Cardiac rehabilitation secondary prevention programs

Efficacy of risk stratification protocols and clinical, physical, and biochemical parameters to previse signals and symptoms during cardiovascular rehabilitation programs: Protocol for an observational trial

INTRODUCTION

Despite the benefits, cardiovascular rehabilitation programs (CRPs) have been related to the appearance of signals and symptoms. Risk stratification protocols are commonly used to identify risks during the physical exercise; however, studies that investigate their efficacy to previse signals and symptoms are inconclusive. Furthermore, clinical, physical, and biochemical parameters have been used as risk markers for the appearance of adverse events, and to investigate their efficacy to previse signals and symptoms during the CRP sessions that could better guide the strategies adopted on these programs.

OBJECTIVES

The aim of this study was to evaluate the correlations between risk stratification protocols and clinical, physical, and biochemical parameters with the appearance of signals/symptoms during CRP, as well as to evaluate if modifications on clinical, physical, and biochemical parameters could influence in the appearance of signals/symptoms during CRP.

MATERIALS AND METHODS

The study was prospectively registered at ClinicalTrials.gov (NCT03446742). Forty-four patient participants of a CRP will be evaluated. First, their risk stratification is going to be performed by 2 evaluators and their clinical, physical, and biochemical parameters are going to be measured. Then, the patients are going to be followed during 24 sessions during their CRP routines in order to identify appearance of their signals/symptoms. So, the patients are going to perform their cardiovascular rehabilitation routines for 6 months and then, their clinical, physical, and biochemical parameters are going to be measured again and they are going to be followed during 24 sessions during their CRP routines in order to identify the appearance of their signals/symptoms.

Cardiac rehabilitation in patients with type 2 diabetes mellitus and coronary disease: a comparative study

INTRODUCTION AND AIMS

Diabetic patients have a 2-4 times higher risk of cardiovascular disease than non-diabetic individuals. The aims of this study are to evaluate the effects of a cardiac rehabilitation program (phase II) in patients with diabetes and coronary disease and to compare the results with regard to control of cardiovascular risk factors and improvement in functional capacity with coronary patients without diabetes.

METHODS

This was a prospective study of patients diagnosed with ischemic heart disease referred for a cardiac rehabilitation program between January 2009 and June 2013. The population was divided into two groups: diabetic and non-diabetic. Patients were assessed at the beginning of phase II and three months later and the following parameters were recorded: body mass index, waist circumference, lipid profile, blood glucose and glycated hemoglobin in diabetic patients, blood pressure, smoking, physical activity level (using the International Physical Activity Questionnaire) and functional capacity (on treadmill stress testing).

RESULTS

The study population consisted of 682 patients (253 diabetic and 429 non-diabetic). Diabetic patients were significantly older, had a worse cardiovascular risk profile (higher prevalence of overweight, dyslipidemia, hypertension and sedentary lifestyle) and lower functional capacity. At the end of phase II, there was a statistically significant improvement (p<0.05) in all risk factors and functional capacity, which was similar in both groups, except for body mass index, triglycerides and functional capacity.

CONCLUSIONS

Diabetic patients may benefit from a cardiac rehabilitation program and achieve comparable results to non-diabetic patients.

Comparing two methods of rehabilitation for risk factor modification after a cardiac event

Because fewer than half of cardiac patients in the United States enroll in cardiac rehabilitation (CR) programs, there is a critical need to test alternative strategies of delivering CR services. This study tested whether a home-based CR (home-CR) program was at least as effective as traditional-CR (trad-CR) in the modification of coronary heart disease risk factors from the beginning of CR (baseline) to 2 and 4 months later. A repeated measures non-inferiority quasi-experimental design was used to examine changes in risk factors. Participants selected which CR program, traditional versus home-based, in which to participate: 37 patients chose trad-CR and 24 patients chose home-CR. The following indicators of risk factors were measured: smoking, blood pressure, frequency of aerobic exercise, cholesterol, amount of dietary fat, frequency of anger, body mass index (BMI), and waist circumference. Home-CR was found to be as effective as trad-CR in modification of cardiac risk factors including BMI, waist circumference, blood pressure, frequency of aerobic exercise, total cholesterol, and a low fat diet. Home-CR was not as effective as trad-CR in reducing the frequency of anger. These findings provide support for an alternative method of delivering cardiac rehabilitation services.

Exercise in the Elderly: Research and Clinical Practice

Exercise programs for elderly patients have received much attention recently for their potential role in preventing illness and injury, limiting functional loss and disability, and alleviating the course and symptoms of existing cardiac, pulmonary, and metabolic disorders. The basic components of an exercise training program include strength, endurance, balance, and flexibility. This article reviews the main attributes of each, along with some of the most recent research defining their roles in health care. Where available, it discusses specific recommendations for prescribing exercise modalities. Finally, it presents suggestions for developing integrated exercise programs and enhancing patient compliance.

Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders1∗1No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.∗Key references

This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications.

OVERALL ARTICLE OBJECTIVE

To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.