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Mazzoni G, Raisi A, Myers J, Arena R, Kaminsky L, Zerbini V, Lordi R, Chiaranda G, Mandini S, Sella G, Tonet E, Campo G, Grazzi G. Promotion and maintenance of physically active lifestyle in older outpatients 2 years after acute coronary syndrome. Aging Clin Exp Res 2022; 34:1065-1072. [PMID: 34997543 DOI: 10.1007/s40520-021-02044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
AIMS To examine long-term changes in lifestyle and exercise capacity of older patients hospitalized for acute coronary syndrome (ACS) involved in an innovative centre- and home-based exercise-based secondary prevention program. METHODS A sample of 118 patients with ACS (age 76 [72-80] years) was analysed. Long-term changes in self-reported weekly leisure-time physical activity (wLTPA), walking speed (WS), and estimated cardiorespiratory fitness (eCRF, VO2peak, mL/kg/min) were the outcome variables. The program consisted of seven individual on-site sessions including motivational interviewing to reach exercise goals. Exercise prescription was based on the results of a standardized moderate and perceptually regulated treadmill walk to estimate VO2peak. wLTPA, WS, and eCRF were assessed at 1 (baseline), 2, 3, 4, 6, 12, and 24 months after discharge. RESULTS 87, 76, and 70 patients completed follow-up at 6, 12, and 24 months, respectively. wLTPA significantly increased during the follow-up period (median METs/H/week 2.5, 11.2, 12.0, and 13.4 at baseline, 6, 12, and 24 months, respectively; P < 0.0001). At baseline, 18% of the sample met the current international guidelines for physical activity, while 75%, 70%, and 76% of them met the recommended values at 6-, 12-, and 24-month follow-up sessions, respectively. These results were associated with increasing median WS (2.9 ± 1.0, 4.3 ± 1.2, 4.5 ± 1.1, 4.5 ± 1.2 km/h, respectively, P < 0.0001), and VO2peak (16.5, 21.4, 21.1, 21.3 mL/kg/min, respectively, P < 0.0001). CONCLUSIONS This early, individualized exercise intervention improved long-term adherence to a physically active lifestyle, walking capacity, and eCRF in older patients after ACS. Larger studies are needed to confirm short- and long-term clinical benefits of this intervention.
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Affiliation(s)
- Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy.
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leonard Kaminsky
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Valentina Zerbini
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - Rosario Lordi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Public Health Department, AUSL Piacenza, Piacenza, Italy
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | | | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
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Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol 2019; 27:367-377. [PMID: 31787026 DOI: 10.1177/2047487319892201] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. OBJECTIVE The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. METHODS Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. RESULTS Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups (Ptime > 0.05 for all), irrespective of the intervention (Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity (Ptime < 0.05). No interaction effect was found for physical activity. CONCLUSION Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942.
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Affiliation(s)
- Andrea Avila
- Department of Rehabilitation Science, KU Leuven, Belgium
| | - Jomme Claes
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Roselien Buys
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - May Azzawi
- Cardiovascular Research Group, Manchester Metropolitan University, UK
| | - Luc Vanhees
- Department of Rehabilitation Science, KU Leuven, Belgium
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Livitckaia K, Koutkias V, Kouidi E, van Gils M, Maglaveras N, Chouvarda I. "OPTImAL": an ontology for patient adherence modeling in physical activity domain. BMC Med Inform Decis Mak 2019; 19:92. [PMID: 31023322 PMCID: PMC6485069 DOI: 10.1186/s12911-019-0809-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintaining physical fitness is a crucial component of the therapeutic process for patients with cardiovascular disease (CVD). Despite the known importance of being physically active, patient adherence to exercise, both in daily life and during cardiac rehabilitation (CR), is low. Patient adherence is frequently composed of numerous determinants associated with different patient aspects (e.g., psychological, clinical, etc.). Understanding the influence of such determinants is a central component of developing personalized interventions to improve or maintain patient adherence. Medical research produced evidence regarding factors affecting patients' adherence to physical activity regimen. However, the heterogeneity of the available data is a significant challenge for knowledge reusability. Ontologies constitute one of the methods applied for efficient knowledge sharing and reuse. In this paper, we are proposing an ontology called OPTImAL, focusing on CVD patient adherence to physical activity and exercise training. METHODS OPTImAL was developed following the Ontology Development 101 methodology and refined based on the NeOn framework. First, we defined the ontology specification (i.e., purpose, scope, target users, etc.). Then, we elicited domain knowledge based on the published studies. Further, the model was conceptualized, formalized and implemented, while the developed ontology was validated for its consistency. An independent cardiologist and three CR trainers evaluated the ontology for its appropriateness and usefulness. RESULTS We developed a formal model that includes 142 classes, ten object properties, and 371 individuals, that describes the relations of different factors of CVD patient profile to adherence and adherence quality, as well as the associated types and dimensions of physical activity and exercise. 2637 logical axioms were constructed to comprise the overall concepts that the ontology defines. The ontology was successfully validated for its consistency and preliminary evaluated for its appropriateness and usefulness in medical practice. CONCLUSIONS OPTImAL describes relations of 320 factors originated from 60 multidimensional aspects (e.g., social, clinical, psychological, etc.) affecting CVD patient adherence to physical activity and exercise. The formal model is evidence-based and can serve as a knowledge tool in the practice of cardiac rehabilitation experts, supporting the process of activity regimen recommendation for better patient adherence.
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Affiliation(s)
- Kristina Livitckaia
- Lab of Computing, Medical Informatics & Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Vassilis Koutkias
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thermi, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, School of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd, Tampere, Finland
| | - Nikolaos Maglaveras
- Lab of Computing, Medical Informatics & Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Industrial Engineering and Management Sciences, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL, USA
| | - Ioanna Chouvarda
- Lab of Computing, Medical Informatics & Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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