12-week Cardiac Rehabilitation Program Research Articles

ANDY’S STORY: HYBRID CARDIAC REHABILITATION USING A DIGITAL HEALTH PLATFORM

BackgroundCardiac rehabilitation (CR) is a cornerstone of secondary cardiovascular prevention but remains underutilized, especially among underrepresented minorities. We developed a 12-week hybrid CR program to improve equitable CR access and participation. The program utilizes an evidenced-based digital health platform, Corrie, that consists of a smartphone app, smartwatch, blood pressure monitor, clinician dashboard, and virtual health coaching. We share a patient’s journey to provide insight into his experience of this novel hybrid CR program.NarrativeAndy is a 63 year-old Black man, retired airline industry worker, with hyperlipidemia, hypertension, and former tobacco smoking. He presented to the Johns Hopkins Hospital due to ongoing chest pain and was found to have obstructive coronary artery disease requiring percutaneous coronary intervention to the left anterior descending artery. Andy was identified as a candidate for hybrid CR via an electronic health record automated report. After receiving attending approval, a Corrie patient navigator met Andy at the bedside to discuss the program and set up the technology. He received in-person tutorials supplemented by video instructions and weekly check-in calls. Andy ranked himself as “low digital health literacy,” but through onboarding and coaching, he tracked his medications with 100% adherence, vitals, and viewed educational materials. After completing two in-person CR sessions for safety, he tracked exercises from home, following goals he discussed with his coach. Through the program, Andy increased his exercise capacity and implemented healthy lifestyle habits that he plans to continue into the maintenance phase of CR, such as riding a bicycle he recently rebuilt.ConclusionAndy's Journey on Hybrid Cardiac Rehabilitation ProgramView Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundCardiac rehabilitation (CR) is a cornerstone of secondary cardiovascular prevention but remains underutilized, especially among underrepresented minorities. We developed a 12-week hybrid CR program to improve equitable CR access and participation. The program utilizes an evidenced-based digital health platform, Corrie, that consists of a smartphone app, smartwatch, blood pressure monitor, clinician dashboard, and virtual health coaching. We share a patient’s journey to provide insight into his experience of this novel hybrid CR program. Cardiac rehabilitation (CR) is a cornerstone of secondary cardiovascular prevention but remains underutilized, especially among underrepresented minorities. We developed a 12-week hybrid CR program to improve equitable CR access and participation. The program utilizes an evidenced-based digital health platform, Corrie, that consists of a smartphone app, smartwatch, blood pressure monitor, clinician dashboard, and virtual health coaching. We share a patient’s journey to provide insight into his experience of this novel hybrid CR program. NarrativeAndy is a 63 year-old Black man, retired airline industry worker, with hyperlipidemia, hypertension, and former tobacco smoking. He presented to the Johns Hopkins Hospital due to ongoing chest pain and was found to have obstructive coronary artery disease requiring percutaneous coronary intervention to the left anterior descending artery. Andy was identified as a candidate for hybrid CR via an electronic health record automated report. After receiving attending approval, a Corrie patient navigator met Andy at the bedside to discuss the program and set up the technology. He received in-person tutorials supplemented by video instructions and weekly check-in calls. Andy ranked himself as “low digital health literacy,” but through onboarding and coaching, he tracked his medications with 100% adherence, vitals, and viewed educational materials. After completing two in-person CR sessions for safety, he tracked exercises from home, following goals he discussed with his coach. Through the program, Andy increased his exercise capacity and implemented healthy lifestyle habits that he plans to continue into the maintenance phase of CR, such as riding a bicycle he recently rebuilt. Andy is a 63 year-old Black man, retired airline industry worker, with hyperlipidemia, hypertension, and former tobacco smoking. He presented to the Johns Hopkins Hospital due to ongoing chest pain and was found to have obstructive coronary artery disease requiring percutaneous coronary intervention to the left anterior descending artery. Andy was identified as a candidate for hybrid CR via an electronic health record automated report. After receiving attending approval, a Corrie patient navigator met Andy at the bedside to discuss the program and set up the technology. He received in-person tutorials supplemented by video instructions and weekly check-in calls. Andy ranked himself as “low digital health literacy,” but through onboarding and coaching, he tracked his medications with 100% adherence, vitals, and viewed educational materials. After completing two in-person CR sessions for safety, he tracked exercises from home, following goals he discussed with his coach. Through the program, Andy increased his exercise capacity and implemented healthy lifestyle habits that he plans to continue into the maintenance phase of CR, such as riding a bicycle he recently rebuilt. Conclusion

Barriers and facilitators to implementation of a home-based cardiac rehabilitation programme for patients with heart failure in the NHS: a mixed-methods study

ObjectivesThis study aimed to identify barriers to, and facilitators of, implementation of the Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme within existing cardiac rehabilitation services, and develop and refine...

Short- and Long-Term Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Left Ventricular Remodeling in Patients Early After ST-Segment Elevation Myocardial Infarction-The HIIT-EARLY Randomized Controlled Trial.

AimDue to insufficient evidence on the safety and effectiveness of high-intensity interval training (HIIT) in patients early after ST-segment elevation myocardial infarction (STEMI), we aimed to compare short- and long-term effects of randomized HIIT or moderate-intensity continuous training (MICT) on markers of left ventricular (LV) remodeling in STEMI patients receiving optimal guideline-directed medical therapy (GDMT).Materials and MethodsPatients after STEMI (<4 weeks) enrolled in a 12-week cardiac rehabilitation (CR) program were recruited for this randomized controlled trial (NCT02627586). During a 3-week run-in period with three weekly MICT sessions, GDMT was up-titrated. Then, the patients were randomized to HIIT or isocaloric MICT for 9 weeks. Echocardiography and cardiopulmonary exercise tests were performed after run-in (3 weeks), end of CR (12 weeks), and at 1-year follow-up. The primary outcome was LV end-diastolic volume index (LVEDVi) at the end of CR. Secondary outcomes were LV global longitudinal strain (GLS) and cardiopulmonary fitness.ResultsSeventy-three male patients were included, with the time between STEMI and start of CR and randomization being 12.5 ± 6.3 and 45.8 ± 10.8 days, respectively. Mixed models revealed no significant group × time interaction for LVEDVi at the end of CR (p = 0.557). However, there was a significantly smaller improvement in GLS at 1-year follow-up in the HIIT compared to the MICT group (p = 0.031 for group × time interaction). Cardiorespiratory fitness improved significantly from a median value of 26.5 (1st quartile 24.4; 3rd quartile 1.1) ml/kg/min at randomization in the HIIT and 27.7 (23.9; 31.6) ml/kg/min in the MICT group to 29.6 (25.3; 32.2) and 29.9 (26.1; 34.9) ml/kg/min at the end of CR and to 29.0 (26.6; 33.3) and 30.6 (26.0; 33.8) ml/kg/min at 1 year follow-up in HIIT and MICT patients, respectively, with no significant group × time interactions (p = 0.138 and 0.317).ConclusionIn optimally treated patients early after STEMI, HIIT was not different from isocaloric MICT with regard to short-term effects on LVEDVi and cardiorespiratory fitness. The worsening in GLS at 1 year in the HIIT group deserves further investigation, as early HIIT may offset the beneficial effects of GDMT on LV remodeling in the long term.

Dropout during a 12-week transitional exercise-based cardiac rehabilitation programme: a mixed-methods prospective cohort study.

Investigate the dropout rate during a 12-week transitional exercise-based cardiac rehabilitation (exCR) programme focusing on a halfway transition phase between hospital and the municipality-based cardiac rehabilitation. Secondly, investigate patient characteristics associated with dropout at the transition. Patients with coronary heart disease, heart failure, or heart valve surgery referred to exCR were included in a prospective cohort study conducted between 1 March 2018 and 28 February 2019 at Zealand University Hospital. Exercise-based cardiac rehabilitation was initiated at the hospital with a halfway transitional to local healthcare centres in the municipalities. Dropouts were identified every third week through telephone interviews. A Kaplan-Meier time-to-event analysis was used to investigate time to dropout, while multiple logistic regression assessed associations between patient characteristics and dropout at the transition. Of 560 patients eligible for exCR, 279 participated in the study. Fourteen patients were lost to follow-up and 103 dropped out, resulting in a dropout rate of 39% [95% confidence interval (CI) 33-45%]. Of the 103 dropouts, 72 patients (70%) dropped out at the transition. In the adjusted analysis, patients attached to the labour market were associated with dropout at the transition [odds ratio (OR) = 6.31 (95% CI 2.04-19.54)]. Furthermore, odds of dropping out at transition were reduced for each extra exercise session attended [OR = 0.79 (95% CI 0.66-0.94)]. The transition phase constitutes a critical dropout period in exCR, in which increased attention on patient adherence is needed. In clinical practice, communication and strategies addressing patient retention across settings could be essential to prevent dropout in transitional exCR.

The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study.

BackgroundPoor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints.ObjectiveWe evaluated the impact on CR participation rates associated with the addition of the option of mobile app–based CR (Cardihab) for patients declining conventional CR.MethodsA total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation.ResultsCR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities.ConclusionsProviding patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake.

SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES

SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES

Impact of Completed Cardiac Rehabilitation Program on Depression Level in Patients with Heart Failure with Reduced Ejection Fraction

Abstract Background Heart failure (HF) is a growing chronic health condition affecting more than 20 million people worldwide. Symptoms of depression are a common co-morbidity affecting as many as 42% of patients with heart failure (HF), and are associated with a poor quality of life and adverse prognosis. Symptoms of depression have negative impacts not only on daily social and domestic activities, but also on hospitalization and mortality rates in HF patients. cardiac rehabilitation has been shown to reduce the rate of mortality, improve functional capacity, and control reduced depressive symptoms and better clinical outcomes. Objective to investigate the impact of a 12-week completed cardiac rehabilitation program on depressive symptoms in patients with heart failure with reduced ejection fraction. Patients and Methods in this prospective non-randomized study, sixty patients with stable heart failure with reduced ejection fraction with mild, moderate and sever depressive symptoms were recruited between January 2018 to June 2019 at Ain Shams University hospitals and divided into two groups Study group(n = 30); participated in 12-week cardiac rehabilitation program Control group did not participate in cardiac rehabilitation program. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behaviors and psychosocial management, Sexual activity education Smoking cessation. All patients personally interviewed for assessment of depression and quality of life before and after study period by Beck's depression inventory –II(BDI-II) and Minnesota living with heart failure questionnaire" (MLHFQ),respectively. Also all of them underwent to echo assessment before and after study period. Result A total of 60 patients in study group were enrolled, 26 (86.7) males in both groups. there were 22 (73.3%) patients (13 with mild depressive symptoms, 5 with moderate and 4 with sever depressive symptoms) showed significant improvement in BDI-II score (P &amp;lt; 0.001), whereas 8 (26.7%) patients only did not improve significantly after exercise period, no one of the study group had been show worsening of his depressive symptoms after completed cardiac rehabilitation program. BDI-II score has significant positive correlation with MLHFQ score (r = 0.748, P &amp;lt; 0.001). In contrast, only 4 (13.3%) patients (all of them were having mild depressive symptoms) of control group improved significantly regarding depressive symptoms (P &amp;lt; 0.001), and the majority of participants 16 (53.3%) patients deteriorated regarding depressive symptoms, and the rest of group 10 (33.3%) patients didn’t show significant improvement of their depressive symptoms according to BDI-II score after study period (that was 3 months). There was a significant difference when compared BDI-II score at baseline with score after study period for CR group. The BDI-II score difference after study period also was significant between two groups (P &amp;lt; 0.001). Conclusion in conclusion, the results of this prospective, non-randomized study demonstrate that completed CR program improves depressive symptoms, quality of life and LVEF in patients with heart failure with reduced ejection fraction. Recommendation cardiac rehabilitation should be implemented in routine management of patients with heart failure to improve psychological and physical complication of HF.

Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

BackgroundCancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD. MethodsPatients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates. ResultsAmong 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254). ConclusionCompleting a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.

Cardiac Rehabilitation Effects on Depression in Stable Heart Failure with Reduced Ejection Fraction Patients

Background: Heart failure (HF) is a growing chronic health condition affecting more than 20 million people worldwide. Symptoms of depression are a common co-morbidity affecting as many as 42% of patients with heart failure (HF) and are associated with a poor quality of life and adverse prognosis. Symptoms of depression have negative impacts not only on daily social and domestic activities, but also on hospitalization and mortality rates in HF patients. Cardiac rehabilitation has been shown to reduce the rate of mortality, improve functional capacity, and control reduced depressive symptoms and better clinical outcomes. Objective: to investigate the impact of a 12-week completed cardiac rehabilitation program on depressive symptoms in patients with heart failure with reduced ejection fraction. Patients and Methods: Sixty patients with stable heart failure with reduced ejection fraction (HFrEF) with mild, moderate and severe depressive symptoms were recruited between January 2018 to June 2019 at Ain Shams University hospitals and randomly assigned to whether or not receive a 12 weeks cardiac rehabilitation program. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, behavioral and psychosocial management, and sexual activity education smoking cessation. All patients were personally interviewed for assessment of depression and quality of life before and after study period by Beck's depression inventory – II(BDI-II) and Minnesota living with heart failure questionnaire" (MLHFQ), respectively. Besides, all patients underwent echocardiographic assessment before and after study period. Result: A total of 60 patients in study group were enrolled, 26 (86.7%) males in both groups. There were 22 (73.3%) patients (13 with mild depressive symptoms, 5 with moderate and 4 with severe depressive symptoms) showed significant improvement in BDI-II score (P&lt;0.001), whereas 8 (26.7%) patients only did not improve significantly after exercise period, no patients in the study group showed worsening of his depressive symptoms after completed cardiac rehabilitation program. BDI-II score has significant positive correlation with MLHFQ score (r=0.748, P&lt;0.001). In contrast, only 4 (13.3%) patients (all of them were having mild depressive symptoms) of control group improved significantly regarding depressive symptoms (P&lt;0.001), and the majority of participants 16 (53.3%) patients deteriorated regarding depressive symptoms, and the rest of group 10 (33.3%) patients didn’t show significant improvement of their depressive symptoms according to BDI-II score after the 3 month study period. There was a significant difference when compared BDI-II score at baseline with score after study period for the cardiac rehabilitation group. The BDI-II score difference after study period also was significant between two groups (P &lt;0.001). Conclusion: The results of this study demonstrated that a complete and organized cardiac rehabilitation program improves depressive symptoms, quality of life as well as LVEF in patients with heart failure with reduced ejection fraction. Recommendation: Cardiac rehabilitation should be implemented in routine management of patients with heart failure to improve psychological and physical complication of HF. Keywords: Cardiac Rehabilitation; Depression; Heart Failure

Physical Activity and Sedentary Behavior in Cardiac Rehabilitation: Does Body Mass Index Matter?

ObjectiveThe purpose of this study was to investigate the relationship between body mass index (BMI) class and physical activity and sedentary behavior in patients with acute coronary syndrome (ACS) during cardiac rehabilitation (CR).MethodsThis study was a secondary analysis of the OPTICARE trial. Physical activity and sedentary behavior were measured in participants with ACS (n = 359) using actigraphy at baseline, directly after completion of a multidisciplinary 12-week exercise-based CR program and 9 months thereafter. Outcome measures were step count and duration of time (percentage of wear time) spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior. Participants were classified as normal weight (BMI = 18.5–24.99 kg/m2; n = 82), overweight (BMI = 25.0–29.99 kg/m2; n = 182), or obese (BMI ≥ 30.0 kg/m2; n = 95). Linear mixed-effects models were applied to study the relationship between BMI class and physical activity and sedentary behavior.ResultsAt the start of CR, compared with participants with normal weight, participants with obesity made on average 1.11 steps fewer per minute (952 steps/d), spent 2.9% (25 min/d) less time in light physical activity, and spent 3.31% (28 min/d) more time in sedentary behavior. Participants of all BMI classes improved their physical activity and sedentary behavior levels similarly during CR, and these improvements were maintained after completion of CR.ConclusionParticipants with ACS who had obesity started CR with a less favorable physical activity and sedentary behavior profile than that of participants with normal weight. Because all BMI classes showed similar improvement during CR, this deficit was preserved.ImpactThis study indicates that reconsideration of the CR program in the Netherlands for patients with ACS and obesity is warranted, and development of more inclusive interventions for specific populations is needed. A new program for people with obesity should include added counseling on increasing physical activity and preventing sedentary behavior to facilitate weight loss and reduce mortality risk.Lay SummaryPeople with ACS who have obesity are less active and sit more than individuals with normal weight, both during and after CR. This study suggests that CR needs to be changed to help individuals increase their physical activity to help them lose weight and reduce their risk of death.

Cardiorespiratory Fitness After A 12-Week Cardiac Rehabilitation Program - Insights in a Contemporary Cohort of Cardiac Patients

Purpose: Cardiorespiratory fitness (CRF) is a strong predictor of mortality. Cardiac rehabilitation (CR) increases CRF measured by peakVO2 by an average of 2±3.3ml/kg/min according to historical data. Progress in interventional and surgical procedures as well as advances in medical therapies and CR training protocols may result in optimization of CRF gain after a phase 2 CR program. Because data on CRF in contemporary patient populations undergoing CR are scarce, we here report CRF data from our latest patient cohort.

Trajectories of physical activity and sedentary behaviour during and after cardiac rehabilitation in patients with acute coronary syndrome

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Big Medilytics - Horizon 2020 Background Physical behaviour is a multidimensional construct comprising physical activity (PA) and sedentary behaviour. PA adherence, during and after cardiac rehabilitation (CR), is problematic with less than 55% of the patients meeting recommended levels. Furthermore, CR only results in limited improvements in sedentary behaviour. To optimize CR programs, more information is needed on which patients could benefit from additional physical behaviour counselling. Purpose To explore trajectories (improvement, stabilization, or worsening) of moderate-to-vigorous PA (MVPA) and sedentary behaviour during and after CR, and to identify predictors for trajectory membership in patients with acute coronary syndrome (ACS). Methods The study was performed among 533 patients (mean age 57.9 ± 8.9years; 18.2% women) who participated in a 12-week multi-dimensional CR program that started (median) 35 days after hospitalization for ACS. Physical behaviour was measured using accelerometry at CR start, CR completion and 12 and 18 months follow-up. Latent class trajectory modelling was applied to explore trajectories for MVPA and sedentary behaviour. Separate trajectories were determined for the CR period and post-CR period. Using multinomial logistic regression, potential demographic, psychological, and cardiovascular predictors for each of the trajectories were explored. Results Using trajectory analyses, three classes of patients were identified for MVPA and sedentary behaviour both during and after CR: an increasing group, a declining group, and a steady group with only minor changes (see figure 1). Baseline physical behaviour level was the main predictor for declining trajectories, where, interestingly, patients with a higher starting level of the specific physical behaviour were more likely to be in the declining group as compared to the steady group (odds ratio (OR) for MVPA and sedentary behaviour during and post-CR ranging from 1.06-1.45, all p &amp;lt; 0.05). During CR, smokers were less likely to be in the declining group for sedentary behaviour (OR 0.29 (0.09-0.96)) as compared to the steady group. Post-CR, participants with a higher age were less likely to be in the increasing group for MVPA and more likely to be in the increasing group for sedentary behaviour (OR respectively 0.96 (0.93-1.00), 1.04 (1.01-1.07)). Furthermore, participants with a higher BMI were also less likely to be in the increasing group for MVPA post-CR (0.91 (0.84-1.00)). Conclusion: Distinct trajectories for MVPA and sedentary behaviour exist for CR patients, which are mainly distinguished by baseline physical behaviour level, where patients with a higher starting level of the specific physical behaviour were more likely to be in the declining class. We did not see this for the increasing group, suggesting that this phenomenon was not only explained by regression to the mean. Abstract Figure.

Changes in fear of movement in patients attending cardiac rehabilitation: responsiveness of the TSK-NL Heart

Abstract Funding Acknowledgements Type of funding sources: None. Background An important factor related to low physical activity in cardiac patients is fear of movement (kinesiophobia). The setting of cardiac rehabilitation (CR) seems suitable for targeting kinesiophobia. Nevertheless, the impact of CR on kinesiophobia is currently unknown, partly due to the absence of information on the responsiveness of instruments to measure kinesiophobia. Purpose To determine the responsiveness of the Dutch version of the Tampa Scale for Kinesiophobia questionnaire (TSK-NL Heart), to asses changes in kinesiophobia during participation in CR and to assess predictors of high levels of kinesiophobia at completion of CR. Methods This study was performed among 109 patients (mean age: 61 years; 76% men) who participated in a 6- till 12-week CR program. Kinesiophobia was measured using the TSK-NL Heart questionnaire. To determine the responsiveness of the TSK-NL Heart, the Cardiac Anxiety Questionnaire (CAQ) and the general anxiety scale of the Hospital Anxiety and Depression Scale (HADS-A) were used as external measures. All questionnaires were completed pre- and post-CR. Internal responsiveness was estimated by calculating the effect size (ES) and standardized response mean (SRM). External responsiveness was determined by calculating the correlation between change scores on the TSK-NL heart and on the external measures. Furthermore, univariate logistic regression analysis was performed with the dichotomized TSK-NL Heart score post-CR as dependent variable (high vs low scores) and baseline characteristics (age, sex, reason for referral and pre-CR scores on the TSK-NL Heart, CAQ and HADS) as predictor variables. Results Prevalence of a high levels of kinesiophobia improved from 40.4% pre-CR to 25.7% at completion of CR (p = 0.05). Both the ES and the SRM of the TSK change score were moderate for patients with an improved CAQ and HADS-A score (respectively ES = 0.52; SRM = 0.57 and ES = 0.54; SRM = 0.60) and small for patients with a stable score (ES = 0; SRM = 0 and ES = 0.26; SRM = 0.36). There was a moderate correlation between the TSK-NL Heart change score and the CAQ (Rs = 0.30, p = 0.023) and a small correlation between the TSK-NL Heart change score and the HADS-A (Rs =0.21, p = 0.107). The odds of having high kinesiophobia levels post-CR were increased by having a high level of kinesiophobia pre-CR (OR= 9.83, 95%CI: 3.52-27.46), a higher baseline score on the CAQ (OR = 1.12, 95%CI: 1.06-1.19), and a higher baseline score on the HADS-A (OR = 1.26, 95% CI: 1.11-1.42). Conclusion The TSK-NL Heart has moderate responsiveness. In addition, this study shows that there are reductions in kinesiophobia during the course of CR. Nevertheless, a large number of patients (26%) still had high levels of kinesiophobia at completion of CR. Interventions targeting kinesiophobia should focus on patients that enter CR with high levels of kinesiophobia, cardiac anxiety and generic anxiety.

Impact of exercise based cardiac rehabilitation program in patients with transcatheter aortic valve replacement

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Due to the increase in global prevalence of degenerative valve disease, aortic stenosis (AS) has played a preponderant role in the cardiovascular scenario, especially in patients undergoing transcatheter aortic valve replacement (TAVR). An alternative management for this patients are the cardiac rehabilitation programs (CRP); however, their effect has not been completely understood, both in exercise capacity and quality of life, but neither in the improvement of cardiopulmonary performance and other cardiovascular outcomes. Purpose: To evaluate the effect of the CRP on exercise tolerance and cardiopulmonary performance in patients with AS undergoing TAVR. Methods: A cohort study was conducted including 26 patients with AS undergoing TAVR and divided into an intervention group who performed a 4-week supervised training program in the Cardiac Rehabilitation Service and a control group to whom instructions and recommendations to performed unsupervised exercise at home were given. Demographic and clinical data (VO2Max, METS12, oxygen pulse, heart rate, double product, left ventricular ejection fraction, body mass index) were collected at baseline and after a 4-week follow-up. Results: 15 patients were included in the intervention group and 11 patients in the control group. There were no baseline significant differences between groups. After the intervention, significant differences were observed in the METS 12 final gain variable between the control and intervention group (4.55 vs 3.1 p = 0.01). Intergroup analysis showed significant differences (percentage changes) in the intervention group with an increase of METS12 (67.4%, p = 0.001), oxygen pulse (18.21%, p = 0.01), final METS (39.47% p = 0.001) and a decrease in VO2 recovery time (-12.5%, p = 0.05), in the ergometric performance index by heart rate (-38.17%, p = 0.001) and by double product (-38.1%, p = 0.001). Conclusions A 4-week cardiac rehabilitation program is effective to improve exercise tolerance and cardiopulmonary response in patients with AS undergoing TAVR; improvement was statistically significant in METS12, oxygen pulse, VO2 recovery time, METS-load and ergometric performance index for heart rate and double product. METS12 final gain was statistically significant in intervention group in comparison with the control group. Abstract Figure. Control vs Intervention Group (METS12)

The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

ObjectivePatient 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. MethodsAdults 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. ResultsAmong 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. ConclusionWhereas 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 implicationsCardiac 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.

A randomized controlled trial of motivational interviewing as a tool to enhance secondary prevention strategies in cardiovascular disease (MICIS study)

Background Physical activity/exercise has consistently been shown to improve objective measures of functional capacity, enhance quality of life, improve coronary risk profile, and reduce mortality for individuals with coronary heart disease. Despite the gains achieved by those who attend cardiac rehabilitation (CR) many individuals fail to maintain lifestyle changes. Aim(s) The aims of this study were to evaluate the effectiveness of motivational interviewing as a strategy for promoting maintenance of cardiac risk factor modification in patients who had participated in standard, 6-week outpatient CR programs. Methods In a randomized controlled trail, participants in usual care and intervention group (Motivational interviewing supplemental to a standard 6-week CR program) were followed up at 6-weeks and 12-months. The primary outcome was distance walked on the six-minute walk test (6MWT), used as both an indicator of functional capacity and habitual physical activity. Secondary outcomes included modifiable coronary risk factors (smoking, self-reported physical activity, waist circumference, body mass index and medication adherence), psychological status (depression, anxiety, stress, perceived cardiac control, perceived social support, exercise self-efficacy) and quality of life. Results Total 110 patients, usual care (n = 58) and intervention (n = 52), consented to participate in the study. Overall, demographic and clinical characteristics did not differ between groups at baseline. Motivational interviewing was no more likely to promote maintenance of cardiac risk factor modification (both primary and secondary outcomes) than a standard CR program alone. Both intervention and control groups maintained the gains achieved during CR at the 12-month follow-up except for weight loss. Conclusions Although both groups maintained the gains achieved during CR for physical activity, there was no effect of the intervention on maintenance of cardiac risk factor modification on both primary and secondary outcomes.

Improved Walk Test Performance and Blood Pressure Responses in Men and Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability.

Purpose. To evaluate changes in walk test performance and blood pressure (BP) responses following a 12-week exercise-based outpatient cardiac rehabilitation (CR) program. Methods. Six-Minute Walk Test (6MWT) and resting systolic BP (SBP), diastolic BP (DBP), post-6MWT heart rate (HR), and post-6MWT BPs were measured before and after CR in 311 (237 men,74 women) patients. Using age as a covariate, 2 by 2 (Gender × Measurement) ANCOVAs were used to determine differences in 6MWT performance and hemodynamic variables. Results. After adjusting for age, men covered a greater 6MWT distance than women; pre-CR versus post-CR program values are as follows: men, 429.3 ± 94.6 versus 557.6 ± 90.7 m, P ≤ .001; women, 374.9 ± 100.7 versus 483.2 ± 82.9 m, P ≤ .001. Both genders reduced resting DBP following the CR program (men: 67.2 ± 9.8 vs 65.6 ± 8.5 mm Hg, P = .034; women: 69.2 ± 10.7 vs 65.0 ± 8.0 mm Hg, P = .001) and increased HR following the 6MWT after the CR program (men: 97.7 ± 16.8 vs 112.7 ± 21.3 bpm, P ≤ .001; women: 100.7 ± 20.8 vs 110.2 ± 22.0 bpm, P ≤ .001). Similarly, SBP increased immediately following the 6MWT (122.8 ± 18.5 vs 133.6 ± 20.7 mm Hg; P ≤ .001) in men but not in women. Conclusion. The present findings indicate similar relative improvements in 6MWT performance and BP responses in adherent men and women following an exercise-based CR program.

Patient Forgoes Knee Replacement Surgery by at Least 2 Years After Appropriate Nonsurgical Care Following Cardiac Rehabilitation: A Case Report

Background Guidelines for knee osteoarthritis recommend that appropriate nonsurgical care, including education and exercise therapy, be offered prior to considering total knee replacement (TKR) surgery. Case Description A 66-year-old man with severe knee osteoarthritis was scheduled for TKR. Preoperative cardiac testing led to cardiac surgery and subsequent appropriate nonsurgical care for his knee osteoarthritis. This included aerobic exercise (cardiac rehabilitation) and a targeted exercise therapy and education program (Good Life with osteoArthritis in Denmark [GLA:D]®). Outcome and Follow-Up Following the 6-week cardiac rehabilitation program, the patient's walking distance improved by 130 m (39% improvement during the 6-minute walk test). Following the 6-week GLA:D® program, average knee pain reduced by 76% (6.5-cm reduction on a 10-cm visual analog scale) and joint-related quality of life improved by 72% (50 units using the Knee injury and Osteoarthritis Outcome Score [KOOS]). At 2-year follow-up, this patient had still not undergone a TKR. Discussion This case avoided a TKR for at least 2 years after accidentally receiving appropriate nonsurgical care. JOSPT Cases 2021;1(1):21–26. doi:10.2519/josptcases.2021.9943

High intensity interval training does not result in short- or long-term dietary compensation in cardiac rehabilitation: Results from the FITR heart study

The aim of this study was to investigate short- and long-term compensatory effects on dietary intake following high intensity interval training (HIIT) compared with usual care moderate intensity continuous training (MICT) during and following a cardiac rehabilitation program. This study investigates secondary outcomes of a clinical trial. Ninety-three participants with coronary artery disease enrolled in a 4-week cardiac rehabilitation program, were randomised to 1) 4x4-minute HIIT; or 2) 40-min of MICT (usual care). Patients were instructed to complete 3 weekly sessions (2 supervised, 1 home-based) for 4-weeks, and 3 weekly home-based sessions thereafter for another 48-weeks. Dietary intake was measured by telephone-based 24-h recall over 2 day at baseline, 4-weeks, 3-months, 6-months, and 12-months. Three-Factor Eating Questionnaire was used to measure dietary behaviour and Leeds Food Preference Questionnaire used to measure food preferences. Appetite was assessed by a visual analogue scale and appetite-regulating hormones. There was no change over the study period or differences between groups for daily energy intake at 4-weeks or 12-months. There were also no group differences for any other measures of dietary intake, fasting hunger or appetite-related hormones, dietary behaviour, or food preferences. These findings suggest that compared to moderate intensity exercise, HIIT does not result in compensatory increases of energy intake or indicators of poor diet quality. This finding appears to be the same for patients with normal weight and obesity. HIIT can therefore be included in cardiac rehabilitation programs as an adjunct or alterative to MICT, without concern for any undesirable dietary compensation.

Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery

BackgroundCardiac rehabilitation has been shown to reduce cardiac mortality, improve quality of life, and reduce hospitalizations. Cardiac rehabilitation programs are usually performed over a 12-week period. Studies have shown that similar benefits could be achieved with shorter programs. Abnormal heart rate recovery after exercise has been associated with an increased risk of cardiovascular events and mortality. The main aim of this study was to compare the effect of a 6-week phase 2 cardiac rehabilitation program on heart rate recovery to a 12-week one in patients who had recovered from an anterior wall ST segment elevation myocardial infarction.ResultsThis prospective study included 60 patients enrolled in cardiac rehabilitation programs randomized into two equal groups: a 6-week and a 12-week program. Baseline patient demographics, lipid profile, and left ventricular ejection fraction (LVEF) were assessed. METs achieved, total exercise time, resting heart rate, peak heart rate, and heart rate recovery at 1 min were examined. These were re-assessed at the end of each program.Results showed no difference between both groups at the end of each program regarding lipid profile and LVEF. Patients enrolled in the 12-week cardiac rehabilitation program were able to achieve more METs, had a longer exercise time, a higher peak heart rate, and had a lower resting heart rate at the end of the program. Heart rate recovery was slightly higher in patients enrolled in the 6-week program 26.5 ± 6.78 versus 23.17 ± 6.12 bpm (p = 0.051).On comparing the magnitude of change between both programs, those in the 12-week program had more increase in HDL-C levels, METs achieved, and exercise time. Additionally, they had more reduction of resting heart rate. Heart rate recovery was more increased for those in the 6-week program.ConclusionAlthough heart rate recovery increases after completion of each of a 6-week and 12-week cardiac rehabilitation program compared to their baseline, there is no difference on comparing heart rate recovery between both programs at their end.Patients enrolled in a standard 12-week cardiac rehabilitation program achieve more METs, have a longer exercise time, a higher peak HR, and a lower resting HR at the end of the program compared to those in the 6-week program.