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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thomas RJ. Cardiac Rehabilitation - Challenges, Advances, and the Road Ahead. N Engl J Med 2024; 390:830-841. [PMID: 38416431 DOI: 10.1056/nejmra2302291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Randal J Thomas
- From the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Md Ali NA, El-Ansary D, Abdul Rahman MR, Ahmad S, Royse C, Huat CT, Muhammad Nor MA, Dillon J, Royse A, Haron H, Ismail MI, Abdul Manaf MR, Katijjahbe MA. E arly S u p ervised I ncremental R es istance T raining ( ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial. BMJ Open 2023; 13:e067914. [PMID: 37451709 PMCID: PMC10351238 DOI: 10.1136/bmjopen-2022-067914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy. METHODS AND ANALYSIS This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants. ETHICS AND DISSEMINATION The study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trials Number (ISRCTN17842822).
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Affiliation(s)
- Nur Ayub Md Ali
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Doa El-Ansary
- School of Biomedical and Health Sciences, RMIT, Victoria, Melbourne, Australia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Suriah Ahmad
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, Victoria, Melbourne, Australia
- Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Melbourne, Australia
- Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chong Tze Huat
- Department of Surgery, Hospital Serdang, Cheras, Selangor, Malaysia
| | | | - Jeswant Dillon
- Department of Cardiothoracic and Vascular Surgery, National Institute Heart Centre, Kuala Lumpur, Malaysia
| | - Alistair Royse
- Department of Surgery, The University of Melbourne, Victoria, Melbourne, Australia
- Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Melbourne, Australia
| | - Hairulfaizi Haron
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Muhamad Ishamudin Ismail
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Md Ali Katijjahbe
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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van Bakel BMA, de Koning IA, Bakker EA, Pop GAM, Cramer E, van Geuns RM, Thijssen DHJ, Eijsvogels TMH. Rapid Improvements in Physical Activity and Sedentary Behavior in Patients With Acute Myocardial Infarction Immediately Following Hospital Discharge. J Am Heart Assoc 2023; 12:e028700. [PMID: 37158085 PMCID: PMC10227295 DOI: 10.1161/jaha.122.028700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
Background Little is known about changes in physical activity (PA) and sedentary behavior (SB) patterns in the acute phase of a myocardial infarction (MI). We objectively assessed PA and SB during hospitalization and the first week after discharge. Methods and Results Consecutively admitted patients hospitalized with an MI were approached to participate in this prospective cohort study. SB, light-intensity PA, and moderate-vigorous intensity PA were objectively assessed for 24 h/d during hospitalization and up to 7 days after discharge in 165 patients. Changes in PA and SB from the hospital to home phase were evaluated using mixed-model analyses, and outcomes were stratified for predefined subgroups based on patient characteristics. Patients (78% men) were aged 65±10 years and diagnosed with ST-segment-elevation MI (50%) or non-ST-segment-elevation MI (50%). Sedentary time was high during hospitalization (12.6 [95% CI, 11.8-13.7] h/d) but substantially decreased following transition to the home environment (-1.8 [95% CI, -2.4 to -1.3] h/d). Furthermore, the number of prolonged sedentary bouts (≥60 minutes) decreased between hospital and home (-1.6 [95% CI, -2.0 to -1.2] bouts/day). Light-intensity PA (1.1 [95% CI, 0.8-1.6] h/d) and moderate-vigorous intensity PA (0.2 [95% CI, 0.1-0.3] h/d) were low during hospitalization but significantly increased following transition to the home environment (light-intensity PA: 1.8 [95% CI, 1.4-2.3] h/d; moderate-vigorous intensity PA: 0.4 [95% CI, 0.3-0.5] h/d; both P<0.001). Improvements in PA and SB were similar across groups, except for patients who underwent coronary artery bypass grafting and who did not improve their PA patterns after discharge. Conclusions Patients with MI demonstrate high levels of SB and low PA volumes during hospitalization, which immediately improved following discharge at the patient's home environment. Registration URL: trialsearch.who.int/; Unique identifier: NTR7646.
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Affiliation(s)
- Bram M. A. van Bakel
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Iris A. de Koning
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Esmée A. Bakker
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Gheorghe A. M. Pop
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Etienne Cramer
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Robert‐Jan M. van Geuns
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Dick H. J. Thijssen
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
- Research Institute for Sports and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
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Ngaage DL, Mitchell N, Dean A, Mitchell A, Hinde S, Akowuah E, Doherty P, Nichols S, Fairhurst C, Flemming K, Hewitt C, Ingle L, Watson J. A randomised controlled, feasibility study to establish the acceptability of early outpatient review and early cardiac rehabilitation compared to standard practice after cardiac surgery and viability of a future large-scale trial (FARSTER). Pilot Feasibility Stud 2023; 9:79. [PMID: 37170367 PMCID: PMC10172724 DOI: 10.1186/s40814-023-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To determine the acceptability and feasibility of delivering early outpatient review following cardiac surgery and early cardiac rehabilitation (CR), compared to standard practice to establish if a future large-scale trial is achievable. METHODS A randomised controlled, feasibility trial with embedded health economic evaluation and qualitative interviews, recruited patients aged 18-80 years from two UK cardiac centres who had undergone elective or urgent cardiac surgery via a median sternotomy. Eligible, consenting participants were randomised 1:1 by a remote, centralised randomisation service to postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control), or postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention). The primary outcome measures related to trial feasibility including recruitment, retention, CR adherence, and acceptability to participants/staff. Secondary outcome measures included health-rated quality of life using EQ-5D-5L, NHS resource-use, Incremental Shuttle Walk Test (ISWT) distance, 30- and 90-day mortality, surgical site complications and hospital readmission rates. RESULTS Fifty participants were randomised (25 per group) and 92% declared fit for CR. Participant retention at final follow-up was 74%; completion rates for outcome data time points ranged from 28 to 92% for ISWT and 68 to 94% for follow-up questionnaires. At each time point, the mean ISWT distance walked was greater in the intervention group compared to the control. Mean utility scores increased from baseline to final follow-up by 0.202 for the intervention (0.188 control). Total costs were £1519 for the intervention (£2043 control). Fifteen participants and a research nurse were interviewed. Many control participants felt their outpatient review and CR could have happened sooner; intervention participants felt the timing was right. The research nurse found obtaining consent for willing patients challenging due to discharge timings. CONCLUSION Recruitment and retention rates showed that it would be feasible to undertake a full-scale trial subject to some modifications to maximise recruitment. Lower than expected recruitment and issues with one of the clinical tests were limitations of the study. Most study procedures proved feasible and acceptable to participants, and professionals delivering early CR. TRIAL REGISTRATION ISRCTN80441309 (prospectively registered on 24/01/2019).
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Affiliation(s)
- Dumbor L Ngaage
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road Cottingham, Hull, UK.
| | - Natasha Mitchell
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Alexandra Dean
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Alex Mitchell
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Sebastian Hinde
- Centre for Health Economics, Alcuin A Block, University of York, York, UK
| | - Enoch Akowuah
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Simon Nichols
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Collegiate Campus, Sheffield, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Judith Watson
- Department of Health Sciences, University of York, ARRC Building, York, UK
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Lyapina IN, Shaleva VA, Teplova YE, Pomeshkina SA, Barbarash OL. Effect of early postoperative rehabilitation with aerobic exercise on functional status and cardiac remodeling in patients after heart valve surgery. Cardiovasc Ther Prev 2023. [DOI: 10.15829/1728-8800-2023-3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Aim. To develop a program for early physical rehabilitation of inpatients after heart valve surgery and to evaluate its effectiveness and safety.Material and methods. The study included 80 patients with valvular heart disease (VHD) after elective on pump valve surgery. Patients in the control group (n=47) underwent standard cardiac rehabilitation after surgery; patients of the main group (n=33) additionally, starting from the 8th day after the intervention, had 14-day treadmill training with the program selection, taking into account the results of cycle ergometry spirometry (CES). A week after the operation and at the end of the training course (median, 24 days after the operation), cardiac remodeling and functional status was assessed according to echocardiography and CE, respectively.Results. For 7 days after surgery, patients of both groups were comparable. During physical training in the main group, there were no lifethreatening cardiac arrhythmias, episodes of ischemia, desaturation, as well as intracardiac hemodynamics deterioration. With a 14-day training, CES showed a significant increase in exercise tolerance (ET) in the main group from a median of 50 to 75 W (p=0,002), peak oxygen uptake (VO2peak) from 11,7 to 13,4 ml/kg/min (p=0,001). For 24 days after surgery in the control group, there was a trend towards improvement in ET and VO2peak, but without significant changes (p=0,09/p=0,08).Conclusion. Early inhospital rehabilitation, including physical training of moderate intensity with an individual treadmill speed and incline angle, starting from day 8 after surgery, showed effectiveness and safety in the form of an increase in ET and VO2peak, while not worsening hemodynamic parameters.
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Affiliation(s)
- I. N. Lyapina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V. A. Shaleva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - Yu. E. Teplova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. A. Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Van Iterson EH, Laffin LJ, Svensson LG, Cho L. Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection. Eur Heart J Open 2022; 2:oeac075. [PMID: 36518261 PMCID: PMC9741551 DOI: 10.1093/ehjopen/oeac075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Aims Prescribed aerobic-based exercise training is a low-risk fundamental component of cardiac rehabilitation (CR). Secondary prevention therapeutic strategies following a spontaneous coronary artery dissection (SCAD) or aortic dissection (AD) should include CR. Current exercise guidance for post-dissection patients recommends fundamental training components including target heart rate zones are not warranted. Omitting fundamental elements from exercise prescriptions risks safety and makes it challenging for both clinicians and patients to understand and implement recommendations in real-world practice. We review the principles of exercise prescription for CR, focusing on translating guidelines and evidence from well-studied high-risk CR populations to support the recommendation that exercise testing and individualized exercise prescription are important for patients following a dissection. Methods and results When patients self-perceive exercise intensity there is a tendency to underestimate intensities within metabolic domains that should be strictly avoided during routine exercise training following a dissection. However, exercise testing associated with CR enrolment has gained support and has not been linked to adverse events in optimally medicated post-dissection patients. Graded heart rate and blood pressure responses recorded throughout exercise testing provide key information for developing an exercise prescription. An exercise prescription that is reflective of medical history, medications, and cardiorespiratory fitness optimizes patient safety and yields improvements in blood pressure control and cardiorespiratory fitness, among other benefits. Conclusion This clinical practice and education article demonstrates how to develop and manage a CR exercise prescription for post-acute dissection patients that can be safe and effective for maintaining blood pressure control and improving cardiorespiratory fitness pre-post CR.
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Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J4-1, Cleveland, OH 44195, USA
| | - Leslie Cho
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH 44195, USA
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Frühe Rehabilitation nach Sternotomie? Dtsch Med Wochenschr 2022; 147:951-951. [DOI: 10.1055/a-1805-3262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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