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Baross AW, Kay AD, Baxter BA, Wright BH, McGowan CL, Swaine IL. Effects of isometric resistance training and detraining on ambulatory blood pressure and morning blood pressure surge in young normotensives. Front Physiol 2022; 13:958135. [PMID: 36160861 PMCID: PMC9500147 DOI: 10.3389/fphys.2022.958135] [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: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Isometric resistance training (IRT) has been shown to reduce resting and ambulatory blood pressure (BP), as well as BP variability and morning BP surge (MBPS). However, there are no data available regarding how long after cessation of IRT these effects are maintained. Therefore, the purpose of this study was to determine the effects of 8 weeks of detraining on resting BP, ambulatory BP and MBPS following 8 weeks of IRT in a population of young normotensive individuals and to further substantiate previously reported reductions in MBPS following IRT. Twenty-five apparently healthy participants with resting BP within the normal range (16 men, age = 23 ± 6 years; 9 women, age = 22 ± 4 years, resting BP: 123 ± 5/69 ± 7 mmHg) were randomly assigned to a training-detraining (TRA-DT, n = 13) or control (CON, n = 12) group. Resting BP, ambulatory BP and MBPS were measured prior to, after 8 weeks of bilateral leg IRT using an isokinetic dynamometer (4 × 2-min contractions at 20% MVC with 2-min rest periods, 3 days/week) and following an 8-week detraining period. There were significant reductions in 24-h ambulatory systolic BP (SBP) and calculated SBP average real variability (ARV) following IRT that were maintained after detraining (pre-to-post detraining, −6 ± 4 mmHg, p = 0.008, −2 ± 1.5 mmHg, p = 0.001). Similarly, the training-induced decreases in daytime SBP and daytime SBP ARV (pre-to-post detraining, −5 ± 6 mmHg, p = 0.001; −2 ± 1.2 mmHg, p = 0.001, respectively), MBPS (pre-to-post detraining, −6 ± 9 mmHg, p = 0.046) and resting SBP (pre-to-post detraining, −4 ± 6 mmHg, p = 0.044) were preserved. There were no changes in night-time or night-time SBP ARV across all time points (pre-to-post detraining, −1 ± 8 mmHg, p = 1.00, −0.7 ± 2.9 mmHg, p = 1.00). These results confirm that IRT causes significant reductions in resting BP, ambulatory BP, ambulatory ARV and MBPS. Importantly, the changes remained significantly lower than baseline for 8 weeks after cessation of training, suggesting a sustained effect of IRT.
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Affiliation(s)
- A. W. Baross
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
- *Correspondence: A. W. Baross,
| | - A. D. Kay
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. A. Baxter
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - B. H. Wright
- Sport and Exercise Science, University of Northampton, Northampton, United Kingdom
| | - C. L. McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - I. L. Swaine
- Sport Science, University of Greenwich, London, United Kingdom
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Borland M, Bergfeldt L, Cider Å, Rosenkvist A, Jakobsson M, Olsson K, Lundwall A, Andersson L, Nordeman L. Effects of 3 months of detraining following cardiac rehabilitation in patients with atrial fibrillation. Eur Rev Aging Phys Act 2022; 19:14. [PMID: 35488206 PMCID: PMC9052551 DOI: 10.1186/s11556-022-00293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation negatively impacts physical fitness and health-related quality of life. We recently showed that 3 months of physiotherapist-led exercise-based cardiac rehabilitation improves physical fitness and muscle function in elderly patients with permanent atrial fibrillation and concomitant diseases. Little is, however, known about the consequences for physical fitness, physical activity level, and health-related quality of life after ending the rehabilitation period. Methods Prospective 3 months follow-up study of 38 patients out of 40 eligible (10 women) who, as part of a randomized controlled trial, had completed a 3 months physiotherapist-led cardiac rehabilitation resulting in improved physical fitness,. In the current study, the participants were instructed to refrain from exercise for 3 months after completion of the rehabilitation period. Primary outcome measure was physical fitness measured as highest achieved workload using an exercise tolerance test. Secondary outcome measures were muscle function (muscle endurance tests), physical activity level (questionnaire and accelerometer), and health-related quality of life, (Short Form-36), as in the preceding intervention study. We used the Wilcoxon Signed Rank test to analyse differences between the end of rehabilitation and at follow-up. The effect size was determined using Cohen’s d . Results Exercise capacity and exercise time significantly decresead between end of rehabilitation and at follow-up (p < .0001 for both). A significant reduction in shoulder flexion repetitions (p = .006) was observed as well as reduced health-related quality of life in the Short Form-36 dimensions Physical Function (p = .042), Mental Health (p = .030), and Mental Component Score (p = .035). There were, however, no changes regarding objective and subjective physical activity measurements. Conclusion In older patients with permanent atrial fibrillation, previously achieved improvements from physiotherapist-led exercise-based cardiac rehabilitation in physical fitness and muscle function were lost, and health-related quality of life was impaired after ending the rehabilitation period. A strategy for conserving improvements after a rehabilitation period is essential.
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Affiliation(s)
- Maria Borland
- Närhälsan Sörhaga Rehabilitation Center, Alingsås, Sweden. .,Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Borås Västra Götaland, Sweden. .,Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. .,SV Hospital Group rehabilitation Center, Alingsås Hospital, 441 83, Alingsås, Sweden.
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Marika Jakobsson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristin Olsson
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Lundwall
- Habo Health Center, Bra Liv Health Center, Habo, Jönköping, Sweden
| | | | - Lena Nordeman
- Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg, Borås Västra Götaland, Sweden.,Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Kirwan R, Perez de Heredia F, McCullough D, Butler T, Davies IG. Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom. BMC Sports Sci Med Rehabil 2022; 14:67. [PMID: 35418304 PMCID: PMC9007266 DOI: 10.1186/s13102-022-00459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. METHODS An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. RESULTS The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format. CONCLUSIONS Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.
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Affiliation(s)
- Richard Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Fatima Perez de Heredia
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Deaglan McCullough
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
| | - Tom Butler
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Price KJ, Gordon BA, Bird SR, Benson AC. Is the Clinical Delivery of Cardiac Rehabilitation in an Australian Setting Associated with Changes in Physical Capacity and Cardiovascular Risk and Are Any Changes Maintained for 12 Months? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178950. [PMID: 34501541 PMCID: PMC8431287 DOI: 10.3390/ijerph18178950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 08/22/2021] [Indexed: 11/17/2022]
Abstract
Long-term maintenance of changes in cardiovascular risk factors and physical capacity once patients leave the supervised program environment have not previously been reported. This study investigated the changes in physical capacity outcomes and cardiovascular risk factors in an Australian cardiac rehabilitation setting, and the maintenance of changes in these outcomes in the 12 months following cardiac rehabilitation attendance. Improvements in mean (95% CI) cardiorespiratory fitness (16.4% (13.2–19.6%), p < 0.001) and handgrip strength (8.0% (5.4–10.6%), p < 0.001) were observed over the course of the cardiac rehabilitation program, and these improvements were maintained in the 12 months following completion. Waist circumference (p = 0.003) and high-density lipoprotein cholesterol (p < 0.001) were the only traditional cardiovascular risk factors to improve during the cardiac rehabilitation program. Vigorous-intensity aerobic exercise was associated with significantly greater improvements in cardiorespiratory fitness, Framingham risk score, and waist circumference in comparison to moderate-intensity exercise. An increase in the intensity of the exercise prescribed during cardiac rehabilitation in Australia is recommended to induce larger improvements in physical capacity outcomes and cardiovascular risk. A standardized exercise test at the beginning of the rehabilitation program is recommended to facilitate appropriate prescription of exercise intensity.
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Affiliation(s)
- Kym Joanne Price
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia;
- Correspondence:
| | - Brett Ashley Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3550, Australia;
| | - Stephen Richard Bird
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia;
| | - Amanda Clare Benson
- Sport Innovation Research Group, Department of Health and Biostatistics, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
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Corres P, MartinezAguirre-Betolaza A, Fryer SM, Gorostegi-Anduaga I, Arratibel-Imaz I, Aispuru GR, Maldonado-Martín S. Long-Term Effects in the EXERDIET-HTA Study: Supervised Exercise Training vs. Physical Activity Advice. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2020; 91:209-218. [PMID: 31647384 DOI: 10.1080/02701367.2019.1656794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Purpose: To determine whether improvements in cardiorespiratory fitness (CRF), blood pressure (BP) and body composition previously seen after a 16-week exercise intervention (POST) with hypocaloric diet are maintained following six months (6M) of unsupervised exercise time. Methods: Overweight/obese, physically inactive participants with primary hypertension (HTN) (n = 190) were randomly assigned into an attention control group (physical activity recommendations) or one of three supervised exercise groups. After POST, all participants received diet and physical activity advice for the following 6M but no supervision. All anthropometric and physiological measurements were taken pre and post the 16-week supervised intervention period, as well as after 6M of no supervision. Results: After 6M: 1) body mass (BM) (Δ = 2.5%) and waist circumference (Δ = 1.8%) were higher (P < .005) than POST, but lower (P < .005) than pre-intervention (BM, Δ = -5.1%; waist circumference, Δ = -4.7%), with high-volume and high-intensity interval training group revealing a higher BM reduction (Δ = -6.4 kg) compared to control group (Δ = -3.5 kg); 2) BP variables were higher (P < .001) compared to POST with no change from pre-intervention; and 3) CRF was higher compared to pre-intervention (Δ = 17.1%, P < .001) but lower than POST (Δ = -5.7%, P < .001). Conclusions: When an overweight/obese population with HTN attains significant improvements in cardiometabolic health POST intervention with diet restriction, there is a significant reduction following 6M when exercise and diet supervision is removed, and only recommendations were applied. These results suggest the need for a regular, systematic and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.
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Corres P, Fryer SM, Aguirre-Betolaza AM, Gorostegi-Anduaga I, Arratibel-Imaz I, Pérez-Asenjo J, Francisco-Terreros S, Saracho R, Maldonado-Martín S. A Metabolically Healthy Profile Is a Transient Stage When Exercise and Diet Are Not Supervised: Long-Term Effects in the EXERDIET-HTA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082830. [PMID: 32326133 PMCID: PMC7216152 DOI: 10.3390/ijerph17082830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
Metabolically unhealthy obesity (MUO) is a regular state in people with primary hypertension (HTN), obesity, and who are physically inactive. To achieve and maintain a metabolically healthy overweight/obese (MHO) state should be a main treatment goal. The aims of the study were (1) to determine differences in metabolic profiles of overweight/obese, physically inactive individuals with HTN following a 16-week (POST) supervised aerobic exercise training (SupExT) intervention with an attentional control (AC) group, and (2) to determine whether the changes observed were maintained following six months (6 M) of unsupervised time. Participants (n = 219) were randomly assigned into AC or SupExT groups. All participants underwent a hypocaloric diet. At POST, all participants received diet and physical activity advice for the following 6 M, with no supervision. All measurements were assessed pre-intervention (PRE), POST, and after 6 M. From PRE to POST, MUO participants became MHO with improved (p < 0.05) total cholesterol (TC, ∆ = -12.1 mg/dL), alanine aminotransferase (∆ = -8.3 U/L), glucose (∆ = -5.5 mg/dL), C-reactive protein (∆ = -1.4 mg/dL), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) compared to unhealthy optimal cut-off values. However, after 6 M, TC, glucose, and SBP returned to unhealthy values (p < 0.05). In a non-physically active population with obesity and HTN, a 16-week SupExT and diet intervention significantly improves cardiometabolic profile from MUO to MHO. However, after 6 M of no supervision, participants returned to MUO. The findings of this study highlight the need for regular, systematic, and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.
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Affiliation(s)
- Pablo Corres
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain; (P.C.); (A.M.A.-B.); (I.G.-A.); (I.A.-I.)
| | - Simon M. Fryer
- School of Sport and Exercise, Oxstalls Campus, University of Gloucestershire, Gloucester GL2 9HW, UK;
| | - Aitor Martínez Aguirre-Betolaza
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain; (P.C.); (A.M.A.-B.); (I.G.-A.); (I.A.-I.)
| | - Ilargi Gorostegi-Anduaga
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain; (P.C.); (A.M.A.-B.); (I.G.-A.); (I.A.-I.)
| | - Iñaki Arratibel-Imaz
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain; (P.C.); (A.M.A.-B.); (I.G.-A.); (I.A.-I.)
| | - Javier Pérez-Asenjo
- Cardiology Unit, Igualatorio Médico Quirúrgico (IMQ-Amárica), 01005 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain;
| | - Silvia Francisco-Terreros
- Clinical Trials Unit, Health and Quality of Life Area, TECNALIA, 01009 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain;
| | - Ramón Saracho
- Nefrology Department, Osakidetza, Hospital University of Araba, 01009 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain;
| | - Sara Maldonado-Martín
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain; (P.C.); (A.M.A.-B.); (I.G.-A.); (I.A.-I.)
- Correspondence: ; Tel.: +34-945013534; Fax: +34-945013501
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Pinto R, Angarten V, Santos V, Melo X, Santa-Clara H. The effect of an expanded long-term periodization exercise training on physical fitness in patients with coronary artery disease: study protocol for a randomized controlled trial. Trials 2019; 20:208. [PMID: 30975195 PMCID: PMC6458824 DOI: 10.1186/s13063-019-3292-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background Benefits from cardiac rehabilitation (CR) programs are evidence-based and widely recognized. Less than 50% of people who participate in hospital-based CR programs maintain an exercise regime for as long as six months after completion. Little is known about interventions making the patients continue to exercise after the hospital-based formal program has ended. Methods to ensure sustained benefits of CR need to be tackled. Exercise periodization is a method typically used in sports training, but the impact of periodized exercise to yield optimal beneficial effects in cardiac patients is unclear. Therefore, the purpose of this trial is to evaluate the effects of a long-term exercise periodization on health-related physical fitness components such as cardiorespiratory endurance, muscular strength, skeletal muscle function, and body composition. Methods Fifty patients with coronary artery disease will be recruited among those who underwent the hospital-based CR phase. These patients will be randomized (1:1) into one of the following exercise groups: (1) periodized group; and (2) non-periodized group (exercise prescription based on standard guidelines). There will be four assessment time points: at baseline, and 3, 6, and 12 months after starting the exercise training program. At each time point, maximal and submaximal cardiorespiratory fitness, skeletal muscle deoxygenation dynamics, body composition by dual energy radiographic absorptiometry, functional fitness, maximal isometric and dynamic strength, physical activity, and quality of life will be assessed. This experimental design will last for 48 weeks with a frequency of three times per week for both groups. Discussion Most medium- to long-term exercise-based CR programs do not employ periodization or exercise progression. Randomized controlled trials are necessary to evaluate long-term periodization outcomes and assess the length of change observed in supervised CR programs. This study will contribute to generate evidence-based exercise prescription approaches to prolong the exercise training after the end of hospital-based CR programs. Trial registration ClinicalTrials.gov, NCT03335319. Registered on 22 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3292-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rita Pinto
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-687, Cruz Quebrada, Portugal.
| | - Vitor Angarten
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-687, Cruz Quebrada, Portugal
| | - Vanessa Santos
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-687, Cruz Quebrada, Portugal
| | - Xavier Melo
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-687, Cruz Quebrada, Portugal.,Ginásio Clube Português, GCP Lab, Praça Ginásio Clube Português 1, 1250-111, Lisboa, Portugal
| | - Helena Santa-Clara
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1495-687, Cruz Quebrada, Portugal
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9
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Giuliano C, Parmenter BJ, Baker MK, Mitchell BL, Williams AD, Lyndon K, Mair T, Maiorana A, Smart NA, Levinger I. Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2017. [PMID: 28638244 PMCID: PMC5470863 DOI: 10.1177/1179546817710028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of disease burden worldwide. Referral to cardiac rehabilitation (CR) is a class I recommendation for all patients with CAD based on findings that participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity and quality of life. However, programme uptake remains low, systematic progression through the traditional CR phases is often lacking, and communication between health care providers is frequently suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no longer treated by a single practitioner, but rather by an array of health professionals, across multiples specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted approach is required to achieve continuity and optimise patient outcomes. ‘Continuity of care’ has been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3 specific domains: informational, management, and relational continuity. This is examined in the context of CR.
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Affiliation(s)
- Catherine Giuliano
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael K Baker
- Australian Catholic University School of Exercise Science, Strathfield, NSW Australia
| | - Braden L Mitchell
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Andrew D Williams
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Katie Lyndon
- Exercise & Sports Science Australia, Albion, QLD, Australia
| | - Tarryn Mair
- Division of Medicine, Exercise Physiology Department, ACT Health, Canberra, ACT, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise, Science, Curtin University, Perth, WA, Australia.,Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, WA, Australia
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Itamar Levinger
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University and Western Health, St. Albans, VIC, Australia
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10
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Anderson L, Thompson DR, Oldridge N, Zwisler A, Rees K, Martin N, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2016; 2016:CD001800. [PMID: 26730878 PMCID: PMC6491180 DOI: 10.1002/14651858.cd001800.pub3] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane systematic review previously published in 2011. OBJECTIVES To assess the effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with usual care on mortality, morbidity and HRQL in patients with CHD.To explore the potential study level predictors of the effectiveness of exercise-based CR in patients with CHD. SEARCH METHODS We updated searches from the previous Cochrane review, by searching Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 6, 2014) from December 2009 to July 2014. We also searched MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Science Citation Index Expanded (December 2009 to July 2014). SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with a no exercise control. The study population comprised men and women of all ages who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris, or coronary artery disease. We included RCTs that reported at least one of the following outcomes: mortality, MI, revascularisations, hospitalisations, health-related quality of life (HRQL), or costs. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on the above inclusion and exclusion criteria. One author extracted data from the included trials and assessed their risk of bias; a second review author checked data. We stratified meta-analysis by the duration of follow up of trials, i.e. short-term: 6 to 12 months, medium-term: 13 to 36 months, and long-term: > 3 years. MAIN RESULTS This review included 63 trials which randomised 14,486 people with CHD. This latest update identified 16 new trials (3872 participants). The population included predominantly post-MI and post-revascularisation patients and the mean age of patients within the trials ranged from 47.5 to 71.0 years. Women accounted for fewer than 15% of the patients recruited. Overall trial reporting was poor, although there was evidence of an improvement in quality of reporting in more recent trials.As we found no significant difference in the impact of exercise-based CR on clinical outcomes across follow-up, we focused on reporting findings pooled across all trials at their longest follow-up (median 12 months). Exercise-based CR reduced cardiovascular mortality compared with no exercise control (27 trials; risk ratio (RR) 0.74, 95% CI 0.64 to 0.86). There was no reduction in total mortality with CR (47 trials, RR 0.96, 95% CI 0.88 to 1.04). The overall risk of hospital admissions was reduced with CR (15 trials; RR 0.82, 95% CI 0.70 to 0.96) but there was no significant impact on the risk of MI (36 trials; RR 0.90, 95% CI 0.79 to 1.04), CABG (29 trials; RR 0.96, 95% CI 0.80 to 1.16) or PCI (18 trials; RR 0.85, 95% CI 0.70 to 1.04).There was little evidence of statistical heterogeneity across trials for all event outcomes, and there was evidence of small study bias for MI and hospitalisation, but no other outcome. Predictors of clinical outcomes were examined across the longest follow-up of studies using univariate meta-regression. Results show that benefits in outcomes were independent of participants' CHD case mix (proportion of patients with MI), type of CR (exercise only vs comprehensive rehabilitation) dose of exercise, length of follow-up, trial publication date, setting (centre vs home-based), study location (continent), sample size or risk of bias.Given the heterogeneity in outcome measures and reporting methods, meta-analysis was not undertaken for HRQL. In five out of 20 trials reporting HRQL using validated measures, there was evidence of significant improvement in most or all of the sub-scales with exercise-based CR compared to control at follow-up. Four trial-based economic evaluation studies indicated exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years.The quality of the evidence for outcomes reported in the review was rated using the GRADE method. The quality of the evidence varied widely by outcome and ranged from low to moderate. AUTHORS' CONCLUSIONS This updated Cochrane review supports the conclusions of the previous version of this review that, compared with no exercise control, exercise-based CR reduces the risk of cardiovascular mortality but not total mortality. We saw a significant reduction in the risk of hospitalisation with CR but not in the risk of MI or revascularisation. We identified further evidence supporting improved HRQL with exercise-based CR. More recent trials were more likely to be well reported and include older and female patients. However, the population studied in this review still consists predominantly of lower risk individuals following MI or revascularisation. Further well conducted RCTs are needed to assess the impact of exercise-based CR in higher risk CHD groups and also those presenting with stable angina. These trials should include validated HRQL outcome measures, explicitly report clinical event outcomes including mortality and hospital admissions, and assess costs and cost-effectiveness.
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Affiliation(s)
- Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - David R Thompson
- University of MelbourneDepartment of PsychiatrySt Vincent's HospitalMelbourneVictoriaAustraliaVIC 3000
| | - Neil Oldridge
- Aurora Sinai/Aurora St. Luke's Medical CenterUniversity of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular ServicesMilwaukeeWisconsinUSA
| | - Ann‐Dorthe Zwisler
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegsdamsvej 9CopenhagenDenmark2100
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Nicole Martin
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
- University of Southern DenmarkNational Institute of Public HealthCopenhagenDenmark
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11
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Reibis R, Salzwedel A, Buhlert H, Wegscheider K, Eichler S, Völler H. Impact of training methods and patient characteristics on exercise capacity in patients in cardiovascular rehabilitation. Eur J Prev Cardiol 2015; 23:452-9. [PMID: 26285771 DOI: 10.1177/2047487315600815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/24/2015] [Indexed: 01/14/2023]
Abstract
AIM We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training methods for training achievements and final fitness of CR patients. METHODS We studied 557 consecutive patients (51.7 ± 6.9 years; 87.9% men) admitted to a three-week in-patient CR. Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training volume and final physical fitness (assessed by peak O2 utilization (VO2peak) were analysed using analysis of covariance (ANCOVA) models. RESULTS Mean training intensity was 90.7 ± 9.7% of maximum heart rate (81% continuous/19% interval training, 64% additional strength training). A total of 12.2 ± 2.6 bicycle exercise training sessions were performed. Increase of training volume by an average of more than 100% was achieved (difference end/beginning of CR: 784 ± 623 watts × min). In the multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO2peak was mainly dependent on age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and training method. CONCLUSION CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on various factors associated with training, which supports the recommendation that CR should be offered to all cardiac patients.
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Affiliation(s)
- Rona Reibis
- Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany
| | - Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Sarah Eichler
- Center of Rehabilitation Research, University of Potsdam, Germany
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Germany Department of Cardiology, Klinik am See, Rüdersdorf, Germany
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12
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Romero-Arenas S, Martínez-Pascual M, Alcaraz PE. Impact of resistance circuit training on neuromuscular, cardiorespiratory and body composition adaptations in the elderly. Aging Dis 2013; 4:256-63. [PMID: 24124631 DOI: 10.14336/ad.2013.0400256] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 11/01/2022] Open
Abstract
Declines in maximal aerobic power and skeletal muscle force production with advancing age are examples of functional declines with aging, which can severely limit physical performance and independence, and are negatively correlated with all cause mortality. It is well known that both endurance exercise and resistance training can substantially improve physical fitness and health-related factors in older individuals. Circuit-based resistance training, where loads are lifted with minimal rest, may be a very effective strategy for increasing oxygen consumption, pulmonary ventilation, strength, and functional capacity while improving body composition. In addition, circuit training is a time-efficient exercise modality that can elicit demonstrable improvements in health and physical fitness. Hence, it seems reasonable to identify the most effective combination of intensity, volume, work to rest ratio, weekly frequency and exercise sequence to promote neuromuscular, cardiorespiratory and body composition adaptations in the elderly. Thus, the purpose of this review was to summarize and update knowledge about the effects of circuit weight training in older adults and elderly population, as a starting point for developing future interventions that maintain a higher quality of life in people throughout their lifetime.
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Affiliation(s)
- Salvador Romero-Arenas
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Ciencias de la Actividad Física y del Deporte - UCAM, Universidad Católica San Antonio de Murcia, Spain. ; UCAM Research Center for High Performance Sport - UCAM, Universidad Católica San Antonio de Murcia, Spain
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13
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Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline. Neth Heart J 2013; 21:429-38. [PMID: 23975619 PMCID: PMC3776079 DOI: 10.1007/s12471-013-0467-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics. METHODS A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1-4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation. RESULTS Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation. CONCLUSIONS There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation.
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14
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Effects of community-based cardiac rehabilitation on body composition and physical function in individuals with stable coronary artery disease: 1.6-year followup. BIOMED RESEARCH INTERNATIONAL 2013; 2013:903604. [PMID: 23865071 PMCID: PMC3707214 DOI: 10.1155/2013/903604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/24/2013] [Indexed: 12/25/2022]
Abstract
Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR). Design. Thirty-four individuals (69.7 ± 8.2 years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance. Results. Participants attended 38.5 ± 30.3% sessions during 1.6 ± 0.2 year followup. A significant increase in 30-second chair stands (17.0 ± 4.7 to 19.6 ± 6.4, P < 0.001), body weight (75.8 ± 11.1 to 77.2 ± 12.1 kg, P = 0.001), and body fat (27.0 ± 9.5 to 29.1 ± 9.6%, P < 0.001) and a decline in handgrip strength (36.4 ± 9.4 to 33.0 ± 10.6 kg·f, P < 0.001) and muscle mass (40.8 ± 5.6 to 39.3 ± 5.8%, P < 0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes. Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.
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15
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Ormsbee MJ, Arciero PJ. Detraining increases body fat and weight and decreases VO2peak and metabolic rate. J Strength Cond Res 2012; 26:2087-95. [PMID: 22027854 DOI: 10.1519/jsc.0b013e31823b874c] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Competitive collegiate swimmers commonly take a month off from swim training after their last major competition. This abrupt cessation of intense physical training has not been well studied and may lead to physiopsychological decline. The purpose of this investigation was to examine the effects of swim detraining (DT) on body composition, aerobic fitness, resting metabolism, mood state, and blood lipids in collegiate swimmers. Eight healthy endurance-trained swimmers (V(O2)peak, 46.7 ± 10.8 ml · kg(-1) · min(-1)) performed 2 identical test days, 1 in the trained (TR) state and 1 in the detrained (~5 weeks) state (DT). Body composition and circumferences, maximal oxygen consumption (V(O2)peak), resting metabolism (RMR), blood lipids, and mood state were measured. After DT, body weight (TR, 68.9 ± 9.7 vs. DT, 69.8 ± 9.8 kg; p = 0.03), fat mass (TR, 14.7 ± 7.6 vs. DT, 16.5 ± 7.4 kg; p = 0.001), and waist circumference (TR, 72.7 ± 3.1 vs. DT, 73.8 ± 3.6 cm; p = 0.03) increased, whereas V(O2)peak (TR, 46.7 ± 10.8 vs. DT, 43.1 ± 10.3 ml · kg(-1) · min(-1); p = 0.02) and RMR (TR, 1.34 ± 0.2 vs. DT, 1.25 ± 0.17 kcal · min(-1); p = 0.008) decreased, and plasma triglycerides showed a trend to increase (p = 0.065). Our data suggest that DT after a competitive collegiate swim season adversely affects body composition, fitness, and metabolism. Athletes and coaches need to be aware of the negative consequences of detraining from swimming, and plan off-season training schedules accordingly to allow for adequate rest/recovery and prevent overuse injuries. It's equally important to mitigate the negative effects on body composition, aerobic fitness and metabolism so performance may continue to improve over the long term.
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Affiliation(s)
- Michael J Ormsbee
- Human Performance Laboratory, Department of Nutrition, Food, and Exercise Sciences, The Florida State University, Tallahassee, Florida, USA
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16
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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Heran BS, Chen JMH, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011:CD001800. [PMID: 21735386 PMCID: PMC4229995 DOI: 10.1002/14651858.cd001800.pub2] [Citation(s) in RCA: 449] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health. OBJECTIVES To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD. SEARCH STRATEGY RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009). SELECTION CRITERIA Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography. DATA COLLECTION AND ANALYSIS Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information. MAIN RESULTS This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health-related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise-based cardiac rehabilitation than usual care. AUTHORS' CONCLUSIONS Exercise-based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well-designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health-related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost-effectiveness.
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Affiliation(s)
- Balraj S Heran
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Jenny MH Chen
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tiffany Moxham
- Wimberly Library, Florida Atlantic University, Boca Raton, Florida, USA
| | - Neil Oldridge
- University of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
| | - Rod S Taylor
- Peninsula College of Medicine and Dentistry, Universities of Exeter & Plymouth, Exeter, UK
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Willis FB, Smith FM, Willis AP. Frequency of exercise for body fat loss: a controlled, cohort study. J Strength Cond Res 2010; 23:2377-80. [PMID: 19826285 DOI: 10.1519/jsc.0b013e3181b8d4e8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study is to examine the changes in body fat mass of previously sedentary, deconditioned subjects who began following the U.S. Surgeon General's recommendation in frequency of exercise. Ninety subjects of both sexes were recruited; ages ranged from 22 to 74 (mean 37.5 +/- 13) years. Subjects were prescribed exercise of 4 times a week, 30 minutes of continuous exercise, for 8 weeks. Eighty subjects completed the 8-week study and were categorized based on voluntary compliance: control (no exercise); exercise less than 2 times/week; exercise 3 to 4 times/week; exercise 4 or more times/week. Body fat mass was the dependent variable in this study, as measured by air displacement plethysmography, and data analysis was accomplished with a repeated measures analysis of variance. There was a significant change in body fat mass in this study, but the only significant difference between groups was for the group that exercised 4 or more times/week, (p = 0.004). Adherence to the U.S. Surgeon General's Guidelines for frequency of exercising 4 times per week for 30 minutes was effective in reducing subjects' body fat mass in this study.
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Affiliation(s)
- F Buck Willis
- Dynasplint Systems, Landmark Medical, Austin, Texas, USA.
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