[The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)]

Change in exercise capacity, physical activity and motivation for physical activity at 12 months after a cardiac rehabilitation program in coronary heart disease patients: a prospective, monocentric and observational study

Background

Exercise capacity (EC) and physical activity (PA) are relevant predictors of mortality in patients with coronary heart disease (CHD) but the CHD-specific long-term trajectories of these outcomes after a cardiac rehabilitation (CR) program are not well known. The main objective of this study was to determine the mean change in EC (6-min walking test (6MWT) distance) in CHD patients at 12 months after a CR program compared to the end of the program. We also performed a series of exploratory analyses: (i) estimating the decile shifts and the typical (median) individual change for EC, PA (International Physical Activity Questionnaire-Short Form Metabolic Equivalent of Task (IPAQ-SF MET)-min/week), and motivation for PA (Echelle de Motivation envers l'Activité Physique en contexte de Santé (EMAPS) scores) over the 12-month follow-up period; (ii) characterizing the PA motivational profiles at the end of the program and 12 months after the program; (iii) characterizing the barriers to PA perceived at 12 months; and (iv) estimating the categories of changes in EC and PA over time and their potential predictors.

Methods

Eighty-three patients were recruited at the end of a CR program.

Results

For an average patient, EC was trivially increased at 12 months. However, the decile shifts analysis did not confirm that the positive shift of the distribution of the performances over time was uniform. In contrast, we observed a significant decrease in PA between the end of the program and 12 months post-program but not between 6 and 12 months post-program when considering both the group of patients as a whole and the typical individual change. The results regarding motivation for PA were mixed, with significant and non-uniform shifts of the deciles towards scores depicting degrees of autonomous and controlled motivations as well as amotivation that would be more in favor of PA, but with no significant typical individual changes except for introjected regulation. Two motivational profiles were identified both at the end of the program and 12 months after the program: one with a very high level of autonomous motivation and a high level of introjected regulation; and another one with a high level of autonomous motivation and a moderate level of introjected regulation. Unfavorable weather, lack of time, fatigue, and fear of injury were the main barriers to PA at 12 months post-program. The change in EC and PA could be categorized into different classes without the possibility to determine any potential predictor of the assignment to a given class. Overall, these results suggest that clinicians managing a CR program with CHD patients as the one implemented in the present study may expect slightly positive or at least steady trajectories in EC, PA (after 6 months), and motivation for PA during the year after the program when considering the bulks of the distributions of patient scores. However, these global trajectories are actually the results of heterogeneous individual changes with some profiles of patients who could need a particular attention.

Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional Cardiovascular Risk Factors and Prognostic Markers

BACKGROUND

Endothelial function (EndFx) is a core component of cardiovascular (CV) health and cardioprotection following acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).

HYPOTHESIS

AMI patients experience endothelial dysfunction (EndDys), associated with traditional CV risk factors and sleep patterns. EndFx may also predict short and mid-term outcomes.

METHODS

EndFx was assessed in 63 patients (56.2 ± 7.6 years) using the Endothelium Quality Index (EQI). Sleep quality and quantity were evaluated using objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index questionnaire) measures. Cardiorespiratory fitness was quantified through the 6-min walking test. Cardiac function was assessed using the left ventricular ejection fraction.

RESULTS

Following AMI, patients tended to experience EndDys (EQI = 1.4 ± 0.7). A severe EndDys was observed in 23.8% of patients (n = 15), while a mild EndDys was present in 63.49% (n = 40). Furthermore, EndDys was significantly associated with traditional CV risk factors (i.e., low physical activity level [12.8%], age [-4.2%], and smoking [-0.7%]) (R2 adjusted = 0.50, p < 0.001). Patients with EndDys had poor sleep quality (p = 0.001) and sleep efficiency (p = 0.016) compared to healthy persons. Patients with severe EndDys exhibited lower cardiorespiratory fitness compared to those with healthy EndFx (p = 0.017). Furthermore, during a follow-up period (nearly 4 months) following PCI, major adverse cardiac events were observed in four patients with severe EndDys.

CONCLUSIONS

Our results emphasize the importance of adequate sleep and an active lifestyle, notably physical activity practice, as modifiable elements to enhance EndFx, which is regarded as a predictive tool following AMI. However, other factors remain to be elucidated as predictors of CV risk.

TRIAL REGISTRATION

The study protocol was registered in the Pan African Clinical Trial Registry under the trial ID: PACTR202208834230748.

Staying at home in the COVID-19 period: Effects on well-being and physical activity in women living with overweight or obesity

Background: Between March and May 2020, the COVID-19 pandemic led governments to take specific lockdown measures. Investigations have defined obesity as a risk factor for disease severity, but none has addressed the effects of lockdown on psychological well-being and physical activity in this population. The objective of the study was to analyze the evolution (before vs. during lockdown) of well-being and physical activity among French adult women living with overweight or obesity. Methods: 250 women, divided into 5 Body Mass Index (BMI) categories (healthy weight, overweight, obesity I, II or III), provided online information concerning their self-perceived psychological well-being and level of physical activity before and after one month (± 1 week) of lockdown. Results: This study shows that BMI is a factor that is associated with well-being and physical activity. Compared to women with a healthy weight who significantly increased their level of physical activity, those living with overweight or obesity perceived a significant decrease in psychological well-being, positive affect, and physical exercise. Conclusions: This study highlights the importance of taking into account the well-being and active behavior of women living with overweight or obesity during any lockdown period that could occur in future pandemics.

Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care

Objectives: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. Methods: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci–Gagnon questionnaire. Results: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci–Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci–Gagnon score. A Ricci–Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). Conclusion: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications.

[Education program for cardiac rehabilitation: Impact of the "Drugs" multidisciplinary workshop on the patients' knowledge in the short- and long-term]

OBJECTIVE

The aim of this study is to assess the impact of the "Drugs" workshop of a therapeutic education program for cardiac rehabilitation on the patients' knowledge in the short and long term.

METHODS

This observational study includes patients who participated in the workshops from June 2016 to June 2017 (10 workshops). The scores obtained on the knowledge assessment survey submitted before (S1), after (S2) and at a distance (S3) from the workshops were compared (total scores and scores per question). The existence of a link between the patients' characteristics and the overall progression was assessed.

RESULTS

The mean total S1 (4.46/10) and S2 (7.98/10) scores were statistically different (n=62; P<0.0001) as well as the S1 (4.46/10) and S3 (7.53/10) scores (n=46; P<0.0001). A significant difference was observed for five out of six questions (P<0,0001) in the first sequence and for four out of six in the second one (P<0,0001). Initially, the best progress was made in terms of actions to be taken if a dose of medication has been missed; the worst one was the role of platelet inhibitors. Among the patients, 93.5% had a higher distance score than initially obtained. None of the chosen patient characteristics had a significant influence on the progression.

CONCLUSION

The workshop significantly improved patients' knowledge in the short and long term, regardless of their profile. This study identified areas for improvement for future workshops.

[Utility of the 6-minute walk test in assessing maintenance of physical activity after cardiac rehabilitation]

Evaluation of therapeutic patient education (TPE) is an integral part of cardiac rehabilitation programs. An important component of this involves assessing continued physical activity (PA) after rehabilitation. Few tools are available to assess the maintenance of physical activity, and we argue that use of a field test like the 6-minute walk test (6MWT) can provide some useful indicators. Objective: to study the utility of the 6MWT as a tool for assessing maintenance of PA in post-rehabilitation follow-up. Methods: we conducted a retrospective study of 168 patients (133 men and 35 women) with a mean age of 60.65 years (+/-9.7). First, we analyzed the data from a stress test (ST) and a 6MWT at the beginning and end of rehabilitation. We then analyzed the data from a 6MWT and an International Physical Activity Questionnaire (IPAQ) performed six months after the end of rehabilitation. Results: there was a significant correlation between the 6MWT and the initial and final ST (r=0.5456, p<0.001 for the initial ST, r= 0.604, p<0.001 for the final ST), confirming the validity of using this test in cardiac rehabilitation. We observed a slight correlation between the 6MWT and the IPAQ (r=0.3923, p<0.001) six months post-rehabilitation. The IPAQ results show that patients with a significant level of physical activity during the week maintain their 6MWT distance. Conclusion: the 6MWT is a reliable test in cardiac rehabilitation. It can be used in conjunction with the IPAQ to assess patient adherence to physical activity guidelines in post-rehabilitation follow-up.

[Nutritional education of the coronary patient in practice]

BACKGROUND

The Mediterranean diet is one of the food models which showed its ability at the patient at high cardiovascular risk in numerous cohort studies and two major interventional studies: Lyon Heart Study in 1999 and PREDIMED in 2013.

AIM OF THE STUDY

Propose a practical assistance in the analysis of the dietary habits of the coronary patient with a simplified food frequency questionnaire.

PATIENTS AND METHODS

Hundred coronary patients followed a program of cardiac rehabilitation and benefited from a nutritional education. The analysis of their dietary habits was made with the questionnaire of frequency of consumption of Rennes upon their arrival and 6months later. We have coded again these data by means of a simplified questionnaire with 15 items and compared the results and their evolution in 6months.

RESULTS

On studied 200 questionnaires, the score of Rennes was 10.6±4.5 and the simplified score 8.2±3.4 with a coefficient of correlation of Pearson r=0.94 (0.91-0.95) at risk P<0.0001. Initial scores were respectively 8.0±4.4 and 6.3±3.4 (r=0.93) and the scores at 6months 13.1±2.9 and 10.1±2.2 (r=0.86). The evolution of the scores of 100 patients were respectively 14.2±11.7% and 12.6±11% (P<0.26).

CONCLUSION

The use of a simplified questionnaire allows to analyze the dietary habits of the coronary patient and to estimate their evolution during a therapeutic educational program.

[Effects of a cardiac rehabilitation programme in coronary patient according to age]

BACKGROUND

Benefits of cardiac rehabilitation (CR) are well established in coronary heart disease. The effects according to age are less known, especially in France.

AIM OF THE STUDY

Evaluation at 6 months of a CR programme in three groups of patients with different age.

PATIENTS AND METHODS

Two hundred and two coronary patients were included in the CR department in Machecoul between 2007 and 2009. They attended the CR programme and were examined at six months. Patients were divided into three groups: group 1, n=103 (<65 years), group 2, n=71 (65 to 75 years) and group 3, n=28 (>75 years). We analysed the exercise capacity (exercise stress testing and six minutes walk-test or 6MWT), two questionnaires (dietary and physical activity) and bio-clinical data.

RESULTS

Exercise capacity improved respectively by 24, 27 and 18% (P<0.004 between G2 and G3). The 6MWT improved by 19, 22 and 25% (P<0.01 between G1 and G3). At 6 months, the 6MWT remain stable, the dietary and physical activity scales improved in the three groups, the body mass index (BMI) was unchanged, HDL cholesterol increased, smoking prevalence was respectively 16, 0 and 0% and medical treatment were optimal in 90, 82 and 79% (NS).

CONCLUSION

If the impact of CR was almost similar in the three groups, a more prolonged physical training seems desirable in patients over 75 years.