Home- and Hospital-Based Cardiac Rehabilitation Exercise: The Important Role of Physician Recommendation

Associations Among Perceived Social Support, Physical Activity, and Health-Related Quality of Life in Patients With Ischemic Heart Disease Reporting Moderate to Severe Hopelessness

BACKGROUND

Associations among perceived social support (PSS), physical activity (PA), and health-related quality of life (HRQoL) in individuals with ischemic heart disease (IHD) are well established. However, little is known about these associationsin patients with IHD experiencing hopelessness.

OBJECTIVE

The objective of this study is to explore the associations among PSS, PA, and HRQoL in patients with IHD reporting moderate to severe hopelessness.

METHODS

Using a cross-sectional design, secondary data were collected from 156 participants enrolled in a randomized controlled trial while hospitalized in the Midwestern United States. Data were collected 2 weeks after hospital discharge, including the Cardiac Rehabilitation Exercise Participation Tool, ENRICHD Social Support Inventory, EuroQol 5-Dimension 5-Level, and a demographic form. Linear models were used to assess associations among the variables, and Macro process mediation was completed to explore potential mediation.

RESULTS

Most participants were male, had some college education or higher, and non-Hispanic White. Over half of the sample were married and not employed (eg, disabled, retired). Higher PSS and higher PA were each separately associated with higher HRQoL after adjusting for relevant covariates (PSS: rpartial = -0.24, P = .005; PA: rpartial = -0.23, P = .003). Engagement in PA (rpartial = -0.19, 95% bootstrap CI, -0.34 to -0.03; P = .02) partially mediated the relationship between PSS and HRQoL (rpartial = -0.18, 95% bootstrap CI, -0.35 to -0.01; P = .03) showing a 22% partial mediation with indirect effect at -0.05 (95% CI bootstrap, -0.11 to -0.002).

CONCLUSION

Even among patients with high perceptions of hopelessness, better perceived social support and more engagement in physical activity are associated with better HRQoL. Longitudinal research in larger and more diverse samples is needed to examine the relationships among PSS, PA, and HRQoL in patients with IHD reporting hopelessness.

Acceptability, Preferred Medium, and Components of Nurse-Led Cardiac Telerehabilitation: A Cross-Sectional Study

Cardiac rehabilitation (CR) is a comprehensive and multidisciplinary secondary prevention care in coronary heart disease (CHD). There are barriers at the patient and health system levels that prevent CR from being utilized. Cardiac telerehabilitation led by nurses (Ne-CTR) can alleviate the obstacles to participation in CR. A patient perspective can improve CR access. This study was the first pre-program investigation to clarify the status of knowledge and participation in CTR. We sought to clarify the acceptability, the reasons for rejection, the desired form, components, and associated factors with the components needed for (Ne-CTR) in patients with CHD. The study aimed to help develop a protocol for Ne-CTR for Chinese patients with CHD. A cross-sectional study was conducted between 2020 and 2021. Hospitals in four provinces in China were included. The participants were 671 patients with CHD in hospitals located in three regions of China. A self-administered questionnaire collected information about demographics, knowledge, and participation in CTR, acceptability, preferred medium, and components of Ne-CTR. Student's t-test, analysis of variance, and multiple linear regression analyzed the factors associated with component needs. All the analyses were conducted using IBM SPSS version 25.0. Most participants (n = 434, 66.77%) had a poor understanding and participation in CTR. In addition, 65.38% (n = 439) of participants were willing to accept the Ne-CTR program, and 43.56% (n = 98) identified safety as reasons for not accepting such a program. In the group accepting Ne-CTR, 35% chose hospital-designed professional applications as a medium for Ne-CTR when offered. Education (4.44 ± 1.056) and drug information (4.44 ± 1.040) had the highest average need score. Education, monthly income, marital status, previous CTR participation, and health insurance were associated with the demand level scores of Ne-CTR. This study demonstrated high levels of need for Ne-CTR among patients with CHD and identified the desired medium, components, and associated factors of Ne-CTR. These findings provide reference information for the construction of a Ne-CTR program.

Improving muscle strength and physical function in older people living with sarcopenia and physical frailty: Not all exercise is created equal

Exercise is an increasingly widely used treatment for older people across a range of clinical conditions including sarcopenia and physical frailty. Whilst exercise can have many benefits for older people, adaptations to exercise are specific to the exercise mode that is performed and not all exercise is created equal. The correct type of exercise, at the correct dose, needs to be prescribed to maximise effectiveness in treating sarcopenia and physical frailty where maintaining or improving muscle strength and physical function represent key aims. Resistance exercise (RE) is the most potent approach to improving muscle strength and physical function and should be prioritised within exercise programmes delivered to this group. Resistance exercise programme design should be underpinned by the fundamental principles of exercise prescription in order to deliver an appropriate and individualised exercise dose to maximise the potential of RE as a treatment for older people living with sarcopenia and physical frailty.

Exercise-based cardiac rehabilitation programs in the era of COVID-19: a critical review

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Increased rates of morbidity and mortality have led to the increased need for the implementation of secondary prevention interventions. Exercise-based cardiac rehabilitation (CR) represents a multifactorial intervention, including elements of physical exercise and activity, education regarding healthy lifestyle habits (smoking cessation, nutritional habits), to improve the physical capacity and psychological status of cardiac patients. However, participation rates in CR programs remain low due to socioeconomic, geographical and personal barriers. Recently the COVID-19 pandemic restrictions have added another barrier to CR programs. Therefore there is an emerging need to further improve the types and methods of implementing CR. Cardiac telerehabilitation, integrating advanced technology for both monitoring and communicating with the cardiac population, appears to be an innovative CR alternative that can overcome some of the barriers preventing CR participation. This review paper aims to describe the background and core components of center-based CR and cardiac telerehabilitation, and discuss their implications for present day clinical practice and their future perspectives.

Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs

Early outpatient (ECR) and maintenance cardiac rehabilitation (MCR) programs are essential, evidence-based services that have received unequivocal endorsement by national and international professional organizations. However, the latest data characterizing ECR enrollment and adherence fell well short of what would be expected for a therapy that has accumulated decades of empirical evidence touting the associated physiologic, physical, psychosocial, and financial benefits. Although national participation levels have remained stagnant, a series of recent publications showcase effective strategies that could bolster both ECR enrollment and adherence levels at the institutional level. Unlike ECR, fewer reports on enrollment and adherence rates exist for MCR, partly due to the lack of standardization of this service. In this review, we aim to highlight current data on enrollment and adherence to ECR and MCR and discuss evidence-based programmatic strategies to support utilization of both services.

Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation

Background

Adherence to medication and lifestyle changes are very important in the secondary prevention of cardiovascular disease. One of the ways is by doing a cardiac rehabilitation program.

Main body of the abstract

Cardiac rehabilitation program is divided into three phases. The cardiac rehabilitation program’s implementation, especially the second phase, center-based cardiac rehabilitation (CBCR), has many barriers not to participate optimally. Therefore, the third phase, known as home-based cardiac rehabilitation (HBCR), can become a substitute or addition to CBCR. On the other hand, this phase is also an essential part of the patients’ functional capacity. During the coronavirus disease-2019 pandemic, HBCR has become the leading solution in the cardiac rehabilitation program’s sustainability. Innovation is needed in its implementation, such as telerehabilitation. So, the cardiac rehabilitation program can be implemented by patients and monitored by health care providers continuously.

Short conclusion

Physicians play an essential role in motivating patients and encouraging their family members to commit to a sustainable CR program with telerehabilitation to facilitate its implementation.

Updated Outpatient Cardiac Rehabilitation Delivery Formats Tailored to the Iranian Population

This article is a Letter to Editor and does not include an Abstract.

Healthcare providers' discussions of physical activity with older survivors of cancer: Potential missed opportunities for health promotion

OBJECTIVES

Physical activity (PA) promotes physical functioning and health-related quality of life in older survivors of cancer. Using a population-based sample of Medicare Advantage beneficiaries, we aimed to characterize the survivors who reported discussing PA with their healthcare provider.

MATERIALS AND METHODS

Data from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was linked with the 2008-2014 Medicare Health Outcomes Survey (MHOS). Older survivors diagnosed with localized- or regional-stage female breast, prostate, or colorectal cancer ≥24 months prior to survey and had visited a healthcare provider in the previous year were included in the multiple logistic regression model. Best-fitting models were identified using the Hosmer and Lemeshow Goodness-of-Fit test.

RESULTS

The final sample (N = 5630) included 3006 survivors who reported discussing PA and 2624 survivors who did not report discussing PA. Older survivors of cancer were significantly more likely to report discussing PA if they had a history of cardiovascular disease (p < .001), diabetes (p < .001), or musculoskeletal disease (p < .001); had a history of fall(s) in the previous twelve months (p = .003); or were obese (p < .001).

DISCUSSION

PA is an important aspect of the management of cancer, other comorbid conditions, and maintenance of physical functioning in older adulthood. The results suggest that PA discussions are not occurring consistently across survivors, and key opportunities for health promotion are being missed. Future work should identify ways to encourage these conversations in all cancer follow-up appointments.

Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction

BACKGROUND

Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown.

METHODS AND RESULTS

We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30-4.06) and non-CR participation (odds ratio, 2.34; 95 confidence interval, 1.22-4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70).

CONCLUSIONS

CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI.