Jakše B. Placing a Well-Designed Vegan Diet for Slovenes. Nutrients 2021; 13:4545. [PMID: 34960098 PMCID: PMC8706043 DOI: 10.3390/nu13124545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023] Open
Abstract
Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations, athletes or individuals with fast-paced lifestyles, there is room for further appropriate supplementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.
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Affiliation(s)
- Boštjan Jakše
- Department of Food Science, Biotechnical Faculty, University of Ljubljana, SI-1000 Ljubljana, Slovenia
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Świątkiewicz I, Di Somma S, De Fazio L, Mazzilli V, Taub PR. Effectiveness of Intensive Cardiac Rehabilitation in High-Risk Patients with Cardiovascular Disease in Real-World Practice. Nutrients 2021; 13:nu13113883. [PMID: 34836144 PMCID: PMC8620098 DOI: 10.3390/nu13113883] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022] Open
Abstract
Structured lifestyle interventions through cardiac rehabilitation (CR) are critical to improving the outcome of patients with cardiovascular disease (CVD) and cardiometabolic risk factors. CR programs' variability in real-world practice may impact CR effects. This study evaluates intensive CR (ICR) and standard CR (SCR) programs for improving cardiometabolic, psychosocial, and clinical outcomes in high-risk CVD patients undergoing guideline-based therapies. Both programs provided lifestyle counseling and the same supervised exercise component. ICR additionally included a specialized plant-based diet, stress management, and social support. Changes in body weight (BW), low-density lipoprotein cholesterol (LDL-C), and exercise capacity (EC) were primary outcomes. A total of 314 patients (101 ICR and 213 SCR, aged 66 ± 13 years, 75% overweight/obese, 90% coronary artery disease, 29% heart failure, 54% non-optimal LDL-C, 43% depressive symptoms) were included. Adherence to ICR was 96% vs. 68% for SCR. Only ICR resulted in a decrease in BW (3.4%), LDL-C (11.3%), other atherogenic lipids, glycated hemoglobin, and systolic blood pressure. Both ICR and SCR increased EC (52.2% and 48.7%, respectively) and improved adiposity indices, diastolic blood pressure, cholesterol intake, depression, and quality of life, but more for ICR. Within 12.6 ± 4.8 months post-CR, major adverse cardiac events were less likely in the ICR than SCR group (11% vs. 17%), especially heart failure hospitalizations (2% vs. 8%). A comprehensive ICR enhanced by a plant-based diet and psychosocial management is feasible and effective for improving the outcomes in high-risk CVD patients in real-world practice.
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Affiliation(s)
- Iwona Świątkiewicz
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA 92037, USA;
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
- Correspondence:
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy; (S.D.S.); (L.D.F.); (V.M.)
| | - Ludovica De Fazio
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy; (S.D.S.); (L.D.F.); (V.M.)
| | - Valerio Mazzilli
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy; (S.D.S.); (L.D.F.); (V.M.)
| | - Pam R. Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA 92037, USA;
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Petersen MR, Freeman AM, Madrid M, Aggarwal M. Strategies for Incorporating Lifestyle Medicine in Everyday Hospital Practice. Am J Lifestyle Med 2021; 15:531-537. [PMID: 34646102 PMCID: PMC8504330 DOI: 10.1177/15598276211006664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease and its associated risk factors such as hypertension, obesity, and diabetes are contributing to a large portion of morbidity, mortality, and health care costs in the United States. Diet and lifestyle education have been shown to be beneficial in reducing cost, mortality, and morbidity associated with these diseases. However, the lack of implementation of diet and lifestyle tools into clinical practices and into hospital systems leaves much room for improvement. Obstacles such as poor physician education, financial concerns, patient preference, and social resistance to change have made it difficult to promote healthy lifestyle and nutrition practices throughout all aspects of health systems. Some hospital systems and hospital-based clinical practices have had important successes in creating prevention clinic models, implementing plant-based menus in their hospital systems, and incorporating intensive rehabilitation programs that will pave the way for more future change. This review describes the current deficits, obstacles, and innovative strategies for implementing lifestyle medicine into hospital systems.
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Affiliation(s)
- Matthew R. Petersen
- Department of Medicine, Shands Hospital at the University of Florida, Gainesville, Florida
| | - Andrew M. Freeman
- the Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Marcy Madrid
- Community Health, Midland Health, Midland, Texas
| | - Monica Aggarwal
- the Division of Cardiology, University of Florida, Gainesville, Florida (MA)
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González-Salvado V, Peña-Gil C, Lado-Baleato Ó, Cadarso-Suárez C, Prada-Ramallal G, Prescott E, Wilhelm M, Eser P, Iliou MC, Zeymer U, Ardissino D, Bruins W, van der Velde AE, Van't Hof AWJ, de Kluiver EP, Kolkman EK, Prins L, González Juanatey JR. Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study. Eur J Prev Cardiol 2021; 28:558-568. [PMID: 33558875 DOI: 10.1093/eurjpc/zwaa104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. METHODS AND RESULTS The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. CONCLUSION In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.
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Affiliation(s)
- Violeta González-Salvado
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Carlos Peña-Gil
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Óscar Lado-Baleato
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Prada-Ramallal
- Epidemiology, Statistics and Research Methodology Unit, Santiago de Compostela Institute for Research Foundation (FIDIS), Santiago de Compostela, Spain
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Astrid E van der Velde
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | | | - José Ramón González Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
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Krauss J, Frates E, Parekh M, Chan J, Kiratli BJ, Myers J. Comprehensive Lifestyle Medicine Program Improves Fitness, Function, and Blood Pressure in Poststroke Veteran Cohort: A Pilot Study. Am J Lifestyle Med 2021; 16:765-771. [DOI: 10.1177/1559827620988659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Comprehensive lifestyle medicine programs have begun to show efficacy in patients with cerebrovascular disease. The Veterans Affairs (VA) health care system has a large poststroke population and VA rehabilitation departments have significant expertise and resources for promoting healthy lifestyles. A 12-week clinical lifestyle medicine program was therefore implemented for poststroke patients, along with an optional observational study evaluating cardiovascular fitness, function, body composition, vitals, and quality of life before and after the program. Seventeen of 18 clinical patients elected to participate in the study, and 3 later withdrew. The 14 participants improved VO2 max by 1.94 mL O2/min/kg ( P = .001, 95% CI 0.96-2.90). Significant improvements were seen in estimated metabolic equivalents, exercise duration, 6-minute walk test, 30-second sit to stand, grip strength, and balance. Among patients who were hypertensive at baseline, mean decrease in supine systolic blood pressure (SBP) was −9.70 mm Hg (n = 10, P = .005, 95% CI −15.7 to −3.7) and standing SBP was −11.09 mm Hg (n = 11, P = .009, 95% CI −18.7 to −3.48). There were no significant improvements in laboratory measures or body composition. Participant satisfaction was high. These findings corroborate recent literature suggesting that lifestyle programs improve stroke recovery and reduce recurrence risk.
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Affiliation(s)
- Jeffrey Krauss
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Orthopedics, Physical Medicine and Rehabilitation Division, Stanford School of Medicine, Stanford, California
| | - Elizabeth Frates
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts
| | - Mira Parekh
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
| | - John Chan
- Department of Orthopedics, Physical Medicine and Rehabilitation Division, Stanford School of Medicine, Stanford, California
| | - B. Jenny Kiratli
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
| | - Jonathan Myers
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
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Yiaslas TA, Sood A, Ono G, Rogers-Soeder TS, Kitazono RE, Embree J, Spann C, Caputo CA, Taylor J, Schaefer S. The Design and Implementation of a Heart Disease Reversal Program in the Veterans Health Administration: Before and During the COVID-19 Pandemic. Fed Pract 2021; 37:558-565. [PMID: 33424214 DOI: 10.12788/fp.0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Heart disease continues to be the leading cause of death in the US, and the number of people with cardiovascular disease (CVD) is rising. CVD is more prevalent among military veterans than nonveterans, and veteran status is associated with higher risk of incident heart disease after controlling for socioeconomic status, other medical diseases, depression, and lifestyle. Many patients seeking care in the Veterans Health Administration, including those who undergo cardiac catheterization, meet the criteria for multimorbidity (defined as ≥ 2 chronic diseases). Observations The Heart Disease Reversal Program (HDRP) is a novel interdisciplinary, multicomponent lifestyle program at the US Department of Veterans Affairs (VA) Sacramento VA Medical Center. This program is a streamlined adaptation of behavioral/lifestyle interventions aimed at promoting partial reversal (regression) of atherosclerotic heart disease and achievement of comprehensive cardiovascular risk reduction. HDRP was developed and implemented within a VA behavioral medicine clinic and successfully adapted for delivery through videoconferencing during the COVID-19 pandemic. Patient satisfaction survey data indicate a very high level of patient acceptability. We found direct-to-patient clinical outreach an effective method for launching a disease reversal program. Conclusions Beyond the clinical benefits to patients, there is significant value and benefit added to the health care system by offering an intervention within the disease reversal paradigm. Efforts of the health care team to reverse a disease can be considered the highest aim of medicine and health care.
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Affiliation(s)
- Themis A Yiaslas
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Ajay Sood
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Gregory Ono
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Tara S Rogers-Soeder
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Rachel E Kitazono
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Janelle Embree
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Cynthia Spann
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Carrie A Caputo
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - June Taylor
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
| | - Saul Schaefer
- is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento
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Depression Is Associated With Reduced Outpatient Cardiac Rehabilitation Completion Rates: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2020; 39:365-372. [PMID: 30913045 DOI: 10.1097/hcr.0000000000000419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Depression is associated with recurrent cardiac events and death in patients with coronary heart disease and congestive heart failure. Furthermore, depression may be associated with reduced completion of outpatient cardiac rehabilitation (CR), an empirically supported treatment for patients with coronary heart disease and congestive heart failure that reduces recurrent coronary events and cardiac mortality. The goal of the current systematic review and meta-analysis was to explore the association between depression and outpatient CR completion. METHOD A systematic literature review cross-referenced 3 electronic databases (PsycINFO, MEDLINE, and Dissertation Abstracts International) from inception through February 15, 2015. Studies quantifying an association between depression and outpatient CR completion were identified for review. A random-effects model was used to pool quantitative data, moderators were tested, and publication bias was analyzed. RESULTS Seventeen studies with 19 independent samples consisting of 30 586 cardiac patients were included in the meta-analysis. A moderate inverse relationship between depression and outpatient CR completion was observed (g = -0.44; 95% CI, -0.59 to -0.29), indicating that depressed CR patients were significantly less likely to complete their prescribed CR programs. No significant moderator variables were identified. A minor amount of publication bias was detected. CONCLUSION Depression is associated with reduced outpatient CR completion rates. Future research should focus on attendance interventions for depressed CR patients, as completion of outpatient CR reduces cardiac and all-cause mortality.
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El Missiri A, Amin SA, Tawfik IR, Shabana AM. Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery. Egypt Heart J 2020; 72:69. [PMID: 33052491 PMCID: PMC7560662 DOI: 10.1186/s43044-020-00107-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Cardiac rehabilitation has been shown to reduce cardiac mortality, improve quality of life, and reduce hospitalizations. Cardiac rehabilitation programs are usually performed over a 12-week period. Studies have shown that similar benefits could be achieved with shorter programs. Abnormal heart rate recovery after exercise has been associated with an increased risk of cardiovascular events and mortality. The main aim of this study was to compare the effect of a 6-week phase 2 cardiac rehabilitation program on heart rate recovery to a 12-week one in patients who had recovered from an anterior wall ST segment elevation myocardial infarction. Results This prospective study included 60 patients enrolled in cardiac rehabilitation programs randomized into two equal groups: a 6-week and a 12-week program. Baseline patient demographics, lipid profile, and left ventricular ejection fraction (LVEF) were assessed. METs achieved, total exercise time, resting heart rate, peak heart rate, and heart rate recovery at 1 min were examined. These were re-assessed at the end of each program. Results showed no difference between both groups at the end of each program regarding lipid profile and LVEF. Patients enrolled in the 12-week cardiac rehabilitation program were able to achieve more METs, had a longer exercise time, a higher peak heart rate, and had a lower resting heart rate at the end of the program. Heart rate recovery was slightly higher in patients enrolled in the 6-week program 26.5 ± 6.78 versus 23.17 ± 6.12 bpm (p = 0.051). On comparing the magnitude of change between both programs, those in the 12-week program had more increase in HDL-C levels, METs achieved, and exercise time. Additionally, they had more reduction of resting heart rate. Heart rate recovery was more increased for those in the 6-week program. Conclusion Although heart rate recovery increases after completion of each of a 6-week and 12-week cardiac rehabilitation program compared to their baseline, there is no difference on comparing heart rate recovery between both programs at their end. Patients enrolled in a standard 12-week cardiac rehabilitation program achieve more METs, have a longer exercise time, a higher peak HR, and a lower resting HR at the end of the program compared to those in the 6-week program.
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Affiliation(s)
- Ahmed El Missiri
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.
| | - Sameh Atteya Amin
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Islam Reda Tawfik
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Adel Mohamed Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
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Rudchenko IV, Tyrenko VV, Kachnov VA. Nutrition as one of the important factors in prevention and treatment of atherosclerotic cardiovascular diseases. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The article discusses the issues of nutrition types and related effects on cardiovascular disease, the potential benefits of a particular diet for the cardiovascular system. The problems in studying the nutrition effect on cardiovascular diseases are characterized. Special attention is paid to the plant-based diet and its effect on atherosclerosis. An analysis of PURE (Prospective Urban and Rural Epidemiological) study, which contains a modern view of the diet and the development of cardiovascular diseases, is carried out.
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Abstract
PURPOSE OF REVIEW Obesity continues to be a growing concern globally due to association with a number of comorbidities and contributing significantly to increase in health care expenditures. Despite availability of a number of treatment modalities, lifestyle modification with dietary modification and exercise continues to be the foundation. However, the standard model of lifestyle modification is not efficacious or sustainable for many patients leading them to seek alternative approaches. We conducted a comprehensive literature review to present the data regarding efficacy and sustainability of many common dietary approaches. RECENT FINDINGS Building upon previous work, recent randomized controlled trials have compared many popular diets head to head in varying patient populations. Along with the weight changes, studies have investigated the changes in metabolic parameters, inflammatory markers, and cardiac risk factor reduction. Though the studies do not show superiority of one diet compared to the other, the preventive benefits and other favorable metabolic changes of the diets make them worthy of consideration.
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Sanchez A, Chung SC, Mejia A, Ramirez FE, Shavlik GW, Bivens RL, Brown-Fraser S, Gallant RD. Multiple lifestyle interventions reverses hypertension. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1636534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Albert Sanchez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - S. Christine Chung
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Alfredo Mejia
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Francisco E. Ramirez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Research, Nedley Clinic, Weimar, CA, USA
| | | | | | - Sherine Brown-Fraser
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
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Morin É, Michaud-Létourneau I, Couturier Y, Roy M. A whole-food, plant-based nutrition program: Evaluation of cardiovascular outcomes and exploration of food choices determinants. Nutrition 2019; 66:54-61. [PMID: 31207440 DOI: 10.1016/j.nut.2019.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An ideal diet to prevent cardiovascular diseases contains an unlimited intake of various plant foods and a reduced intake of animal and highly processed foods. Researchers have reported that nutrition education programs that prioritize whole-plant foods effectively contribute to the prevention of unhealthy cardiovascular outcomes. We examined whether a 12-wk nutrition education program in adults from Montreal (Quebec, Canada) with at least one risk factor of cardiovascular disease was effective in modifying their eating patterns toward including more whole-plant foods. We further evaluated the effects of this program on participants' cardiovascular outcomes and explored determinants influencing food choices toward whole-food, plant-based diets. METHODS A sequential, explanatory, mixed-methods, research design was used. A quantitative step (i.e., single-arm, quasi-experimental trial) preceded participant recruitment for a qualitative phase (i.e., phenomenological study; semistructured interview; thematic analysis). The examined outcomes were changes in cardiovascular risk factors (paired t tests) and determinants of food choice (thematic analysis). RESULTS Weight (-10.5 lbs; 95% confidence interval [CI]: -9.0 to -12.0), waist circumference (-7.4 cm; 95% CI: -6.5 to -8.4), total cholesterol (-0.87 mmol/L; 95% CI: -0.57 to -1.17), and low-density lipoprotein cholesterol (-29.7% or -0.84 mmol/L; 95% CI: -0.55 to -1.13) all improved significantly (P ˂ 0.001). Encouraging ad libitum intake of various whole-food plant-based items appealed more to participants than traditional strategies. Altruistic and societal motives, in addition to health, were identified as key determinants of an increased adoption of whole-food plant-based diets. CONCLUSIONS The whole-food, plant-based nutrition program improves cardiovascular health in adults and features characteristics that may inform future nutrition programs and public health interventions.
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Affiliation(s)
- Étienne Morin
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Arts and Humanities, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Michaud-Létourneau
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Yves Couturier
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Arts and Humanities, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mathieu Roy
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Quebec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine & Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.
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Ijaz N, Rioux J, Elder C, Weeks J. Whole Systems Research Methods in Health Care: A Scoping Review. J Altern Complement Med 2019; 25:S21-S51. [PMID: 30870019 PMCID: PMC6447996 DOI: 10.1089/acm.2018.0499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: This scoping review evaluates two decades of methodological advances made by “whole systems research” (WSR) pioneers in the fields of traditional, complementary, and integrative medicine (TCIM). Rooted in critiques of the classical randomized controlled trial (RCT)'s suitability for evaluating holistic, complex TCIM interventions, WSR centralizes the principle of “model validity,” representing a “fit” between research design and therapeutic paradigm. Design: In consultation with field experts, 41 clinical research exemplars were selected for review from across 13 TCIM disciplines, with the aim of mapping the range and methodological characteristics of WSR studies. Using an analytic charting approach, these studies' primary and secondary features are characterized with reference to three focal areas: research method, intervention design, and outcome assessment. Results: The reviewed WSR exemplars investigate a wide range of multimodal and multicomponent TCIM interventions, typified by wellness-geared, multitarget, and multimorbid therapeutic aims. Most studies include a behavioral focus, at times in multidisciplinary or team-based contexts. Treatments are variously individualized, often with reference to “dual” (biomedical and paradigm-specific) diagnoses. Prospective and retrospective study designs substantially reflect established biomedical research methods. Pragmatic, randomized, open label comparative effectiveness designs with “usual care” comparators are most widely used, at times with factorial treatment arms. Only two studies adopt a double-blind, placebo-controlled RCT format. Some cohort-based controlled trials engage nonrandomized allocation strategies (e.g., matched controls, preference-based assignment, and minimization); other key designs include single-cohort pre–post studies, modified n-of-1 series, case series, case report, and ethnography. Mixed methods designs (i.e., qualitative research and economic evaluations) are evident in about one-third of exemplars. Primary and secondary outcomes are predominantly assessed, at multiple intervals, through patient-reported measures for symptom severity, quality of life/wellness, and/or treatment satisfaction; some studies concurrently evaluate objective outcomes. Conclusions: Aligned with trends emphasizing “fit-for-purpose” research designs to study the “real-world” effectiveness of complex, personalized clinical interventions, WSR has emerged as a maturing scholarly discipline. The field is distinguished by its patient-centered salutogenic focus and engagement with nonbiomedical diagnostic and treatment frameworks. The rigorous pursuit of model validity may be further advanced by emphasizing complex analytic models, paradigm-specific outcome assessment, inter-rater reliability, and ethnographically informed designs. Policy makers and funders seeking to support best practices in TCIM research may refer to this review as a key resource.
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Affiliation(s)
- Nadine Ijaz
- 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Charles Elder
- 3 Kaiser Permanente Center for Health Research, Portland, OR
| | - John Weeks
- 4 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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19
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Simons RL, Woodring D, Simons LG, Sutton TE, Lei MK, Beach SRH, Barr AB, Gibbons FX. Youth Adversities Amplify the Association between Adult Stressors and Chronic Inflammation in a Domain Specific Manner: Nuancing the Early Life Sensitivity Model. J Youth Adolesc 2019; 48:1-16. [PMID: 30603835 DOI: 10.1007/s10964-018-0977-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022]
Abstract
There is strong evidence that chronic, systemic inflammation hastens onset of the diseases of old age that ultimately lead to death. Importantly, several studies suggest that childhood adversity predicts chronic inflammation. Unfortunately, this research has been plagued by retrospective reports of childhood adversity, an absence of controls for adult stressors, and a failure to investigate various competing models of the link between childhood adversity and chronic inflammation. The present study was designed to address these limitations. Using 18 years of data collected from 413 African Americans (58% female) included in the Family and Community Health Study, hierarchical regression analyses provided support for a nuanced early life sensitivity explanation for the link between early adversity and adult chronic inflammation. Controlling for health risk behaviors and adult SES, late childhood (ages 10-12) adversity amplified the association between adult adversity (age 29) and chronic inflammation. This interaction operated in a domain-specific fashion. Harsh parenting amplified the relation between intimate partner hostility and inflammation, whereas early discrimination amplified the relation between adult discrimination and inflammation. These findings suggest that individuals may be primed to respond physiologically to adverse adult circumstances that resemble those experienced earlier in life.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA.
| | - David Woodring
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA
| | | | - Tara E Sutton
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA
| | - Man-Kit Lei
- Center for Family Research, University of Georgia, Athens, GA, 30605, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA
| | - Ashley B Barr
- Department of Sociology, SUNY Buffalo, Buffalo, NY, 14260, USA
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
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Katzenberg C, Silva E, Young MJ, Gilles G. Outcomes in a Community-Based Intensive Cardiac Rehabilitation Program: Comparison with Hospital-Based and Academic Programs. Am J Med 2018; 131:967-971. [PMID: 29660352 DOI: 10.1016/j.amjmed.2018.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population. METHODS Participants seeking either primary or secondary coronary artery disease prevention voluntarily enrolled in the 12-week intensive cardiac rehabilitation program. Data were obtained at baseline and 6-12 months after completion of the program. RESULTS A total of 142 individuals, mean age 69 years, completed the Heart Series between 2012 and 2016. Follow-up data were available in 105 participants (74%). Participants showed statistically significant improvements in mean weight (165 to 162 lbs, P = .0005), body mass index (26 to 25 kg/m2, P = .001), systolic blood pressure (126 to 122 mm Hg, P = .01), diastolic blood pressure (73 to 70 mm Hg, P = .0005), total cholesterol (175 to 168 mg/dL, P = .03), low-density lipoprotein cholesterol (LDL-C) (100 to 93 mg/dL, P = .005), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (1.8 to 1.6, P = .005), and cholesterol/HDL-C ratio (3.2 to 3.0, P = .003). Changes in HDL-C, triglycerides, and fasting blood glucose did not reach statistical significance, but all trended in favorable directions. Adverse cardiovascular disease outcomes were rare (one stent placement, no deaths). CONCLUSIONS A total of 105 participants completed our 12-week community-based intensive cardiac rehabilitation program and showed significant positive changes in several measures of cardiac risk, with only 1 adverse event. These results compare favorably with those of hospital-based and academic institutional programs.
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Affiliation(s)
- Charles Katzenberg
- Pima Heart Associates, Tucson, Az; Sarver Heart Center, University of Arizona, Tucson, Az; Foundation for Cardiovascular Health, Tucson, Az.
| | - Edna Silva
- Foundation for Cardiovascular Health, Tucson, Az
| | - M Jean Young
- Foundation for Cardiovascular Health, Tucson, Az
| | - Greg Gilles
- Foundation for Cardiovascular Health, Tucson, Az
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Wang C, Redgrave J, Shafizadeh M, Majid A, Kilner K, Ali AN. Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis. Br J Sports Med 2018; 53:1515-1525. [PMID: 29743171 DOI: 10.1136/bjsports-2017-098903] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Secondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA). DESIGN Intervention systematic review and meta-analysis. DATA SOURCES OVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017. ELIGIBILITY CRITERIA Randomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control. RESULTS Twenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) -4.30 mm Hg (95% CI -6.77 to -1.83) and diastolic blood pressure -2.58 mm Hg (95% CI -4.7 to -0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (-8.46 mm Hg, 95% CI -12.18 to -4.75 vs -2.33 mm Hg, 95% CI -3.94 to -0.72), and in those incorporating an educational component (-7.81 mm Hg, 95% CI -14.34 to -1.28 vs -2.78 mm Hg, 95% CI -4.33 to -1.23). Exercise was also associated with reductions in total cholesterol (-0.27 mmol/L, 95% CI -0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered. SUMMARY Exercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.
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Affiliation(s)
- Cheng Wang
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Jessica Redgrave
- Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mohsen Shafizadeh
- Sheffield Hallam University, Academy of Sport and Physical Activity, Sheffield, UK
| | - Arshad Majid
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK.,Sheffield NIHR Biomedical Research Centre, Sheffield, UK
| | - Karen Kilner
- Sheffield Hallam University, Centre for Health and Social Care Research, Sheffield, UK
| | - Ali N Ali
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Geriatrics and Stroke Medicine, Sheffield, UK
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Association Between Depressive Symptoms and Exercise Capacity in Patients With Heart Disease: A META-ANALYSIS. J Cardiopulm Rehabil Prev 2018; 37:239-249. [PMID: 27428818 DOI: 10.1097/hcr.0000000000000193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Depression and reduced exercise capacity are risk factors for poor prognosis in patients with heart disease, but the relationship between the 2 is unclear. We assessed the relationship between depressive symptoms and exercise capacity in patients with heart disease. METHODS PubMed, Cochrane Library, Google Scholar, and ProQuest databases were browsed for English-language studies published from January 2000 to September 2013. Studies including adult patients with coronary artery disease, heart failure, congenital heart disease, and implantable cardioverter defibrillator, reporting correlation between a depression scale and exercise capacity ((Equation is included in full-text article.)O2peak, peak watts, estimated metabolic equivalents, and incremental shuttle walk test distance), as well as studies from which such a correlation could be calculated and provided by the authors, were included. Correlation coefficients (CCs) were converted to Fischer z values, and the analysis was performed using a random-effects model. Then, summary effects and 95% CIs were converted back to CCs. RESULTS Fifty-nine studies (25 733 participants) were included. Depressive symptoms were inversely correlated to exercise capacity (CC = -0.15; 95% CI, -0.17 to -0.12). Heterogeneity was significant (I = 64%; P < .001). There was no evidence of publication bias (Fail-safe N = 4681; Egger test: P = .06; Kendall test: P = .29). CONCLUSIONS Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.
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Prevention of Cardiovascular Disease Among Cancer Survivors: the Role of Pre-existing Risk Factors and Cancer Treatments. CURR EPIDEMIOL REP 2017. [DOI: 10.1007/s40471-017-0117-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, Devries S, O'Keefe J, Miller M, Ornish D, Williams K, Kris-Etherton P. Trending Cardiovascular Nutrition Controversies. J Am Coll Cardiol 2017; 69:1172-1187. [PMID: 28254181 DOI: 10.1016/j.jacc.2016.10.086] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
The potential cardiovascular benefits of several trending foods and dietary patterns are still incompletely understood, and nutritional science continues to evolve. However, in the meantime, a number of controversial dietary patterns, foods, and nutrients have received significant media exposure and are mired by hype. This review addresses some of the more popular foods and dietary patterns that are promoted for cardiovascular health to provide clinicians with accurate information for patient discussions in the clinical setting.
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Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado.
| | - Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina
| | - Neal Barnard
- George Washington University School of Medicine; Physicians Committee for Responsible Medicine, Washington, DC
| | | | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Arthur Agatston
- Herbert Wertheim College of Medicine, Florida International University and Baptist Health of South Florida, Miami, Florida
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael Miller
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California and University of California-San Francisco, San Francisco, California
| | - Kim Williams
- Rush University Medical Center, Chicago, Illinois
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
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Berra K, Franklin B, Jennings C. Community-Based Healthy Living Interventions. Prog Cardiovasc Dis 2017; 59:430-439. [PMID: 28062265 DOI: 10.1016/j.pcad.2017.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 02/05/2023]
Abstract
In an environment in which most people have lifestyles that increase risk for initial or recurrent cardiovascular disease (CVD) events, community-based healthy lifestyle initiatives are highly effective in providing programs, education and support to reduce associated CVD risk factors and improve outcomes. Pioneering programs, such as the Stanford Three Community and Five Cities studies, and the North Karelia project in Finland, served as prototypes for current initiatives. These include partnerships with national organizations (e.g., YMCA DPP) and faith-based programs. Training may be provided by healthcare professionals and/or community healthcare workers; initiatives include exercise-based and weight-reduction programs, smoking cessation interventions, dietary counseling and education, and medication adherence. Contemporary technologies and home-based programs provide alternatives to those who might not otherwise have access to center-based programs. Community-based initiatives, particularly those with state or national support, have the potential to enhance the delivery and effectiveness of CVD prevention at low cost.
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Affiliation(s)
- Kathy Berra
- Cardiovascular Medicine and Coronary Interventions, Redwood City, CA, Stanford Prevention Research Center, Stanford University School of Medicine (Emeritus), USA.
| | - Barry Franklin
- Preventive Cardiology & Cardiac Rehabilitation, William Beaumont Hospital Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Chauvet-Gelinier JC, Bonin B. Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Ann Phys Rehabil Med 2016; 60:6-12. [PMID: 27771272 DOI: 10.1016/j.rehab.2016.09.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 09/25/2016] [Indexed: 02/09/2023]
Abstract
Cardiovascular events and emotional disorders share a common epidemiology, thus suggesting fundamental pathways linking these different diseases. Growing evidence in the literature highlights the influence of psychological determinants in somatic diseases. A patient's socio-economic aspects, personality traits, health behavior and even biological pathways may contribute to the course of cardiovascular disease. Cardiac events often occur suddenly and the episode can be traumatic for people not prepared for such an event. In this review of the literature, the authors tackle the question of psychobiological mechanisms of stress, in a pathophysiological approach to fundamental pathways linking the brain to the heart. Various psychological, biological and genetic arguments are presented in support of the hypothesis that various etiological mechanisms may be involved. The authors finally deal with biological and psychological strategies in a context of cardiovascular disease. Indeed, in this context, cardiac rehabilitation, with its global approach, seems to be a good time to diagnose emotional disorders like anxiety and depression, and to help people to cope with stressful events. In this field, cardiac rehabilitation seems to be a crucial step in order to improve patients' outcomes, by helping them to understand the influence of psychobiological risk factors, and to build strategies in order to manage daily stress.
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Affiliation(s)
- Jean-Christophe Chauvet-Gelinier
- Service de Psychiatrie et d'Addictologie, Centre Hospitalier Universitaire, 14, rue Gaffarel, bâtiment Marion, 21000 Dijon, France; Laboratoire de Psychopathologie et Psychologie Médicale, EA 4452, IFR Santé STIC 100, Université de Bourgogne-Franche-Comté, France.
| | - Bernard Bonin
- Service de Psychiatrie et d'Addictologie, Centre Hospitalier Universitaire, 14, rue Gaffarel, bâtiment Marion, 21000 Dijon, France; Laboratoire de Psychopathologie et Psychologie Médicale, EA 4452, IFR Santé STIC 100, Université de Bourgogne-Franche-Comté, France
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Ellsworth DL, Costantino NS, Blackburn HL, Engler RJM, Kashani M, Vernalis MN. Lifestyle modification interventions differing in intensity and dietary stringency improve insulin resistance through changes in lipoprotein profiles. Obes Sci Pract 2016; 2:282-292. [PMID: 27708845 PMCID: PMC5043634 DOI: 10.1002/osp4.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/03/2016] [Accepted: 06/25/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Metabolic dysfunction characterized by insulin resistance (IR) is an important risk factor for type‐2 diabetes and coronary artery disease (CAD). The aim of this study was to determine if clinical lifestyle interventions differing in scope and intensity improve IR, defined by the lipoprotein IR (LPIR) score, in individuals differing in the severity of metabolic dysfunction. Methods Subjects with diagnosed type‐2 diabetes, CAD or significant risk factors participated in one of two clinical lifestyle modification interventions: (i) intensive non‐randomized programme with a strict vegetarian diet (n = 90 participants, 90 matched controls) or (ii) moderate randomized trial following a Mediterranean‐style diet (n = 89 subjects, 58 controls). On‐treatment and intention‐to‐treat analyses assessed changes over 1 year in LPIR, lipoprotein profiles and metabolic risk factors in intervention participants and controls in both programmes. Results In the on‐treatment analysis, both interventions led to weight loss: [−8.9% (95% CI, −10.3 to −7.4), intensive programme; −2.8% (95% CI, −3.8 to −1.9), moderate programme; adjusted P < 0.001] and a decrease in the LPIR score [−13.3% (95% CI, −18.2 to −8.3), intensive; −8.8% (95% CI, −12.9 to −4.7), moderate; adjusted P < 0.01] compared with respective controls. Of the six lipoprotein parameters comprising LPIR, only large very‐low‐density lipoprotein particle concentrations decreased significantly in participants compared with controls in both programmes [−26.3% (95% CI, −43.0 to −9.6), intensive; −14.2% (95% CI, −27.4 to −1.0), moderate; P < 0.05]. Intention‐to‐treat analysis confirmed and strengthened the primary results. Conclusion A stringent lifestyle modification intervention with a vegetarian diet and a moderate lifestyle modification intervention following a Mediterranean diet were both effective for improving IR defined by the LPIR score.
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Affiliation(s)
- D L Ellsworth
- Integrative Cardiac Health Program Chan Soon-Shiong Institute of Molecular Medicine at Windber Windber PA USA
| | - N S Costantino
- Integrative Cardiac Health Program Chan Soon-Shiong Institute of Molecular Medicine at Windber Windber PA USA
| | - H L Blackburn
- Integrative Cardiac Health Program Chan Soon-Shiong Institute of Molecular Medicine at Windber Windber PA USA
| | - R J M Engler
- Integrative Cardiac Health Program Walter Reed National Military Medical Center Bethesda MD USA
| | - M Kashani
- Integrative Cardiac Health Program Walter Reed National Military Medical Center Bethesda MD USA
| | - M N Vernalis
- Integrative Cardiac Health Program Walter Reed National Military Medical Center Bethesda MD USA
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O'Donnell MP. Can Diabetes Prevention Improve Health and Save Medicare Money, Does Medicare Care Know, and Why Is This Important? Am J Health Promot 2016; 30:412-5. [PMID: 27445323 DOI: 10.1177/0890117116658442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Franklin BA, Brinks J. Cardiac Rehabilitation: Underrecognized/Underutilized. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:62. [PMID: 26526338 DOI: 10.1007/s11936-015-0422-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Unfortunately, too many patients continue to rely on costly coronary revascularization procedures, cardioprotective medications, or both, as first-line strategies to stabilize the course of coronary heart disease. However, these palliative therapies do not address the foundational or most proximal risk factors for coronary disease, that is, unhealthy dietary habits, physical inactivity, and cigarette smoking. Because most acute myocardial infarctions evolve from mild-to-moderate coronary artery stenosis (<70 % obstruction), rather than at the more severe obstructions that are commonly treated with coronary revascularization, these findings help explain the inability to demonstrate a reduction in acute cardiac events in most studies examining coronary artery bypass graft surgery and/or percutaneous coronary interventions. The delivery of comprehensive cardiovascular risk reduction, including exercise-based cardiac rehabilitation as an integral component, offers patients a bona fide treatment intervention to prevent recurrent cardiovascular events and the need for repeated revascularization procedures, while simultaneously providing referring physicians with ongoing surveillance data to potentially enhance their medical management.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA. .,Internal Medicine and Biomedical Engineering, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. .,Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI, 48073, USA.
| | - Jenna Brinks
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA.,Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI, 48073, USA
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Ellsworth DL, Mamula KA, Blackburn HL, McDyer FA, Jellema GL, van Laar R, Costantino NS, Engler RJM, Vernalis MN. Importance of substantial weight loss for altering gene expression during cardiovascular lifestyle modification. Obesity (Silver Spring) 2015; 23:1312-9. [PMID: 25960328 DOI: 10.1002/oby.21079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/13/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine relationships between weight loss through changes in lifestyle and peripheral blood gene expression profiles. METHODS A prospective nonrandomized trial was conducted over 1 year in participants undergoing intensive lifestyle modification to reverse or stabilize progression of coronary artery disease. Cardiovascular risk factors, inflammatory biomarkers, and gene expression as a function of weight loss were assessed in 89 lifestyle participants and 71 retrospectively matched controls undergoing usual care. RESULTS Substantial weight loss (-15.2 ± 3.8%) in lifestyle participants (n = 33) was associated with improvement in selected cardiovascular risk factors and significant changes in peripheral blood gene expression from pre- to post-intervention: 132 unique genes showed significant expression changes (false discovery rate corrected P-value <0.05 and fold-change ≥1.4). Altered molecular pathways were related to immune function and inflammatory responses involving endothelial activation. In contrast, participants losing minimal weight (-3.1 ± 2.5%, n = 32) showed only minor changes in cardiovascular risk factors and markers of inflammation and no changes in gene expression compared to non intervention controls after 1 year. CONCLUSIONS Weight loss (≥10%) during lifestyle modification is associated with down-regulation of genetic pathways governing interactions between circulating immune cells and the vascular endothelium and may be required to successfully reduce CVD risk.
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Affiliation(s)
- Darrell L Ellsworth
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Kimberly A Mamula
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Heather L Blackburn
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | | | | | - Ryan van Laar
- Bioinformatics Department, ChipDX LLC, New York, New York, USA
| | - Nicholas S Costantino
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Renata J M Engler
- Integrative Cardiac Health Program, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Marina N Vernalis
- Integrative Cardiac Health Program, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Blackburn HL, McErlean S, Jellema GL, van Laar R, Vernalis MN, Ellsworth DL. Gene expression profiling during intensive cardiovascular lifestyle modification: Relationships with vascular function and weight loss. GENOMICS DATA 2015; 4:50-3. [PMID: 26484175 PMCID: PMC4536023 DOI: 10.1016/j.gdata.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 11/26/2022]
Abstract
Heart disease and related sequelae are a leading cause of death and healthcare expenditure throughout the world. Although many patients opt for surgical interventions, lifestyle modification programs focusing on nutrition and exercise have shown substantial health benefits and are becoming increasing popular. We conducted a year-long lifestyle modification program to mediate cardiovascular risk through traditional risk factors and to investigate how molecular changes, if present, may contribute to long-term risk reduction. Here we describe the lifestyle intervention, including clinical and molecular data collected, and provide details of the experimental methods and quality control parameters for the gene expression data generated from participants and non-intervention controls. Our findings suggest successful and sustained modulation of gene expression through healthy lifestyle changes may have beneficial effects on vascular health that cannot be discerned from traditional risk factor profiles. The data are deposited in the Gene Expression Omnibus, series GSE46097 and GSE66175.
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Affiliation(s)
- Heather L. Blackburn
- Integrative Cardiac Health Program, Windber Research Institute, Windber, PA 15963, USA
| | | | | | | | - Marina N. Vernalis
- Integrative Cardiac Health Program, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Darrell L. Ellsworth
- Integrative Cardiac Health Program, Windber Research Institute, Windber, PA 15963, USA
- Corresponding author at: Windber Research Institute, 620 Seventh Street, Windber, PA 15963, USA. Tel.: + 1 814 361 6911.
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Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. ARTHRITIS 2015; 2015:708152. [PMID: 25815212 PMCID: PMC4359818 DOI: 10.1155/2015/708152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/10/2015] [Indexed: 12/16/2022]
Abstract
Objective. To evaluate the effectiveness of a whole-foods, plant-based diet (WFPB) to reduce symptoms of osteoarthritis. Methods. Six-week, prospective randomized open-label study of patients aged 19–70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure. Results. Forty participants were randomized. Thirty-seven of them, 18 control and 19 intervention, completed the study. The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality, physical functioning, role physical, and the physical component summary scale. The differences between the intervention and control PGIC scales were statistically significant over time. Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward. Conclusion. Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients.
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Sagner M, Katz D, Egger G, Lianov L, Schulz KH, Braman M, Behbod B, Phillips E, Dysinger W, Ornish D. Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community. Int J Clin Pract 2014; 68:1289-92. [PMID: 25348380 DOI: 10.1111/ijcp.12509] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/25/2014] [Indexed: 01/05/2023] Open
Affiliation(s)
- M Sagner
- European Society of Lifestyle Medicine, Paris, France
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Raghuram N, Parachuri VR, Swarnagowri MV, Babu S, Chaku R, Kulkarni R, Bhuyan B, Bhargav H, Nagendra HR. Yoga based cardiac rehabilitation after coronary artery bypass surgery: one-year results on LVEF, lipid profile and psychological states--a randomized controlled study. Indian Heart J 2014; 66:490-502. [PMID: 25443601 DOI: 10.1016/j.ihj.2014.08.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/14/2014] [Accepted: 08/11/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors. METHODS In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35-65 years) who satisfied the selection criteria and consented were randomized into two groups. Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively. RESULTS Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (≥23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ≥110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety. CONCLUSION Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence.
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Affiliation(s)
- Nagarathna Raghuram
- Dean, Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India.
| | - Venkateshwara Rao Parachuri
- Department of Cardiology, Narayana Hrudayalaya Institute of Cardiac Sciences, No. 258/A, Bommasandra Industrial Area, Hosur Road, Anekal Taluk, Karnataka, India
| | - M V Swarnagowri
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India
| | - Suresh Babu
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India; Department of Cardiology, Narayana Hrudayalaya Institute of Cardiac Sciences, No. 258/A, Bommasandra Industrial Area, Hosur Road, Anekal Taluk, Karnataka, India
| | - Ritu Chaku
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India
| | | | - Bhagavan Bhuyan
- Department of Cardiology, Narayana Hrudayalaya Institute of Cardiac Sciences, No. 258/A, Bommasandra Industrial Area, Hosur Road, Anekal Taluk, Karnataka, India
| | - Hemant Bhargav
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India
| | - Hongasandra Ramarao Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore, Karnataka, India
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Najafi F, Nalini M, Nikbakht MR. Changes in risk factors and exercise capacity after cardiac rehabilitation and its effect on hospital readmission. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e4899. [PMID: 25031860 PMCID: PMC4082520 DOI: 10.5812/ircmj.4899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 01/28/2013] [Accepted: 02/15/2014] [Indexed: 11/16/2022]
Abstract
Background: Despite the positive outcomes reported with cardiac rehabilitation (CR), its impacts have been reported to be different from a region or country to another, which may be due to the different contents of rehabilitation programs. Objectives: To investigate the effect of CR on cardiovascular risk factors. Patients and Methods: This is a retrospective cohort study on the data from Imam Ali Cardiac Rehabilitation Center in Kermanshah province, Iran from 2001 to 2008. We used paired t-test to evaluate the effect of CR on cardiovascular risk factors. Logistic regression or t-test (unequal variance) were used to assess the factors influencing re-admission (due to cardiac problems). The relationship between different variables and death was studied using univariate cox proportional hazard. P values < 0.05 were considered significant for all analyses. Results: Out of 504 patients who completed rehabilitation, a total of 499 were analyzed. These 499 patients consisted of 383 men and 116 women. All anthropometric measurements, blood lipids (except HDL cholesterol), systolic and diastolic blood pressure, depression, anxiety and exercise capacity improved after rehabilitation (P < 0.05 for all cases). The improvement was observed in both sexes. A total of 39 patients were re-admitted to hospital after rehabilitation. Being female (OR = 2.40; 95%CI: 1.22-4.68) and history of diabetes (OR = 2.04; 95%CI: 1.04-4.02) increased the risk of re-admission significantly. Patients who were readmitted had higher anthropometric measurements at the beginning and the end of the program. Moreover, the initial exercise capacity of readmitted patients was lower than those who were not readmitted. After a maximal follow-up period of 6.3 years (median = 2.99 years), only eight patients expired (survival rate: 97.5%; 95%CI: 94.7-98.8). None of the variables in our study was significantly related to the survival rate. Conclusions: The comprehensive CR program in Imam Ali Center efficiently reduces cardiovascular risk factors and improves exercise capacity.
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Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Authors: Mehdi Nalini, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel:+98-9183853465, Fax: +98-8318392834, E-mail: ; Farid Najafi, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel: +98-9183853465, Fax: +98-8318392834, E-mail:
| | - Mehdi Nalini
- Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Authors: Mehdi Nalini, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel:+98-9183853465, Fax: +98-8318392834, E-mail: ; Farid Najafi, Vice Chancellery of Research and Technology, Kermanshah University of Medical Sciences, Building No 2, Shahid Beheshti Blvd, Kermanshah, IR Iran, Tel: +98-9183853465, Fax: +98-8318392834, E-mail:
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Kim SS, Lee S, Kim G, Kang SM, Ahn JA. Effects of a comprehensive cardiac rehabilitation program in patients with coronary heart disease in Korea. Nurs Health Sci 2014; 16:476-82. [DOI: 10.1111/nhs.12155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/30/2014] [Accepted: 05/13/2014] [Indexed: 12/21/2022]
Affiliation(s)
- So-Sun Kim
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul Korea
| | - Sunhee Lee
- College of Nursing; The Catholic University of Korea; Seoul Korea
| | - GiYon Kim
- Department of Nursing; Yonsei University, Wonju College of Medicine; Wonju Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, College of Medicine; Yonsei University; Seoul Korea
| | - Jeong-Ah Ahn
- School of Nursing; Bouvé College of Health Sciences, Northeastern University; Boston Massachusetts USA
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Kent L, Morton D, Hurlow T, Rankin P, Hanna A, Diehl H. Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study. BMJ Open 2013; 3:e003751. [PMID: 24259389 PMCID: PMC3840335 DOI: 10.1136/bmjopen-2013-003751] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the long-term (three or more years) effectiveness of the volunteer-delivered Complete Health Improvement Program (CHIP) intervention. DESIGN Cohort study. SETTING Hawera, New Zealand. PARTICIPANTS Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age=64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration=49.2+10.4 months). INTERVENTION 30-day lifestyle modification programme (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting. MAIN OUTCOME MEASURES Changes in body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG). RESULTS After approximately 4 years, participants with elevated biometrics at programme entry maintained significantly lowered BMI (-3.2%; 34.8±5.4 vs 33.7±5.3 kg/m(2), p=0.02), DBP (-9.4%; 89.1±4.1 vs 80.8±12.6 mm Hg, p=0.005), TC (-5.5%; 6.1±0.7 vs 5.8±1.0 mmol/L, p=0.04) and TG (-27.5%; 2.4±0.8 vs 1.7±0.7 mmol/L, p=0.002). SBP, HDL, LDL and FPG were not significantly different from baseline. Participants with elevated baseline biometrics who reported being compliant to the lifestyle principles promoted in the intervention (N=71, 67% of follow-up participants) recorded further reductions in BMI (-4.2%; 34.8±4.5 vs 33.4±4.8 kg/m(2), p=0.02), DBP (-13.3%; 88.3±3.2 vs 77.1±12.1 mm Hg, p=0.005) and FPG (-10.4%; 7.0±1.5 vs 6.3±1.3 mmol/L, p=0.02). CONCLUSIONS Individuals who returned for follow-up assessment and entered the CHIP lifestyle intervention with elevated risk factors were able to maintain improvements in most biometrics for more than 3 years. The results suggest that the community-based CHIP lifestyle intervention can be effective in the longer term, even when delivered by volunteers.
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Affiliation(s)
- Lillian Kent
- Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Darren Morton
- Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Trevor Hurlow
- Waratah Medical Services, Morisset, New South Wales, Australia
| | - Paul Rankin
- Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Althea Hanna
- Department of Health, New Zealand Pacific Union Conference, Auckland, New Zealand
| | - Hans Diehl
- Lifestyle Medicine Institute, Loma Linda, California, USA
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Adapting and RE-AIMing a heart disease prevention program for older women with diabetes. Transl Behav Med 2013; 2:180-7. [PMID: 24073110 DOI: 10.1007/s13142-012-0118-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials-the Mediterranean Lifestyle Program and ¡Viva Bien!. Results from these two trials, including readiness for dissemination, are evaluated using the RE-AIM framework in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Program adaptations produced relative high reach as well as consistent and replicated effectiveness and maintenance, and were adopted by a high percentage of primary care offices and clinicians approached. We discuss key findings, lessons learned, future directions for related research, and use of RE-AIM for program development, adaptation, scale-up, and evaluation.
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Estruch R, Ros E, Martínez-González MA. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med 2013; 369:675-6. [PMID: 23944307 DOI: 10.1056/nejmc1306659] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Review on depression and coronary heart disease. Arch Cardiovasc Dis 2013; 106:103-10. [PMID: 23527914 DOI: 10.1016/j.acvd.2012.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/15/2022]
Abstract
The impact of psychological factors on somatic disorders - and vice versa - and the involvement of biological mechanisms in psychic disorders have generated considerable interest in recent years, notably thanks to cutting-edge investigation techniques (immunohistochemistry, functional imaging, genetics, etc.). In the field of psychosomatics, coronary heart disease (CHD) is a frequent co-morbidity of mental disorders, particularly mood disorders. Indeed, there is a bidirectional relationship between CHD and mood disorders, with a strong co-occurrence of the two diseases accompanied by a reciprocal worsening of the prognosis for the two conditions. Various epidemiological studies have shown that depression is a psychic risk factor for CHD and that CHD is present in almost 30% of patients with affective disorders. In this review of the literature, we tackle the crucial question of the diagnosis of depression during myocardial infarction. This clinical approach is essential given the underevaluation of this psychic problem. Then, various psychological, biological and genetic arguments are presented in support of the hypothesis that various aetiological mechanisms of the two disorders are partly shared. We finally deal with the treatment of depression in the context of CHD with its pharmacological and psychological specificities. In conclusion, this review reiterates the need for a multidisciplinary approach, which is necessary to understand, diagnose and then treat this frequent co-morbid condition of heart disease and depression.
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What patients want: relevant health information technology for diabetes self-management. HEALTH AND TECHNOLOGY 2012. [DOI: 10.1007/s12553-012-0022-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Development of a Smart e-Health Portal for Chronic Disease Management. ALGORITHMS AND ARCHITECTURES FOR PARALLEL PROCESSING 2012. [DOI: 10.1007/978-3-642-33065-0_30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ricanati EH, Golubić M, Yang D, Saager L, Mascha EJ, Roizen MF. Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program. Nutr Metab (Lond) 2011; 8:83. [PMID: 22112436 PMCID: PMC3264524 DOI: 10.1186/1743-7075-8-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/23/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases. METHODS Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months. RESULTS Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications. CONCLUSION Implementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.
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Affiliation(s)
- Elizabeth Hw Ricanati
- Wellness Institute, Cleveland Clinic, 1950 Richmond Road, TR2-341, Lyndhurst, OH 44124, USA.
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O'Donnell MP, Bensky JM. Integrating wellness into hospital systems. Am J Health Promot 2011; 26:TAHP1-TAHP14. [PMID: 22040401 DOI: 10.4278/ajhp.26.2.tahp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Toobert DJ, Strycker LA, King DK, Barrera M, Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Transl Behav Med 2011; 1:416-426. [PMID: 22022345 PMCID: PMC3196590 DOI: 10.1007/s13142-010-0011-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended longterm lifestyle changes and reduce heart disease risk. To test the longer-term (24-month) effects of a previously successful, culturally adapted, multiple-healthbehavior- change program, ¡Viva Bien!, 280 Latinas were randomly assigned to usual care or ¡Viva Bien!. Treatment included group meetings to promote a culturally adapted Mediterranean diet, physical activity, supportive resources, problem solving, stress-management practices, and smoking cessation. ¡Viva Bien! participants achieved and maintained some lifestyle improvements from baseline through 24 months, including significant improvements for psychosocial outcomes, fat intake, social-environmental support, body mass index, and hemoglobin A1c. Effects tended to diminish over time. The ¡Viva Bien! multiple-behavior program was effective in improving and maintaining some psychosocial, behavioral, and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes, a high-risk, underserved population (ClinicalTrials.gov number, NCT00233259).
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Affiliation(s)
- Deborah J Toobert
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Lisa A Strycker
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Diane K King
- />Institute for Health Research Address Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Manuel Barrera
- />Psychology Department, Arizona State University, Box 871104, Tempe, AZ 85287-1104 USA
| | - Diego Osuna
- />University of Colorado Health Sciences Center, Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Russell E Glasgow
- />Dissemination and Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., Room 6144, Rockville, MD 20852 USA
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