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Redfern J, Singleton AC, Raeside R, Santo K, Hafiz N, Spencer L, Leung RW, Roberts M, King M, Cho JG, Carr B, Jenkins C, Partridge SR, Hayes A, Chow CK, Hyun K. Integrated Text Messaging (ITM) for people attending cardiac and pulmonary rehabilitation: A multicentre randomised controlled trial. Ann Phys Rehabil Med 2024; 67:101800. [PMID: 38118248 DOI: 10.1016/j.rehab.2023.101800] [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: 02/28/2023] [Revised: 07/29/2023] [Accepted: 10/17/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. OBJECTIVES To 1) test the effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes amongst people attending cardiac and pulmonary rehabilitation. Also, 2) to evaluate the program's acceptability and utility using patient-reported outcome and experience measures. METHODS Multicentre randomised controlled trial (3:1, intervention:control) amongst cardiac and pulmonary rehabilitation attendees. Control received usual care (no message program). Intervention also received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, patient-reported outcome and experience measures, medication adherence and rehabilitation attendance. RESULTS A total of 316 participants were recruited. They had a mean age of 66.7 (SD 10.1) years. Sixty percent were male (190/316) and 156 were cardiac rehabilitation participants. The cohort's mean baseline 6MWD was higher in the intervention than the control group. At 6 months, 6MWD improved in both groups; it was significantly greater amongst intervention than control participants (unadjusted mean difference of 43.4 m, 95 % CI 4.3 to 82.4; P = 0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2 m, -21.2 to 25.6; P = 0·85), medication adherence, or cardiovascular risk factors. At 6-month follow-up, intervention participants reported significantly lower depression scores (adjusted mean difference -1.3, 95 % CI -2.2 to -0.3; P = 0.0124) and CAT scores (adjusted mean difference -3.9, 95 % CI -6.6 to -1.3; P = 0.0038), and significantly lower anxiety (adjusted mean difference -1.1, 95 %CI -2.1 to 0; P = 0.0456). Most participants (86 %) read most of their messages and strongly/agreed that the intervention was easy to understand (99 %) and useful (86 %). CONCLUSIONS An educational and supportive text message program for cardiac and pulmonary rehabilitation attendees improved anxiety and depression plus program attendance. The program was acceptable to, and useful for, participants and would be suitable for implementation alongside rehabilitation programs. TRIAL REGISTRATION NUMBER ACTRN12616001167459.
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Affiliation(s)
- Julie Redfern
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney; The George Institute for Global Health, University of New South Wales, NSW, Australia.
| | - Anna C Singleton
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Rebecca Raeside
- MPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Karla Santo
- Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil; The George Institute for Global Health, University of New South Wales, NSW, Australia
| | - Nashid Hafiz
- MIPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Lissa Spencer
- PhD, Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Regina Wm Leung
- PhD, Department of Thoracic Medicine, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia
| | - Mary Roberts
- MPal Care, Department of Respiratory and Sleep Medicine, Westmead Hospital, Western Sydney Local Health District, NSW, Australia; Faculty of Medicine and Health, The University of Sydney at Westmead Hospital, NSW, Australia
| | - Meredith King
- B Physiotherapy, Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, NSW, Australia
| | - Jin-Gun Cho
- PhD, Department of Respiratory and Sleep Medicine, Westmead Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney at Westmead Hospital, Australia
| | - Bridie Carr
- BA Comms, NSW Agency for Clinical Innovation, NSW, Australia
| | - Christine Jenkins
- PhD, The George Institute for Global Health, Sydney and UNSW Faculty of Medicine and Health, NSW, Australia
| | - Stephanie R Partridge
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Alison Hayes
- PhD, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Clara K Chow
- PhD, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney; Western Sydney Local Health District; The George Institute for Global Health, University of New South Wales, NSW, Australia
| | - Karice Hyun
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia
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The Effect of Exercise-Based Cardiac Rehabilitation on Neutrophil to Lymphocyte Ratio in Patients with Coronary Artery Disease. COR ET VASA 2023. [DOI: 10.33678/cor.2022.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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3
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Contribution of individual and cumulative frailty-related health deficits on cardiac rehabilitation completion. BMC Geriatr 2023; 23:34. [PMID: 36658538 PMCID: PMC9854083 DOI: 10.1186/s12877-022-03624-0] [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] [Received: 01/22/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion. METHODS Data from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined. RESULTS A total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)). CONCLUSION A greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.
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Naami R, Naami E, Omari T, Lowi SG, Natanzon SS, Patel V, Lerner A, Rozner E, Turgeman Y, Koren O. Cardiac rehabilitation performance predicts 1-year major adverse cardiovascular events. Clin Cardiol 2022; 45:1036-1043. [PMID: 35904222 PMCID: PMC9574735 DOI: 10.1002/clc.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes. HYPOTHESIS Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events. METHODS We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group"). RESULTS Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03). CONCLUSION Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.
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Affiliation(s)
- Robert Naami
- Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Edmund Naami
- School of Medicine, University of Illinois, Springfield, Illinois, USA
| | | | | | | | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Addee Lerner
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, California, USA
| | | | - Yoav Turgeman
- Emek Medical Center, Afula, Israel.,Technion Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ofir Koren
- Emek Medical Center, Afula, Israel.,Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Technion Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Williamson TM, Rouleau CR, Aggarwal SG, Arena R, Hauer T, Campbell TS. The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease. PATIENT EDUCATION AND COUNSELING 2021; 104:2969-2978. [PMID: 33994262 DOI: 10.1016/j.pec.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance. METHODS Adults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review. RESULTS Among 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance. CONCLUSION Whereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance. PRACTICE IMPLICATIONS Cardiac PE programs may be more successful in promoting exercise attendance if they target patients' behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.
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Affiliation(s)
- Tamara M Williamson
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada.
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Department of Physical Therapy, Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60607, USA
| | - Sandeep G Aggarwal
- TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Heritage Medical Research Building (HMRB) Room 72, Foothills Campus, 3310 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Ross Arena
- TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Department of Physical Therapy, Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60607, USA
| | - Trina Hauer
- TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Heritage Medical Research Building (HMRB) Room 72, Foothills Campus, 3310 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
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Medina-Inojosa JR, Grace SL, Supervia M, Stokin G, Bonikowske AR, Thomas R, Lopez-Jimenez F. Dose of Cardiac Rehabilitation to Reduce Mortality and Morbidity: A Population-Based Study. J Am Heart Assoc 2021; 10:e021356. [PMID: 34612055 PMCID: PMC8751887 DOI: 10.1161/jaha.120.021356] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence‐based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). Methods and Results This is an historical cohort study of all patients who had coronary artery disease and who initiated supervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow‐up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all‐cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5±11.1 of 36 prescribed sessions. After a mean follow‐up of 6 years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55–0.91) in those completing ≥20 sessions, when compared with those not exposed to formal exercise sessions (≤1 session; log‐rank P=0.007). We did not find evidence of nonlinearity (P≥0.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97–0.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58–0.94]). Conclusions CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.
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Affiliation(s)
- Jose R Medina-Inojosa
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN.,Division of Epidemiology Department of Quantitative Health SciencesMayo Clinic Rochester MN
| | - Sherry L Grace
- KITE & Peter Menk Cardiac Centre University Health NetworkUniversity of Toronto Toronto Ontario Canada.,Faculty of Health York University Toronto Ontario Canada
| | - Marta Supervia
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN.,Gregorio Marañón Health Research InstituteGregorio Marañón General University Hospital Madrid Spain
| | - Gorazd Stokin
- International Clinical Research Center St. Anne University Hospital Brno Czech Republic
| | - Amanda R Bonikowske
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN
| | - Randal Thomas
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN
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Grace SL, Prior PL, Mamataz T, Hartley T, Oh P, Suskin N. Cardiac Rehabilitation Component Attendance and Impact of Intervening Clinical Events, as Well as Disease Severity and Risk Factor Burden. J Cardiopulm Rehabil Prev 2021; 41:40-45. [PMID: 33351541 DOI: 10.1097/hcr.0000000000000571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine: (1) the rate of clinical events precluding cardiac rehabilitation (CR) continuation, (2) CR attendance by component in those without events, and (3) the association between disease severity (eg, tobacco use, diabetes, and depression) and component attendance (eg, exercise, diet, stress management, and tobacco cessation). METHODS Retrospective analysis of electronic records of the CR program in London, Ontario, from 1999 to 2017. Patients in the supervised program are offered exercise sessions 2 times/wk with a minimum of 48 prescribed sessions tailored to patient need. Patients attending ≥1 session without major factors that would limit their exercise ability were included. Intervening events were recorded, as was component attendance. RESULTS Of 5508 enrolled, supervised patients, 3696 did not have a condition that could preclude exercise. Of those enrolled, one-sixth (n = 912) had an intervening event; these patients were less likely to work, more likely to have medical risk factors, had more severe angina and depression, and lower functional capacity. The remaining cohort attended a mean of 26.5 ± 21.3 sessions overall (median = 27; 19% attending ≥48 sessions), including 20.5 ± 17.4 exercise sessions (median = 21). After exercise, the most common components attended were individual dietary and psychological counseling. Patients with more severe angina and depressive symptoms as well as tobacco users attended significantly fewer total sessions, but more of some specific components. CONCLUSIONS In one-sixth of patients, CR attendance and completion are impacted by clinical factors beyond their control. Many patients are taking advantage of components specific to their risk factors, buttressing the value of individually tailored, menu-based programming.
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Affiliation(s)
- Sherry L Grace
- York University, Toronto, Ontario, Canada (Drs Grace and Mamataz); KITE, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Grace and Oh); Lawson Health Research Institute, St Joseph's Health Care, London, Ontario, Canada (Drs Prior and Suskin and Mr Hartley); and Department of Medicine, Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (Mr Suskin)
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Clinic Utilization and Characteristics of Patients Accessing a Prostate Cancer Supportive Care Program's Sexual Rehabilitation Clinic. J Clin Med 2020; 9:jcm9103363. [PMID: 33092185 PMCID: PMC7589360 DOI: 10.3390/jcm9103363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer (PC) treatment leads to impairment of sexual function. The Prostate Cancer Supportive Care (PCSC) Program's Sexual Rehabilitation clinic (SRC) assists patients and their partners with sexual recovery using a biopsychosocial approach to rehabilitation. This study characterizes patients seen in the SRC between July 2013-1 July 2019. Data was retrospectively abstracted from clinic records. In total, 965 patients were seen over 3391 appointments during the study period. Median age (standard deviation (SD)) was 66 years (SD = 7.1), 82.0% were partnered, yet 81.7% attended appointments alone. 88.0% were treated with surgery, 5.1% with brachytherapy, 3.7% with external beam radiation (EBRT), 1.8% with combined brachytherapy and EBRT, and 1.4% with androgen deprivation therapy. In total, 708 patients (73.4%) attended ≥1 follow-up appointment. Median time (SD) between end of prostate cancer treatment to first SRC appointment was 270 days (range 0-7766). The mean (SD) self-reported overall sexual satisfaction (extracted from International Index of Erectile Function-5 (IIEF-5)) significantly increased both with erectile aids (1.69 (SD = 1.52) to 2.26 (SD = 1.66), p < 0.001, n = 148) and without erectile aids (1.71 (SD = 1.44) to 2.35 (SD = 1.57), p < 0.001, n = 235). This study provides guidance for further investigation to refine treatment, wait-times, support, and/or resource offerings in this type of program.
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Adherence to Home-Based Rehabilitation in Older Adults With Diabetes After Hip Fracture. Nurs Res 2019; 68:383-389. [DOI: 10.1097/nnr.0000000000000371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bowles L, Curtis J, Davies C, Lengerich A, Bugajski A. The effect of music on mood, motivation, and exercise among patients in a cardiac rehabilitation program: A pilot study. Nurs Forum 2019; 54:340-344. [PMID: 30802308 DOI: 10.1111/nuf.12334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/09/2019] [Accepted: 02/10/2019] [Indexed: 06/09/2023]
Abstract
AIM Exploring the effect of music on mood, motivation, and exercise performance among patients with phase III cardiac rehabilitation. BACKGROUND Cardiac rehabilitation programs address risk factors associated with heart health following acute heart issues or cardiac surgery. In phase III, patients are involved in cardiac health maintenance. Exercise is a major component. Motivating patients to engage in exercise and remain in the program has been problematic. Evidence suggests that music could enhance patient involvement in exercise activities. METHOD A quasi-experimental design was used in this pilot study. A convenience sample of 17 phase III cardiac rehabilitation patients participated. Data were collected on: mood, motivation, and exercise. Participants responded to the Brief Mood Introspection Scale, a 5-point visual analog scale, and an investigator-designed questionnaire on motivation. Treadmill data (speed, distance, and time) were also collected. RESULTS At baseline participants scored high on mood, motivation to exercise, and fondness for music. Little change occurred over the 9 week period. Participants in this study walked further, on average, than individuals of the same age. CONCLUSION Music appears to maintain patients' positive moods, motivate them to exercise and help them to continue rehabilitation efforts. Over time music may encourage patients to walk a further distance.
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Affiliation(s)
| | - Jami Curtis
- Cardiac Rehabilitation Baptist Health, Lexington, Kentucky
| | - Claire Davies
- Cardiac Rehabilitation Baptist Health, Lexington, Kentucky
| | - Alex Lengerich
- College of Counseling and Psychology, University of Kentucky, Lexington, Kentucky
| | - Andrew Bugajski
- College of Nursing, Assistant Professor, University of Southern Florida, Tampa, Florida
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Abstract
PURPOSE Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality rates following a major cardiac event. Although a dose-response relationship between the number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study, we examined associations between the number of sessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES). METHODS Multiple logistic regression and classification and regression tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and the number of sessions completed in a prospectively collected CR clinical database (n = 1658). RESULTS Current smoking, lower SES, nonsurgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (ie, risk profiles) predict the number of sessions completed. Those with the highest-risk profile for nonadherence (<65 years old, current smoker, lower SES) completed on average 9 sessions while those with the lowest-risk profile (>72 years old, not current smoker, higher SES, surgical diagnosis) completed 27 sessions on average. CONCLUSIONS Younger individuals, as well as those who report smoking or economic challenges or have a nonsurgical diagnosis, may require additional support to maintain CR session attendance.
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Abell B, Glasziou P, Hoffmann T. The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression. SPORTS MEDICINE - OPEN 2017; 3:19. [PMID: 28477308 PMCID: PMC5419959 DOI: 10.1186/s40798-017-0086-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. METHODS In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, The Cochrane Library, SPORTDiscus) from citation tracking and hand-searching. Studies were included if they were randomised trials of a structured exercise intervention (versus usual care) for participants with coronary heart disease and reported at least one of cardiovascular mortality, total mortality, myocardial infarction or revascularisation outcomes. Each included trial was assessed using the Cochrane Risk of Bias Tool. Authors were also contacted for missing intervention details or data. Random effects meta-analysis was performed to calculate a summary risk ratio (RR) with 95% confidence interval (CI) for the effect of exercise on outcomes. Random effects meta-regression and subgroup analyses were conducted to examine the association between pre-specified co-variates (exercise components or trial characteristics) and each clinical outcome. RESULTS Sixty-nine trials were included, evaluating 72 interventions which differed markedly in terms of exercise components. Exercise-based cardiac rehabilitation was effective in reducing cardiovascular mortality (RR 0.74, 95% CI 0.65 to 0.86), total mortality (RR 0.90, 95% CI 0.83 to 0.99) and myocardial infarction (RR 0.80, 95% CI 0.70 to 0.92). This effect generally demonstrated no significant differences across subgroups of patients who received various types of usual care, more or less than 150 min of exercise per week and of differing cardiac aetiologies. There was however some heterogeneity observed in the efficacy of cardiac rehabilitation in reducing total mortality based on the presence of lipid lowering therapy (I 2 = 48%, p = 0.15 for subgroup treatment interaction effect). No single exercise component was identified through meta-regression as a significant predictor of mortality outcomes, although reductions in both total (RR 0.81, p = 0.042) and cardiovascular mortality (RR 0.72, p = 0.045) were observed in trials which reported high levels of participant exercise adherence, versus those which reported lower levels. A dose-response relationship was found between an increasing exercise session time and increasing risk of myocardial infarction (RR 1.01, p = 0.011) and the highest intensity of exercise prescribed and an increasing risk of percutaneous coronary intervention (RR 1.05, p = 0.047). CONCLUSIONS Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease. While our analysis was constrained by the quality of included trials and missing information about intervention components, there appears to be little differential effect of variations in exercise intervention, particularly on mortality outcomes. Given the observed effect between higher adherence and improved outcomes, it may be more important to provide exercise-based cardiac rehabilitation programs which focus on achieving increased adherence to the exercise intervention.
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Affiliation(s)
- Bridget Abell
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia.
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
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Piepoli MF. Editor's presentation. Eur J Prev Cardiol 2017; 24:1907-1909. [PMID: 29164941 DOI: 10.1177/2047487317744488] [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: 11/15/2022]
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Taylor C, Tsakirides C, Moxon J, Moxon JW, Dudfield M, Witte K, Ingle L, Carroll S. Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study. Open Heart 2017; 4:e000623. [PMID: 28878950 PMCID: PMC5574458 DOI: 10.1136/openhrt-2017-000623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/28/2017] [Accepted: 06/20/2017] [Indexed: 01/10/2023] Open
Abstract
Aims To investigate the relationship between exercise participation, exercise ‘dose’ expressed as metabolic equivalent (MET) hours (h) per week, and prognosis in individuals attending an extended, community-based exercise rehabilitation programme. Methods Cohort study of 435 participants undertaking exercise-based cardiac rehabilitation (CR) in Leeds, West Yorkshire, UK between 1994 and 2006, followed up to 1 November 2013. MET intensity of supervised exercise was estimated utilising serial submaximal exercise test results and corresponding exercise prescriptions. Programme participation was routinely monitored. Cox regression analysis including time-varying and propensity score adjustment was applied to identify predictors of long-term, all-cause mortality across exercise dose and programme duration groups. Results There were 133 events (31%) during a median follow-up of 14 years (range, 1.2 to 18.9 years). The significant univariate association between exercise dose and all-cause mortality was attenuated following multivariable adjustment for other predictors, including duration in the programme. Longer-term adherence to supervised exercise training (>36 months) was associated with a 33% lower mortality risk (multivariate-adjusted HR: 0.67; 95% CI: 0.47 to 0.97; p=0.033) compared with all lesser durations of CR (3, 12, 36 months), even after adjustment for baseline fitness, comorbidities and survivor bias. Conclusion Exercise dose (MET-h per week) appears less important than long-term adherence to supervised exercise for the reduction of long-term mortality risk. Extended, supervised CR programmes within the community may play a key role in promoting long-term exercise maintenance and other secondary prevention therapies for survival benefit.
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Affiliation(s)
- Claire Taylor
- Carnegie School of Sport,Leeds Beckett University, Leeds, UK
| | | | | | | | | | - Klaus Witte
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Sean Carroll
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
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Alter DA, Yu B, Bajaj RR, Oh PI. Relationship Between Cardiac Rehabilitation Participation and Health Service Expenditures Within a Universal Health Care System. Mayo Clin Proc 2017; 92:S0025-6196(17)30075-7. [PMID: 28365098 DOI: 10.1016/j.mayocp.2016.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/06/2016] [Accepted: 12/28/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the relationship between cardiac rehabilitation participation and health service expenditures in Ontario, Canada. PATIENTS AND METHODS A total of 6284 patients referred to cardiac rehabilitation between April 1, 2003, and December 31, 2010, were linked to 6284 matched cardiac rehabilitation eligible nonreferred controls and followed over a 3-year period across multiple linked administrative databases to identify health service utilization expenditures and mortality. All patients had previous cardiac hospitalizations within the preceding year. Four cardiac rehabilitation eligible groups of patients were balanced using propensity score weights: (1) no referral; (2) no participation; (3) low participation levels (ie, attending <67% of prescheduled classes); and (4) high participation levels (ie, attending ≥67% prescheduled classes). Each group of patients was balanced in age, sex, geography, socioeconomic status, previous hospitalizations, ambulatory care conditions, cardiovascular risk factors, comorbidities, and previous health care expenditures. Generalized linear models were used to examine differences in health service expenditures (from all sources including hospitalizations, physician visits, diagnostic tests, and drugs for those older than 65 years) per "eligible day alive" over the 3-year period. RESULTS Compared with the nonreferred population, health service expenditures followed a dose-response relationship and were lowest in patients who had the highest cardiac rehabilitation programmatic participation levels (P<.001). Cost differences across groups separated early, remained divergent, and applied to all components of health care expenditures (P<.001). Sensitivity analyses confirmed that the findings were not secondary to reverse causality. CONCLUSION Participation in cardiac rehabilitation is associated with lower long-term health service utilization expenditures within a publicly funded health care system.
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Affiliation(s)
- David A Alter
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Bing Yu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ravi R Bajaj
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Paul I Oh
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Baseline risk has greater influence over behavioral attrition on the real-world clinical effectiveness of cardiac rehabilitation. J Clin Epidemiol 2016; 79:55-61.e1. [DOI: 10.1016/j.jclinepi.2016.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/02/2016] [Accepted: 03/11/2016] [Indexed: 12/29/2022]
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17
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Omega-3 Fatty Acids, Depressive Symptoms, and Cognitive Performance in Patients With Coronary Artery Disease: Analyses From a Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Psychopharmacol 2016; 36:436-44. [PMID: 27529771 PMCID: PMC5017271 DOI: 10.1097/jcp.0000000000000565] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This trial investigated the efficacy of omega-3 polyunsaturated fatty acid (n-3 PUFA) treatment for improving depressive symptoms and cognitive performance in patients with coronary artery disease (CAD) participating in cardiac rehabilitation. Patients with CAD aged 45 to 80 years were randomized to receive either 1.9-g/d n-3 PUFA treatment or placebo for 12 weeks. Depressive symptoms were measured using the Hamilton Depression Rating Scale (HAM-D, primary outcome) and the Beck Depression Inventory II (BDI-II). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were used to identify a depressive episode at baseline. Cognitive performance was measured using a standardized battery for vascular cognitive impairment. In 92 patients (age, 61.7 ± 8.7 y; 76% male, 40% depressed; HAM-D, 6.9 ± 5.9; BDI-II, 12.3 ± 10.9; n = 45 n-3 PUFA, n = 47 placebo), depression decreased (HAM-D, F3,91 = 2.71 and P = 0.049; BDI-II, F3,91 = 6.24 and P < 0.01), and cognitive performance improved (attention/processing speed, F1,91 = 5.57, P = 0.02; executive function, F1,91 = 14.64, P < 0.01; visuospatial memory, F1,91 = 4.01, P = 0.04) over cardiac rehabilitation. Omega-3 PUFA treatment increased plasma eicosapentaenoic acid (F1,29 = 33.29, P < 0.01) and docosahexaenoic acid (F1,29 = 15.29, P < 0.01) concentrations but did not reduce HAM-D (F3,91 = 1.59, P = 0.20) or BDI-II (F3,91 = 0.46, P = 0.50) scores compared with placebo. Treatment did not improve cognitive performance; however, n-3 PUFAs significantly increased verbal memory compared with placebo in a subgroup of nondepressed patients (F1,54 = 4.16, P = 0.04). This trial suggests that n-3 PUFAs do not improve depressive and associated cognitive symptoms in those with CAD. The possible benefits of n-3 PUFAs for verbal memory may warrant investigation in well-powered studies.
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House CM, Anstadt MA, Stuck LH, Nelson WB. The Association Between Cardiac Rehabilitation Attendance and Hospital Readmission. Am J Lifestyle Med 2016; 12:513-520. [PMID: 30783406 DOI: 10.1177/1559827616670118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose: Cardiac rehabilitation is associated with improved clinical outcomes, but the impact of individual cardiac rehabilitation sessions on readmission rates is less studied. Methods: A retrospective evaluation of the relationship between the number of cardiac rehabilitation sessions completed and all-cause and cardiac readmission rates at 1 year was conducted. The 1-year cardiac readmission counts were modeled via Poisson regression. Results: Of the 347 patients included in the primary analysis, 227 (65%) completed all assigned cardiac rehabilitation sessions. At 1 year, 135 patients (39%) had at least 1 cardiac readmission, and 155 patients (45%) had at least 1 all-cause readmission. The primary result was that every additional cardiac rehabilitation session completed was associated with a 1.75% lower incidence rate of 1-year cardiac readmission (P = .01) and a 2% lower incidence rate of all-cause hospital readmission (P = .001). Conclusion: Regardless of the number of cardiac rehabilitation sessions assigned, each additional session attended was associated with reduced cardiac readmission by 1.75% and all-cause readmission by 2%.
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Affiliation(s)
- Chad M House
- Department of Cardiology, Regions Hospital, St Paul, Minnesota (CMH, MAA, WBN).,HealthPartners Medical Group, Bloomington, Minnesota (CMH, MAA, WBN).,HealthPartners Institute for Education and Research, Bloomington, Minnesota (LHS).,University of Minnesota School of Medicine, Minneapolis, Minnesota (WBN)
| | - Mary A Anstadt
- Department of Cardiology, Regions Hospital, St Paul, Minnesota (CMH, MAA, WBN).,HealthPartners Medical Group, Bloomington, Minnesota (CMH, MAA, WBN).,HealthPartners Institute for Education and Research, Bloomington, Minnesota (LHS).,University of Minnesota School of Medicine, Minneapolis, Minnesota (WBN)
| | - Logan H Stuck
- Department of Cardiology, Regions Hospital, St Paul, Minnesota (CMH, MAA, WBN).,HealthPartners Medical Group, Bloomington, Minnesota (CMH, MAA, WBN).,HealthPartners Institute for Education and Research, Bloomington, Minnesota (LHS).,University of Minnesota School of Medicine, Minneapolis, Minnesota (WBN)
| | - William B Nelson
- Department of Cardiology, Regions Hospital, St Paul, Minnesota (CMH, MAA, WBN).,HealthPartners Medical Group, Bloomington, Minnesota (CMH, MAA, WBN).,HealthPartners Institute for Education and Research, Bloomington, Minnesota (LHS).,University of Minnesota School of Medicine, Minneapolis, Minnesota (WBN)
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Grace SL, Turk-Adawi K, Santiago de Araújo Pio C, Alter DA. Ensuring Cardiac Rehabilitation Access for the Majority of Those in Need: A Call to Action for Canada. Can J Cardiol 2016; 32:S358-S364. [PMID: 27692116 DOI: 10.1016/j.cjca.2016.07.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022] Open
Abstract
Cardiac rehabilitation (CR) is a proven model of secondary prevention. Indicated cardiac conditions for CR are well established, and participation of these patients results in significantly lower mortality and morbidity when compared with usual care. There are approximately 170 CR programs in Canada, which varies widely by province. There is a grossly insufficient capacity to treat all patients with cardiac indications in Canada and beyond. The density of CR services is about half that in the United States, at 1 program per 208,823 inhabitants or 1 program per 7779 patients with cardiac disease. Despite the Canadian Cardiovascular Society's target of 85% referral for CR for cardiac inpatients with the appropriate indications, significantly fewer patients are referred for CR. Moreover, certain patient groups-such as women, ethnocultural minorities, and those of low socioeconomic status-are less likely to access CR, despite greater need because of poorer outcomes. CR appears to be reaching a healthier population that is perhaps more adherent to secondary prevention recommendations and hence in less need of the limited CR spots available. The reasons for CR underuse are well established and include factors at patient, referring provider, CR program, and health system levels. A Cochrane review has established some effective interventions to increase CR use, and these must be implemented more broadly. We must advocate for CR reimbursement. Finally, we must reallocate our CR resources to patients with the greatest need. This may involve risk stratification, with subsequent allocation of lower-risk patients to a more widely available, lower-cost, and effective alternative model of CR.
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Affiliation(s)
- Sherry L Grace
- York University, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
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20
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Grace SL, Midence L, Oh P, Brister S, Chessex C, Stewart DE, Arthur HM. Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial. Mayo Clin Proc 2016; 91:140-8. [PMID: 26682921 DOI: 10.1016/j.mayocp.2015.10.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/15/2015] [Accepted: 10/12/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR). PATIENTS AND METHODS Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013. Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario, Canada. Consenting participants completed a preprogram survey, and clinical data were extracted from charts. Participants were referred to CR at 1 of 3 sites. After intake assessment, including a graded exercise stress test, eligible patients were randomized to supervised mixed-sex, supervised women-only, or home-based CR. Six months later, CR adherence and exit assessment data were ascertained. RESULTS Of the 264 consenting patients, 169 (64.0%) were eligible and randomized. Twenty-seven (16.0%) did not attend, and 43 (25.4%) attended a different model. Program adherence was moderate overall (54.46%±35.14%). Analysis of variance revealed no significant differences based on per-protocol analysis (P=.63), but as-treated, home-based participants attended significantly more than did women-only participants (P<.05). Overall, there was a significant increase in functional capacity preprogram to postprogram (P<.001). Although there were no significant differences in functional capacity by model at CR exit based on per-protocol analysis, there was a significant difference on an as-treated basis, which sustained adjustment. Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs (P<.05). CONCLUSION Offering women alternative program models may not promote greater CR adherence or functional capacity; however, replication is warranted. Other proven strategies such as action planning and self-monitoring should be applied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01019135.
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Affiliation(s)
- Sherry L Grace
- York University, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
| | | | - Paul Oh
- University Health Network, Toronto, Ontario, Canada
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Alter DA, O'Sullivan M, Oh PI, Redelmeier DA, Marzolini S, Liu R, Forhan M, Silver M, Goodman JM, Bartel LR. Synchronized personalized music audio-playlists to improve adherence to physical activity among patients participating in a structured exercise program: a proof-of-principle feasibility study. SPORTS MEDICINE-OPEN 2015; 1:23. [PMID: 26284164 PMCID: PMC5005752 DOI: 10.1186/s40798-015-0017-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 04/09/2015] [Indexed: 11/17/2022]
Abstract
Background Preference-based tempo-pace synchronized music has been shown to reduce perceived physical activity exertion and improve exercise performance. The extent to which such strategies can improve adherence to physical activity remains unknown. The objective of the study is to explore the feasibility and efficacy of tempo-pace synchronized preference-based music audio-playlists on adherence to physical activity among cardiovascular disease patients participating in a cardiac rehabilitation. Methods Thirty-four cardiac rehabilitation patients were randomly allocated to one of two strategies: (1) no music usual-care control and (2) tempo-pace synchronized audio-devices with personalized music playlists + usual-care. All songs uploaded onto audio-playlist devices took into account patient personal music genre and artist preferences. However, actual song selection was restricted to music whose tempos approximated patients’ prescribed exercise walking/running pace (steps per minute) to achieve tempo-pace synchrony. Patients allocated to audio-music playlists underwent further randomization in which half of the patients received songs that were sonically enhanced with rhythmic auditory stimulation (RAS) to accentuate tempo-pace synchrony, whereas the other half did not. RAS was achieved through blinded rhythmic sonic-enhancements undertaken manually to songs within individuals’ music playlists. The primary outcome consisted of the weekly volume of physical activity undertaken over 3 months as determined by tri-axial accelerometers. Statistical methods employed an intention to treat and repeated-measures design. Results Patients randomized to personalized audio-playlists with tempo-pace synchrony achieved higher weekly volumes of physical activity than did their non-music usual-care comparators (475.6 min vs. 370.2 min, P < 0.001). Improvements in weekly physical activity volumes among audio-playlist recipients were driven by those randomized to the RAS group which attained weekly exercise volumes that were nearly twofold greater than either of the two other groups (average weekly minutes of physical activity of 631.3 min vs. 320 min vs. 370.2 min, personalized audio-playlists with RAS vs. personalized audio-playlists without RAS vs. non-music usual-care controls, respectively, P < 0.001). Patients randomized to music with RAS utilized their audio-playlist devices more frequently than did non-RAS music counterparts (P < 0.001). Conclusions The use of tempo-pace synchronized preference-based audio-playlists was feasibly implemented into a structured exercise program and efficacious in improving adherence to physical activity beyond the evidence-based non-music usual standard of care. Larger clinical trials are required to validate these findings. Trial registration ClinicalTrials.gov ID (NCT01752595) Electronic supplementary material The online version of this article (doi:10.1186/s40798-015-0017-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David A Alter
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; Department of Health Policy, Management and Evaluation, University of Toronto, 40 St George Street, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Mary O'Sullivan
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Paul I Oh
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Donald A Redelmeier
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Sunnybrook Health Sciences, 2075 Bayview Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; Department of Health Policy, Management and Evaluation, University of Toronto, 40 St George Street, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Susan Marzolini
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Richard Liu
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Mary Forhan
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Faculty of Rehabilitation Medicine, The University of Alberta, 8205 114 Street, Alberta, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Michael Silver
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Jack M Goodman
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Exercise Sciences, Faculty of Physical Education and Health, University of Toronto, 27 King's College Circle, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
| | - Lee R Bartel
- Music and Health Research Collaboratory, Faculty of Music, University of Toronto, 80 Queens Park, Toronto, Canada ; Dean's Office, Faculty of Music, University of Toronto, 80 Queens Park, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada
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