CORRIGENDUM: JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease

Effect of protein consumption and supplementation on body composition and functional capacity in cardiovascular disease patients undergoing cardiovascular rehabilitation: A systematic review and meta-analysis

Cardiovascular diseases (CVD) remain the leading cause of death worldwide. Nutritional strategies, including protein intake, play a crucial role in cardiovascular rehabilitation by supporting overall health and recovery. This review explores the hypothesis that protein supplementation enhances muscle mass, leading to improved body composition and functional capacity in CVD patients. We conducted a systematic review of randomized controlled trials (RCTs) in accordance with the Cochrane Manual for Systematic Reviews of Interventions, with the protocol registered under CRD42022292687. A comprehensive search strategy, incorporating population, intervention, and study design terms, was executed across PubMed, EMBASE, Scopus, and Web of Science from data inception to February 1, 2024. Study quality was assessed using the Cochrane risk of bias tool (RoB 2.0), and meta-analysis was performed with statistical packages in Rstudio 3.6.2. From 10 939 initial citations, seven RCTs and three pilot RCTs met the eligibility criteria. Sample sizes ranged from 11 to 70 participants, with mean ages between 55 and 80 years. The narrative synthesis revealed mixed effects of protein supplementation on body composition and functional capacity. Lean body mass improvements were observed in several trials, particularly when protein intake was combined with resistance training. However, reductions in adipose tissue were inconsistent. Functional capacity enhancements-such as improved handgrip strength and 10-meter walk test performance-were observed in some trials, especially those using whey or leucine-enriched protein supplements. However, findings on VO2 peak, a key indicator of exercise capacity, were inconclusive, some trials reporting improvements while others showed no significant effect. Risk of bias varied from low to high across trials, and heterogeneity in intervention types, protein dosages, and study durations limited direct comparisons. Outcomes classified with very low certainty of evidence included body mass index, the 6-minute walk test, and VO2 peak or maximum. Meanwhile, low-certainty evidence was found for handgrip strength, fat mass, and lean body mass. In conclusion, while protein supplementation may support improvements in body composition and functional capacity, variability in protein types and dosages prevents a clear recommendation for CVD patients in cardiovascular rehabilitation. Further high-quality trials with larger sample sizes are needed to establish more specific protein intake guidelines for this population.

Effects of cardiac rehabilitation on in vivo nailfold microcirculation in patients with cardiovascular disease

This study aimed to explore the impact of cardiac rehabilitation (CR) on in vivo and ex vivo microcirculation, exercise capacity, and oxidative stress in patients with cardiovascular disease (CVD). The study included patients with acute coronary syndrome (ACS; n = 45; age, 69.0 ± 14.1 years) and heart failure (HF; n = 66; age, 77.3 ± 10.7 years) who underwent supervised CR during hospitalization. The control group comprised patients without CVD (NCVD; n = 20; age, 75.9 ± 11.2 years). In vivo microcirculatory observations using nailfold video capillary endoscopy at rest and during hyperemia, exercise capacity, and oxidative stress were assessed at baseline and 12 weeks after discharge. Baseline capillary densities were significantly lower in the ACS (5.0 ± 1.7 capillaries/mm2) and HF (4.9 ± 1.7 capillaries/mm2) groups than in the NCVD group (6.5 ± 1.1 capillaries/mm2, p < 0.01). Similarly, capillary density during reactive hyperemia was significantly lower in the ACS (5.8 ± 1.7 capillaries/mm2) and HF (5.4 ± 1.8 capillaries/mm2) groups than in the NCVD group (7.3 ± 1.4 capillaries/mm2, p < 0.01). Patients with ACS and HF had increased capillary densities at 12 weeks compared with at baseline (p < 0.05). This improvement was particularly pronounced among post-discharge outpatient CR participants (n = 20). Grip strength, exercise capacity, and oxidative stress improved at 12 weeks. Baseline capillary density changes were positively correlated with grip strength changes (r = 0.45, p < 0.001). CR significantly improved nailfold capillary density in patients with ACS and HF 12 weeks after discharge.

Online Intensive Cardiac Rehabilitation Program for Japanese Patients With Coronary Artery Disease - A Pilot Study Protocol

Background

A comprehensive cardiac rehabilitation (CR) program is recommended for coronary artery disease (CAD). However, many facilities do not have established programs for dietary guidance and patient education, resulting in an exercise-based CR program and limited efficacy for secondary prevention.

Methods and Results

A pilot study will be conducted to develop an online Japanese-style intensive cardiac rehabilitation (J-ICR) program for Japanese patients with CAD and will examine adherence, safety, and efficacy. Twenty-four patients diagnosed with stable CAD will be randomly assigned in a 1 : 1 ratio to either an early or late-phase group. The program will comprise the following four parts: exercise sessions; dietary education centered on "the Japan diet"; mindfulness; and group support, with a frequency of 3 h per session, once a week for 12 weeks (a total of 36 h). The primary endpoint will be program feasibility, determined by examining its adherence. Physical examination and function, stress-coping skills, risk of classic CAD (e.g., lipid profile, glucose tolerance, and blood pressure), and dietary changes will be assessed as secondary endpoints.

Conclusions

The online J-ICR program is designed as a comprehensive CR program for Japanese patients with CAD. If this program shows high adherence and an improvement in CAD risk factors, its secondary prevention effect should be verified with appropriately powered randomized trials at multiple centers.

Impact of frailty and prefrailty on the mid-term outcomes and rehabilitation course after cardiac surgery

PURPOSE

This study examined the impact of frailty and prefrailty on mid-term outcomes and rehabilitation courses after cardiac surgery.

METHODS

A total of 261 patients (median age: 73 years; 30% female) who underwent elective cardiac surgery were enrolled in this study. The Japanese version of the Cardiovascular Health Study Frailty Index classified 86, 131, and 44 patients into frailty, prefrailty, and robust groups, respectively. We examined the recovery of walking ability, outcomes at discharge, mid-term all-cause mortality, and rehospitalization related to major adverse cardiovascular and cerebrovascular events (MACCE) across the three cohorts.

RESULTS

The 3-year survival rates in the frailty, prefrailty, and robust groups were 87%, 97%, and 100%, respectively (p = 0.003). The free event rates of all-cause mortality and re-hospitalization related to MACCE were 59%, 79%, and 95%, respectively (p < 0.001), with a graded elevation in adjusted morbidity among patients in the prefrailty (hazard ratio [HR], 4.57; 95% confidence interval [CI], 1.08-19.4) and frailty (HR, 9.29; 95% CI 2.21-39.1) groups. Patients with frailty also experienced a delayed recovery of walking ability and a reduced number of patients with frailty were discharged home.

CONCLUSION

Frailty and prefrailty adversely affect the mid-term prognosis and rehabilitation course after cardiac surgery.

Cardiac-output response to exercise after allogeneic hematopoietic stem cell transplantation: a case report with a 2-year follow-up

Cardiac-output response to exercise was evaluated over a 2-year period in hematopoietic stem cell transplant recipients treated with cardiotoxic drugs. During the study period, resting cardiac function was normal; however, the cardiac output response to exercise decreased, and an association with exercise tolerance was observed. Regular assessments of cardiopulmonary function and exercise guidance are vital for patients at high risk of cancer therapy-related cardiac dysfunction, in line with the principles of cardiac oncology rehabilitation.

Effects of Early Gait Training on Inpatient Frailty After Transcatheter Aortic Valve Implantation

INTRODUCTION

This study aimed to clarify the relationship between the number of days of early gait training and frailty in in-hospital patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis, focusing on the Clinical Frailty Scale (CFS) and clinical laboratory data.

METHODS AND RESULTS

Sixty-nine patients admitted to the Ichinomiya West Hospital from November 1, 2019 to November 30, 2023 were included in the study. Of the 69 patients, those who started gait training on postoperative day 0 or 1 were defined as the early gait training group and those who started gait training later than postoperative day 1 were defined as the delayed gait training group. There was a significant difference in the number of days to gait training initiation, which was 3.9 days in the delayed gait training group and 0.9 days in the early gait training group. The early gait training group started early mobilization and had a significantly shorter postoperative hospital stay than the delayed gait training group. Clinical laboratory data showed that walking speed was significantly faster and grip strength was significantly higher in the early group. The number of days to gait training initiation was an independent predictor of changes in CFS scores.

CONCLUSION

Early gait training in patients after TAVI may predict early improvements in physical function and movement, shorter hospital stay, and frailty at discharge.