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Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
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Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
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Orzechowski P, Piotrowicz R, Zaręba W, Główczyńska R, Szalewska D, Pluta S, Irzmański R, Kalarus Z, Banach M, Opolski G, Pencina MJ, Kowalik I, Piotrowicz E. Assessment of ECG during hybrid comprehensive telerehabilitation in heart failure patients-Subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) randomized clinical trial. Ann Noninvasive Electrocardiol 2021; 26:e12887. [PMID: 34499396 PMCID: PMC8588375 DOI: 10.1111/anec.12887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Exercise training in heart failure (HF) patients should be monitored to ensure patients' safety. Electrocardiographic (ECG) telemonitoring was used to assess the safety of hybrid comprehensive telerehabilitation (HCTR). OBJECTIVE Analysis of ECG recorded during HCTR in HF patients. METHODS The TELEREH-HF multicenter, randomized, controlled trial enrolled 850 HF patients with New York Heart Association class I-III and left ventricular ejection fraction of ≤40%. This subanalysis focuses on 386 patients (aged 62 ± 11 years, LVEF 31 ± 7%) randomized to HCTR. HCTR was telemonitored with a device allowing to record 16-s fragments of ECG and to transmit the data via mobile phone network to the monitoring center. ResultsIn 386 patients, 16,622 HCTR sessions were recorded and 66,488 ECGs fragments were evaluated. Sinus rhythm was present in 320 (83%) and permanent atrial fibrillation (AF) in 66 (17%) patients, respectively. The most common arrhythmias were ventricular and atrial premature beats, recorded in 76.4% and 27.7% of the patients, respectively. Non-sustained ventricular tachycardia (21 episodes in 8 patients) and paroxysmal AF episodes (6 in 4 patients) were rare. None of the analyzed demographic and clinical characteristics was predictive for onset of the new arrhythmias on exercise. CONCLUSION Telerehabilitation in HF patients was safe without the evidence for symptomatic arrhythmias requiring discontinuation of telerehabilitation. Only one mildly symptomatic paroxysmal AF episode led to the short-term suspension of the training program. The most common arrhythmias were atrial and ventricular premature beats. These arrhythmias did not result in any changes in rehabilitation and therapy regimens.
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Affiliation(s)
- Piotr Orzechowski
- Telecardiology Center, National Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Coronary Disease and Rehabilitation, National Institute of Cardiology, Warsaw, Poland.,Warsaw Academy of Medical Rehabilitation, Warsaw, Poland
| | | | - Renata Główczyńska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Szalewska
- Chair and Clinic of Rehabilitation Medicine, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Robert Irzmański
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, Łódź, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, Łódź, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, Warsaw, Poland
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Arakelian VM, Goulart CL, Mendes RG, Caruso FC, Baldissera V, Arena R, Borghi-Silva A. Cardiorespiratory and metabolic determinants during moderate and high resistance exercise intensities until exhaustion using dynamic leg press: comparison with critical load. ACTA ACUST UNITED AC 2018; 51:e7837. [PMID: 30328936 PMCID: PMC6190210 DOI: 10.1590/1414-431x20187837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/28/2018] [Indexed: 11/29/2022]
Abstract
The objective of this study was to assess cardiovascular, respiratory, and metabolic responses during a commonly used dynamic leg press resistance exercise until exhaustion (TEx) at different intensities and compare with critical load (CL). This was a prospective, cross-sectional, controlled, and crossover study. Twelve healthy young men (23±2.5 years old) participated. The subjects carried out three bouts of resistance exercise in different percentages of 1 repetition maximum (60, 75, and 90% 1RM) until TEx. CL was obtained by means of hyperbolic model and linearization of the load-duration function. During all bout intensities, oxygen uptake (VO2), carbon dioxide production (VCO2), ventilation (VE), and respiratory exchange ratio (RER) were obtained. Variations (peak-rest=Δ) were corrected by TEx. In addition, systolic and diastolic blood pressure (SBP and DBP), blood lactate concentration [La-] and Borg scores were obtained at the peak and corrected to TEx. CL induced greater TEx as well as number of repetitions when compared to all intensities (P<0.001). During CL, Borg/TEx, ΔSBP/TEx, ΔDBP/TEx, and [La-] were significantly lower compared with 90% load (P<0.0001). In addition, VO2, VCO2, VE, and RER were higher during CL when compared to 90 or 75%. TEx was significantly correlated with VO2 on CL (r=0.73, P<0.05). These findings support the theory that CL constitutes the intensity that can be maintained for a very long time, provoking greater metabolic and ventilatory demand and lower cardiovascular and fatigue symptoms during resistance exercise.
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Affiliation(s)
- V M Arakelian
- Programa de Pós-graduação Interunidades em Bioengenharia, Universidade de São Paulo, São Carlos, SP, Brasil.,Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil.,Laboratório de Fisiologia do Exercício, Departamento de Ciências Fisiológicas, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - C L Goulart
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - R G Mendes
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F C Caruso
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - V Baldissera
- Laboratório de Fisiologia do Exercício, Departamento de Ciências Fisiológicas, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - R Arena
- Department of Physical Therapy, University of Illinois, Chicago, USA
| | - A Borghi-Silva
- Programa de Pós-graduação Interunidades em Bioengenharia, Universidade de São Paulo, São Carlos, SP, Brasil.,Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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Doyle MP, Indraratna P, Tardo DT, Peeceeyen SC, Peoples GE. Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 26:36-45. [PMID: 30188177 DOI: 10.1177/2047487318798924] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2-6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period. METHODS A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery. A meta-analysis was performed comparing functional, aerobic and safety outcomes in patients receiving early postoperative aerobic exercise compared with usual postoperative care. RESULTS Six-minute walk test distance at hospital discharge was 419 ± 88 m in early aerobic exercise patients versus 341 ± 81 m in those receiving usual care (mean difference 69.5 m, 95% confidence interval (CI) 39.2-99.7 m, p < 0.00001). Peak aerobic power was 18.6 ± 3.8 ml·kg-1·min-1 in those receiving early exercise versus 15.0 ± 2.1 ml·kg-1·min-1 in usual care (mean difference 3.20 ml·kg-1·min-1, 95% CI 1.45-4.95, p = 0.0003). There was no significant difference in adverse events rates between the two groups (odds ratio 0.41, 95% CI 0.12-1.42, p = 0.16). CONCLUSION Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery. While adverse event rates did not differ significantly, patients included were very low risk. Further studies are required to adequately assess safety outcomes of aerobic exercise commenced early after cardiac surgery.
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Affiliation(s)
- Mathew P Doyle
- 1 School of Medicine, University of Wollongong, Wollongong, Australia.,2 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Praveen Indraratna
- 3 Department of Cardiology, St George Hospital, Sydney, Australia.,4 Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daniel T Tardo
- 3 Department of Cardiology, St George Hospital, Sydney, Australia.,5 School of Medicine, University of Notre Dame, Sydney, Australia
| | - Sheen Cs Peeceeyen
- 2 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Gregory E Peoples
- 1 School of Medicine, University of Wollongong, Wollongong, Australia
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Postacute rehabilitation after coronary surgery: the effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation. Am J Phys Med Rehabil 2011; 90:308-15. [PMID: 21765246 DOI: 10.1097/phm.0b013e31820f9535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Postoperative atrial fibrillation (AF) is a frequent complication after cardiac surgery. AF may also occur after hospital discharge during postacute rehabilitation. Several studies have addressed the AF that occurs in the hospital after surgery, and predictors have already been identified. Postoperative AF that occurs after hospital discharge has not been investigated thoroughly, and predictors are still unknown. In this study, we hypothesized that moderate-intensity physical activity in the year before surgery might favorably affect the incidence of AF during postacute rehabilitation. DESIGN We tested our hypothesis in a cohort of 158 older patients admitted to a medical rehabilitation facility for postacute inpatient rehabilitation after coronary surgery and continuously monitored by telemetry for the duration of the rehabilitation. RESULTS Independent of potential confounders, patients who reported low-intensity physical activity in the year before surgery showed a significantly higher incidence of AF during postacute rehabilitation when compared with those who reported moderate-intensity physical activity (32.1% vs. 8.1%; P = 0.029). Other independent predictors of AF during postacute rehabilitation were the occurrence of AF during the patients' stay in hospital, larger left atrial volume, and lower left atrial emptying fraction. CONCLUSIONS These findings confirm our hypothesis that physical activity in the year before surgery affects the incidence of postoperative AF during postacute rehabilitation. The results also provide information regarding possible predictors that may assist in identifying patients who could benefit from preventive treatments.
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Macchi C, Fattirolli F, Lova RM, Conti AA, Luisi MLE, Intini R, Zipoli R, Burgisser C, Guarducci L, Masotti G, Gensini GF. Early and Late Rehabilitation and Physical Training in Elderly Patients After Cardiac Surgery. Am J Phys Med Rehabil 2007; 86:826-34. [PMID: 17885315 DOI: 10.1097/phm.0b013e318151fd86] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few randomized trials have enrolled patients who have undergone cardiac surgery, and even fewer have included patients aged 75 yrs or more. Furthermore, the optimal timing of cardiac rehabilitation for postsurgical patients has not yet been codified. The aim of this study was to verify whether rehabilitation outcomes are also favorable in postsurgical patients aged 75 yrs or more and whether an early rehabilitation program is as effective and safe as a late one. DESIGN Three hundred patients who underwent cardiac surgery, 27.7% of whom were at least 75 yrs old, were randomly assigned to a rehabilitation program starting within the second week after operation or within the fourth week. All events occurring during the rehabilitation program or in the following year were recorded. RESULTS During the rehabilitation program, new-onset atrial fibrillation was significantly more frequent in the early rehabilitation group, independent of age class, and anemia was significantly more frequent in older patients, independent of rehabilitation timing. At the end of the rehabilitation program, more than 90% of patients showed significant increases in walking distance, and during the follow-up, no significant difference was found with regard to mortality, nonfatal events, functional ability, or control of cardiovascular risk factors, independent of rehabilitation timing and age class. CONCLUSIONS This study provides evidence that in selected patients who have undergone cardiac surgery, rehabilitation outcomes are also favorable in patients aged 75 yrs or more, and an early rehabilitation program is as effective and safe as a traditionally late one.
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Affiliation(s)
- Claudio Macchi
- Cardiac Rehabilitation Unit, Don Gnocchi Foundation, Florence, Italy
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Bartels MN, Whiteson JH, Alba AS, Kim H. Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 1. Cardiac Rehabilitation Review. Arch Phys Med Rehabil 2006; 87:S46-56. [PMID: 16500192 DOI: 10.1016/j.apmr.2005.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 11/23/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Cardiac rehabilitation includes not only the rehabilitation of people with ischemic heart disease but also those with congestive heart failure, heart transplantation, congenital heart disease, and other conditions. New advances in medical treatment have arisen, and there are new approaches in treatment, including alternative medicine and complementary care. New surgical approaches that help restore cardiac function have also been introduced, and rehabilitation professionals must be aware of these advances and be able to incorporate this knowledge into the practice of rehabilitation medicine. OVERALL ARTICLE OBJECTIVES (a) To identify major categories of cardiac disease, (b) to elucidate appropriate interventions and support for patients with coronary artery disease, (c) to describe the new interventions available for the treatment of cardiac disease, and (d) to describe the appropriate role of cardiac rehabilitation for people with various forms of cardiac disease.
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Affiliation(s)
- Matthew N Bartels
- Rehabilitation Medicine Department, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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