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Piaggi G, Paneroni M, Maestri R, Salvioni E, Corrà U, Caporotondi A, Scalvini S, Agostoni P, La Rovere MT. Estimating maximum work rate during cardiopulmonary exercise testing from the six-minute walk distance in patients with heart failure. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200247. [PMID: 38496329 PMCID: PMC10943044 DOI: 10.1016/j.ijcrp.2024.200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Background Exercise is recommended for patients with chronic heart failure (CHF) and its intensity is usually set as a percentage of the maximal work rate (MWR) during cardiopulmonary exercise testing (CPX) or a symptom-limited incremental test (SLIT). As these tests are not always available in cardiac rehabilitation due to logistic/cost constraints, we aimed to develop a predictive model to estimate MWR at CPX (estMWR@CPX) in CHF patients using anthropometric and clinical measures and the 6-min walk test (6 MWT), the most widely used exercise field test. Methods This is a multicentre cross-sectional retrospective study in a cardiac rehabilitation setting. Six hundred patients with HF in New York Heart Association (NYHA) functional class I-III underwent both CPX and 6 MWT and, through multivariable linear regression analysis, we defined several predictive models to define estMWR@CPX. Results The best model included 6 MWT, sex, age, weight, NYHA class, left ventricular ejection fraction (LVEF), smoking status and chronic obstructive pulmonary disease COPD (adjusted R2 = 0.55; 95% LoA -39 to 33 W). When LVEF was excluded as a predictor, the resulting model performed only slightly worse (adjusted R2 = 0.54; 95% LoA -42 to 34 W). Only in 34% of cases was the percentage difference between estMWR@CPX and real MWR@CPX <10% in absolute value. EstMWR@CPX tended to overestimate low values and underestimate high values of true MWR@CPX. Conclusions Our results showed a lack of accuracy in the predictive model evaluated; therefore, for an accurate prescription of cycle-ergometer exercise training, it is necessary to assess MWR by CPX or SLIT.
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Affiliation(s)
- Giancarlo Piaggi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory and Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Cardio-Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Biomedical Engineering of the Institute of Montescano, Pavia, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiac Rehabilitation of the Institute of Veruno, Novara, Italy
| | - Angelo Caporotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
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Cotie LM, Vanzella LM, Pakosh M, Ghisi GLDM. A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps. Can J Cardiol 2024; 40:330-346. [PMID: 38376955 DOI: 10.1016/j.cjca.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND After 2020, clinical practice recommendations have been released to inform cardiac rehabilitation (CR) programs of best practices for post-COVID programming. The objective of this systematic review was to identify and summarize recommendations from clinical practice guidelines (CPGs) and consensus statements for CR delivery postpandemic. METHODS Five databases (March 2020 through April 2023), grey literature and Web sites of CR international associations were searched. Inclusion criteria were local, national, and international association-endorsed CPGs, and/or position, expert, and scientific statements related to CR delivery (program models, program elements, and core components). Two researchers independently screened the citations for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE) II was used for quality assessment. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guidelines. RESULTS Overall, 4890 records were identified; 4 CPGs, 9 position/scientific statements, and 6 expert/Delphi consensus papers were included. All guidelines/statements included information related to program delivery models, with 95% endorsing the use of virtual, hybrid, home-based, and telerehabilitation, especially during the pandemic. Outside of the context of COVID-19, program components including referral, CR indications, CR contraindications, timing, and structure were included in the 4 CPGs and 2 of 15 statements. Recommendations related to CR core components were primarily focused on exercise, with no changes since before the pandemic except for COVID-19 considerations for safety. One guideline was specific to women, and 1 scientific statement to heart failure with preserved ejection fraction. CONCLUSIONS Although 19 documents were identified, CR delivery in low resource settings and for culturally and linguistically diverse populations require attention. Additionally, few recommendations on nutrition, psychosocial counselling, and patient education were reported.
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Affiliation(s)
- Lisa M Cotie
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| | - Lais M Vanzella
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library and Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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3
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Kirsch M, Iliou MC, Vitiello D. Hemodynamic Response to Exercise Training in Heart Failure With Reduced Ejection Fraction Patients. Cardiol Res 2024; 15:18-28. [PMID: 38464706 PMCID: PMC10923260 DOI: 10.14740/cr1591] [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: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Background Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Methods Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O2peak). Results There were statistically significant differences in V̇O2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (COpeak) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by COpeak (ROC AUC = 0.77, P < 0.0001). Conclusion V̇O2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.
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Affiliation(s)
- Marine Kirsch
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hopital Corentin Celton, APHP Centre, France
| | - Damien Vitiello
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
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4
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Colas C, Le Berre Y, Fanget M, Savall A, Killian M, Goujon I, Labeix P, Bayle M, Féasson L, Roche F, Hupin D. Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6513. [PMID: 37569053 PMCID: PMC10418371 DOI: 10.3390/ijerph20156513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared to two control groups composed of coronary artery disease (n = 38) and fibromyalgia patients (n = 38), two populations for whom exercise benefits are well known. Efficacy of exercise training was assessed by a cardiopulmonary exercise test, a handgrip force test, and a supine heart rate variability recording at rest before and after the rehabilitation program. Cardiorespiratory and muscular parameters were enhanced after exercise rehabilitation in the three groups (p < 0.001). No significant difference was observed for the autonomic variables. Through this comparative study with control groups, we confirm and reinforce the interest of caring for long COVID patients without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training, by personalizing the program to the patient and symptoms.
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Affiliation(s)
- Claire Colas
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
| | - Yann Le Berre
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- Jacques Lisfranc Medicine Faculty, Jean Monnet University, 42000 Saint-Etienne, France
| | - Marie Fanget
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
| | - Angélique Savall
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
- Department of Education and Research in General Practice, Jean Monnet University, 42000 Saint-Etienne, France
| | - Martin Killian
- Department of Internal Medicine, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Team GIMAP, Jean Monnet University, Claude Bernard Lyon 1 University, Inserm, U1111, CNRS, UMR530, 42000 Saint-Etienne, France
- CIC 1408 Inserm, University Hospital Centre of Saint-Etienne, 42000 Saint-Etienne, France
| | - Ivan Goujon
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
| | - Pierre Labeix
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
| | - Manon Bayle
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
| | - Léonard Féasson
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- Inter-University Laboratory of Human Movement Biology, EA 7424, Jean Monnet University, 42000 Saint-Etienne, France
| | - Frederic Roche
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
| | - David Hupin
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42000 Saint-Etienne, France
- INSERM, U1059, DVH Team, SAINBIOSE, Jean Monnet University, 42000 Saint-Etienne, France
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5
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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6
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Zhang S, Ding R, Chen S, Meng X, Jianchao L, Wang DW, Hu D. Availability and trend of dissemination of cardiac rehabilitation in China: report from the multicenter national registration platform between 2012 and 2021. Front Cardiovasc Med 2023; 10:1210068. [PMID: 37404729 PMCID: PMC10315840 DOI: 10.3389/fcvm.2023.1210068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
The study aimed to evaluate the current status of cardiac rehabilitation programs in China by registering and tracking patients undergoing CR programs in the database. Data were extracted from the online registry platform of the China Society of Cardiopulmonary Prevention and Rehabilitation from February 2012 to December 2021. Overall, data on 19,896 patients with cardiovascular diseases (CVDs) from 159 hospitals in 34 provinces of China were extracted. From a time point of view, the number of patients who had undergone CR and institutions that perform CR showed the first decline in 2009 and then increased until 2021. From a geographic point of view, the degree of participation varied greatly among regions, most of which were concentrated in eastern parts of China. A higher population of patients who underwent CR were male, aged less than 60 years, with low-a risk for coronary heart disease (CHD), and tended to choose the hospital-based CR program among all cases registered in the database. The top three diseases in the patients who participated in CR were CHD, hypertension, and metabolic syndrome (MS). Centers with CR were more likely to be tertiary-level hospitals. After adjusting for baseline values, there were significant differences in post-CR exercise capacity among the three groups (home-based CR group, hospital-based CR group, and hybrid CR group), which were in favor of the hybrid CR group compared with other groups. The underutilization of CR is a global issue, not just in China. Despite the number of CR programs showing an increasing trend in the past years, CR in China is still in the preliminary stage of development. Furthermore, the participation of CR in China shows wide diversity across geography, disease, age, sex, risk stratification, and hospital-level factors. These findings reinforce the importance of the implementation of effective measures to improve the participation, enrollment in, and uptake of cardiac rehabilitation.
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Affiliation(s)
- Sisi Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongjing Ding
- Department of Rehabilitation, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sikun Chen
- Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoping Meng
- Department of Cardiology and Cardiac Rehabilitation, The Affiliated Hospital of Traditional Chinese Medicine, Changchun, China
| | - Li Jianchao
- School of Engineering Medicine, Beijing Advanced Innovation for Biomedical Engineering, Beihang University, Beijing, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dayi Hu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Kirsch M, Feriel M, Aurelia LT, Oksana K, Christophe BJ, François L, Pascal C, Vitiello D, Marie-Christine I. Impact of training on combined cardiopulmonary exercise test with stress echocardiography parameters in HFrEF patients. Int J Cardiol 2023; 371:252-258. [PMID: 36162522 DOI: 10.1016/j.ijcard.2022.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/20/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation is recognized to improve quality of life in heart failure patients. However, the effects on the cardiac function are understudied. The main objective was to assess the impact of a 4-week cardiac rehabilitation program on cardiopulmonary exercise testing (CPET) combined with simultaneous echocardiography parameters in chronic heart failure (CHF) patients. The secondary aim was to investigate patients' responses to training. METHODS Forty-one CHF patients with reduced ejection fraction (29.3 ± 0.1%) underwent CPET and stress echocardiography before and after a 4-week of exercise-training program. Blood parameters, echocardiography and cardiopulmonary parameters were assessed before and after training. Potential echocardiography derived predictive parameters like left and right contractile reserves, left ventricle elastance, end systolic volume and right ventricle S wave response to exercise were also assessed. RESULTS The training program increased the peak oxygen consumption (VO2) (P < 0.001), the peak systolic blood pressure, the left ventricular outflow tract velocity time integral (P < 0.05) and the circulatory (P < 0.001) and ventilatory (P < 0.01) powers. It also decreased the VE/VCO2 slope (P < 0.001). As the median value of peak VO2 gain was 17%, patients above this value were considered as responders and patients below as non-responders to training. The responders presented a higher left ventricle contractile reserve compared to non-responder patients. The peak left ventricle elastance and peak right ventricle S wave response tended to be higher in responders. CONCLUSION Combination of CPET and stress echocardiography may contribute to establish the disease severity stratification and to predict response to training in CHF patients with reduced ejection fraction.
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Affiliation(s)
- Marine Kirsch
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France
| | - Moatemri Feriel
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Lamar Tanguy Aurelia
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Kovalska Oksana
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Blanchard Jean Christophe
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Ledru François
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Cristofini Pascal
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
| | - Damien Vitiello
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France.
| | - Iliou Marie-Christine
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France; Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, APHP Centre, France
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8
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Pack QR, Shea M, Brawner CA, Headley S, Hutchinson J, Madera H, Keteyian SJ. Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation: A NATIONAL SURVEY. J Cardiopulm Rehabil Prev 2022; 42:359-365. [PMID: 35185145 PMCID: PMC9385888 DOI: 10.1097/hcr.0000000000000680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE High-quality exercise training improves outcomes in cardiac rehabilitation (CR), but little is known about how most programs prescribe exercise. Thus, the aim was to describe how current CR programs prescribe exercise. METHODS We conducted a 33-item anonymous survey of CR program directors registered with the American Association of Cardiovascular and Pulmonary Rehabilitation. We assessed the time, mode, and intensity of exercise prescribed, as well as attitudes about maximal exercise testing and exercise prescription. Results were summarized using descriptive statistics. Open-ended responses were coded and quantitated thematically. RESULTS Of 1470 program directors, 246 (16.7%) completed the survey. In a typical session of CR, a median of 5, 35, 10, and 5 min was spent on warm-up, aerobic exercise, resistance training, and cooldown, respectively. The primary aerobic modality was the treadmill (55%) or seated dual-action step machine (40%). Maximal exercise testing and high-intensity interval training (HIIT) were infrequently reported (17 and 8% of patients, respectively). The most common method to prescribe exercise intensity was ratings of perceived exertion followed by resting heart rate +20-30 bpm, although 55 unique formulas for establishing a target heart rate or range (THRR) were reported. Moreover, variation in exercise prescription between staff members in the same program was reported in 40% of programs. Program directors reported both strongly favorable and unfavorable opinions toward maximal exercise testing, HIIT, and use of THRR. CONCLUSIONS Cardiac rehabilitation program directors reported generally consistent exercise time and modes, but widely divergent methods and opinions toward prescribing exercise intensity. Our results suggest a need to better study and standardize exercise intensity in CR.
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Affiliation(s)
- Quinn R. Pack
- Division of Cardiovascular Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School – Baystate, Springfield, MA
- Department of Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA
| | - Meredith Shea
- Division of Cardiovascular Medicine, University of Massachusetts Medical School – Baystate, Springfield, MA
- Springfield College Department of Exercise Science and Athletic Training Springfield MA
- Mayo Clinic Arizona, Scottsdale AZ
| | | | - Samuel Headley
- Springfield College Department of Exercise Science and Athletic Training Springfield MA
| | - Jasmin Hutchinson
- Springfield College Department of Exercise Science and Athletic Training Springfield MA
| | - Hayden Madera
- Center for Cardiac Fitness, The Miriam Hospital, Providence, RI
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9
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Effectiveness and Safety of Four Aerobic Exercise Intensity Prescription Techniques in Rehabilitation Training for Patients with Coronary Heart Disease. Cardiol Res Pract 2022; 2022:1647809. [PMID: 35874554 PMCID: PMC9307357 DOI: 10.1155/2022/1647809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives. Exercise intensity is a key indicator for the safety and effectiveness of aerobic exercise program in cardiac rehabilitation (CR) in patients with coronary heart disease (CHD). The majority of CR guidelines recommend aerobic exercise prescription based on moderate intensity and suggest many techniques for setting the heart rate target of exercise to match the intensity. But even high-risk CHD patients rarely adhere to exercise training under medical monitoring. The effectiveness and safety of exercise under these high-intensity techniques is still a paucity of evidence. The purpose of this study was to determine if these techniques can safely and effectively inform exercise prescription for individuals with CHD. Methods. A retrospective study was conducted on all patients with CHD who were admitted to CR and completed cardiopulmonary exercise tests (CPET) in Guangdong Hospital of traditional Chinese medicine. According to the risk stratification method of CHD, all participants were divided into three groups: low, moderate, and high risk. The training target heart rates (HRt) of each participant were calculated according to the formula of heart-rate-reserve (HRR), maximum-heart-rate (MHR), target-heart-rate (THR), and anaerobic threshold (AT) method provided in the guideline. Among them, the HRR method using the maximum-heart-rate obtained by the age formula was named “HRR method A,” and that using the actual measured peak heart rate was named “HRR method B.” For the three groups, the effectiveness and safety indexes at the target-heart-rate zone set by the different formulas above are counted and compared using CPET data. Results. A total of 324 patients were included in the analysis. There was no significant difference between the target-heart-rate set by the HRR method A and AT method among the three groups (
). The mean value of HRt set by other methods was lower than the AT heart rate (
). The HRt set by the THR method was close to the AT, while that set by the MHR method was the lowest. The frequency of patients whose HRt was set by the MHR method was lower than the AT one, which was the highest. None of the participants had serious adverse events. There were no risks of ECG abnormalities in the low- and moderate-risk groups. The HRR method A had the highest incidence of various risks of ECG abnormalities, while the MHR method had the lowest one, and the safety of the THR method is close to that of the AT method (
). Conclusion. The heart rate calculated by HRR method A is more consistent with the actual AT. All four techniques are safe in low- and moderate-risk patients. In high-risk patients, using HRR method A has certain risks. It is recommended to use the MHR method for safety reasons, but its effectiveness is low. If considering both effectiveness and safety, the THR method can be conservatively selected at the beginning of the CR program.
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Poty A, Krim F, Lopes P, Garaud Y, Leprêtre PM. Benefits of a Supervised Ambulatory Outpatient Program in a Cardiovascular Rehabilitation Unit Prior to a Heart Transplant: A Case Study. Front Cardiovasc Med 2022; 9:811458. [PMID: 35665250 PMCID: PMC9160327 DOI: 10.3389/fcvm.2022.811458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Preoperative peak oxygen uptake (V.O2peak) and ventilatory efficiency (V.E/V.CO2slope) are related to the vital prognosis after cardiac transplantation (HTx). The objective of our study was to evaluate the effects of exercise-based cardiac rehabilitation (ECR) program on the preoperative exercise capacity of a HTx candidate. A male patient, aged 50–55 years, with chronic heart failure was placed on the HTx list and performed 12 weeks of intensive ECR (5 sessions-a-week). Our results showed that the cardiac index continuously increased between the onset and the end of ECR (1.40 vs. 2.53 L.min–1.m2). The first 20 sessions of ECR induced a V.O2peak increase (15.0 vs. 19.3 ml.min–1.kg–1, corresponding to 42.0 and 53.0% of its maximal predicted values, respectively). The peak V.O2 plateaued between the 20th and the 40th ECR session (19.3 vs. 19.4 ml.min–1.kg–1) then progressively increased until the 60th ECR session to reach 25.7 ml.min–1.kg–1, i.e., 71.0% of the maximal predicted values. The slope of V.E/V.CO2 showed a biphasic response during the ECR program, with an increase between the onset and the 20th ECR session (58.02 vs. 70.48) and a decrease between the 20th and the 40th ECR session (70.48 vs. 40.94) to reach its minimal value at the 60th ECR session (31.97). After the first 40 sessions of the ECR program, the Seattle Heart Failure Model score predicted median survival time was estimated at 7.2 years. In conclusion, the improvement in exercise capacity and cardiorespiratory function following the ECR helped delay the heart transplant surgery in our patient awaiting heart transplantation.
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Affiliation(s)
- Antoine Poty
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Florent Krim
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
| | - Philippe Lopes
- Laboratoire de Biologie de l’Exercice Pour la Performance et la Santé, Université d’Évry Val d’Essonne, Évry, France
| | - Yves Garaud
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Pierre-Marie Leprêtre
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
- *Correspondence: Pierre-Marie Leprêtre,
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Zhou N, Fortin G, Balice M, Kovalska O, Cristofini P, Ledru F, Mampuya WM, Iliou MC. Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection. J Clin Med 2022; 11:jcm11082107. [PMID: 35456200 PMCID: PMC9025085 DOI: 10.3390/jcm11082107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/10/2022] Open
Abstract
Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training.
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Affiliation(s)
- Na Zhou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Gabriel Fortin
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Maria Balice
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Oksana Kovalska
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Pascal Cristofini
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Francois Ledru
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Warner M. Mampuya
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
- Correspondence:
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12
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Evaluation of Maintained PhysicAl CaPacity 1-yr After Coronary Patient Cardiac Rehabilitation (EMAP): A FRENCH MULTICENTER STUDY. J Cardiopulm Rehabil Prev 2022; 42:E42-E47. [PMID: 35385860 DOI: 10.1097/hcr.0000000000000684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Data are scarce concerning the sustainable effects of cardiac rehabilitation (CR), on cardiorespiratory fitness (CRF) of patients with coronary artery disease (CAD). This study, carried out using data from a French multicenter study, aimed to clarify the evolution of the CRF of patients with CAD 1 yr after the end of a CR stay. METHODS Patients were included after an acute coronary syndrome (77%) and/or coronary revascularization, occurring <3 mo beforehand. All underwent a CR program with CRF evaluation by exercise testing (ET) on a cycle ergometer at the beginning of CR (ET1), at its end (ET2), and 1 yr later (ET3)-all ETs were performed with medication. RESULTS Two hundred fifty-nine patients were included (age 60 ± 10 yr, 89% male) in 16 French CR centers. Left ventricular ejection fraction was 55.3 ± 9%. Revascularization was complete (82%). Maximal workloads were 110 ± 37 (ET1), 139 ± 43 (ET2), and 144 ± 46 W (ET3) (P< .001). The estimated metabolic equivalents of the task (METs) were respectively 5.3 ± 1.4, 6.4 ± 1.6 (P< .001), and 6.6 ± 1.7 (P< .002). One year later, 163 patients (63%) improved or maintained their CRF (ET3 ≥ ET2), 73 (28%) decreased (ET1 < ET3 < ET2), and 23 (9%) lost the benefit of CR (ET3 ≤ ET1). CONCLUSION Among completers who agreed to enroll in this study, most patients with CAD seem to maintain their CRF 1 yr after CR.
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Duan Y, Li X, Guo L, Liang W, Shang B, Lippke S. A WeChat Mini Program-Based Intervention for Physical Activity, Fruit and Vegetable Consumption Among Chinese Cardiovascular Patients in Home-Based Rehabilitation: A Study Protocol. Front Public Health 2022; 10:739100. [PMID: 35392478 PMCID: PMC8980353 DOI: 10.3389/fpubh.2022.739100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCardiac rehabilitation programs aim to avoid further progression and relapse of cardiovascular diseases (CVDs). Patients with CVDs undergoing rehabilitation often experience difficulties in integrating and transferring the learned health behaviors into their daily life after returning home. This includes regular physical activity (PA) and sufficient fruit and vegetable consumption (FVC). eHealth individualized interventions have shown to be effective in increasing PA and FVC in home settings. As WeChat is the most popular social media site in China, this should be used for the intervention. The aim of this study is to develop and examine a WeChat mini program-based intervention on PA and FVC promotion among Chinese cardiovascular patients in home-based rehabilitation.MethodsThe study will adopt a randomized controlled trial (RCT), comprising a WeChat mini program-based intervention group and a waiting-list control group. The intervention content will be designed based on the Health Action Process Approach (HAPA). One hundred fifty-eight outpatients will be recruited from the cardiac rehabilitation center of a hospital in southern China and randomly assigned to one of the two groups. During the 10-week duration of the intervention, participants will be invited to access a WeChat mini program comprising two Modules. Module 1 provides weekly learning sessions addressing PA and FVC simultaneously for 10 weeks. Module 2 provides a platform, where participants can review their progress with Module 1 at any time and attend incentive activities aiming at promoting engagement and retention. The outcome variables include PA (mins/week), FVC (portion/day), healthy lifestyle (the synthesis of PA and FVC), social-cognitive predictors of behavior change (risk perception, outcome expectancies, self-efficacy, intention, planning, social support, and action control) as well as health outcomes (Body mass index, depression, and quality of life). Data collection will be implemented at pre-test, post-test and a post-test after 3-month respectively.DiscussionThe current study will be significant to understand how such a cost-effective social media mini program-based intervention enables participants to adopt and maintain a healthy lifestyle. If it is effective, it will enrich home-based cardiac rehabilitation approaches which can in turn save the lives of patients as well as much monetary, time and other investments.Trial RegistrationThe study was registered at ClinicalTrials.gov (Identifier: NCT03636724; Last update posted: July 28, 2020).
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Affiliation(s)
- Yanping Duan
- Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- *Correspondence: Yanping Duan
| | - Xin Li
- Department of Physical Education, School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, China
| | - Lan Guo
- Cardiac Rehabilitation Center, Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Wei Liang
- Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
- Wei Liang
| | - Borui Shang
- Department of Social Sciences, Hebei Sport University, Shijiazhuang, China
- Borui Shang
| | - Sonia Lippke
- Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
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14
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Fanget M, Bayle M, Labeix P, Roche F, Hupin D. Effects of Cardiac Telerehabilitation During COVID-19 on Cardiorespiratory Capacities in Patients With Coronary Artery Disease. Front Physiol 2022; 13:837482. [PMID: 35370786 PMCID: PMC8969221 DOI: 10.3389/fphys.2022.837482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background The COVID-19 pandemic led to the closure of most cardiac therapy centers. One of the solutions was to adapt the existing cardiac rehabilitation (CR) program in an institute to a remote approach offered by home-based telerehabilitation. The aim of this study was to measure the cardiorespiratory effects of telerehabilitation compared to conventional center-based CR. Methods Patients were assigned to two 3-week CR programs: telerehabilitation and conventional center-based CR. The telerehabilitation group wore a connected watch to monitor heart rate (HR) and gave their perception of effort according to a modified Borg scale. The exercise training (four sessions/week) consisted of 1-h aerobic endurance and strength training session at the target HR zone determined by results based on cardiopulmonary exercise test (CPET) and perception of effort, respectively. The exercise protocol was the same for conventional CR participants except the duration of session that lasted 2 h instead of one. The week before and after the training program, peak oxygen uptake (VO2 peak), oxygen uptake at first ventilatory threshold (VO2 at VT1), peak workload, percent of predicted maximum HR, and the absolute differences in HR and systolic blood pressure between maximum and recovery at 1 and 3 min were measured using a CPET. A two-way ANOVA with one repeated measure and one independent factor was performed. Results Fifty-four patients (mean age: 61.5 ± 8.6 years, 10 women) equally split in the two groups were included in this experiment. A significant increase was observed in both groups on VO2 peak (telerehabilitation: 8.1 ± 7.8% vs. conventional: 10.1 ± 9.7%, p < 0.001), VO2 at VT1 (telerehabilitation: 8.8 ± 4.4% vs. conventional: 7.3 ± 19.0%, p = 0.02) and peak workload (telerehabilitation: 16.6 ± 18.9% vs. conventional: 17.2 ± 7.0%, p < 0.001) after the 3-week telerehabilitation and conventional CR, respectively. No significant difference was noticed between both groups. Conclusion A 3-week exercise program improved patients’ cardiorespiratory fitness. Telerehabilitation was as effective and represents a safe alternative CR program during the COVID-19 period. In the future, this approach could facilitate the continuity of care for patients unable to participate in center-based CR.
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Affiliation(s)
- Marie Fanget
- INSERM, U1059, SAINBIOSE, DVH, University of Lyon, Jean Monnet University, Saint-Etienne, France
- *Correspondence: Marie Fanget,
| | - Manon Bayle
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, Saint-Etienne, France
| | - Pierre Labeix
- INSERM, U1059, SAINBIOSE, DVH, University of Lyon, Jean Monnet University, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Roche
- INSERM, U1059, SAINBIOSE, DVH, University of Lyon, Jean Monnet University, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, Saint-Etienne, France
| | - David Hupin
- INSERM, U1059, SAINBIOSE, DVH, University of Lyon, Jean Monnet University, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, Saint-Etienne, France
- Department of Medicine, K2, Solna, Karolinska Institutet, Stockholm, Sweden
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15
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Arenja N, Mueller C, Tomilovskaya E, Koryak Y, Poltavskaya M, Saner H. Real-world experience of feasibility and efficacy of electrical muscle stimulation in elderly patients with acute heart failure: A randomized controlled study. Int J Cardiol 2021; 344:113-119. [PMID: 34627967 DOI: 10.1016/j.ijcard.2021.09.062] [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: 07/25/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Reduced aerobic capacity and deconditioning contributes to morbidity and mortality in elderly acute heart failure (AHF) patients. Electrical muscle stimulation (EMS) has shown to be a suitable alternative to exercise in AHF. However, feasibility and efficacy are unknown in a real-world setting. METHODS This is a prospective, open label blinded, randomized, controlled study, investigating feasibility and efficacy of high-intensity versus low-intensity EMS versus controls in elderly AHF patients. Patients and investigators were blinded to the intervention. EMS was offered to > 60 years old AHF patients, initiated during hospitalization and continued at home. Outcome measures included changes in 6-min walking test distance (6-MWTD), functional capacity and quality-of-life at 3 and 6 weeks. RESULTS Among 97 consecutive AHF patients (78.1 ± 9.4 years, 42.3% females), 60 (61.9%) were eligible for EMS. Of these, 27 provided written informed consent and were randomly assigned to high-intensity (n = 10), low-intensity EMS (n = 9) and controls (n = 8). 13/27 completed the intervention. Main reason for dropouts was intolerance of the overall intervention burden. MACE occurred in 5 and were not associated with the study. EMS groups showed significant improvement of 6-MWTD (controls vs low-intensity p = 0.018) and of independence in daily living (for both p < 0.05). CONCLUSIONS Changes in 6-MWTD suggest efficacy of EMS. Whereas all tolerated EMS well, the burden of study intervention was too high and resulted in a consent rate of <50% and high dropouts, which limit the interpretability of our data. Less demanding EMS protocols are required to evaluate the full potential of EMS in elderly AHF patients.
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Affiliation(s)
- Nisha Arenja
- Department of Cardiology, Kantonsspital Olten, Solothurner Spitäler AG, Olten, Switzerland.
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Elena Tomilovskaya
- Institute for Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Yuri Koryak
- Institute for Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Maria Poltavskaya
- I.M. Sechenov, First Moscow State Medical University, Moscow, Russia
| | - Hugo Saner
- I.M. Sechenov, First Moscow State Medical University, Moscow, Russia; Institute for Social and Preventive Medicine and ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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MEdical TReatment Optimization in cardiac rehabilitation (METRO study) : a French multicenter study. Ann Cardiol Angeiol (Paris) 2021; 70:275-280. [PMID: 34635328 DOI: 10.1016/j.ancard.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is the right place to optimize the medical treatment in coronary artery disease (CAD) patients. AIMS To report the medical management in CAD patients during CR and evaluate the consequences. METHODS CAD patients who attended a CR program within less than three months of an acute coronary syndrome (ACS), a percutaneous coronary intervention (PCI), or a coronary artery bypass graft (CABG) were included in a prospective multicenter study. Medical treatments were analyzed at the beginning and at discharge of the CR stay. Results of exercise tests were compared between 4 groups. G1: unchanged medication, n=443, G2: beta-blockers or bradycardic agents adaptation n=199, G3: renin-angiotensin system (RAS) inhibitors adaptation, n=194, G4: both medications adaptation, n=164. RESULTS One thousand consecutive patients were included in 23 French CR centers (85.3% males; mean age 59.9 ± 11 years). The index event was ACS (68.5%), PCI (62.6%) and CABG (36.3%). During CR, we noted an adaptation for beta-blockers in 32.1%, in other bradycardic agents (ivabradine, verapamil, diltiazem, amiodarone) in 9.5%, and in RAS inhibitors in 36.3%. Patients of group 1 had an initial resting heart rate lower than in group 2 and 4, but at the final exercise testing, the range of the decrease was more important in group 2 and 4. The combination of physical training and therapeutic modifications resulted in similar exercise capacities in the four groups, from 5.2, 5.3, 5.4 and 5.2 MET (p=0.68), to 6.3, 6.5, 6.5 and 6.1 MET (p=0.44), respectively. CONCLUSION The METRO study showed that significant alteration in medical treatment during cardiac rehabilitation programs could take part in improving physical capacity.
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17
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Scheer A, Shah A, Ito Ramos de Oliveira B, Moreno-Suarez I, Jacques A, Green D, Maiorana A. Twelve weeks of water-based circuit training exercise improves fitness, body fat and leg strength in people with stable coronary heart disease: a randomised trial. J Physiother 2021; 67:284-290. [PMID: 34518147 DOI: 10.1016/j.jphys.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
QUESTION In people with stable coronary heart disease, what are the effects of water-based circuit training exercise on aerobic capacity, strength and body composition? How do these effects compare with those of gym-based exercise? DESIGN Parallel group, randomised controlled trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS Fifty-two participants with stable coronary heart disease. INTERVENTIONS Twelve weeks of: three 1-hour sessions per week of moderate-intensity water-based circuit training exercise with alternating aerobic and resistance stations (WEX); three 1-hour sessions per week of moderate-intensity gym-based circuit training exercise (GEX); or continuing usual activities (control). OUTCOME MEASURES Aerobic capacity (VO2peak), upper and lower limb one repetition maximum strength (biceps curl, latissimus dorsi pulldown, hamstring curl and leg press), anthropometry (weight, body mass index and girth) and dual energy x-ray absorptiometry. RESULTS Forty-five participants completed the study (WEX n = 15, GEX n = 18, control n = 12). Both training groups significantly improved VO2peak compared with control: WEX by 2.5 ml/kg/min (95% CI 0.6 to 4.4) and GEX by 2.3 ml/kg/min (95% CI 0.6 to 4.0). WEX and GEX improved hamstring strength compared with control: WEX by 6.3 kg (95% CI 1.2 to 11.3) and GEX by 7.6 kg (95% CI 2.9 to 12.2). Compared with control, GEX increased leg press strength by 15.5 kg (95% CI 5.7 to 25.3), whereas the effect of WEX was less clear (MD 7.1 kg, 95% CI -3.5 to 17.7). Only GEX improved latissimus dorsi pulldown strength. Compared with control, total body fat was reduced with WEX (-1.1 kg, 95% CI -2.3 to 0.0) and GEX (-1.2 kg, 95% CI -2.3 to -0.1). There were negligible between-group differences in weight or waist circumference. CONCLUSION WEX was well tolerated and improved aerobic capacity, leg strength and body fat to a similar degree as GEX in people with coronary heart disease. These findings suggest that WEX is an effective exercise training alternative to GEX for people with coronary heart disease. TRIAL REGISTRATION ANZCTR12616000102471.
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Affiliation(s)
- Anna Scheer
- School of Allied Health, Curtin University, Perth, Australia
| | - Amit Shah
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia
| | | | - Ignacio Moreno-Suarez
- School of Allied Health, Curtin University, Perth, Australia; The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong
| | - Angela Jacques
- School of Allied Health, Curtin University, Perth, Australia
| | - Daniel Green
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Andrew Maiorana
- School of Allied Health, Curtin University, Perth, Australia; Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia; Allied Health Department, Fiona Stanley Hospital, Perth, Australia.
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18
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Colas C, Goutte J, Creac'h C, Fontana L, Vericel MP, Manzanares J, Peuriere M, Akrour M, Martin C, Presles E, Barth N, Guyot J, Garros M, Trombert B, Massoubre C, Roche F, Féasson L, Marotte H, Cathebras P, Hupin D. Efficiency of an Optimized Care Organization in Fibromyalgia Patients: The From Intent to Move (FIMOUV) Study Protocol of a Randomized Controlled Trial. Front Public Health 2021; 9:554291. [PMID: 34113593 PMCID: PMC8185292 DOI: 10.3389/fpubh.2021.554291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Fibromyalgia (FM) is characterized by multiple symptoms including pain, fatigue, and sleep disorders, altering patient's quality of life. In the absence of effective pharmacological therapy, the last European guidelines recommend a multidisciplinary management based on exercise and education. Thus, our main objective was to measure the effectiveness of a healthcare organization offering a specific program of adapted physical activity combined with a therapeutic education program for FM patients. Methods and Analysis: The From Intent To Move (FIMOUV) study will recruit 330 FM patients randomized into two groups: test and control. The test group will benefit from a 1-month mixed exercise training program supervised at the hospital, followed by 2 months in a community-based relay in a health-sport structure. In addition, each of the two groups will benefit from therapeutic patient education sessions. The main endpoint is the measurement of the level of physical activity by accelerometry at 1 year. The secondary endpoints concern adherence to the practice of physical activity, impact on lifestyle, state of health, and physical capacity, as well as an estimate of the budgetary impact of this management strategy. Discussion: This interventional research will allow us to assess the evolution of behaviors in physical activity after an FM syndrome management based solely on patient education or based on a supervised and adapted practice of physical activity associated with this same therapeutic education program. It seems to be the first study evaluating the impact of its intervention on objective data for measuring physical activity and sedentary behavior via accelerometry among FM patients. Trial registration:ClinicalTrials.gov NCT04107948.
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Affiliation(s)
- Claire Colas
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
| | - Julie Goutte
- Department of Internal Medicine, University Hospital Center, Saint-Étienne, France
| | - Christelle Creac'h
- Pain Center, University Hospital Center, Saint-Étienne, France.,University Claude Bernard, Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, Bron, France
| | - Luc Fontana
- Department of Occupational and Environmental Medicine, University Hospital Center, Saint-Étienne, France.,University Lyon, University Lyon 1, University St Etienne, University Gustave Eiffel, IFSTTAR, UMRESTTE, UMR_T9405, Saint-Étienne, France
| | - Marie-Pierre Vericel
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
| | | | - Marie Peuriere
- Clinical Research, Innovation and Pharmacology Unit, University Hospital Center, Saint-Étienne, France
| | - Madjid Akrour
- Clinical Research, Innovation and Pharmacology Unit, University Hospital Center, Saint-Étienne, France
| | - Charly Martin
- Clinical Research, Innovation and Pharmacology Unit, University Hospital Center, Saint-Étienne, France
| | - Emilie Presles
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Clinical Research, Innovation and Pharmacology Unit, University Hospital Center, Saint-Étienne, France.,Department of Clinical Investigation Center, CIC 1408-INSERM, University Hospital Center, Saint-Étienne, France
| | - Nathalie Barth
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,University Lyon, UJM-Saint-Etienne Chaire Santé des Ainés, Saint-Étienne, France.,Gerontopole Auvergne-Rhone-Alpes, Saint-Étienne, France
| | - Jessica Guyot
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,University Lyon, UJM-Saint-Etienne Chaire Santé des Ainés, Saint-Étienne, France
| | - Maël Garros
- Sport Health House, CDOS 42, Saint-Étienne, France
| | - Béatrice Trombert
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Department of Public Health, University Hospital Center, Saint-Étienne, France
| | | | - Frédéric Roche
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
| | - Léonard Féasson
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France.,University Lyon, UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, Saint-Étienne, France
| | - Hubert Marotte
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Department of Rheumatology, University Hospital Center, Saint-Étienne, France
| | - Pascal Cathebras
- Department of Internal Medicine, University Hospital Center, Saint-Étienne, France
| | - David Hupin
- University Lyon, UJM-Saint-Etienne Sainbiose Laboratory, INSERM U1059, Saint-Étienne, France.,Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France.,Department of Medicine, K2, Solna Karolinska Institutet, Stockholm, Sweden
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19
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Denolle T, Pellen C, Serandour AL, Lebreton S, Revault d'Allonnes F. Persistence of uncontrolled hypertension post-cardiac rehabilitation in stable coronary patients. J Hum Hypertens 2021; 36:537-543. [PMID: 33963270 DOI: 10.1038/s41371-021-00544-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 01/02/2023]
Abstract
In stable coronary heart disease, uncontrolled risk factors are strongly associated with incident myocardial infarction. We analysed the management of hypertension in 746 stable coronary patients recruited between 2005 and 2015 in a single-centre prospective study. Risk factors and pharmacological treatments were documented prior to and immediately after cardiac rehabilitation, and 1 year later. One year post-cardiac rehabilitation, all cardiovascular risk factors were significantly better controlled with the notable exception of hypertension: blood pressure (BP) <140/90 mmHg in 60% of the total population vs 49% (N = 450) of hypertensive patients (20% or 10%, according to the ACC/AHA 2017 or ESH/ESC guidelines, respectively). Of those who had achieved normotension by the end of cardiac rehabilitation, 42% had uncontrolled hypertension again 1 year later; in addition, body weight had increased, while physical activity and antihypertensive drug use had dropped (differences between controlled or uncontrolled hypertension at 1 year post-cardiac rehabilitation, NS). Three factors were correlated with BP elevations: discontinuation of betablockade: +7.9 mmHg; age >65 years: +6.2 mmHg; diabetes mellitus: +7.6 mmHg. Only 48% hypertensive patients were on guideline-recommended antihypertensive polytherapy. Although 28% were still hypertensive post-cardiac rehabilitation, and hypertension remained uncontrolled in 70% 1 year later, 61% antihypertensive prescriptions were not adjusted post-cardiac rehabilitation. One year post-cardiac rehabilitation, hypertension was the only cardiovascular risk factor that had not improved. This can be attributed to three main reasons, all associated with BP elevations: precipitous reduction in betablockade, physicians' inertia when faced with uncontrolled hypertension and lack of adherence to international guidelines.
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Affiliation(s)
- Thierry Denolle
- Rivarance Network, Arthur Gardiner Hospital Dinard, Dinard, France.
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20
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Techniques de renforcement musculaire en réadaptation cardiaque. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX - PRATIQUE 2020; 2020:16-21. [PMID: 32562474 PMCID: PMC7243777 DOI: 10.1016/j.amcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Gower B, Girard D, Mitchell BL, Gehling T, Maiorana A, Davison K. Lack of Cited Evidence Underpinning Recommendations for Objective Assessment of Cardiovascular Function to Inform Exercise Prescription: A Systematic Review. Sports Med 2020; 50:1469-1481. [PMID: 32297250 DOI: 10.1007/s40279-020-01283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effectiveness of exercise in managing cardiovascular (CV) health and function is well established. Less clear is the process for optimising the safety and efficacy of an intervention, particularly how objective assessments might inform this process. OBJECTIVE The aim of this review was to investigate the cited evidence underpinning recommendations for assessing CV function to inform the safe and effective prescription of exercise in populations with established CV disease, as published in documents to guide practice authored by prominent organisations in cardiology and sports medicine. METHODS A systematic review of position statements and guiding documents on exercise prescription for CV health was conducted. Included documents were published between 1997 and 2016. RESULTS Following removal of duplicates, 3158 documents were considered, with full-text screening required for 334. Twenty-seven documents were included which provided 106 individual recommendations for specific objective assessments. Of the total number of recommendations, 60% had no accompanying citation and 28% of recommendations provided citations that did not directly support the statement made. Additionally, 52% of included documents did not state the methods of document development. That is, it was not clear if there was a literature review and/or expert consensus that was used to form recommendations included within. CONCLUSION Almost no cited evidence underpinning the extracted recommendations from the included guiding documents, nor any acknowledgement of this deficiency was established. There were limited explanations found for the methods involved in developing such guiding documents.
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Affiliation(s)
- Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Danielle Girard
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Braden L Mitchell
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Thomas Gehling
- TG Exercise Physiology Services, Adelaide, SA, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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22
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Fanget M, Rossi J, Samozino P, Morin JB, Testa R, Roche F, Busso T, Laukkanen JA, Hupin D. Dynamic Force Production Capacities Between Coronary Artery Disease Patients vs. Healthy Participants on a Cycle Ergometer. Front Physiol 2020; 10:1639. [PMID: 32038306 PMCID: PMC6993059 DOI: 10.3389/fphys.2019.01639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background The force-velocity-power (FVP) profile is used to describe dynamic force production capacities, which is of great interest in training high performance athletes. However, FVP may serve a new additional tool for cardiac rehabilitation (CR) of coronary artery disease (CAD) patients. The aim of this study was to compare the FVP profile between two populations: CAD patients vs. healthy participants (HP). Methods Twenty-four CAD patients (55.8 ± 7.1 y) and 24 HP (52.4 ± 14.8 y) performed two sprints of 8 s on a Monark cycle ergometer with a resistance corresponding to 0.4 N/kg × body mass for men and 0.3 N/kg × body mass for women. The theoretical maximal force (F0) and velocity (V0), the slope of the force-velocity relationship (Sfv) and the maximal mechanical power output (Pmax) were determined. Results The Pmax (CAD: 6.86 ± 2.26 W.kg–1 vs. HP: 9.78 ± 4.08 W.kg–1, p = 0.003), V0 (CAD: 5.10 ± 0.82 m.s–1 vs. HP: 5.79 ± 0.97 m.s–1, p = 0.010), and F0 (CAD: 1.35 ± 0.38 N.kg–1 vs. HP: 1.65 ± 0.51 N.kg–1, p = 0.039) were significantly higher in HP than in CAD. No significant difference appeared in Sfv (CAD: −0.27 ± 0.07 N.kg–1.m.s–1 vs. HS: −0.28 ± 0.07 N.kg–1.m.s–1, p = 0.541). Conclusion The lower maximal power in CAD patients was related to both a lower V0 and F0. Physical inactivity, sedentary time and high cardiovascular disease (CVD) risk may explain this difference of force production at both high and low velocities between the two groups.
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Affiliation(s)
- Marie Fanget
- UJM-Saint-Etienne Autonomic Nervous System Research Laboratory, EA 4607 SNA-EPIS, University of Lyon, Saint-Étienne, France
| | - Jérémy Rossi
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, Saint-Étienne, France
| | - Pierre Samozino
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, University Savoie Mont Blanc, Chambéry, France
| | | | - Rodolphe Testa
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, Saint-Étienne, France
| | - Frédéric Roche
- UJM-Saint-Etienne Autonomic Nervous System Research Laboratory, EA 4607 SNA-EPIS, University of Lyon, Saint-Étienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Étienne, France
| | - Thierry Busso
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, Saint-Étienne, France
| | - Jari Antero Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland.,Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - David Hupin
- UJM-Saint-Etienne Autonomic Nervous System Research Laboratory, EA 4607 SNA-EPIS, University of Lyon, Saint-Étienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Étienne, France
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23
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Mehra VM, Gaalema DE, Pakosh M, Grace SL. Systematic review of cardiac rehabilitation guidelines: Quality and scope. Eur J Prev Cardiol 2019; 27:912-928. [PMID: 31581808 DOI: 10.1177/2047487319878958] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiac rehabilitation is a comprehensive model of secondary prevention proven to reduce mortality and morbidity. The World Health Organization is developing a Package of Rehabilitation Interventions for implementation by ministries of health as part of universal healthcare across the continuum. Through a systematic review, we sought to identify the best-quality cardiac rehabilitation guidelines, and extract their recommendations for implementation by member states. A systematic search was undertaken of academic databases and guideline repositories, among other sources, through to April 2019, for English-language cardiac rehabilitation guidelines from the last 10 years, free from conflicts, and with strength of recommendations. Two authors independently considered all citations. Potentially eligible guidelines were rated for quality using the Appraisal of Guidelines for Research and Evaluation tool, and for other characteristics such as being multi-professional, comprehensive and international in perspective; the latter criteria were used to inform selection of 3-5 guidelines meeting inclusion criteria. Equity considerations were also extracted. Altogether, 2076 unique citations were identified. Thirteen passed title and abstract screening, with six guidelines potentially eligible for inclusion in the Package of Rehabilitation Interventions and rated for quality; for two guidelines the Appraisal of Guidelines for Research and Evaluation tool ratings did not meet World Health Organization minimums. Of the four eligible guidelines, three were selected: the International Council of Cardiovascular Prevention and Rehabilitation (2016), National Institute for Health and Care Excellence (#172; 2013) and Scottish Intercollegiate Guideline Network (#150; 2017). Extracted recommendations were comprehensive, but psychosocial recommendations were contradictory and diet recommendations were inconsistent. A development group of the World Health Organization will review and refine the recommendations which will then undergo peer review, before open source dissemination for implementation.
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Affiliation(s)
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA
| | - Maureen Pakosh
- Library and Information Services, Toronto Rehabilitation Institute, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada
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24
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Deley G, Culas C, Blonde MC, Mourey F, Vergès B. Physical and Psychological Effectiveness of Cardiac Rehabilitation: Age Is Not a Limiting Factor! Can J Cardiol 2019; 35:1353-1358. [DOI: 10.1016/j.cjca.2019.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 10/25/2022] Open
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25
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Zores F, Iliou MC, Gellen B, Kubas S, Berthelot E, Guillo P, Bauer F, Lamblin N, Bosser G, Damy T, Cohen-Solal A, Beauvais F. Physical activity for patients with heart failure: Position paper from the heart failure (GICC) and cardiac rehabilitation (GERS-P) Working Groups of the French Society of Cardiology. Arch Cardiovasc Dis 2019; 112:723-731. [PMID: 31542331 DOI: 10.1016/j.acvd.2019.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.
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Affiliation(s)
- Florian Zores
- Groupe médical spécialisé, 67000 Strasbourg, France.
| | - Marie-Christine Iliou
- Service de réadaptation cardiaque et prévention secondaire, hôpital Corentin-Celton, AP-HP, 92130 Issy-les-Moulineaux, France
| | | | | | - Emmanuelle Berthelot
- Pôle Thorax, service de cardiologie, hôpital Bicêtre, AP-HP, 94270 Le-Kremlin-Bicêtre, France
| | | | - Fabrice Bauer
- Service de cardiologie, CHU de Rouen, 76000 Rouen, France
| | - Nicolas Lamblin
- Inserm, institut Pasteur, U1167, université de Lille, CHU de Lille, 59000 Lille, France
| | - Gilles Bosser
- Cardiology Department, University Hospital, 54511 Vandoeuvre-lès-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Thibaud Damy
- CHU d'Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Alain Cohen-Solal
- UMR-S 942, service de cardiologie, hôpital Lariboisière, université de Paris, AP-HP, 75010 Paris, France
| | - Florence Beauvais
- UMR-S 942, service de cardiologie, hôpital Lariboisière, université de Paris, AP-HP, 75010 Paris, France
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26
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Évaluation d’un programme d’éducation thérapeutique du patient sur l’activité physique, à distance d’une rééducation réadaptation cardiovasculaire. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Abreu A, Pesah E, Supervia M, Turk-Adawi K, Bjarnason-Wehrens B, Lopez-Jimenez F, Ambrosetti M, Andersen K, Giga V, Vulic D, Vataman E, Gaita D, Cliff J, Kouidi E, Yagci I, Simon A, Hautala A, Tamuleviciute-Prasciene E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Pavy B, Kiessling A, Sovova E, Grace SL. Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? Eur J Prev Cardiol 2019; 26:1131-1146. [DOI: 10.1177/2047487319827453] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Santa Maria, Portugal
| | - Ella Pesah
- Department of Kinesiology and Health Sciences, York University, Canada
| | - Marta Supervia
- Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Spain
| | | | | | | | - Marco Ambrosetti
- Istituti Clinici Scientifici Maugeri, Care and Research Institute Department of Cardiac Rehabilitation, Italy
| | - Karl Andersen
- Department of Internal Medicine, University of Iceland, Iceland
| | - Vojislav Giga
- Institute of Cardiovascular Diseases, Clinical Center of Serbia, Serbia
| | - Dusko Vulic
- University of Banja Luka, Center for Medical Research, Bosnia and Herzegovina
| | - Eleonora Vataman
- Institute of Cardiology, Moldova Academy of Science, Republica Moldova
| | - Dan Gaita
- University of Medicine and Pharmacy “Victor Babes”, Cardiovascular Prevention and Rehabilitation Clinic, Romania
| | - Jacqueline Cliff
- Cardiac Rehabilitation Department, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, UK
| | - Evangelia Kouidi
- Department of First Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Ilker Yagci
- Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Turkey
| | - Attila Simon
- Cardiac Rehabilitation Department, State Hospital for Cardiology, Hungary
| | - Arto Hautala
- Cardiovascular Research Group, Oulu University Hospital, Finland
| | | | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Zbigniew Eysymontt
- Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Poland
| | | | - Jo Hayward
- Cardiology Department, Norfolk and Norwich University Hospital, UK
| | - Eva Prescott
- Cardiology Department, Bispebjerg Frederiksberg Hospital, Denmark
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, France
| | - Anna Kiessling
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Sweden
| | - Eliska Sovova
- Department of Internal Medicine, University of Palacky, University Hospital Olomouc, Czech Republic
| | - Sherry L Grace
- Department of Kinesiology and Health Sciences, York University, Canada
- Toronto Rehabiliation Institute, University Health Network, Canada
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28
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Gabet A, De Peretti C, Iliou MC, Nicolau J, Olié V. National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014. Arch Cardiovasc Dis 2018; 111:625-633. [DOI: 10.1016/j.acvd.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022]
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29
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Pavy B, Marcadet DM, Brion R. [Advocate for a secondary prevention assessment of coronary artery disease]. Ann Cardiol Angeiol (Paris) 2018; 67:339-344. [PMID: 30327135 DOI: 10.1016/j.ancard.2018.08.009] [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: 08/11/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
Secondary prevention is paramount in patients who are survivors of an acute coronary syndrome. Cardiac rehabilitation has proven to be effective for several decades in the long-term implementation of preventive measures. Despite this evidence, prescription and real participation in these programs remain limited for a many reasons, including the patient, physician, health care system. Recent statistics are a major regional disparity in prescription that leads to inequality in access to care. A reflection is therefore necessary on the organization of the course of care of the patient after an acute coronary syndrome. The secondary prevention plan that we are proposing here is based on a secondary prevention assessment that allows the patient to be guided in rehabilitation or in an alternative proposal.
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Affiliation(s)
- B Pavy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, 44270 Machecoul, France.
| | - D M Marcadet
- Réadaptation cardiaque, Clinique Turin, 75008 Paris, France
| | - R Brion
- CAPIO, 113, boulevard Stalingrad, 69100 Villeurbanne, France; Dieulefit Santé, domaine de Chamonix, 26220 Dieulefit, France
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30
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Angoulvant D, Bejan-Angoulvant T. The best in coronary artery disease management is yet to come. Arch Cardiovasc Dis 2018; 111:621-624. [PMID: 30366857 DOI: 10.1016/j.acvd.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Denis Angoulvant
- Service de cardiologie, hôpital Trousseau, CHRU de Tours & EA4245-T2I, Loire Valley Cardiovascular Collaboration, université de Tours, 37000 Tours, France.
| | - Theodora Bejan-Angoulvant
- Service de pharmacologie médicale, hôpital Bretonneau, CHRU de Tours & EA7501-GICC, université de Tours, 37000 Tours, France
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31
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Thomas D, Paillard F, Lecerf JM, Carré F. [The behavioral goals of the coronary patient: No longer smoke, eat better, move more and better]. Ann Cardiol Angeiol (Paris) 2018; 67:352-360. [PMID: 30314667 DOI: 10.1016/j.ancard.2018.08.010] [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: 08/11/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
The behavioral goals of the coronary patient require active management by the cardiologist. Every smoker must be clearly informed about the cardiovascular consequences of smoking and the major benefits of smoking cessation. The only advice to "quit smoking" is not enough. Validated "treatments" (cognitive-behavioral therapy, nicotine replacement therapy, varenicline, bupropion) must be used, with a precise strategy and prolonged follow-up. All drugs assistance can be prescribed in coronary patients and nicotine replacement therapy can even be used just after a myocardial infarction. Nutrition plays a significant role in cardiovascular prevention. Counseling today is based on solid evidence, although evidence is harder to obtain than with drugs. It should no longer be advisable only to "suppress cooked fats and starches" because these recommendations are unclear and/or false. Today we need positive food-based benchmarks and complex dietary patterns in which fruits and vegetables, fish, whole grains, pulses, nuts, olive oil and a diet closed to the Mediterranean diet. Dairy products have their place. Sugary foods should be limited especially in case of overweight and metabolic syndrome. Physical activity is part of good nutrition. Indeed, the fight against a very sedentary lifestyle and physical inactivity in coronary and heart failure patients is part of the lifelong treatment of these patients. The cardiologist and the general practitioner must be much more involved in their prescription and education to hope for good compliance.
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Affiliation(s)
- D Thomas
- Institut de cardiologie, université Paris-VI-Sorbonne, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; 25, rue Guérin, 94220 Charenton-Le-Pont, France.
| | - F Paillard
- Centre de prévention cardiovasculaire, CHU Pontchaillou, 35033 Rennes, France
| | - J M Lecerf
- Service de nutrition, institut Pasteur de Lille, 59019 Lille, France
| | - F Carré
- Inserm U1099, université Rennes 1, CHU Pontchaillou, 35033 Rennes, France
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32
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Iliou MC, Corone S, Gellen B, Denolle T, Roche F, Nelson AC, Darné C. Is ventilatory therapy combined with exercise training effective in patients with heart failure and sleep-disordered breathing? Results of a randomized trial during a cardiac rehabilitation programme (SATELIT-HF). Arch Cardiovasc Dis 2018; 111:573-581. [DOI: 10.1016/j.acvd.2018.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 02/23/2018] [Accepted: 03/03/2018] [Indexed: 12/13/2022]
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33
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Marcadet DM, Pavy B, Bosser G, Claudot F, Corone S, Douard H, Iliou MC, Vergès-Patois B, Amedro P, Le Tourneau T, Cueff C, Avedian T, Solal AC, Carré F. French Society of Cardiology guidelines on exercise tests (part 2): Indications for exercise tests in cardiac diseases. Arch Cardiovasc Dis 2018; 112:56-66. [PMID: 30093255 DOI: 10.1016/j.acvd.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/28/2022]
Abstract
The exercise test is performed routinely in cardiology; its main indication is the diagnosis of myocardial ischemia, evaluated along with the subject's pretest probability and cardiovascular risk level. Other criteria, such as analysis of repolarization, must be taken into consideration during the interpretation of an exercise test, to improve its predictive value. An exercise test is also indicated for many other cardiac diseases (e.g. rhythm and conduction disorders, severe asymptomatic aortic stenosis, hypertrophic cardiomyopathy, peripheral artery disease, hypertension). Moreover, an exercise test may be indicated for specific populations (women, the elderly, patients with diabetes mellitus, patients in a preoperative context, asymptomatic patients and patients with congenital heart defects). Some cardiac diseases (such as chronic heart failure or arterial pulmonary hypertension) require a cardiopulmonary exercise test. Finally, an exercise test or a cardiopulmonary exercise test is indicated to prescribe a cardiac rehabilitation programme, adapted to the patient.
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Affiliation(s)
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, boulevard des Régents, BP2, 44270 Machecoul, France.
| | - Gilles Bosser
- Paediatric and Congenital Cardiology Department, M3C Regional Competences Centre, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Frédérique Claudot
- Platform for Clinical Research Assistance, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 4360 APEMAC, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Sonia Corone
- Cardiac Rehabilitation Department, Bligny Medical Centre, 91640 Briis-sous-Forges, France
| | - Hervé Douard
- Cardiac Rehabilitation Department, Bordeaux University Hospital, 33604 Pessac, France
| | - Marie-Christine Iliou
- Cardiac Rehabilitation Department, Corentin-Celton Hospital, 92130 Issy-Les-Moulineaux, France
| | | | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046, University of Montpellier, 34295 Montpellier, France
| | - Thierry Le Tourneau
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Caroline Cueff
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Taniela Avedian
- Cardiac Rehabilitation Department, Turin Clinic, 75008 Paris, France
| | | | - François Carré
- Department of Sport Medicine, Pontchaillou Hospital, University of Rennes 1, Inserm 1099, 35043 Rennes, France
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Hupin D, Pichot V, Berger M, Sforza E, Raffin J, Lietar C, Poyraz E, Maudoux D, Barthelemy JC, Roche F. Obstructive Sleep Apnea in Cardiac Rehabilitation Patients. J Clin Sleep Med 2018; 14:1119-1126. [PMID: 29991415 DOI: 10.5664/jcsm.7206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 03/01/2018] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity. METHODS Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis. RESULTS Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (-11.6 ± 9.1, P < .001). CONCLUSIONS Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.
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Affiliation(s)
- David Hupin
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Vincent Pichot
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Mathieu Berger
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Emilia Sforza
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jérémy Raffin
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Cécile Lietar
- Jacques Lisfranc Medical Faculty, University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Erkan Poyraz
- Jacques Lisfranc Medical Faculty, University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Delphine Maudoux
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Jean-Claude Barthelemy
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
| | - Frédéric Roche
- EA SNA EPIS 4607, Autonomic Nervous System, University of Lyon, University Jean Monnet, Saint-Etienne, France.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, France
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Leprêtre PM, Ghannem M, Delanaud S, Jaunet N, Gaillard L, Barnabé A, Porcher T, Weissland T. [Short-term exercise-based cardiac rehabilitation induced changes in cardiorespiratory, mechanical and neuromuscular responses to progressive exercise testing]. Ann Cardiol Angeiol (Paris) 2017; 66:283-287. [PMID: 28992936 DOI: 10.1016/j.ancard.2017.09.006] [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: 07/18/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Previous studies showed that changes in peak of oxygen uptake value (VO2peak) with training were poorly related to changes in Maximal Tolerated Power output (MTP) among patients with cardiovascular disease. This result could be due to a difference between cardiopulmonary adaptation to training and the skeletal muscle conditioning. OBJECTIVE The aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters. METHODS Nine cardiac patients (64.0±3.1y, 172.9±4.8cm, 83.4±16.3kg, BMI: 27.8±4.5) performed an incremental cycling exercise test to determine MTP, VO2peak and peak values of heart rate, before and after an aerobic training. Ventilatory thresholds were respectively determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (VT1) and the point at which the ratio of minute ventilation to carbon dioxide output starts to increase (VT2). EMGth1 and EMGth2 were defined as the first and the second breakpoints in the rms-EMG - power output relationship. RESULTS Short-term exercise training (23.7±8.8 days) induced a significant increase in VO2peak (P=0.004), MTP (P=0.015), VT1 (P=0.001) and VT2 (P=0.001). Changes in VO2peak only attained the survival criteria (3.5±2.9mLmin-1kg-1). No significant differences (P>0.05) existed between mean power values of VT1 and EMGth1 (60.5±4.1 vs. 59.2±9.6% of MTP, respectively), or between VT2 and EMGth2 (78.3±5.7 vs. 80.2±5.2% of MTP). After training, EMGth1 occurred significantly before VT1 (60.5±6.2 vs. 64.8±4.8% of MTP, P=0.049). CONCLUSION This might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients.
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Affiliation(s)
- P-M Leprêtre
- EA-3300, UFR-STAPS, laboratoire « Adaptations physiologiques à l'exercice et Réadaptation à l'Effort », université de Picardie-Jules-Verne, allée Paschal-Grousset, campus Sud, 80025 Amiens cedex 1, France.
| | - M Ghannem
- EA-3300, UFR-STAPS, laboratoire « Adaptations physiologiques à l'exercice et Réadaptation à l'Effort », université de Picardie-Jules-Verne, allée Paschal-Grousset, campus Sud, 80025 Amiens cedex 1, France; Service de cardiologie, centre hospitalier de Gonesse, Pôle 6, spécialités médicales et médecine polyvalente, 95500 Gonesse, France
| | - S Delanaud
- Unité mixte INERIS, UMI_01, laboratoire périnatalité et risques toxiques PERITOX, centre hospitalier universitaire Amiens-Picardie, 80480 Salouël, France; Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80036 Amiens, France
| | - N Jaunet
- Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - L Gaillard
- Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80036 Amiens, France; Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - A Barnabé
- Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80036 Amiens, France
| | - T Porcher
- Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - T Weissland
- EA-3300, UFR-STAPS, laboratoire « Adaptations physiologiques à l'exercice et Réadaptation à l'Effort », université de Picardie-Jules-Verne, allée Paschal-Grousset, campus Sud, 80025 Amiens cedex 1, France; Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80036 Amiens, France
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Iliou MC, Vergès-Patois B, Pavy B, Charles-Nelson A, Monpère C, Richard R, Verdier JC. Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study. Eur J Prev Cardiol 2017; 24:1274-1282. [PMID: 28569553 DOI: 10.1177/2047487317712601] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients.
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Affiliation(s)
- Marie C Iliou
- 1 Service de réadaptation cardiaque et prévention secondaire, Hôpital Corentin Celton, France
| | | | - Bruno Pavy
- 3 Service de réadaptation cardiaque, Hôpital Loire Vendée Océan, France
| | - Anais Charles-Nelson
- 4 Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, France.,5 Université Paris Descartes, France
| | - Catherine Monpère
- 6 Service de réadaptation cardiaque, Centre Bois Gibert, Ballan Miré, France
| | - Rudy Richard
- 7 Médecine du sport et explorations fonctionnelles. CHU Clermont Ferrand, France
| | - Jean C Verdier
- 8 Service de réadaptation cardiaque, Institut Cœur Effort Santé, France
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Murphy BM. Stress management training should be an integral component of cardiac rehabilitation. EVIDENCE-BASED MEDICINE 2017; 22:65. [PMID: 28130388 DOI: 10.1136/ebmed-2016-110532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
- Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
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Exercise Training in a Patient With a Left Ventricular Assist Device and Large Aortic Valve Thrombus. J Cardiopulm Rehabil Prev 2017; 37:421-423. [PMID: 28350641 DOI: 10.1097/hcr.0000000000000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
DETAILS OF THE CLINICAL CASE An aortic valve thrombus (AVT) is a rare complication after HeartMate II implantation. In a 44-year-old man, a large AVT was discovered 6 weeks after implantation of a HeartMate II for severe dilated cardiomyopathy. The aortic valve was permanently closed. DISCUSSION After a followup of 3 months without embolic events, the patient started a cardiac rehabilitation (CR) program involving aerobic exercise, resistance exercises, group gymnastics, and relaxation exercise, and completed the program without any complications, resulting in a significant functional benefit. SUMMARY CR might not be systematically contraindicated in patients with HeartMate II and an AVT, in particular, if there is no opening of the aortic valve at rest.
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Amedro P, Gavotto A, Bredy C, Guillaumont S. [Cardiac rehabilitation for children and adults with congenital heart disease]. Presse Med 2017; 46:530-537. [PMID: 28126509 DOI: 10.1016/j.lpm.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/27/2016] [Accepted: 12/20/2016] [Indexed: 01/02/2023] Open
Abstract
Advances in heart surgery over the past 30 years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies. The starting point is the cardiopulmonary exercise test (CPET), with the measurement of oxygen uptake, or "VO2". CPET is now recommended in the follow-up of the adults with CHD. Maximum oxygen uptake correlates to the quality of life of children and adults with CHD. The principles of the rehabilitation in patients with heart failure may usually be applied to CHD patients. Some studies in complex CHD showed improvement of VO2 and quality of life after rehabilitation, without any adverse events. However few physicians have the experience in rehabilitation among CHD patients, especially children. Randomized trials on cardiac rehabilitation in adult and pediatric CHD patients are essential to increase the level of evidence and lead to specific guidelines in this population.
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Affiliation(s)
- Pascal Amedro
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France.
| | - Arthur Gavotto
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France
| | - Charlène Bredy
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Clinique Fontfroide, service de réhabilitation cardiaque, Montpellier, France
| | - Sophie Guillaumont
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Institut-Saint-Pierre, unité d'évaluation et de réhabilitation en cardiologie pédiatrique, Palavas-Les-Flots, France
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Leprêtre PM, Ghannem M, Delanaud S, Porcher T, Barnabé A, Gaillard L, Jaunet N, Weissland T. [Is there a disassociation of ventilatory and electromyographic thresholds in patients with heart disease during a graded cycling exercise?]. Ann Cardiol Angeiol (Paris) 2016; 65:306-310. [PMID: 27697301 DOI: 10.1016/j.ancard.2016.09.011] [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: 06/28/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED Exercise prescription was generally based on the determination of ventilatory thresholds (VT1, VT2) during cardiopulmonary exercise testing (CPX). Changes in surface electromyographic activity (EMGth1, EMGth2) were also related to VT1 and VT2 in healthy subjects. OBJECTIVE To observe the occurrence of EMGth1 and EMGth2 and whether these events accompany VT1 and VT2 during CPX in cardiac patients (CP). METHOD Thirty-four CP (62.1±7.3years, 172.1±6.3cm, 81.3±15.3kg, BMI: 27.3±4.1) performed a cycle CPX at a 60-rpm cadence. VT1 was determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (V-slope method). VT2 was defined as the point at which the ratio of minute ventilation to carbon dioxide output starts to increase. The root mean square of electromyogram (rms-EMG) was on-line calculated from the real time bipolar surface electromyographic signals recorded from the vastus lateralis. EMGth1 and EMGth2 were defined as the first and the second breakpoints in the rms-EMG-power output relationship. RESULTS Peak values of oxygen uptake (16.3±4.6mL·min-1·kg-1) and heart rate (106.7±13.8bpm) were reached at 112.9±38.5w (PMT). VT1 and VT2 occurred at 71.1±25.9w (62.5±5.5% PMT) and 87.9±28.6w (78.0±5.1% PMT). All subjects presented two breakpoints in the rms-EMG curve, EMGth1 at 68.0±24.7w and EMGth2 at 88.5±30.1w, i.e. 60.0±7.6 and 78.6±5.0% of PMT. EMGth1 occurred significantly before VT1 (P=0.004, small effect size). No significant difference was observed between EMGth2 and VT2 (P=0.13, small effect size). CONCLUSION The EMGth1 occurrence before VT1 suggested a role of skeletal muscle conditioning on ventilatory responses, which should be taken into account in cardiac rehabilitation program prescription.
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Affiliation(s)
- P-M Leprêtre
- EA-3300, laboratoire « adaptations physiologiques à l'exercice et réadaptation à l'effort », UFR-STAPS, université de Picardie-Jules-Verne, campus Sud, allée Paschal-Grousset, 80025 Amiens cedex 1, France.
| | - M Ghannem
- EA-3300, laboratoire « adaptations physiologiques à l'exercice et réadaptation à l'effort », UFR-STAPS, université de Picardie-Jules-Verne, campus Sud, allée Paschal-Grousset, 80025 Amiens cedex 1, France; Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - S Delanaud
- Laboratoire périnatalité et risques toxiques PERITOX - UMI_01, unité mixte INERIS, CHU Amiens-Picardie, 80480 Salouël, France; Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80000 Amiens, France
| | - T Porcher
- Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - A Barnabé
- Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80000 Amiens, France
| | - L Gaillard
- Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France; Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80000 Amiens, France
| | - N Jaunet
- Centre de réadaptation cardiaque Léopold-Bellan, château d'Ollencourt, 60170 Tracy-Le-Mont, France
| | - T Weissland
- EA-3300, laboratoire « adaptations physiologiques à l'exercice et réadaptation à l'effort », UFR-STAPS, université de Picardie-Jules-Verne, campus Sud, allée Paschal-Grousset, 80025 Amiens cedex 1, France; Institut d'ingénierie de la santé (2IS), UFR de médecine, université de Picardie-Jules-Verne, 80000 Amiens, France
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Pavy B, Darchis J, Merle E, Caillon M. [Cardiac rehabilitation in "sports" patients]. Ann Cardiol Angeiol (Paris) 2016; 65:311-317. [PMID: 27692751 DOI: 10.1016/j.ancard.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/02/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) addresses for the greater part a middle-aged sedentary population. Nevertheless, some patients referred in CR are active or sportive, and care for these patients is less known. AIM OF THE STUDY To compare the results of CR between a little or not active population and an active or athletic population. PATIENTS AND METHODS Every patient referred in a CR department in Loire-Atlantique between 2010 and 2016 were included either in the group 1 (sedentary or little active) or in the group 2 (at least once a week physical training).) RESULTS: Among 2916 patients included, 2288 patients did two exercise tests, the functional capacity in the group 1 (n=2117) increased from 4.7±1.2 to 5.6±1.3 METs versus 6.5±1.7 to 7.6±1.8 METs in the group 2 (n=171), the gain was similar in both groups from 19±13% to 18±14% (P=0.16). The 6minutes Walking Test respectively increased from 445±91 to 517±89 versus 518±87 to 603±73 meters with a gain of 18±18 versus 18±16% (P=0.93). The prognosis is yet to be best in the group 2 in accordance to a best maximal functional capacity (P<0.01). CONCLUSION Cardiac rehabilitation is useful in active or athletic patients and should be prescribed based on the current recommendations.
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Affiliation(s)
- B Pavy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France.
| | - J Darchis
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - E Merle
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France; Cardiocéan réadaptation cardiaque, 25, allée de la Tourtillière, 17138 Puilboreau, France
| | - M Caillon
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
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Babu AS, Lopez-Jimenez F, Thomas RJ, Isaranuwatchai W, Herdy AH, Hoch JS, Grace SL. Advocacy for outpatient cardiac rehabilitation globally. BMC Health Serv Res 2016; 16:471. [PMID: 27600379 PMCID: PMC5013580 DOI: 10.1186/s12913-016-1658-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the leading cause of death globally. Cardiac rehabilitation (CR) is an evidence-based intervention recommended for patients with CVD, to prevent recurrent events and to improve quality of life. However, despite the proven benefits, only a small percentage of those would benefit from CR actually receive it worldwide. This paper by the International Council of Cardiovascular Prevention and Rehabilitation forwards the groundwork for successful CR advocacy to achieve broader reimbursement, and hence implementation. METHODS First, the results of the International Council's survey on national CR reimbursement policies by government and insurance companies are summarized. Second, a multi-faceted approach to CR advocacy is forwarded. Finally, as per the advocacy recommendations, the economic impact of CVD and the corresponding benefits of CR and its cost-effectiveness are summarized. This provides the case for CR reimbursement advocacy. RESULTS Thirty-one responses were received, from 25 different countries: 18 (58.1 %) were from high-income countries, 10 (32.4 %) from upper middle-income, and 3 (9.9 %) from lower middle-income countries. When asked who reimburses at least some portion of CR services in their country, 19 (61.3 %) reported the government, 17 (54.8 %) reported patients pay out-of-pocket, 16 (51.6 %) reported insurance companies, 12 (38.7 %) reported that it is shared between the patient and another source, and 7 (22.6 %) reported another source. CONCLUSIONS Many patients pay out-of-pocket for CR. CR reimbursement around the world is inconsistent and insufficient. Advocacy campaigns forwarding the CR cause, supported by the relevant literature, enlisting sources of support in a unified manner with an organized plan, are needed, and must be pursued persistently.
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Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, 576104 Karnataka India
| | - Francisco Lopez-Jimenez
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Randal J. Thomas
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
| | - Artur Haddad Herdy
- Institute of Cardiology of Santa Catarina, Universidade e do Sul de Santa Catarina, Palhoça, Brazil
| | - Jeffrey S. Hoch
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
| | - Sherry L. Grace
- School of Kinesiology and Health Science, York University, Bethune 368, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
- Toronto Western Hospital, GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, ON Canada
| | - in conjunction with the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR)
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, 576104 Karnataka India
- Preventive Cardiology Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1 W8 ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3 M7 ON Canada
- Institute of Cardiology of Santa Catarina, Universidade e do Sul de Santa Catarina, Palhoça, Brazil
- School of Kinesiology and Health Science, York University, Bethune 368, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
- Toronto Western Hospital, GoodLife Fitness Cardiovascular Rehabilitation Unit, University Health Network, Toronto, ON Canada
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Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur J Prev Cardiol 2016; 23:1715-1733. [PMID: 27353128 DOI: 10.1177/2047487316657669] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiac rehabilitation is an important component in the continuum of care for individuals with cardiovascular disease, providing a multidisciplinary education and exercise programme to improve morbidity and mortality risk. Internationally, cardiac rehabilitation programmes are implemented through various models. This review compared cardiac rehabilitation guidelines in order to identify any differences and/or consensus in exercise testing, prescription and monitoring. METHODS Guidelines, position statements and policy documents for cardiac rehabilitation, available internationally in the English language, were identified through a search of electronic databases and government and cardiology society websites. Information about programme delivery, exercise testing, prescription and monitoring were extracted and compared. RESULTS Leading cardiac rehabilitation societies in North America and Europe recommend that patients progress from moderate- to vigorous-intensity aerobic endurance exercise over the course of the programme, with resistance training included as an important adjunct, for maintaining independence and quality of life. North American and European guidelines also recommend electrocardiograph-monitored exercise stress tests. Guidelines for South America and individual European nations typically include similar recommendations; however, those in the United Kingdom, Australia and New Zealand specify lower-intensity exercise and less technical assessment of functional capacity. CONCLUSION Higher-intensity aerobic training programmes, supplemented by resistance training, have been recommended and deemed safe for cardiac rehabilitation patients by many authorities. Based on research evidence, this may also provide superior outcomes for patients and should therefore be considered when developing an international consensus for exercise prescription in cardiac rehabilitation.
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Affiliation(s)
- Kym Joanne Price
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Brett Ashley Gordon
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Richard Bird
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Amanda Clare Benson
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Delsart P, Maldonado-Kauffmann P, Bic M, Boudghene-Stambouli F, Sobocinski J, Juthier F, Domanski O, Coisne A, Azzaoui R, Rousse N, Fayad G, Modine T, Haulon S, Vincentelli A, Mounier-Vehier C, Montaigne D. Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities. Int J Cardiol 2016; 219:271-6. [PMID: 27343419 DOI: 10.1016/j.ijcard.2016.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/12/2016] [Indexed: 11/27/2022]
Abstract
BACK GROUND Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these patients are unexplored yet. METHODS We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. RESULTS The population was composed of 76% of male, with a mean age of 57.9±12.4years. There were an equal distribution between the two type of dissection (47% of type A and 53% of type B aortic dissection). No cardiac event occurred during or after CPX. One third of patients have normal aerobic exercise capacity defined as peak oxygen uptake upper than 85% of their predicted capacity. Mean oxygen uptake peak was quite low 19.2±5.2ml/kg/min (5.5±1.5 metabolic equivalents). Aerobic capacity was limited by cardiac chronotropic incompetence in 42% or peripheral deconditioning in 45%. Blood pressure remained in an acceptable range during the exercise. Systolic and diastolic blood pressures were respectively 151±20 and 77±13mmHg at first ventilatory threshold. CONCLUSIONS CPX is a safe exploration in patients with post aortic dissection syndrome. Given the fact that most of these patients are faced with significant alteration of aerobic capacities, the recommended daily practice of moderate exercise at 3-5 METS should be adapted and personalized to each patient thanks to CPX.
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Affiliation(s)
- Pascal Delsart
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France.
| | | | - Mathieu Bic
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France
| | | | - Jonathan Sobocinski
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - Francis Juthier
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - Olivia Domanski
- CHU Lille, Echocardiography department, Bd Pr Leclercq, F-59000 Lille, France
| | - Augustin Coisne
- CHU Lille, Echocardiography department, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - Richard Azzaoui
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France
| | - Natacha Rousse
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - George Fayad
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France
| | - Thomas Modine
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France
| | - Stephan Haulon
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - Andre Vincentelli
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - Claire Mounier-Vehier
- CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
| | - David Montaigne
- CHU Lille, Echocardiography department, Bd Pr Leclercq, F-59000 Lille, France; University of Lille, CHU Lille, F-59000 Lille, France
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Jackson AC, Le Grande MR, Higgins RO, Rogerson M, Murphy BM. Psychosocial Screening and Assessment Practice within Cardiac Rehabilitation: A Survey of Cardiac Rehabilitation Coordinators in Australia. Heart Lung Circ 2016; 26:64-72. [PMID: 27283446 DOI: 10.1016/j.hlc.2016.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many cardiac rehabilitation (CR) guidelines and position statements recommend screening for psychosocial risk factors, although there is wide variation in the recommended factors and recommended screening tools. Little is known about screening in CR in Australia. METHODS Cardiac rehabilitation coordinators at the 314 CR programs operating across Australia, drawn from the 2014 Australian Directory of Cardiac Rehabilitation Services were invited to participate in an online survey. RESULTS Of 165 complete responses, 157 (95%) CR coordinators indicated that they screened at entry with 132 (80%) screening on exit. At CR entry, programs screened for - depression (83%), anxiety (75%), stress (75%), and sleep disturbance (57%). The use of standardised instruments by those screening at entry varied from 89% for depression to only 9% for sleep disturbance. Organisational, resource and personal barriers inhibited the routine screening for many psychosocial factors. CONCLUSIONS Surveys such as this are useful for monitoring the rate of adoption of guideline recommendations and identifying barriers to implementation. Findings can also inform discussions about what should be included in minimum data sets for CR programs, and the identification of brief screening tools that have been validated not just in the general population but in cardiac patients.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health, Melbourne, Vic., Australia; Centre on Behavioural Health, University of Hong Kong, Pokfulam, Hong Kong; Faculty of Health, Deakin University, Melbourne, Vic., Australia.
| | - Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, Vic., Australia; Faculty of Health, Deakin University, Melbourne, Vic., Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, Melbourne, Vic., Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Vic., Australia; School of Psychology, Deakin University, Melbourne, Vic., Australia
| | - Michelle Rogerson
- Australian Centre for Heart Health, Melbourne, Vic., Australia; Faculty of Health, Deakin University, Melbourne, Vic., Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, Vic., Australia; Faculty of Health, Deakin University, Melbourne, Vic., Australia; Department of Psychology, University of Melbourne, Melbourne, Vic., Australia; School of Medicine & Public Health, University of Newcastle, Newcastle, NSW, Australia
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Triest FJ, Singh SJ, Vanfleteren LE. Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation: Can we learn from cardiac rehabilitation? Chron Respir Dis 2016; 13:286-94. [PMID: 27081189 DOI: 10.1177/1479972316642367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) who participate in pulmonary rehabilitation (PR) often have concomitant cardiovascular disease (CVD), which is a frequently undiagnosed and undertreated comorbidity. CVD contributes to the burden of the disease and is associated with an increased risk for hospitalizations and mortality. Optimizing the diagnosis and management of cardiovascular risk and disease should be considered as part of the holistic approach of PR. In addition, we need to consider similarities and differences in cardiac and PR programs, in order to improve personalized care in patients with both diseases. The current review addresses the burden of CVD in COPD patients who participate in PR, how CVD and its risk factors affect PR and should be managed during PR, and extends on what we can learn of the organization of cardiac rehabilitation programs.
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Affiliation(s)
- Filip Jj Triest
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Pouche M, Ruidavets JB, Ferrières J, Iliou MC, Douard H, Lorgis L, Carrié D, Brunel P, Simon T, Bataille V, Danchin N. Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study. Arch Cardiovasc Dis 2015; 109:178-87. [PMID: 26711546 DOI: 10.1016/j.acvd.2015.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
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Affiliation(s)
- Marion Pouche
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France
| | - Hervé Douard
- Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France
| | - Didier Carrié
- Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Philippe Brunel
- Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France
| | - Vincent Bataille
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Nicolas Danchin
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France
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Pavy B, Darchis J, Merle E, Caillon M, Charrier C, Vergne K, Caupenne G, Jourdy A. [The daily living activities of the cardiac patient: Monocentre study]. Ann Cardiol Angeiol (Paris) 2015; 64:337-44. [PMID: 26482636 DOI: 10.1016/j.ancard.2015.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/03/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND The main aim of cardiac rehabilitation is for the patient to sustain physical activity at home. The daily living activities (DLA) are important to take into account. AIM OF THE STUDY Analyze the DLA of patients in CR. PATIENTS AND METHODS One thousand seven hundred and eighty patients (mean age: 60.9±11 years) followed a CR programme between 2010 and 2015. They were tested for several DLA with their cardiac frequency (CF). The observed CF was included in the Karvonen's formula, used for the prescription of physical activity. RESULTS The coefficient of Karvonen was situated between 0.54 to 0.69, which was compatible with the prescribed physical training. Nevertheless, when the maximal exercise capacity was less than 5 METs, the coefficients were higher (0.53-0.89). CONCLUSION It was useful to test the cardiac patients for DLA during a CR programme. The use of Karvonen's formula allowed to compare these exercises with recommended physical training. We must be prudent when the maximal physical capacity is less than 5 METs.
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Affiliation(s)
- B Pavy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France.
| | - J Darchis
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - E Merle
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France; Cardiocéan réadaptation cardiaque, 25, allée de la Tourtillière, 17138 Puilboreau, France
| | - M Caillon
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - C Charrier
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - K Vergne
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - G Caupenne
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - A Jourdy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
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Ski CF, Jelinek M, Jackson AC, Murphy BM, Thompson DR. Psychosocial interventions for patients with coronary heart disease and depression: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2015; 15:305-16. [PMID: 26475227 DOI: 10.1177/1474515115613204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/30/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Depression is common in patients with coronary heart disease, and together these conditions significantly affect health outcomes. Impaired social support is also considered an important predictor of coronary heart disease prognosis and, as there is a complex interplay between social isolation and depression, interventions to address both may be required. This review aimed to assess the effectiveness of psychosocial interventions addressing both depression and social support for people with coronary heart disease and depression. METHODS PRISMA guidelines were used to search major health databases to identify randomised controlled trials that evaluated psychosocial interventions compared with usual care in patients with coronary heart disease and depression; the primary outcome was depressive symptoms and secondary outcomes were mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety, social support and quality of life. Data, when suitable, were pooled using a random-effects meta-analysis model. RESULTS Five studies (n=1358 participants) were eligible and included. The psychosocial intervention group had significantly lower levels of depressive symptoms (standardised mean difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03; P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to 0.30; P=0.01) but no differences were found for mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety or quality of life. CONCLUSIONS Psychosocial interventions for patients with coronary heart disease and depression result in modest reductions in depressive symptoms and improvements in social support. However, caution is warranted in view of the small number of studies included in the review and potential heterogeneity in outcomes and in differences in treatment.
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Affiliation(s)
- Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Michael Jelinek
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Barbara M Murphy
- Heart Research Centre, Melbourne, Australia Department of Psychology, University of Melbourne, Melbourne, Australia
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Vergès B, Patois-Vergès B, Iliou MC, Simoneau-Robin I, Bertrand JH, Feige JM, Douard H, Catargi B, Fischbach M. Influence of glycemic control on gain in VO2 peak, in patients with type 2 diabetes enrolled in cardiac rehabilitation after an acute coronary syndrome. The prospective DARE study. BMC Cardiovasc Disord 2015; 15:64. [PMID: 26152221 PMCID: PMC4495681 DOI: 10.1186/s12872-015-0055-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/10/2015] [Indexed: 01/04/2023] Open
Abstract
Background Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia. Methods We set up a prospective multicenter study (DARE) whose primary objective was to determine whether good glycemic control during CR may improve the gain in VO2 peak. Sixty four type 2 diabetic patients, referred to CR after a recent ACS, were randomized to insulin intensive therapy or a control group with continuation of the pre-CR antidiabetic treatment. The primary objective was to study the effect of glycemic control during CR on the improvement of peak VO2 by comparing first the 2 treatment groups (insulin intensive vs. control) and second, 2 pre-specified glycemic control groups according to the final fructosamine level (below and above the median). Results At the end of the CR program, the gain in VO2 peak and the final fructosamine level (assessing glycemic level during CR) were not different between the 2 treatment groups. However, patients who had final fructosamine level below the median value, assessing good glycemic control during CR, showed significantly higher gain in VO2 peak (3.5 ± 2.4 vs. 1.7 ± 2.4 ml/kg/min,p = 0.014) and ventilatory threshold (2.7 ± 2.5 vs. 1.2 ± 1.9 ml/kg/min,p = 0.04) and a higher proportion of good CR-responders (relative gain in VO2 peak ≥ 16 %): 66 % vs. 36 %, p = 0.011. In multivariate analysis, gain in VO2 peak was associated with final fructosamine level (p = 0.010) but not with age, gender, duration of diabetes, type of ACS, insulin treatment or basal fructosamine. Conclusions The DARE study shows that, in type 2 diabetes, good glycemic control during CR is an independent factor associated with gain in VO2 peak. This emphasizes the need for good glycemic control in CR for type 2 diabetic patients. Trial registration Trial registered as NCT00354237 (19 July 2006).
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Affiliation(s)
- Bruno Vergès
- Service endocrinologie, diabétologie, CHU Le Bocage, 21000, Dijon, France.
| | | | - Marie-Christine Iliou
- Service réadaptation cardiaque, Hôpital Corentin Celton, Issy les Moulineaux, France.
| | | | | | - Jean-Michel Feige
- Unité de réadaptation cardiaque, Clinique du Lavarin, Avignon, France.
| | - Hervé Douard
- Service réadaptation cardiaque, Hôpital du Haut Lévêque, Pessac, France.
| | - Bogdan Catargi
- Service endocrinologie, diabétologie, Hôpital du Haut Lévêque, Pessac, France.
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