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Choi SB, Kim JH. Relationship Between Number of Cardiac Rehabilitation Exercise Training Sessions, Muscle Mass, and Cardiorespiratory Fitness in Rural Elderly Patients with Coronary Artery Disease. J Multidiscip Healthc 2023; 16:3309-3318. [PMID: 37954469 PMCID: PMC10638896 DOI: 10.2147/jmdh.s434056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose This study aimed to compare the effects of a cardiac rehabilitation (CR) exercise program on skeletal muscle index (SMI) and cardiorespiratory fitness (CRF) in patients aged ≥65 years. Patients and Methods From January 2012 to December 2021, patients living in rural regions aged ≥65 who underwent percutaneous coronary intervention for acute myocardial infarction (AMI) and at least one CR exercise session were enrolled. We retrospectively reviewed the medical records of the patients who underwent an exercise tolerance test (ETT) at initial and 3-month follow-ups. A total of 36 patients were enrolled who underwent a mean of 6.56 exercise sessions and were divided into groups based on the number of center-based CR (CBCR) sessions: 14 in Group A (≥7 sessions) and 22 in Group B (<7 sessions). In CBCR session, we comprehensively counseled them about their nutrition, smoking cessation et al. Both groups underwent an ETT after 12 weeks. The outcomes were CRF parameters examined by a cardiorespiratory exercise test and the SMI examined by bioimpedance analysis (BIA). Results The number of exercise sessions was significantly correlated with the rate of SMI change. Group A showed significant increases in metabolic equivalent of task (MET), maximal oxygen uptake (VO2max), and SMI after 3 months. There were significant differences in the rates of change in MET, VO2max, and SMI between the two groups. Conclusion CRF significantly improved in Group A in a short period. Further studies are required to increase long-term CBCR adherence in elderly patients with AMI in rural regions.
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Affiliation(s)
- Seong Bok Choi
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Hospital, Iksan-si, Republic of Korea
| | - Ji Hee Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Hospital, Iksan-si, Republic of Korea
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Zeng CM, Zhao YM, Li YY, Gan RR, Ling Z, Li P. The effects of rate pressure product at admission on cardiopulmonary function during hospitalization in patients with acute myocardial infarction. Postgrad Med 2023; 135:803-808. [PMID: 37864567 DOI: 10.1080/00325481.2023.2274306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE This study aimed to analyze the correlation between the rate pressure product (RPP) and cardiopulmonary function during hospitalization in patients with acute myocardial infarction (AMI). METHODS A total of 362 patients with AMI were selected for the study, and the median admission RPP was used as the cutoff point to divide the patients into a low-RPP group (n = 181) and a high-RPP group (n = 181). The relationship between the RPP at admission and the cardiopulmonary function during hospitalization was analyzed. RESULTS The patients in the high-RPP group had a higher body mass index (BMI) (p = 0.014), a higher prevalence of combined hypertension and diabetes mellitus (p < 0.001), a lower incidence of smoking (p = 0.044), and a higher incidence of oscillatory ventilation (6.1% vs. 1.7%, p = 0.029). The differences in RPP at rest, during warm-up, and within 1 and 4 minutes of recovery were statistically significant between the two groups (p < 0.01 on each occasion), while the differences in anaerobic threshold (AT) and watt max (Max) were not statistically significant (p > 0.05 for both). The patients in the low-RPP group had higher oxygen uptake (VO2 [AT]: 14.9 ± 3.4 vs. 14.2 ± 3.6, p = 0.048) and (VO2peak [Max]:18.2 ± 3.8 vs. 17.3 ± 3.8, p = 0.020). The RPP at admission was negatively correlated with VO2 (AT) and VO2peak (p < 0.05) using the regression Equation VO2peak = 33.682 + (-0.012 * RPP at admission/100) + (-0.105 * Age) + (-0.350 * BMI), while there was no correlation between the RPP at admission and VO2 (AT) (p = 0.149). CONCLUSION The RPP at admission was negatively correlated with cardiopulmonary function during hospitalization in patients with AMI. Patients with a high RPP were more likely to have a combination of obesity, hypertension, diabetes mellitus, and reduced oxygen uptake during exercise, while a high RPP at admission appeared to affect their cardiovascular response indicators during exercise.
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Affiliation(s)
- Chun-Mei Zeng
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
| | - Yan-Mei Zhao
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
| | - Yi-Yi Li
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
| | - Rong-Rong Gan
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
| | - Zheng Ling
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
| | - Ping Li
- Department of Cardiology, Yulin First People's Hospital (The Sixth Affiliated Hospital of Guangxi Medical University), Yulin, Guangxi, China
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Ghodrati N, Haghighi AH, Hosseini Kakhak SA, Abbasian S, Goldfield GS. Effect of Combined Exercise Training on Physical and Cognitive Function in Women With Type 2 Diabetes. Can J Diabetes 2023; 47:162-170. [PMID: 36572617 DOI: 10.1016/j.jcjd.2022.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES One of the consequences of old age is cognitive and physical decline, which can cause a wide range of problems. These complications are more pronounced in those with type 2 diabetes (T2D). The aim of this pilot study was to investigate the effect of combined exercise training on blood biomarkers, physical fitness, and cognitive function in elderly women with T2D. METHODS Twenty-one elderly women with T2D were randomly allocated to training (n=12) and control (n=9) groups. The exercise training program was a combination of aerobic, resistance, and balance exercises performed 3 times per week over 12 weeks. In the same period, the control group received no training intervention. Blood markers, including brain-derived neurotrophic factor (BDNF), irisin, glycated hemoglobin (A1C), fasting blood sugar (FBS), cardiorespiratory fitness (CRF), lower and upper body strength, and cognitive function, were measured in all participants at baseline and after 12 weeks. RESULTS Serum BDNF levels were not significantly different between the exercise and control groups at 12 weeks (p>0.05). FBS and A1C levels in the exercise group decreased significantly compared with the control group (p<0.05). CRF, dynamic balance, and both upper and lower body strength in the exercise group improved significantly compared with the control group (p<0.05). Irisin levels decreased significantly in the control group, but levels did not change significantly in the exercise group. Greater improvements from exercise were observed on the Montreal Cognitive Assessment index compared with the control group (p=0.05), but no other group differences in cognitive function were noted. CONCLUSIONS Combined exercise improved some physical fitness and diabetes-related surrogate factors, as well as select cognitive functions, but had no significant effect on cognition-related biochemical factors (i.e. BDNF) in women with T2D.
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Affiliation(s)
- Nafiseh Ghodrati
- Department of Exercise Physiology, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Amir Hossein Haghighi
- Department of Exercise Physiology, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran.
| | - Seyed Alireza Hosseini Kakhak
- Department of Exercise Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad and Hakim Sabzevari University, Sabzevar, Iran
| | - Sadegh Abbasian
- Department of Sport Sciences, Khavaran Institute of Higher Education, Mashhad, Iran
| | - Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Gil CP, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’tHof AWJ, de Kluiver EP, Wilhelm M. Predictors for one-year outcomes of cardiorespiratory fitness and cardiovascular risk factor control after cardiac rehabilitation in elderly patients: The EU-CaRE study. PLoS One 2021; 16:e0255472. [PMID: 34351942 PMCID: PMC8341663 DOI: 10.1371/journal.pone.0255472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Studies on effectiveness of cardiac rehabilitation (CR) in elderly cardiovascular disease patients are rare, and it is unknown, which patients benefit most. We aimed to identify predictors for 1-year outcomes of cardiorespiratory fitness and CV risk factor (CVRF) control in patients after completing CR programs offered across seven European countries. METHODS Cardiovascular disease patients with minimal age 65 years who participated in comprehensive CR were included in this observational study. Peak oxygen uptake (VO2), body mass index (BMI), resting systolic blood pressure (BPsys), and low-density lipoprotein-cholesterol (LDL-C) were assessed before CR (T0), at termination of CR (T1), and 12 months after start of CR (T2). Predictors for changes were identified by multivariate regression models. RESULTS Data was available from 1241 out of 1633 EU-CaRE patients. The strongest predictor for improvement in peak VO2 was open chest surgery, with a nearly four-fold increase in surgery compared to non-surgery patients. In patients after surgery, age, female sex, physical inactivity and time from index event to T0 were negative predictors for improvement in peak VO2. In patients without surgery, previous acute coronary syndrome and higher exercise capacity at T0 were the only negative predictors. Neither number of attended training sessions nor duration of CR were significantly associated with change in peak VO2. Non-surgery patients were more likely to achieve risk factor targets (BPsys, LDL-C, BMI) than surgery patients. CONCLUSIONS In a previously understudied population of elderly CR patients, time between index event and start of CR in surgery and disease severity in non-surgery patients were the most important predictors for long-term improvement of peak VO2. Non-surgery patients had better CVRF control.
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, SERGAS, FIDIS, CIBER CV, University of Santiago de Compostela, A Coruña, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Arnoud W. J. Van’tHof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Cardiac Rehabilitation and Complementary Physical Training in Elderly Patients after Acute Coronary Syndrome: A Pilot Study. ACTA ACUST UNITED AC 2021; 57:medicina57060529. [PMID: 34070257 PMCID: PMC8225116 DOI: 10.3390/medicina57060529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Nearly 23% of elderly patients hospitalized due to acute coronary syndrome have reduced muscle strength. It is assumed that these patients would better benefit from a complex training—a combination of endurance, strength, balance, coordination, and flexibility—in order to reduce the loss of muscle strength and mass and improve functional capacity. The aim of this study was to assess the effectiveness and safety of two different complementary resistance and balance training programs during short-term cardiac rehabilitation (CR) in elderly patients after a percutaneous or surgical intervention due to acute coronary syndrome. Materials and Methods: This randomized controlled trial was conducted from January 2020 to February 2021 in one Lithuanian rehabilitation hospital. A total of 63 participants who met the inclusion criteria were randomly assigned to three groups (at the ratio of 1:1:1): control (CG, n = 19), intervention 1 (IG-1, n = 26), and intervention 2 (IG-2, n = 18). All the patients attended a usual inpatient CR program of a mean duration of 18.7 ± 1.7 days, while the patients assigned to the intervention groups (IG-1 and IG-2) additionally received different resistance and balance training programs three days a week. Functional capacity, with 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET), as well as physical performance, with the short physical performance battery (SPPB) test and one repetition maximum test (1RM) for leg press, were assessed at baseline and after CR. Results: The mean age of the participants was 72.9 ± 5.5 years; 73% were men. All parameters of functional capacity and physical performance improved significantly after CR (p < 0.05), except for peak VO2 that improved only in the IG-1. Comparison of CR effectiveness among the groups revealed no significant differences. Conclusions: All three rehabilitation programs were safe and well tolerated by elderly patients aged ≥65 years as well as improved functional capacity (6-minute walk distance and peak workload) and physical performance (SPPB and 1RM). Complementary resistance and balance training with traditional physical therapy means and exercises with mechanical devices did not show greater benefits for the results of physical performance compared with the usual CR program.
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Baek S, Ha Y, Mok J, Park HW, Son HR, Jin MS. Community-Based Cardiac Rehabilitation Conducted in a Public Health Center in South Korea: A Preliminary Study. Ann Rehabil Med 2020; 44:481-492. [PMID: 33440096 PMCID: PMC7808795 DOI: 10.5535/arm.20084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the safety and effectiveness of the community-based cardiac rehabilitation (CBCR) program that we had developed. METHODS Individuals aged >40 years with cardiovascular disease or its risk factors who were residing in a rural area were recruited as study subjects. The CBCR program, which consisted of 10 education sessions and 20 weeks of customized exercises (twice a week), was conducted in a public health center for 22 weeks. Comprehensive outcomes including body weight, blood glucose level, and 6-minute walk distance (6MWD) were measured at baseline, 11th week, and completion. Furthermore, the outcomes of young-old (65-74 years) and old-old (≥75 years) female subjects were compared. RESULTS Of 31 subjects, 21 completed the program (completion rate, 67.7%). No adverse events were observed, and none of the subjects discontinued the exercise program because of chest pain, dyspnea, and increased blood pressure. Body weight and blood glucose level were significantly decreased, and 6MWD was significantly increased following program implementation (p<0.05). Both young-old and old-old women exhibited an improvement in blood glucose level and 6MWD test (p<0.05). CONCLUSION We reported the results of the first attempted CBCR in South Korea that was implemented without adverse events during the entire program. Improved aerobic exercise ability and reduced risk factors in all participants were observed. These improvements were also achieved by older adults aged ≥75 years.
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Affiliation(s)
- Sora Baek
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yuncheol Ha
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jaemin Mok
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Division of Public Health, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee-won Park
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyo-Rim Son
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon-gun, Korea
| | - Mi-Suk Jin
- Hongcheon Public Health Center, Hongcheon-gun, Korea
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Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements: A MULTISITE STUDY. J Cardiopulm Rehabil Prev 2020; 41:243-248. [PMID: 32947326 DOI: 10.1097/hcr.0000000000000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated. METHODS Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity. RESULTS Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = -15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23). CONCLUSIONS This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.
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