Enhancing Participation in Cardiac Rehabilitation: A Question of Proximity and Integration of Outpatient Services

Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review

PURPOSE OF REVIEW

Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed.

RECENT FINDINGS

Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.

Increasing Cardiac Rehabilitation Participation Through a "Nearer to Home" Patient Referral Program

PURPOSE

Time to travel to cardiac rehabilitation (CR) centers is a barrier to participation, and tertiary referral centers often care for patients living at a substantial distance. We sought to determine the impact of referring eligible patients to CR centers closer to home or workplace on overall participation rate.

METHODS

An observational review was conducted in patients from a large cardiovascular program who were referred to CR (January 1, 2015, through December 31, 2016). Those declining participation due to distance from their home were identified and provided coordinated referral to a CR program they chose near their home or workplace.

RESULTS

Of the 2912 patients referred to CR, 673 (23%) participated and 1900 declined due to distance. Contact was made in 2017 with 1237 of the 1900 of whom 1083 recalled a discussion of distance referral and completed the phone survey. Participants mean age was 64 yr, predominantly White (88%), male (65%), married (66%), and 70% had ≥ comorbidity. Out of the 1083 referred to a local CR program, 78% reported attending. Of those who attended CR, 55% (469/849) would not have attended had they not been referred to a program closer to their home or workplace. Overall participation increased from 23% to >50% of those referred from our institution.

CONCLUSIONS

Coordinating CR referrals from the discharging facility to facilities closer to home or workplace is an effective means for increasing participation. The very low-cost effort has the potential to have a very meaningful impact on the long-term outcome of cardiovascular patients.

An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk

The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA.