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Al-Ezzi SMS, Inban P, Chandrasekaran SH, Priyatha V, Bamba H, John J, Singh G, Prajjwal P, Marsool MDM, Jain H. The role of exercise training and dietary sodium restriction in heart failure rehabilitation: A systematic review. Dis Mon 2024; 70:101781. [PMID: 38960754 DOI: 10.1016/j.disamonth.2024.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Heart failure (HF) rehabilitation seeks to enhance the entire well-being and quality of life of those with HF by focusing on both physical and mental health. Non-pharmacological measures, particularly exercise training, and dietary salt reduction, are essential components of heart failure rehabilitation. This study examines the impact of these components on the recovery of patients with heart failure. By conducting a comprehensive analysis of research articles published from 2010 to 2024, we examined seven relevant studies collected from sources that include PubMed and Cochrane reviews. Our findings indicate that engaging in physical activity leads to favorable modifications in the heart, including improved heart contractility, vasodilation, and cardiac output. These alterations enhance the delivery of oxygen to the peripheral tissues and reduce symptoms of heart failure, such as fatigue and difficulty breathing. Nevertheless, decreasing the consumption of salt in one's diet to less than 1500 mg per day did not have a substantial impact on the frequency of hospitalizations, visits to the emergency room, or overall mortality when compared to conventional treatment. The combination of sodium restriction and exercise training can have synergistic effects due to their complementary modes of action. Exercise improves cardiovascular health and skeletal muscle metabolism, while sodium restriction increases fluid balance and activates neurohormonal pathways. Therefore, the simultaneous usage of both applications may result in more significant enhancements in HF symptoms and clinical outcomes compared to using each program alone.
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Affiliation(s)
| | - Pugazhendi Inban
- Internal Medicine, St. Mary's General Hospital and St. Clare's Health, NY, USA.
| | | | - Vemparala Priyatha
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Hyma Bamba
- Internal Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Jobby John
- Internal Medicine, Dr. Somervell Memorial CSI Medical College and Hospital Karakonam, Trivandrum, India
| | - Gurmehar Singh
- Internal Medicine, Government Medical College and Hospital, Chandigarh, India
| | | | | | - Hritvik Jain
- Cardiology, All India Institute of Medical Sciences, Jodhpur, India
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Keltz RR, Faricier R, Prior PL, Hartley T, Huitema AA, McKelvie RS, Suskin NG, Keir DA. A standardized approach to evaluate effectiveness of aerobic exercise training interventions in cardiovascular disease at the individual level. Int J Cardiol 2024; 412:132335. [PMID: 38964557 DOI: 10.1016/j.ijcard.2024.132335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/31/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Reliable change indices can determine pre-post intervention changes at an individual level that are greater than chance or practice effect. We applied previously developed minimal meaningful change (MMCRCI) scores for oxygen uptake (V̇O2) values associated with estimated lactate threshold (θLT), respiratory compensation point (RCP), and peak oxygen uptake (V̇O2peak) to evaluate the effectiveness of exercise training in cardiovascular disease patients. METHODS 303 patients (65 ± 11 yrs.; 27% female) that completed a symptom-limited cardiopulmonary exercise test (CPET) before and after 6-months of guideline-recommended exercise training were assessed to determine absolute and relative V̇O2 at θLT, RCP, and V̇O2peak. Using MMCRCI ∆V̇O2 scores of ±3.9 mL·kg-1·min-1, ±4.0 mL·kg-1·min-1, and ± 3.6 mL·kg-1·min-1 for θLT, RCP, and V̇O2peak, respectively, patients were classified as "positive" (ΔθLT, ΔRCP, and/or ΔV̇O2peak ≥ +MMCRCI), "non-" (between ±MMCRCI), or "negative" responders (≤ -MMCRCI). RESULTS Mean RCP (n = 86) and V̇O2peak (n = 303) increased (p < 0.05) from 19.4 ± 3.6 mL·kg-1·min-1 and 18.0 ± 6.3 mL·kg-1·min-1 to 20.1 ± 3.8 mL·kg-1·min-1 and 19.2 ± 7.0 mL·kg-1·min-1 at exit, respectively, whereas θLT (n = 140) did not change (15.5 ± 3.4 mL·kg-1·min-1 versus 15.7 ± 3.8 mL·kg-1·min-1, p = 0.324). For changes in θLT, 6% were classified as "positive" responders, 90% as "non-responders", and 4% as "negative" responders. For RCP, 10% exhibited "positive" changes, 87% were "non-responders", and 2% were "negative" responders. For ΔV̇O2peak, 57 patients (19%) were classified as "positive" responders, 229 (76%) as "non-responders", and 17 (6%) as "negative" responders. CONCLUSION Most patients that completed the exercise training program did not achieve reliable improvements greater than that of chance or practice at an individual level in θLT, RCP and V̇O2peak.
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Affiliation(s)
- Randi R Keltz
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Robin Faricier
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Peter L Prior
- Lawson Health Research Institute, London, Ontario, Canada; Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, Ontario, Canada
| | - Tim Hartley
- Lawson Health Research Institute, London, Ontario, Canada; Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, Ontario, Canada
| | - Ashlay A Huitema
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Robert S McKelvie
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Neville G Suskin
- Lawson Health Research Institute, London, Ontario, Canada; Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Daniel A Keir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
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Li Q, Yan L, Xing W, Zhou C, Li Y, Wan B, Piao J, Gu Y. The effect of fear-avoidance intervention on kinesiophobia and self-efficacy in patients after percutaneous coronary intervention: study protocol for a clinical randomized controlled trial. Trials 2024; 25:517. [PMID: 39085967 PMCID: PMC11293134 DOI: 10.1186/s13063-024-08349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/19/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Kinesiophobia after percutaneous coronary intervention (PCI) may lead to decreased compliance with rehabilitation exercises. Effective interventions are essential to overcome kinesiophobia after PCI. The aim of this trial is to investigate the clinical effects of an intervention based on the fear-avoidance model (FAM) on kinesiophobia in post-PCI patients. METHODS Eighty participants will be recruited in the Department of Cardiology in Hebei Provincial People's Hospital. And they will be randomly allocated to the test group and undergo a 5-day step-to-step intervention. The primary outcome will be the scores of a scale on kinesiophobia. Secondary outcome measures included self-efficacy for exercise, psychogenic anxiety, and the occurrence of cardiovascular adverse events. Primary and secondary outcome data will be collected at baseline (t0), on the day of discharge (t1), and one month after discharge (t2). DISCUSSION The effectiveness of an intervention based on the FAM to increase exercise self-efficacy and decrease kinesiophobia in post-PCI patients will be demonstrated. The findings of this study will facilitate post-PCI patients to participate in cardiac rehabilitation. TRIAL REGISTRATION ChiCTR2200065649 Effect of an intervention based on the fear-avoidance model on exercise fear in patients after percutaneous coronary intervention. Registered on November 10, 2022.
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Affiliation(s)
- Qi Li
- Faculty of Nursing, HeBei University of Chinese Medicine, Xingyuan Rd, LuQuan, No.3 Xingyuan Rd, LuQuan, Shijiazhuang, 050200, Hebei, China
| | - Lingjun Yan
- Faculty of Nursing, HeBei University of Chinese Medicine, Xingyuan Rd, LuQuan, No.3 Xingyuan Rd, LuQuan, Shijiazhuang, 050200, Hebei, China
- Current Address: The Third Hospital of Shijiazhuang City, Shijiazhuang, Hebei Province, China
| | - Wenhui Xing
- Faculty of Nursing, HeBei University of Chinese Medicine, Xingyuan Rd, LuQuan, No.3 Xingyuan Rd, LuQuan, Shijiazhuang, 050200, Hebei, China
| | - Ce Zhou
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yu Li
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Boya Wan
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jingjing Piao
- Faculty of Nursing, HeBei University of Chinese Medicine, Xingyuan Rd, LuQuan, No.3 Xingyuan Rd, LuQuan, Shijiazhuang, 050200, Hebei, China
| | - Yanmei Gu
- Faculty of Nursing, HeBei University of Chinese Medicine, Xingyuan Rd, LuQuan, No.3 Xingyuan Rd, LuQuan, Shijiazhuang, 050200, Hebei, China.
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Crozier A, Graves LE, George KP, Richardson D, Naylor L, Green DJ, Rosenberg M, Jones H. A multi-method exploration of a cardiac rehabilitation service delivered by registered Clinical Exercise Physiologists in the UK: key learnings for current and new services. BMC Sports Sci Med Rehabil 2024; 16:127. [PMID: 38849904 PMCID: PMC11162017 DOI: 10.1186/s13102-024-00907-4] [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: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Cardiac rehabilitation has been identified as having the most homogenous clinical exercise service structure in the United Kingdom (UK), but inconsistencies are evident in staff roles and qualifications within and across services. The recognition of Clinical Exercise Physiologists (CEPs) as a registered health professional in 2021 in the UK, provides a potential solution to standardise the cardiac rehabilitation workforce. This case study examined, in a purposefully selected cardiac exercise service that employed registered CEPs, (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective service teams, and (iii) the existing challenges from staff and patient perspectives. METHODS A multi-method qualitative approach (inc., semi-structured interviews, observations, field notes and researcher reflections) was employed with the researcher immersed for 12-weeks within the service. The Consolidated Framework for Implementation Research was used as an overarching guide for data collection. Data derived from registered CEPs (n = 5), clinical nurse specialists (n = 2), dietitians (n = 1), service managers/leads (n = 2) and patients (n = 7) were thematically analysed. RESULTS Registered CEPs delivered innovative exercise prescription based on their training, continued professional development (CPD), academic qualifications and involvement in research studies as part of the service. Exposure to a wide multidisciplinary team (MDT) allowed skill and competency transfer in areas such as clinical assessments. Developing an effective behaviour change strategy was challenging with delivery of lifestyle information more effective during less formal conversations compared to timetabled education sessions. CONCLUSIONS Registered CEPs have the specialist knowledge and skills to undertake and implement the latest evidence-based exercise prescription in a cardiac rehabilitation setting. An MDT service structure enables a more effective team upskilling through shared peer experiences, observations and collaborative working between healthcare professionals.
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Affiliation(s)
- Anthony Crozier
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Lee E Graves
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - David Richardson
- School of Human and Behavioural Sciences, Bangor University, North Wales, UK
| | - Louise Naylor
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Daniel J Green
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Michael Rosenberg
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Helen Jones
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
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Li Z, Guo K, Yang Y, Shuai Y, Fan R, Li Y, DU J, Niu J, Yang K. Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study. Eur J Phys Rehabil Med 2024; 60:361-372. [PMID: 38345568 PMCID: PMC11112512 DOI: 10.23736/s1973-9087.23.08165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.
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Affiliation(s)
- Zijun Li
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ke Guo
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongqi Yang
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yuxi Shuai
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Rui Fan
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
| | - Jiawei DU
- Second Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Junqiang Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
- First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China -
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
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Albustami M, Hartfiel N, Charles JM, Powell R, Begg B, Birkett ST, Nichols S, Ennis S, Hee SW, Banerjee P, Ingle L, Shave R, McGregor G, Edwards RT. Cost-effectiveness of High-Intensity Interval Training (HIIT) vs Moderate Intensity Steady-State (MISS) Training in UK Cardiac Rehabilitation. Arch Phys Med Rehabil 2024; 105:639-646. [PMID: 37730193 DOI: 10.1016/j.apmr.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR). DESIGN Secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT. SETTING Six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK. PARTICIPANTS 382 participants with CAD (N=382). INTERVENTIONS Participants were randomized to twice-weekly usual care (n=195) or HIIT (n=187) for 8 weeks. Usual care was moderate intensity continuous exercise (60%-80% maximum capacity, MISS), while HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. MAIN OUTCOME MEASURES We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related quality of life was measured with the EQ-5D-5L to estimate quality-adjusted life years (QALYs). Costs were estimated with health service resource use and intervention delivery costs. Cost-utility analysis measured the incremental cost-effectiveness ratio (ICER). Bootstrapping assessed the probability of HIIT being cost-effective according to the UK National Institute for Health and Care Excellence (NICE) threshold value (£20,000 per QALY). Missing data were imputed. Uncertainty was estimated using probabilistic sensitivity analysis. Assumptions were tested using univariate/1-way sensitivity analysis. RESULTS 124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined health care use and delivery cost was £676 per participant for HIIT, and £653 for MISS. QALY changes were 0.003 and -0.013, respectively. For complete cases, the ICER was £1448 per QALY for HIIT compared with MISS. At a willingness-to-pay threshold of £20,000 per QALY, the probability of HIIT being cost-effective was 96% (95% CI, 0.90 to 0.95). CONCLUSION For people with CAD attending CR, HIIT was cost-effective compared with MISS. These findings are important to policy makers, commissioners, and service providers across the health care sector.
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Affiliation(s)
- Mohammed Albustami
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK
| | - Brian Begg
- Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, Wales UK; Aneurin Bevan University Health Board, Gwent, Wales, UK
| | - Stefan T Birkett
- Department of Sport and Exercise Sciences. Manchester Metropolitan University, Manchester, UK
| | - Simon Nichols
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK; Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Stuart Ennis
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | - Rob Shave
- Centre for Heart Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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Duscha BD, Ross LM, Hoselton AL, Piner LW, Pieper CF, Kraus WE. A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality. J Cardiopulm Rehabil Prev 2024; 44:99-106. [PMID: 38113355 PMCID: PMC10913862 DOI: 10.1097/hcr.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality. METHODS Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups. RESULTS During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043). CONCLUSIONS Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.
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Affiliation(s)
- Brian D. Duscha
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Leanna M. Ross
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Andrew L. Hoselton
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Lucy W. Piner
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Carl F. Pieper
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - William E. Kraus
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
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Kemerley A, Gupta A, Thirunavukkarasu M, Maloney M, Burgwardt S, Maulik N. COVID-19 Associated Cardiovascular Disease-Risks, Prevention and Management: Heart at Risk Due to COVID-19. Curr Issues Mol Biol 2024; 46:1904-1920. [PMID: 38534740 DOI: 10.3390/cimb46030124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
The SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) virus and the resulting COVID-19 pandemic have had devastating and lasting impact on the global population. Although the main target of the disease is the respiratory tract, clinical outcomes, and research have also shown significant effects of infection on other organ systems. Of interest in this review is the effect of the virus on the cardiovascular system. Complications, including hyperinflammatory syndrome, myocarditis, and cardiac failure, have been documented in the context of COVID-19 infection. These complications ultimately contribute to worse patient outcomes, especially in patients with pre-existing conditions such as hypertension, diabetes, or cardiovascular disease (CVD). Importantly and interestingly, reports have demonstrated that COVID-19 also causes myocardial injury in adults without pre-existing conditions and contributes to systemic complications in pediatric populations, such as the development of multisystem inflammatory syndrome in children (MIS-C). Although there is still a debate over the exact mechanisms by which such complications arise, understanding the potential paths by which the virus can influence the cardiovascular system to create an inflammatory environment may clarify how SARS-CoV-2 interacts with human physiology. In addition to describing the mechanisms of disease propagation and patient presentation, this review discusses the diagnostic findings and treatment strategies and the evolution of management for patients presenting with cardiovascular complications, focusing on disease treatment and prevention.
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Affiliation(s)
- Andrew Kemerley
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Abhishek Gupta
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Mahesh Thirunavukkarasu
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Monica Maloney
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Sean Burgwardt
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Nilanjana Maulik
- Department of Surgery, Molecular Cardiology and Angiogenesis Laboratory, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
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Nemani RRS, Gade BS, Panchumarthi D, Bathula BVSR, Pendli G, Panjiyar BK. Role of Cardiac Rehabilitation in Improving Outcomes After Myocardial Infarction. Cureus 2023; 15:e50886. [PMID: 38249185 PMCID: PMC10799544 DOI: 10.7759/cureus.50886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Myocardial infarction, an integral part of acute coronary syndrome (ACS), occurs due to atherosclerotic narrowing of the coronary (heart) blood vessels. Acute coronary syndrome, being one of the major cardiovascular diseases (CVDs), has led to a significant amount of mortality and morbidity, the majority of it due to MI. Over a long period following an MI, the physical, psychological, social, emotional, and occupational well-being are greatly impacted. Cardiac rehabilitation (CR) can address the above and help improve long-term well-being and overall quality of life. The benefits of CR include enhanced exercise capacity, risk factor reduction, improved quality of life (QOL), reduced mortality, and hospital readmissions. We used a systematic literature review (SLR) approach in this article to provide a global overview of cutting-edge CR in the post-MI phase. We reviewed 45 articles from journals of good repute published between 2013 and December 1st, 2023, focusing on seven selected papers for in-depth analysis. The analysis was focused on factors such as the positive outcomes of CR and the effects of CR post-MI. There are only a few statistically significant studies in a few domains of CR benefits, namely decreased mortality, cardiac events, depression, depression-associated mortality, hospital readmissions, increased left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic volume (LVESV), metabolic equivalent of task (MET), maximal oxygen consumption (VO2max), and the six-minute walk test (6MWT), and as a result, increased physical performance. Further research is needed to enhance the understanding of its mechanisms and statistically prove its effectiveness in all other domains. As CR continues to evolve, referral and participation in CR should be increased as it improves overall health and well-being.
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Affiliation(s)
| | | | | | | | - Ganesh Pendli
- Medicine, PES Institue of Medical Sciences and Research, Kuppam, IND
| | - Binay K Panjiyar
- Research, Texas Tech University Health Sciences Center, Odessa, USA
- Internal Medicine, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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10
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Collins B, Gordon B, Wundersitz D, Hunter J, Hanson LC, O'Doherty AF, Hayes A, Kingsley M. Comparison of telehealth and supervised phase III cardiac rehabilitation in regional Australia: protocol for a non-inferiority trial. BMJ Open 2023; 13:e070872. [PMID: 37321816 PMCID: PMC10277106 DOI: 10.1136/bmjopen-2022-070872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation programmes (ExCRP) promote recovery and secondary prevention for individuals with cardiovascular disease (CVD). Despite this, enrolment and adherence to ExCRP in rural locations is low. Telehealth programmes provide a convenient, home-based intervention, but concerns remain about compliance to exercise prescription. This paper presents the rationale and protocol design to determine if telehealth delivered ExCRP is not inferior to supervised ExCRP for improving cardiovascular function and exercise fidelity. METHOD AND ANALYSIS A non-inferiority, parallel (1:1), single-blinded randomised clinical trial will be conducted. Fifty patients with CVD will be recruited from a rural phase II ExCRP. Participants will be randomly assigned to telehealth or supervised ExCRP and prescribed three weekly exercise sessions for 6 weeks. Exercise sessions will include a 10 min warm up, up to 30 min of continuous aerobic exercise at a workload equivalent to the ventilatory anaerobic threshold and a 10 min cool down. The primary outcome will be change in cardiorespiratory fitness as measured by cardiopulmonary exercise test. Secondary outcome measures will include change in blood lipid profile, heart rate variability, pulse wave velocity, actigraphy measured sleep quality and training fidelity. Non-inferiority will be confirmed if intention-to-treat and per-protocol analyses conclude the same outcome following independent samples t-test with p<0.025. ETHICS AND DISSEMINATION Research ethics committees at La Trobe University, St John of God Health Care and Bendigo Health approved the study protocol and informed consent. Findings will be published in peer-reviewed journals and disseminated among stakeholders. TRIAL REGISTRATION NUMBER ACTRN12622000872730p; pre-results.
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Affiliation(s)
- Blake Collins
- Holswroth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brett Gordon
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Daniel Wundersitz
- Holswroth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Jayden Hunter
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Lisa C Hanson
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Alasdair F O'Doherty
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Abbey Hayes
- St John of God Health Care, Bendigo, Victoria, Australia
| | - Michael Kingsley
- Holswroth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Exercise Sciences, The University of Auckland, Auckland, Newmarket, New Zealand
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11
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McHale S, Cowie A, Brown S, Butler T, Carver K, Dalal HM, Dawkes S, Deighan C, Doherty P, Evans J, Hinton S, Jones J, Mills J, Nichols S, Taylor RS. Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process. Open Heart 2023; 10:openhrt-2022-002248. [PMID: 37012072 PMCID: PMC10083848 DOI: 10.1136/openhrt-2022-002248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). METHODS The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list. RESULTS From 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic. CONCLUSIONS This PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG.
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Affiliation(s)
- Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Sarah Brown
- BACPR Lay/Patient Representative, London, UK
| | - Tom Butler
- School of Health, Social Care, Edge Hill University, Ormskirk, UK
| | - Kathryn Carver
- Heart Failure Service, Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hasnain M Dalal
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
- Research, Development and Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | | | - Patrick Doherty
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Jo Evans
- Community Cardiac Health and Rehabilitation, Imperial College Healthcare NHS Trust, London, UK
| | - Sally Hinton
- British Association for Cardiovascular Prevention and Rehabilitation, British Cardiovascular Society, London, UK
| | - Jennifer Jones
- Preventive Medicine and Cardiovascular Health, National Institute for Preventive Cardiology, Galway, Ireland
| | - Joseph Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University-Collegiate Crescent Campus, Sheffield, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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12
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Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J 2023; 44:452-469. [PMID: 36746187 PMCID: PMC9902155 DOI: 10.1093/eurheartj/ehac747] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Abstract
AIMS Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken. METHODS AND RESULTS Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias. CONCLUSION This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR.
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Affiliation(s)
- Grace O Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- School of Sport, Health and Community, Faculty Health and Wellbeing, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, 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
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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13
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Koenders N, van Zetten H, Smulders M, Verra ML, van Kimmenade RRJ, van Brakel T, Eijsvogels TMH, Smith T. Outcomes after cardiac rehabilitation in patients following repair of thoracic aortic aneurysm or dissection: a protocol for a systematic review and meta-analysis. Syst Rev 2023; 12:16. [PMID: 36750901 PMCID: PMC9903515 DOI: 10.1186/s13643-023-02180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Patients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), undergoing major surgery, as well as long-term exercise restrictions thereafter. Despite the known risks of exercise, it is vital that patients regain physical activity in order to recover their daily functioning and quality of life. Cardiac rehabilitation could be a safe and effective treatment to support patients to become physically active by providing exercise training, comprehensive rehabilitation services, and safety recommendations. Despite new insights in recent literature and clinical practice, international guidelines do not recommend cardiac rehabilitation due to limited evidence. We aim to fill this knowledge gap by performing a systematic review and meta-analysis on the effectiveness of cardiac rehabilitation in patients following thoracic aortic repair. METHODS This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, Embase, and CINAHL will be searched for eligible observational and interventional studies from inception up to April 2022. Screening (title/abstract and full text), data extraction, risk of bias assessment, and therapeutic validity rating will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse performance-based outcomes, patient-reported outcomes, clinician-reported outcomes, and researcher-reported outcomes. Subsequently, meta-bias and confidence in evidence will be analysed by two independent reviewers. DISCUSSION To exercise or not to exercise in patients following thoracic aortic repair has been a topic of discussion for years. The intended systematic review and meta-analysis will provide comprehensive evidence on the effectiveness of phase III outpatient exercise-based cardiac rehabilitation in patients following thoracic aortic repair. Findings from this review may inform future guidelines for the management of patients with thoracic aortic disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022301204.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Henrita van Zetten
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michelle Smulders
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Berne, Switzerland
| | | | - Thomas van Brakel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim Smith
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Santaularia N, Arnau A, Jaarsma T, Torà N, Vázquez-Oliva G. Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial. Rehabilitacion (Madr) 2023; 57:100720. [PMID: 35317941 DOI: 10.1016/j.rh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years. METHODS We conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years. RESULTS Seventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. CONCLUSIONS Patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.
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Affiliation(s)
- N Santaularia
- Cardiac Rehabilitation Integrated Practice Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Health Sciences at Manresa, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Manresa, Spain.
| | - A Arnau
- Central Catalonia Chronicity Research Group (C3RG), Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Centre d'Estudis Sanitaris i Socials, (CESS), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - T Jaarsma
- Department of Health, Medicine and Care, Division of Nursing Science, Linköping University, Faculty of Medicine and Health Sciences, Linköping, Sweden
| | - N Torà
- Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - G Vázquez-Oliva
- Department of Cardiology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Medicine, Universitat de Vic, Universitat Central de Catalunya (UVic-UCC), Vic, Spain
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15
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Vladimirsky VE, Vladimirsky EV, Lebedeva OD, Fesyun AD, Yakovlev MY, Lunina AN. [Cardiac rehabilitation: investigation of efficacy, results, perspectives]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:45-55. [PMID: 38016056 DOI: 10.17116/kurort202310005145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Previous research experience on cardiac rehabilitation programs as a part of general health care system has shown that they are an important part of the management of cardiovascular patients. Improving quality of life, reducing the severity of risk factors, increasing physical performance, slowing disease progression, decrease in morbidity and mortality indicate the clinical efficacy of cardiac rehabilitation and make it an integral part of therapeutic interventions. Heart rehabilitation is a 1st class recommendation in the majority of modern cardiovascular guidelines around the world.
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Affiliation(s)
| | | | - O D Lebedeva
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A D Fesyun
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - M Yu Yakovlev
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A N Lunina
- E.A. Wagner Perm State Medical University, Perm, Russia
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16
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Effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. Br J Sports Med 2022:bjsports-2022-106002. [DOI: 10.1136/bjsports-2022-106002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/05/2022]
Abstract
ObjectiveTo assess the beneficial and harmful effects of adding exercise to usual care for people with hypertension, type 2 diabetes mellitus and/or cardiovascular disease.DesignSystematic review with meta-analysis and trial sequential analysis of randomised clinical trials.Data sourcesThe CENTRAL, MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and BIOSIS searched from inception to July 2020.Eligibility criteria for selecting studiesWe included all randomised clinical trials adding any form of trialist defined exercise to usual care versus usual care in participants with either hypertension, type 2 diabetes or cardiovascular disease irrespective of setting, publication status, year and language.Outcome and measuresThe primary outcomes were all-cause mortality, serious adverse events and quality of life.Data extraction and synthesisFive independent reviewers extracted data and assessed risk of bias in pairs. Our methodology was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Grading of Recommendations Assessment, Development and Evaluation and Cochrane Risk of Bias-version 1.ResultsWe included 950 trials, of which 248 trials randomising 21 633 participants reported on our predefined outcomes. All included trials were at high risk of bias. The major types of exercise reported were dynamic aerobic exercise (126/248 trials), dynamic resistance exercise (25/248 trials), and combined aerobic and resistance exercise (58/248 trials). The study participants were included due to cardiovascular diseases (189/248 trials), type 2 diabetes (41/248 trials) or hypertension (16/248 trials). The median intervention period was 3 months (IQR: 2–4 months) and the median follow-up period was 6 months (IQR: 3–8 months) after randomisation. Meta-analyses and trial sequential analyses showed evidence of a beneficial effect of adding exercise to usual care when assessing all-cause mortality (risk ratio (RR) 0.82; 95% CI 0.73 to 0.93; I2=0%, moderate certainty of evidence) and serious adverse events (RR 0.79; 95% CI 0.71 to 0.88; I2=0%, moderate certainty of evidence). We did not find evidence of a difference between trials from different economic regions, type of participants, type of exercise or duration of follow-up. Quality of life was assessed using several different tools, but the results generally showed that exercise improved quality of life, but the effect sizes were below our predefined minimal important difference.ConclusionsA short duration of any type of exercise seems to reduce the risk of all-cause mortality and serious adverse events in patients with either hypertension, type 2 diabetes or cardiovascular diseases. Exercise seems to have statistically significant effects on quality of life, but the effect sizes seem minimal.PROSPERO registration numberCRD42019142313.
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Exercise-Based Cardiac Rehabilitation: Is a Little Encouragement Enough? J Cardiopulm Rehabil Prev 2022; 42:E97-E98. [DOI: 10.1097/hcr.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Dafny HA, Champion S, Gebremichael LG, Pearson V, Nesbitt K, Pinero de Plaza MA, Bulto LN, Noonan S, Hines S, Hendriks JM, Clark RA, Beleigoli A. Effectiveness of activity-monitoring devices in patients with cardiovascular disease participating in cardiac rehabilitation programs: an umbrella review protocol. JBI Evid Synth 2022; 20:2806-2814. [PMID: 36081359 DOI: 10.11124/jbies-22-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of the review is to investigate the effect of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease who are participating in cardiac rehabilitation programs. INTRODUCTION Supporting patients with cardiovascular conditions to achieve and maintain healthy physical activity levels is the cornerstone of cardiac rehabilitation programs. The effectiveness of activity-monitoring devices and mobile applications (such as physical activity interventions) utilizing consumer-grade monitoring devices and applications to support patients to improve exercise levels during and after program completion has been investigated. Several systematic reviews evaluating the effectiveness of monitoring devices and applications have indicated varying clinical impact, depending on patient characteristics, stage of rehabilitation, and type of intervention. INCLUSION CRITERIA This review will consider systematic reviews and/or meta-analyses of randomized controlled trials of patients who participated in cardiac rehabilitation programs that included a physical activity intervention that incorporated activity monitoring using electronic devices and/or mobile applications and reported activity and patient health outcomes. METHODS MEDLINE, Embase, Sport Discus, the Cochrane Database of Systematic Reviews, Scopus, CINAHL, the International Network of Agencies for Health Technology Assessment database, Epistemonikos, and Web of Science will be searched from inception to the present. PROSPERO will be searched for unpublished reviews. Articles will be screened by two independent reviewers for inclusion, and methodological quality will be assessed using a JBI critical appraisal tool. Data will be extracted from systematic reviews and a data synthesis of findings will be presented. The certainty will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022298877.
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Affiliation(s)
- Hila Ariela Dafny
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Stephanie Champion
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Lemlem G Gebremichael
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Vincent Pearson
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Katie Nesbitt
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Lemma N Bulto
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Sara Noonan
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,Flinders Rural and Remote Health NT, College of Medicine and Public Health, Flinders University, Alice Springs, NT Australia
| | - Jeroen M Hendriks
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia.,Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Alline Beleigoli
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
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Exercise and Cardio-Oncology Rehab. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freene N, McManus M, Mair T, Tan R, Davey R. Association of device-measured physical activity and sedentary behaviour with cardiovascular risk factors, health-related quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees with coronary heart disease. BMC Sports Sci Med Rehabil 2022; 14:169. [PMID: 36071477 PMCID: PMC9454132 DOI: 10.1186/s13102-022-00562-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022]
Abstract
Background Few studies have considered the relationship between risk factors, physical activity and sedentary behaviour in people with heart disease. Here we examine the independent relationship of device-measured physical activity and sedentary behaviour on risk factors, quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees. Methods Hospital-based phase II cardiac rehabilitation participants with coronary heart disease were assessed at the start and end of cardiac rehabilitation (6-weeks), 6 and 12-months. Physical activity (moderate-to-vigorous (MVPA), light-intensity (LIPA); min/day) and sedentary behaviour (min/day, bouts, breaks) were measured using an ActiGraph accelerometer. Risk factors included waist circumference, body mass index, systolic blood pressure (SBP), fasting blood lipid and glucose levels, anxiety and depression. Quality-of-life and exercise capacity were also collected. Associations were assessed with Generalized Estimating Equation modeling. Results Sixty-seven participants were included (mean age = 64 (SD 9) years; 81% male). An association was found between higher MVPA and lower high density lipoprotein (p ≤ 0.001). No significant (p ≤ 0.001) associations were found between sedentary behaviour variables and other outcomes. At p < 0.05 several associations were significant. Increased MVPA and LIPA were associated with decreased total cholesterol. Higher MVPA was associated with decreased SBP, whereas higher LIPA was associated with decreased waist circumference and body mass index. Higher sedentary behaviour bouts and breaks were associated with increased total cholesterol, anxiety and depression, and decreased SBP over time. Conclusions Any intensity of physical activity was associated with decreased total cholesterol. Increased LIPA was associated with improved measures of adiposity, while breaking up sedentary behaviour and increasing MVPA may decrease SBP over time. Further investigation of MVPA, LIPA and the distribution of sedentary behaviour is indicated in cardiac rehabilitation attendees to explore their relationship with risk factors. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx. Registered 22 September 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00562-7.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia. .,Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | | | - Tarryn Mair
- Exercise Physiology, Canberra Health Services, Garran, ACT, Australia
| | - Ren Tan
- Canberra Health Services, Garran, ACT, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
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21
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Angst F, Giger RD, Lehmann S, Sandor PS, Teuchmann P, Csordas A. Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms. Health Qual Life Outcomes 2022; 20:91. [PMID: 35672749 PMCID: PMC9171950 DOI: 10.1186/s12955-022-01994-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Data on mental health improvement after cardiac rehabilitation (CR) are contradictory. The aim was to examine the mental and psycho-social health of patients admitted to our rehabilitation center following hospital treatment for acute coronary syndrome, before and after multidisciplinary CR.
Methods
Outcome was measured at admission and discharge by the 36-Item Short Form Survey (SF-36), the Symptom Checklist-90 Revised (SCL-90R), the Coping Strategy Questionnaire (CSQ) and the 6-min-walking distance test. The patients’ health status was compared with norms of sex-, age- and comorbidity-matched data from the German general population. Score differences from norms were measured by standardized mean differences (SMDs); health changes were quantified by standardized effect sizes (ESs). Their importance for comprehensive assessment was quantified by explorative factor analysis.
Results
Of n = 70 patients followed-up (male: 79%; mean age: 66.6 years), 79% had ≥ 3 comorbidities. At baseline, SF-36 Physical functioning (SMD = − 0.75), Role physical (− 0.90), Social functioning (SMD = − 0.44), and Role emotional (SMD = − 0.45) were significantly worse than the norm. After CR, almost all scores significantly improved by ES = 0.23 (SCL-90R Interpersonal sensitivity) to 1.04 (SF-36 Physical functioning). The strongest factor (up to 41.1% explained variance) for health state and change was the mental health domain, followed by function & pain (up to 26.3%).
Conclusions
Normative deficits in physical and psycho-social health were reported at baseline. After CR, at follow-up, all scores, except phobia, showed significant improvement. The comprehensive measurement of bio-psycho-social health should not be limited to depression and anxiety but include, especially, the somatization and social participation dimensions.
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22
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Busnatu ȘS, Pană MA, Lăcraru AE, Jercălău CE, Paun N, Caprino M, Gand K, Schlieter H, Kyriazakos S, Andrei CL, Sinescu CJ. Patient Perception When Transitioning from Classic to Remote Assisted Cardiac Rehabilitation. Diagnostics (Basel) 2022; 12:diagnostics12040926. [PMID: 35453974 PMCID: PMC9030505 DOI: 10.3390/diagnostics12040926] [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: 02/13/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 12/10/2022] Open
Abstract
Cardiac rehabilitation is an individualized outpatient program of physical exercises and medical education designed to accelerate recovery and improve health status in heart disease patients. In this study, we aimed for assessment of patients’ perception of the involvement of technology and remote monitoring devices in cardiac recovery. During the Living Lab Phase of the Virtual Coaching Activities for Rehabilitation in Elderly (vCare) project, we evaluated eleven patients (five heart failure patients and six ischemic heart disease patients). Patient admission in the UMFCD cardiology clinical department served as a shared inclusion criterion for both study groups. In addition, the presence of II or III heart failure NYHA stage status was considered an inclusion criterion for the heart failure study group and patients diagnosed with ischemic heart disease for the second one. We conducted a system usability survey to assess the patients’ perception of the system’s technical and medical functions. The survey had excellent preliminary results in the heart failure study group and good results in the ischemic heart disease group. The limited access of patients to cardiac rehabilitation in Romania has led to increased interest and motivation in this study. The final version of the product is designed to adapt to patient needs and necessities; therefore, patient perception is necessary.
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Affiliation(s)
- Ștefan-Sebastian Busnatu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
| | - Maria-Alexandra Pană
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
- Correspondence: ; Tel.: +40-746243990
| | - Andreea Elena Lăcraru
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
| | - Cosmina-Elena Jercălău
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
| | - Nicolae Paun
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Clinical Hospital “Theodor Burghele”, 020021 Bucharest, Romania;
| | - Massimo Caprino
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, 20144 Milano, Italy;
| | - Kai Gand
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, 01062 Dresden, Germany; (K.G.); (H.S.)
| | - Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, 01062 Dresden, Germany; (K.G.); (H.S.)
| | - Sofoklis Kyriazakos
- Department of Business Development and Technology, Aarhus University, 7400 Aarhus, Denmark;
| | - Cătălina Liliana Andrei
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
| | - Crina-Julieta Sinescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania; (Ș.-S.B.); (A.E.L.); (C.-E.J.); (C.L.A.); (C.-J.S.)
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Oliveros MJ, Serón P, Buitrago-García D, Grace SL. Cardiac rehabilitation effectiveness for coronary artery disease by clinical era: trial sequential analysis. Eur J Prev Cardiol 2022; 29:e18-e21. [PMID: 33624075 DOI: 10.1093/eurjpc/zwaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/14/2022]
Affiliation(s)
- María-José Oliveros
- Departamento Medicina Interna-Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Claro Solar #115, Temuco, Chile
| | - Pamela Serón
- Departamento Medicina Interna-Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Claro Solar #115, Temuco, Chile
| | - Diana Buitrago-García
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Calle Rumipamba s/n, Quito, Ecuador.,Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud-FUCS, Carrera 54 No.67A - 80, Bogotá, Colombia
| | - Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, Canada.,KITE, University Health Network, University of Toronto, 550 University Ave, Toronto, Ontario, Canada
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24
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Kianoush S, Al Rifai M, Patel J, George J, Gulati M, Taub P, Moran T, Shapiro MD, Agarwala A, Ullah W, Lavie CJ, Bittner V, Ballantyne CM, Virani SS. Association of participation in Cardiac Rehabilitation with Social Vulnerability Index: The behavioral risk factor surveillance system. Prog Cardiovasc Dis 2022; 71:86-91. [PMID: 35182577 DOI: 10.1016/j.pcad.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify whether social vulnerability is associated with low cardiac rehabilitations (CR) use, a Class I recommendation by current treatment guidelines following acute myocardial infarction (AMI). METHODS We performed this cross-sectional study using the 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. The Centers for Disease Control and Prevention Social Vulnerability Index (CDC SVI) was calculated using 15 social risk factors from 4 main themes including socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. A higher SVI indicates higher social vulnerability. We used multivariable logistic regression models to evaluate the association of CR use with state-level SVI adjusted for demographic, behavioral, socioeconomic, and comorbidity variables. RESULTS A total 2093 participants with history of AMI were included. Out of total, 61.7% were older than 65 years, 42.5% female, 72.5% White, and 42.4% used CR. Participation in CR was lower among females (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.44-0.91), those without a primary care physician (OR, 0.45; 95% CI, 0.23-0.87), and higher with college degree education (OR, 1.95; 95% CI, 1.06-3.59). CR use decreased with increasing SVI tertiles (1st =61%, 2nd =52%, and 3rd =35%). Compared with those residing in states in the 1st tertile, CR use was lower in the 2nd (OR, 0.68; 95% CI, 0.47-0.98) and 3rd (OR, 0.33; 95% CI 0.23-0.48) SVI tertiles. CONCLUSION CR use following AMI is low and is associated with social vulnerability. Identifying social risk factors may help improve access to care among vulnerable populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Jerin George
- Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Tyler Moran
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anandita Agarwala
- Department of Medicine, Division of Cardiology, Baylor Scott and White, The Health Heart Hospital Baylor Plano, 1100 Allied Dr., Plano, TX 75093, USA
| | - Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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25
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Gonzalez-Jaramillo N, Marcin T, Matter S, Eser P, Berlin C, Bano A, Heg D, Franco OH, Windecker S, Räber L, Wilhelm M. Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study. Eur J Prev Cardiol 2021; 29:1093-1103. [PMID: 34894217 DOI: 10.1093/eurjpc/zwab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 12/28/2022]
Abstract
AIMS Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes. METHODS AND RESULTS We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6-9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27-0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57-0.86)] and older adults [0.32 (0.27-0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03-0.37)] and CVD mortality [0.1 (0.02-0.7)], but not with MACE [1.08 (0.8-1.4)]. CONCLUSION Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Sophia Matter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
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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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27
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Wang J, Liu H, Chen C, Chang W, Ma Y, Zhao C, Smith SC, Han J, Yu M, Ma J, Qi J, Xing Y. Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China. J Cardiovasc Nurs 2021; 35:558-567. [PMID: 32379163 PMCID: PMC7553193 DOI: 10.1097/jcn.0000000000000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The level of physical activity (PA) among patients with coronary heart disease (CHD) living in Chinese communities who do not participate in cardiac rehabilitation programs and the factors contributing to patient maintenance of PA are unclear. OBJECTIVE This cross-sectional study, guided by the Transtheoretical Model, evaluated (1) the maintenance of PA in Chinese patients with CHD 12 months after hospital discharge and (2) the demographic, clinical, and psychological characteristics associated with maintenance of PA. METHODS A total of 1162 patients completed 6 questionnaires at 12 months posthospitalization to assess their maintenance of PA, stage of change, symptoms of depression and anxiety, and health-related quality of life and sleep. RESULTS Only 40% of patients with CHD maintained regular PA 12 months after hospital discharge. Walking was their primary PA. Thirty-seven percent of patients reported no intention of having regular PA. Male sex (odds ratio [OR], 1.69), awareness of PA's cardiac benefit (OR, 4.12), a history of regular PA before the cardiac event (OR, 6.08), history of chronic disease (OR, 1.43), mild depressive symptoms (OR, 1.40), moderate and severe depressive symptoms (OR, 0.41), smoking (OR, 0.54), and years of CHD (OR, 0.96) were related to maintenance of regular PA. Patients with CHD who maintained regular PA had better quality of life and sleep (P < .001) and fewer unplanned clinic visits (P = .001) and cardiac cause readmissions (P = .012) and reported fewer declines in PA capacity (P < .001). CONCLUSIONS Walking is the most common form of PA 12 months posthospitalization among patients with CHD in China. Patient education and counseling about the cardiac benefits of PA, taking into account stage of change, are important considerations to improve maintenance of PA.
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Affiliation(s)
- Jianhui Wang
- Jianhui Wang, MSN PhD Candidate, School of Nursing Peking Union Medical College, Beijing, and Director, Nurse Administration Department, Tangshan Gongren Hospital, China. Huaping Liu, PhD, RN, FAAN President, School of Nursing, Peking Union Medical College, Beijing, China. Changxiang Chen, MSN, RN President, School of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, China. Wenhong Chang, BN, RN Manager, Cath Lab, Tangshan Gongren Hospital, China. Yi Ma, PhD, MD Director, Cardiovascular Department, Tangshan Gongren Hospital, China. Caijie Zhao, MSN, RN Secondary Prevention Research Assistant, Tangshan Gongren Hospital, China. Sidney C. Smith, Jr, MD Professor of Medicine/Cardiology, University of North Carolina, Chapel Hill. Jing Han, MSN, RN Manager, Cardiac Unit, Tangshan Gongren Hospital, China. Miao Yu, BN MSN Candidate, Nursing, Nursing and Rehabilitation College, North China University of Science and Technology, Tangshan, China. Jiahui Ma, BN MSN Candidate, Nursing, Tangshan Gongren Hospital, China. Jing Qi, BN, RN Director, Nurse Administration Department, Zhangjiakou First Hospital, China. Yan Xing, MSN, RN Manager of Cardiovascular Unit, Shijiazhuang First Hospital, China
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28
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Taylor JL, Bonikowske AR, Olson TP. Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Front Cardiovasc Med 2021; 8:734278. [PMID: 34540924 PMCID: PMC8446279 DOI: 10.3389/fcvm.2021.734278] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO2peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.
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Affiliation(s)
- Jenna L Taylor
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Amanda R Bonikowske
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Thomas P Olson
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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29
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Nanayakkara GL, Rai T, Kirincic L, Lightfoot R, Senaratne JM, Senaratne M. Differences in Clinical Measures and Outcomes in South Asians vs Caucasians Attending Cardiac Rehabilitation. CJC Open 2021; 3:1019-1024. [PMID: 34505041 PMCID: PMC8413229 DOI: 10.1016/j.cjco.2021.03.014] [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: 01/17/2021] [Accepted: 03/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background South Asians have a greater predisposition to cardiac events, compared to Caucasians. Although cardiac rehabilitation programs (CRPs) are known to improve outcomes, data are sparse regarding benefits acquired by South Asians vs Caucasians. The objective of the current study was to determine the outcomes of South Asian patients undergoing CRPs, compared to Caucasian patients. Methods This study compared baseline characteristics and outcomes in all patients attending a CRP in Edmonton, Canada with a proportionately large South Asian population. Results From 1998 to 2016, a total of 811 South Asians and 5406 Caucasians attended CRPs. Baseline characteristics revealed that there were more nonsmokers (73.4% vs 29.4%, P < 0.001), with a lower body mass index (26.8 ± 0.1 vs 29.6 ± 0.1, P < 0.001), but higher prevalence of diabetes (37.7% vs 20.5%, P < 0.001) in the South Asian population. Outcome measures revealed that South Asians spent less time in the CRP (6.9 weeks ± 0.1 vs 7.3 weeks ± 0.1, P < 0.001), attended the nutrition class less (36.2% vs 53.4%, P < 0.001), and had a lower 6-minute walk improvement (66.9 m vs 73.6 m, P < 0.001). Frequency of use of β-blockers (86.9% vs 86.1%, P > 0.05), antiplatelet agents (96.3% vs 97.1%, P > 0.05), angiotensin-converting enzyme inhibitors (79.9% vs 80.0%, P > 0.05), and cholesterol-lowering agents (91.4% vs 93.8%, P > 0.05) was not significantly different. Conclusions Although South Asians seem to be prescribed and use proven pharmacologic treatments to the same extent as Caucasians, they appeared to benefit less from CRPs. Given higher event rates in South Asians, consideration should be given to altering the delivery of CRPs to South Asians to improve their efficacy.
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Affiliation(s)
| | - Tracey Rai
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | - Lena Kirincic
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | | | - Janek M Senaratne
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Manohara Senaratne
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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30
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Freene N, Brown R, Collis P, Bourke C, Silk K, Jackson A, Davey R, Northam HL. An Aboriginal and Torres Strait Islander Cardiac Rehabilitation program delivered in a non-Indigenous health service (Yeddung Gauar): a mixed methods feasibility study. BMC Cardiovasc Disord 2021; 21:222. [PMID: 33932992 PMCID: PMC8088627 DOI: 10.1186/s12872-021-02016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence of Aboriginal and Torres Strait Islander people attending cardiac rehabilitation (CR) programs despite high levels of heart disease. One key enabler for CR attendance is a culturally safe program. This study evaluates improving access for Aboriginal and Torres Strait Islander women to attend a CR program in a non-Indigenous health service, alongside improving health workforce cultural safety. METHODS An 18-week mixed-methods feasibility study was conducted, with weekly flexible CR sessions delivered by a multidisciplinary team and an Aboriginal and/or Torres Strait Islander Health Worker (AHW) at a university health centre. Aboriginal and Torres Strait Islander women who were at risk of, or had experienced, a cardiac event were recruited. Data was collected from participants at baseline, and at every sixth-session attended, including measures of disease risk, quality-of-life, exercise capacity and anxiety and depression. Cultural awareness training was provided for health professionals before the program commenced. Assessment of health professionals' cultural awareness pre- and post-program was evaluated using a questionnaire (n = 18). Qualitative data from participants (n = 3), the AHW, health professionals (n = 4) and referrers (n = 4) was collected at the end of the program using yarning methodology and analysed thematically using Charmaz's constant comparative approach. RESULTS Eight referrals were received for the CR program and four Aboriginal women attended the program, aged from 24 to 68 years. Adherence to the weekly sessions ranged from 65 to 100%. At the program's conclusion, there was a significant change in health professionals' perception of social policies implemented to 'improve' Aboriginal people, and self-reported changes in health professionals' behaviours and skills. Themes were identified for recruitment, participants, health professionals and program delivery, with cultural safety enveloping all areas. Trust was a major theme for recruitment and adherence of participants. The AHW was a key enabler of cultural authenticity, and the flexibility of the program contributed greatly to participant perceptions of cultural safety. Barriers for attendance were not unique to this population. CONCLUSION The flexible CR program in a non-Indigenous service provided a culturally safe environment for Aboriginal women but referrals were low. Importantly, the combination of cultural awareness training and participation in the program delivery improved health professionals' confidence in working with Aboriginal people. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) 12618000581268, http://www.ANZCTR.org.au/ACTRN12618000581268.aspx , registered 16 April 2018.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | - Roslyn Brown
- Ngunnawal Centre, Office of Aboriginal and Torres Strait Islander Leadership and Strategy, University of Canberra, Bruce, ACT, Australia
| | - Paul Collis
- Faculty of Arts and Design, University of Canberra, Bruce, ACT, Australia
| | - Chris Bourke
- Australian Healthcare and Hospitals Association, Deakin, ACT, Australia
| | - Katharine Silk
- Australian Healthcare and Hospitals Association, Deakin, ACT, Australia
| | - Alicia Jackson
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Holly L Northam
- Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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31
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O'Doherty AF, Humphreys H, Dawkes S, Cowie A, Hinton S, Brubaker PH, Butler T, Nichols S. How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR. BMJ Open 2021; 11:e046051. [PMID: 33879492 PMCID: PMC8061561 DOI: 10.1136/bmjopen-2020-046051] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation. DESIGN A mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety. SETTING International survey of exercise-based cardiac rehabilitation programmes. PARTICIPANTS Healthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide. MAIN OUTCOME MEASURES The proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation. RESULTS Three hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing. CONCLUSIONS The rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.
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Affiliation(s)
- Alasdair F O'Doherty
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Helen Humphreys
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland, UK
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
| | - Aynsley Cowie
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
- Cardiac Rehabilitation, Lister Centre, University Hospital Crosshouse, Kilmarnock, Scotland, UK
| | - Sally Hinton
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Tom Butler
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Simon Nichols
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
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32
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Kyuno E, Iso Y, Tsujiuchi M, Maeda A, Miyazawa R, Kowaita H, Kitai H, Sato T, Ebato M, Sambe T, Suzuki H. Impact of Exercise-Based Cardiac Rehabilitation on the Mid-Term Outcomes of Patients After Acute Myocardial Infarction Treated With Current Acute-Phase Management and Optimal Medical Therapy. Heart Lung Circ 2021; 30:1320-1328. [PMID: 33867276 DOI: 10.1016/j.hlc.2021.03.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/17/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early reported beneficial effects of cardiac rehabilitation (CR) have recently been disputed. The present study aimed to investigate the clinical impact of CR on the mid-term outcomes of patients following ST-segment elevation myocardial infarction (STEMI) treated with currently available management. METHODS This study reviewed 145 consecutive patients who underwent primary coronary intervention and were discharged without any disability after STEMI during 2013-2015. RESULTS Among the patients, 66 (45.5%) completed an outpatient CR program (CR group) and 79 were their non-CR counterparts or patients who dropped out of the program (N-D group). There were no between-group differences in patient demographics and clinical profiles, including door-to-balloon times and prescriptions. A total of 27 patients developed major adverse cardiac and cerebrovascular events (MACCE) during follow-up. The MACCE-free survival rates were 88% and 76% in the CR and N-D groups, respectively (log-rank, p=0.04). Cox proportional analysis demonstrated that inclusion in the N-D group was a significant predictor of MACCEs (HR, 2.36; 95% CI, 1.07-5.74; p=0.03). In the CR group, peak oxygen consumption and ventilatory efficiency determined by cardiopulmonary exercise testing significantly improved after the program (p<0.01). CONCLUSIONS The impact of CR on the mid-term prognosis of patients with STEMI, even in the current myocardial infarction management era, was beneficial.
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Affiliation(s)
- Etsushi Kyuno
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan; Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan; Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Tsujiuchi
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ryo Miyazawa
- Center for Rehabilitation, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Hitoshi Kowaita
- Center for Rehabilitation, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Hitomi Kitai
- Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Tokutada Sato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takeyuki Sambe
- Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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33
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Sangha GS, Goergen CJ, Prior SJ, Ranadive SM, Clyne AM. Preclinical techniques to investigate exercise training in vascular pathophysiology. Am J Physiol Heart Circ Physiol 2021; 320:H1566-H1600. [PMID: 33385323 PMCID: PMC8260379 DOI: 10.1152/ajpheart.00719.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Atherosclerosis is a dynamic process starting with endothelial dysfunction and inflammation and eventually leading to life-threatening arterial plaques. Exercise generally improves endothelial function in a dose-dependent manner by altering hemodynamics, specifically by increased arterial pressure, pulsatility, and shear stress. However, athletes who regularly participate in high-intensity training can develop arterial plaques, suggesting alternative mechanisms through which excessive exercise promotes vascular disease. Understanding the mechanisms that drive atherosclerosis in sedentary versus exercise states may lead to novel rehabilitative methods aimed at improving exercise compliance and physical activity. Preclinical tools, including in vitro cell assays, in vivo animal models, and in silico computational methods, broaden our capabilities to study the mechanisms through which exercise impacts atherogenesis, from molecular maladaptation to vascular remodeling. Here, we describe how preclinical research tools have and can be used to study exercise effects on atherosclerosis. We then propose how advanced bioengineering techniques can be used to address gaps in our current understanding of vascular pathophysiology, including integrating in vitro, in vivo, and in silico studies across multiple tissue systems and size scales. Improving our understanding of the antiatherogenic exercise effects will enable engaging, targeted, and individualized exercise recommendations to promote cardiovascular health rather than treating cardiovascular disease that results from a sedentary lifestyle.
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Affiliation(s)
- Gurneet S Sangha
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Steven J Prior
- Department of Kinesiology, University of Maryland School of Public Health, College Park, Maryland.,Baltimore Veterans Affairs Geriatric Research, Education, and Clinical Center, Baltimore, Maryland
| | - Sushant M Ranadive
- Department of Kinesiology, University of Maryland School of Public Health, College Park, Maryland
| | - Alisa M Clyne
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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34
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Ibeggazene S, Moore C, Tsakirides C, Swainson M, Ispoglou T, Birch K. UK cardiac rehabilitation fit for purpose? A community-based observational cohort study. BMJ Open 2020; 10:e037980. [PMID: 33040006 PMCID: PMC7549464 DOI: 10.1136/bmjopen-2020-037980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables. DESIGN Observational cohort study. SETTING Outpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks. PARTICIPANTS Sixty patients (45 male/15 female 33-86 years) were recruited following referral to local outpatient CR. OUTCOME MEASURES The primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours. RESULTS The mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05). CONCLUSION Patients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.
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Affiliation(s)
- Saïd Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Chelsea Moore
- Department of Sport and Exercise Sciences, Wrexham Glyndwr University, Wrexham, Clwyd, UK
| | - Costas Tsakirides
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Michelle Swainson
- Lancaster University Lancaster Medical School, Lancaster, Lancashire, UK
| | - Theocharis Ispoglou
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Karen Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Khushhal A, Nichols S, Carroll S, Abt G, Ingle L. Characterising the application of the "progressive overload" principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme. PLoS One 2020; 15:e0237197. [PMID: 32790796 PMCID: PMC7425879 DOI: 10.1371/journal.pone.0237197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023] Open
Abstract
Background Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. Design Observational study. Methods We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. Results Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). Conclusion The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.
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Affiliation(s)
- Alaa Khushhal
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield United Kingdom
| | - Sean Carroll
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Grant Abt
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
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36
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Nichols S, McGregor G, Breckon J, Ingle L. Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure. Int J Sports Med 2020; 42:19-26. [PMID: 32650344 DOI: 10.1055/a-1198-5573] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.
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Affiliation(s)
- Simon Nichols
- Sheffield Hallam University Centre for Sports and Exercise Science, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Gordon McGregor
- University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, Coventry University, United Kingdom of Great Britain and Northern Ireland
| | - Jeff Breckon
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, United Kingdom of Great Britain and Northern Ireland
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37
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Effects of Exercise Therapy for Adults With Coronary Heart Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiovasc Nurs 2020; 36:56-77. [PMID: 32649373 DOI: 10.1097/jcn.0000000000000713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Exercise therapy has been recommended as a core element for the prevention of coronary heart disease (CHD). However, the independent impact of exercise therapy remains unclear. OBJECTIVE The aim of this study was to assess the effects of exercise therapy compared with no exercise control in patients with CHD. METHODS We searched 8 electronic databases from January 2000 to March 2020. Randomized controlled trials with at least 6 months of follow-up that evaluated the effects of exercise therapy on hospital admissions, health-related quality of life (HRQoL), mortality, and morbidity in adults with CHD were included. Two reviewers independently screened records for eligibility, extracted data, and assessed risks of bias using the Cochrane tool. Meta-analyses were conducted using the random-effects model. RESULTS We included 22 randomized controlled trials involving 4465 participants. Compared with no exercise control, exercise therapy reduced all-cause hospital admissions (10 studies; risk ratio, 0.46; 95% confidence interval, 0.25-0.83; I = 64%) and cardiovascular mortality (9 studies; risk ratio, 0.44; 95% confidence interval, 0.22-0.89; I= 0%) across all studies reporting these outcomes at their longest follow-up. Eight of 14 studies that assessed HRQoL observed a significant improvement in at least 1 domain or overall HRQoL with exercise therapy compared with control. There were no significant reductions in cardiovascular hospital admissions, all-cause mortality, incidence of myocardial infarction, or revascularization. CONCLUSIONS This review shows the independent benefits of exercise therapy in reducing all-cause hospital admissions and cardiovascular mortality for adults with CHD.
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McGregor G, Powell R, Kimani P, Underwood M. Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis. BMJ Open 2020; 10:e036089. [PMID: 32513887 PMCID: PMC7282413 DOI: 10.1136/bmjopen-2019-036089] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine the effect of contemporary exercise-based cardiac rehabilitation on generic and disease-specific health related quality of life for people with coronary artery disease. DESIGN Systematic review and meta-analysis. STUDY ELIGIBILITY CRITERIA Randomised controlled trials testing exercise-based cardiac rehabilitation versus no exercise control that recruited after 31 December 1999. On 30 July 2019, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases. STUDY APPRAISAL AND SYNTHESIS Studies were screened for inclusion by two independent reviewers. Risk of bias was assessed using the Cochrane risk of bias tool. Data were reported as pooled means (95% CI for between-group difference. RESULTS We identified 24 studies (n=4890). We performed meta-analyses for 15 short-term and 9 medium-term outcomes (36-Item Short Form Survey Instrument (SF-36), EuroQol-5D (EQ-5D) and MacNew, a cardiac-specific outcome). Six short-term and five medium-term SF-36 domains statistically favoured exercise-based cardiac rehabilitation. Only for two short-term SF-36 outcomes, 'physical function' (mean difference 12.0, 95% CI 4.4 to 19.6) and 'role physical' (mean difference 16.9, 95% CI 2.4 to 31.3), did the benefit appear to be clinically important. Meta-analyses of the short-term SF-36 physical and mental component scores, EQ-5D and MacNew and the medium-term SF-36 physical component score, did not show statistically significant benefits. Only two studies had a low risk of bias (n=463 participants). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS There is some evidence of a short-term benefit of contemporary exercise-based cardiac rehabilitation on quality of life for people with coronary artery disease. However, the contemporary data presented in this review are insufficient to support its routine use.
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Affiliation(s)
- Gordon McGregor
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK
| | - Richard Powell
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK
| | - Peter Kimani
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Saha SP, Banks MA, Whayne TF. Managing Cardiovascular Risk Factors without Medications: What is the Evidence? Cardiovasc Hematol Agents Med Chem 2020; 19:8-16. [PMID: 32418531 DOI: 10.2174/1871525718666200518093418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022]
Abstract
In this era of potent medications and interventional cardiovascular (CV) procedures, the importance of beginning with and including Therapeutic Lifestyle Changes (TLC) is frequently forgotten. A major goal of this review article is to show and emphasize that modification of CV risk with nonmedication approaches makes an essential contribution to CV risk reduction. Available information on TLC and modifiable CV risk factors was reviewed and assessed. Modifiable major CV risk factors include diabetes mellitus, hypertension, hyperlipidemia, tobacco abuse, obesity, stress, and a sedentary lifestyle. Age as a major CV risk factor is, of course, not susceptible to modification. A contribution to the control of CV risk factors can occur without the start of medications and there is proof of benefit for beginning with a non-pharmacological approach. TLC can benefit all of the major modifiable CV risk factors and there is good evidence for the additional benefit of supervised and group TLC. TLC includes physical activity, diet, and smoking cessation. Evidence for the benefits of TLC in reducing CV disease events is well established. However, medications must be added in those patients with higher CV risk to obtain maximum cholesterol reduction (lower is better for the low-density lipoprotein cholesterol) and good blood pressure control. The benefit of TLC is frequently forgotten in this era of potent medications and invasive procedures. The benefits of diet and physical activity are emphasized with supporting data. Many motivated patients can prolong their lives significantly by dedication to TLC. Therapeutic Lifestyle Change (TLC) especially encompasses increased physical activity, a healthy diet, and smoking cessation. There is extensive proof for the benefit of TLC in contributing to cardiovascular (CV) disease prevention. CV diseases have strong metabolic and inflammatory components, both of which can be improved by TLC.
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Affiliation(s)
- Sibu P Saha
- Department of Cardiology, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, United States
| | - Melissa A Banks
- Department of Cardiology, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, United States
| | - Thomas F Whayne
- Department of Cardiology, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, United States
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Deter HC, Orth-Gomér K. The effects of usual Care in Psychosocial Intervention Trials of patients with coronary artery disease: a systematic review. Biopsychosoc Med 2020; 14:11. [PMID: 32426033 PMCID: PMC7216354 DOI: 10.1186/s13030-020-00180-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many intervention studies of coronary artery disease (CAD) have found health benefits for patients in the "treatment as usual" (TAU) group like in the specific psychotherapy group. In this pilot study, we wanted to examine and discuss the role and reasons for TAU effects. METHODS By means of a systematic review, we examined the control conditions from psychotherapeutic RCTs with CAD patients related to depressive symptoms, mortality and recurrence rate of events. The review question was limited to factors influencing the TAU effectiveness in such psychotherapeutic outcome studies. RESULTS We found a decrease in depressive symptoms in TAU patients (mean ES: 0.65) and very differing mortality and recurrence rates of events. The effects were dependant on the year the study was published (1986-2016), the follow-up time of the study (0.25-7.8 years) and the treatment arms. A small dose of additional counselling, medical attention, and teaching of therapeutic techniques with clinical competence may reinforce the therapeutic alliance. These factors would be possible moderators of control group efficacy related to the reduction in depressive symptoms and a decrease in mortality and events. CONCLUSION In the reviewed studies, we found that the control condition was beneficial for CAD patients, but this benefit was highly variable. Specified psychotherapeutic interventions showed an additional independent effect of treatment on depression and effects on morbidity and mortality. There is a need to identify patients at risk of remaining depressed or under severe stress during usual care. These patients may require additional psychosocial intervention.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm, 30 12200 Berlin, Germany
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Association between attending exercise-based cardiac rehabilitation and cardiovascular risk factors at one-year post myocardial infarction. PLoS One 2020; 15:e0232772. [PMID: 32392231 PMCID: PMC7213725 DOI: 10.1371/journal.pone.0232772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/21/2020] [Indexed: 12/31/2022] Open
Abstract
Background Randomized trials confirm the benefits of exercise-based cardiac rehabilitation on cardiovascular risk factors. Whether exercise-based cardiac rehabilitation provides the same favourable effects in real-life cardiac rehabilitation settings, in the modern era of myocardial infarction treatment, is less well known. We examined the association between attending exercise-based cardiac rehabilitation and improvements in cardiovascular risk factors at one-year post myocardial infarction in patients included in the Swedish heart disease registry, SWEDEHEART. Methods In this retrospective registry-based cohort study, we included 19 136 patients post myocardial infarction (75% men, 62.8±8.7 years) who were registered in SWEDEHEART between 2011 and 2013. The association between attending exercise-based cardiac rehabilitation (43% participation rate) and changes in cardiovascular risk profile between baseline and one-year follow-up was assessed using multivariable regression analysis adjusting for age, comorbidities and medication. Results Attenders more often reported to have stopped smoking (men 64% vs 50%; women 64% vs 53%, p<0.001 for both, only smokers at baseline considered), be more physically active (men 3.9±2.5 vs 3.4±2.7 days/week; women 3.8±2.6 vs 3.0±2.8 days/week, p<0.001 for both) and achieved a slightly larger reduction in triglycerides (men -0.2±0.8 vs -0.1±0.9 mmol/L, p = 0.001; women -0.1±0.6 vs 0.0±0.8 mmol/L, p = 0.01) at one-year compared to non-attenders. Male attenders gained less weight (+0.0±5.7 vs +0.3±5.7 kg, p = 0.01) while female attenders achieved better lipid control (total cholesterol -1.2±1.4 vs -0.9±1.4 mmol/L, p<0.001; low-density lipoprotein -1.2±1.2 vs -0.9 ±1.2 mmol/L, p<0.001) compared to non-attenders. Conclusions In an unselected registry cohort of patients post myocardial infarction, compared to non-attenders those attending exercise-based cardiac rehabilitation achieved significantly larger improvements in cardiovascular risk factors at one-year after the acute event.
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Nichols S, Taylor C, Goodman T, Page R, Kallvikbacka-Bennett A, Nation F, Clark A, Birkett S, Carroll S, Ingle L. Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study. Int J Cardiol 2020; 305:25-34. [DOI: 10.1016/j.ijcard.2020.01.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
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Le Grande MR, Beauchamp A, Driscoll A, Jackson AC. Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:147. [PMID: 32209053 PMCID: PMC7092582 DOI: 10.1186/s12872-020-01430-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) has been recognised as a risk factor for cardiovascular diseases such as hypertension and cardiovascular events such as acute coronary syndrome (ACS). Since it is also known to reduce exercise tolerance, it is important to establish the prevalence of OSA in ACS patients, particularly in those who are commencing cardiac rehabilitation (CR) programs. Methods Using PRISMA guidelines a systematic search was conducted in order to identify studies that objectively measured (using polysomnography or portable monitoring) the prevalence of OSA in ACS patients following hospital admission. A data extraction table was used to summarise study characteristics and the quality of studies were independently assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analysis of the selected studies was conducted in order to estimate OSA prevalence as a function of the two main methods of measurement, the severity of OSA, and timing of the OSA assessment following ACS hospital admission. Results Pooled prevalence estimates of OSA using the “gold standard” polysomnography ranged from 22% for severe OSA to 70% for mild OSA, at any time after hospital admission. Similar prevalence estimates were obtained using portable monitoring, but interpretation of these results are limited by the significant heterogeneity observed among these studies. Conclusions Prevalence of OSA following ACS is high and likely to be problematic upon patient entry into CR programs. Routine screening for OSA upon program entry may be necessary to optimise effectiveness of CR for these patients.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia. .,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia. .,Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Department of Medicine -Western Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St.Albans, VIC, 3021, Australia.,School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia.,Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
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Chaves GSS, Lima de Melo Ghisi G, Britto RR, Grace SL. Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle-Income Country: A Wait-List Control Crossover Trial. J Am Heart Assoc 2020; 8:e011228. [PMID: 30764702 PMCID: PMC6405675 DOI: 10.1161/jaha.118.011228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Despite the epidemic of cardiovascular diseases in middle‐income countries, few trials are testing the benefits of cardiac rehabilitation (CR). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and heart‐health behaviors and (2) mortality and morbidity at 6 months following CR in a middle‐income country. Methods and Results Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise‐only CR, or wait‐list control). The CR programs were 6 months in duration, at which point follow‐up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait‐list control elected to attend CR. Functional capacity, risk factors, knowledge, and heart‐health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P>0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point (P<0.001). There were 2 deaths. Hospitalizations (P=0.03), nonfatal myocardial infarctions (P=0.04), and percutaneous coronary interventions (P=0.03) were significantly fewer with CR than control at 6 months. Conclusions CR participation is associated with lower morbidity, long‐term maintenance of functional capacity, risk factors, and heart‐health behaviors, as well as with greater cardiovascular knowledge compared with no CR. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02575976.
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Affiliation(s)
- Gabriela S S Chaves
- 1 Physical Therapy Department Federal University of Minas Gerais Belo Horizonte Minas Gerais Brazil
| | - Gabriela Lima de Melo Ghisi
- 2 Cardiovascular Prevention and Rehabilitation Program Toronto Rehabilitation Institute University Health Network University of Toronto Canada
| | - Raquel R Britto
- 1 Physical Therapy Department Federal University of Minas Gerais Belo Horizonte Minas Gerais Brazil
| | - Sherry L Grace
- 2 Cardiovascular Prevention and Rehabilitation Program Toronto Rehabilitation Institute University Health Network University of Toronto Canada.,3 School of Kinesiology and Health Science York University Toronto Canada
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Salzwedel A, Jensen K, Rauch B, Doherty P, Metzendorf MI, Hackbusch M, Völler H, Schmid JP, Davos CH. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II). Eur J Prev Cardiol 2020; 27:1756-1774. [PMID: 32089005 PMCID: PMC7564293 DOI: 10.1177/2047487320905719] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Results Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20–0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53–0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08–0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54–0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36–0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.
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Affiliation(s)
- Annett Salzwedel
- Department of Rehabilitation Research, University of Potsdam, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | | | | | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Heinrich Heine University Düsseldorf, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | - Heinz Völler
- Department of Rehabilitation Research, University of Potsdam, Germany
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Affiliation(s)
- Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Canada.,Division of Cardiology, Providence Health Care, Canada
| | - Susie Cartledge
- Institute for Physical Activity and Nutrition, Deakin University, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Australia
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Guo S, Huang Y, Zhang Y, Huang H, Hong S, Liu T. Impacts of exercise interventions on different diseases and organ functions in mice. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:53-73. [PMID: 31921481 PMCID: PMC6943779 DOI: 10.1016/j.jshs.2019.07.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 05/20/2023]
Abstract
Background In recent years, much evidence has emerged to indicate that exercise can benefit people when performed properly. This review summarizes the exercise interventions used in studies involving mice as they are related to special diseases or physiological status. To further understand the effects of exercise interventions in treating or preventing diseases, it is important to establish a template for exercise interventions that can be used in future exercise-related studies. Methods PubMed was used as the data resource for articles. To identify studies related to the effectiveness of exercise interventions for treating various diseases and organ functions in mice, we used the following search language: (exercise [Title] OR training [Title] OR physical activity [Title]) AND (mice [title/abstract] OR mouse [title/abstract] OR mus [title/abstract]). To limit the range of search results, we included 2 filters: one that limited publication dates to "in 10 years" and one that sorted the results as "best match". Then we grouped the commonly used exercise methods according to their similarities and differences. We then evaluated the effectiveness of the exercise interventions for their impact on diseases and organ functions in 8 different systems. Results A total of 331 articles were included in the analysis procedure. The articles were then segmented into 8 systems for which the exercise interventions were used in targeting and treating disorders: motor system (60 studies), metabolic system (45 studies), cardio-cerebral vascular system (58 studies), nervous system (74 studies), immune system (32 studies), respiratory system (7 studies), digestive system (1 study), and the system related to the development of cancer (54 studies). The methods of exercise interventions mainly involved the use of treadmills, voluntary wheel-running, forced wheel-running, swimming, and resistance training. It was found that regardless of the specific exercise method used, most of them demonstrated positive effects on various systemic diseases and organ functions. Most diseases were remitted with exercise regardless of the exercise method used, although some diseases showed the best remission effects when a specific method was used. Conclusion Our review strongly suggests that exercise intervention is a cornerstone in disease prevention and treatment in mice. Because exercise interventions in humans typically focus on chronic diseases, national fitness, and body weight loss, and typically have low intervention compliance rates, it is important to use mice models to investigate the molecular mechanisms underlying the health benefits from exercise interventions in humans.
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Affiliation(s)
- Shanshan Guo
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Yiru Huang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200032, China
| | - Yan Zhang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200032, China
| | - He Huang
- Key Laboratory of Molecular Enzymology and Engineering of Ministry of Education, College of Life Science, Jilin University, Changchun 130012, China
| | - Shangyu Hong
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200032, China
| | - Tiemin Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- Department of Endocrinology and Metabolism, State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Low-Volume High-Intensity Aerobic Interval Training Is an Efficient Method to Improve Cardiorespiratory Fitness After Myocardial Infarction. J Cardiopulm Rehabil Prev 2020; 40:48-54. [DOI: 10.1097/hcr.0000000000000453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Buttery AK. Cardiac Rehabilitation for Frail Older People. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:131-147. [DOI: 10.1007/978-3-030-33330-0_13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rijal A, Nielsen EE, Hemmingsen B, Neupane D, Gæde PH, Olsen MH, Jakobsen JC. Adding exercise to usual care in patients with hypertension, type 2 diabetes mellitus and/or cardiovascular disease: a protocol for a systematic review with meta-analysis and trial sequential analysis. Syst Rev 2019; 8:330. [PMID: 31847918 PMCID: PMC6918663 DOI: 10.1186/s13643-019-1233-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension, type 2 diabetes mellitus and cardiovascular disease are among the leading causes of mortality globally. Exercise is one of the commonly recommended interventions/preventions for hypertension, type 2 diabetes mellitus and cardiovascular disease. However, the previous reviews have shown conflicting evidence on the effects of exercise. Our objective is to assess the beneficial and harmful effects of adding exercise to usual care for people with hypertension, type 2 diabetes mellitus and/or cardiovascular disease. METHODS This protocol for a systematic review was undertaken using the recommendations of The Cochrane Collaboration, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and the eight-step assessment procedure suggested by Jakobsen et al. We plan to include all relevant randomised clinical trials and cluster-randomised trials assessing the effects of adding exercise to usual care for people with hypertension, type 2 diabetes mellitus and/or cardiovascular disease. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Latin American and Caribbean Health Sciences Literature (LILACS), Science Citation Index Expanded on Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Science Journal Database (VIP) and BIOSIS. We will systematically assess the risks of random errors using Trial Sequential Analysis as well as risks of bias of all included trials. We will create a 'Summary of Findings' table in which we will present our primary and secondary outcomes, and we will assess the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION The present systematic review will have the potential to aid patients, clinicians and decision-makers recommending exercise and thereby, benefit patients with hypertension, type 2 diabetes mellitus and/or cardiovascular disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Emil Eik Nielsen
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bianca Hemmingsen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Dinesh Neupane
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Peter Haulund Gæde
- Department of Cardiology and Endocrinology, Næstved-Slagelse-Ringsted (NSR) Hospital, Slagelse, Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit, Rigshospitalet, Copenhagen, Denmark
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