12-week Cardiac Rehabilitation Program Research Articles

Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: The SAINTEX-CAD study

BackgroundExercise-based cardiac rehabilitation increases peak oxygen uptake (peak VO2), which is an important predictor of mortality in cardiac patients. However, it remains unclear which exercise characteristics are most effective for improving peak VO2 in coronary artery disease (CAD) patients. Proof of concept papers comparing Aerobic Interval Training (AIT) and Moderate Continuous Training (MCT) were conducted in small sample sizes and findings were inconsistent and heterogeneous. Therefore, we aimed to compare the effects of AIT and Aerobic Continuous Training (ACT) on peak VO2, peripheral endothelial function, cardiovascular risk factors, quality of life and safety, in a large multicentre study. MethodsTwo-hundred CAD patients (LVEF >40%, 90% men, mean age 58.4±9.1years) were randomized to a supervised 12-week cardiac rehabilitation programme of three weekly sessions of either AIT (90–95% of peak heart rate (HR)) or ACT (70–75% of peak HR) on a bicycle. Primary outcome was peak VO2; secondary outcomes were peripheral endothelial function, cardiovascular risk factors, quality of life and safety. ResultsPeak VO2 (ml/kg/min) increased significantly in both groups (AIT 22.7±17.6% versus ACT 20.3±15.3%; p-time<0.001). In addition, flow-mediated dilation (AIT+34.1% (range –69.8 to 646%) versus ACT+7.14% (range –66.7 to 503%); p-time<0.001) quality of life and some other cardiovascular risk factors including resting diastolic blood pressure and HDL-C improved significantly after training. Improvements were equal for both training interventions. ConclusionsContrary to earlier smaller trials, we observed similar improvements in exercise capacity and peripheral endothelial function following AIT and ACT in a large population of CAD patients.

Obesity Negatively Impacts Aerobic Capacity Improvements Both Acutely and 1‐Year Following Cardiac Rehabilitation

Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. The purpose of the present investigation was to determine the influence of body weight, assessed through BMI, on acute and long-term improvements in aerobic capacity following completion of CR. Three thousand nine hundred and ninety seven subjects with coronary artery disease (CAD) participated in a 12-week multidisciplinary CR program. Subjects underwent an exercise test to determine peak estimated metabolic equivalents (eMETs) and BMI assessment at baseline, immediately following CR completion and at 1-year follow-up. Normal weight subjects at 1-year follow-up demonstrated the greatest improvement in aerobic fitness and best retention of those gains (gain in peak METs: 0.95 ± 1.1, P < 0.001). Although the improvement was significant (P < 0.001), subjects who were initially classified as obese had the lowest aerobic capacity and poorest retention in CR fitness gains at 1-year follow-up (gain in peak eMETs: 0.69 ± 1.2). Subjects initially classified as overweight by BMI had a peak eMET improvement that was also significantly better (P < 0.05) than obese subjects at 1-year follow-up (gain in peak eMETs: 0.82 ± 1.1). Significant fitness gains, one of the primary beneficial outcomes of CR, can be obtained by all subjects irrespective of BMI classification. However, obese patients have poorer baseline fitness and are more likely to "give back" fitness gains in the long term. Obese CAD patients may therefore benefit from additional interventions to enhance the positive adaptations facilitated by CR.

The Independent Effect of Traditional Cardiac Rehabilitation and the LEARN Program on Weight Loss

Despite its numerous other benefits, cardiac rehabilitation (CR) has not consistently proven to be an effective, although much needed, intervention for weight loss in the cardiovascular disease (CVD) population. Comparatively, the LEARN (Lifestyle, Exercise, Attitudes, Relationships, Nutrition) program appears to be an effective intervention for weight loss. The purpose of the present investigation was to compare changes in body weight in a CVD cohort consecutively participating in traditional CR and the LEARN program. Forty-four patients diagnosed with CVD (22 men/22 women) participated in a 12-week multidisciplinary CR program. All patients successfully completed the LEARN program following CR. Body mass index (BMI) and body weight were recorded immediately prior to and following both CR and LEARN. The peak metabolic equivalents were significantly higher following CR (7.3 ± 1.6 vs 8.5 ± 1.6, P < .001), while body weight (203.5 ± 32.6 vs 201.8 ± 32.5 lbs, P > .10) and BMI (32.1 ± 4.0 vs 31.8 ± 3.9 kg/m, P > .05) were unchanged. All subjects then successfully completed the LEARN program, participating in an average of 10 sessions. There was a significant reduction in body weight (203.3 ± 30.7 vs 190.1 ± 30.4 lbs, P < .001) and BMI (32.0 ± 3.9 vs 29.5 ± 3.8 kg/m, P < .001) following the LEARN program. Our results support the independent value of the LEARN program in eliciting weight loss for CR patients. Clinicians delivering CR services should consider integrating a focused weight loss program, such as LEARN, into their usual CR programs.

Cognitive Impairment Affects Physical Recovery of Patients with Heart Failure Undergoing Intensive Cardiac Rehabilitation

Purpose. To determine whether the presence of cognitive impairment (CI) affects physical recovery of patients with chronic heart failure (CHF) undergoing a cardiac rehabilitation program (CRP). Methods. We enrolled 80 CHF patients (M/F = 53/27). CI was evaluated by means of the Mini-Mental State Examination (MMSE), exercise tolerance was evaluated by six-minute walking test (6 mwt). All patients underwent a 6-week CRP program at 50–70% of maximal V O2. Patients were divided into two groups according to their MMSE (group 1: 16–23; group 2: 24–30). Results. MMSE resulted directly related to ejection fraction (r = 0.42; P = 0.03), and it was inversely related to creatinine (r = −0.36; P = 0.04). At 6 week group 1 had a lower increase in distance walked at 6 MWT than group 2 (P = 0.008). At multivariate logistic regression MMSE 16–23 predicted a reduced exercise recovery in the overall population (OR = 1.84; 95% CI = 1.50–2.18) and in women (OR = 1.42; 95% CI = 1.22–1.75), while it was not predicted in males. Conclusions. CI is a marker of advanced CHF and is an independent predictor of lower exercise recovery after CRP.

Prevalence and predictors of depressive symptoms and wellbeing during and up to nine years after outpatient cardiac rehabilitation

Depression is an important independent prognostic variable in cardiac patients. The prevalence and predictors of depressive symptoms up to nine years after cardiac rehabilitation were studied. Follow-up questionnaires were sent to 2199 patients who had completed a 12-week exercise-based outpatient cardiac rehabilitation (OCR) programme between June 1999 and March 2006. Medical outcome, general wellbeing, and depressive symptoms were assessed, the latter by using two screening questions according to Arrol. Patients with incomplete data due to language problems, lack of compliance and non-response were excluded. Complete data for analysis was available for 710 patients. The median follow up period was 46 months (Interquartile range (IQR) 22-71, min. 6 months). At follow-up, 132 patients (19%) indicated low wellbeing, whereas 81 (11%) were having depressive symptoms. Multivariate analyses revealed impaired quality of life (p <0.001), diabetes (p = 0.013) and low exercise capacity after OCR (p = 0.003) to be independent predictors of low wellbeing at follow-up. Persistent smoking (p = 0.045) as well as negative mood (p = 0.022) at the end of OCR were independent predictors of depressive symptoms at follow-up. In a selected patient population a mean of four years after OCR, persistent smoking, diabetes, low exercise capacity and impaired quality of life at the end of OCR were independent long term predictors of low wellbeing and depressive symptoms, rather than specific cardiac variables. This highlights the need for close cooperation between cardiovascular and psychological specialists in cardiac rehabilitation.

Short-term impact of a 4-week intensive cardiac rehabilitation program on quality of life and anxiety-depression

Introduction Cardiac rehabilitation programs are well recognized as being essential to the comprehensive care of patients with cardiovascular disease and chronic heart failure. These programs aim at reducing cardiovascular risks, promoting healthy lifestyle behaviours and compliance as well as limiting disability and increasing quality of life (QoL) of cardiac patients. Purpose To evaluate the impact of a 4-week cardiac rehabilitation program on physical parameters and several aspects of the QoL of cardiac patients. Methods A cohort of 101 cardiac patients (men: 70%) mean age 65 ± 12 years (mean ± SD) participated in a cardiac rehabilitation program. Before and after the 4-week cardiac rehabilitation program, the study recorded and assessed the patients’ physical parameters such as weight, body mass index (BMI), waist circumference and effort tolerance as well as QoL using different questionnaires: SF-36 Health Survey (SF-36), Hospital Anxiety and Depression Scale (HAD) and the Pittsburgh Sleep Quality Index (PSQI). Results The patients’ physical parameters (BMI and waist circumference) decreased by 3%, while effort tolerance increased by 25% ( P < 0.0001). Furthermore, for all patients, the PSQI, HAD and physical and mental SF-36 scores improved significantly ( P < 0.0001). The different SF-36 subscales’ scores did also increase after the program ( P < 0.0001). Conclusion Despite a modest weight loss and reduction in waist circumference, a 4-week cardiac rehabilitation program (short-term) seems to be sufficient for improving patients’ physical state and mental well-being.

The effects of a cardiac rehabilitation program tailored for women on their perceptions of health: a randomized clinical trial.

The aim of this study was to compare the effects of a cardiac rehabilitation (CR) program tailored for women with a traditional program on perceptions of health among women with coronary heart disease. This 2-group randomized clinical trial compared the perceptions of health among 92 women completing a traditional 12-week CR program with those of 133 women completing a tailored program that included motivational interviewing guided by the transtheoretical model of behavior change. Perceptions of health were measured using the SF-36 Health Survey at baseline, postintervention, and at 6-month follow-up. Analysis of variance was used to compare changes in SF-36 Health Survey subscale scores over time. The group-by-time interaction was significant for the general health (F2,446 = 3.80, P = .023), social functioning (F2,446 = 4.85, P = .008), vitality (F2,446 = 5.85, P = .003), and mental health (F2,446 = 3.61, P = .028) subscales, indicating that the pattern of change was different between the 2 groups. Of the 4 subscales on which there were significant group-by-time interactions, the tailored group demonstrated improved scores over time on all 4 subscales, while the traditional group improved on only the emotional role limitations and vitality subscales. A tailored CR program improved general health perceptions, mental health, vitality, and social functioning in women when compared with traditional CR. To the extent that perceptions of health contribute to healthy behaviors fostered in CR programs, tailoring CR programs to alter perceptions of health may improve adherence.

Improvements in Cognitive Function Following Cardiac Rehabilitation for Older Adults With Cardiovascular Disease

ABSTRACTCognitive impairment is common in persons with cardiovascular disease (CVD). Cardiac rehabilitation (CR) improves many aspects of CVD linked to cognitive impairment. The current study explored whether CR may improve cognitive function. Potential mechanisms for cognitive changes were also examined through exploratory analyses, including changes in cardiovascular fitness and cerebral blood flow. Fifty-one older adults with CVD underwent neuropsychological assessment at baseline and discharge from a 12-week CR program. Cardiovascular fitness (i.e., metabolic equivalents [METs]) was estimated from a symptom-limited volitional stress test. Transcranial doppler quantified mean cerebral blood flow velocity and pulsatility indexes for the middle cerebral artery and anterior cerebral artery (ACA). Repeated measures ANOVA showed improvements in global cognition, attention-executive-psychomotor function, and memory. Exploratory analyses revealed improvement in METs and changes in ACA flow velocity, but only improvement in METs was related to improved verbal recall. CVD patients exhibited improvements in multiple cognitive domains following a 12-week CR program, suggesting that cognitive impairment is modifiable in this population. Although other studies are needed to elucidate underlying mechanisms, exploratory analyses suggest that cognitive improvements may be better explained by physiological processes other than improved cardiovascular fitness and cerebral blood flow.

Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?

Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes. To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure. In a randomized control trial, a total of 105 patients were recruited to the study. Patients in the intervention group received an individualized, multidisciplinary 12-week cardiac rehabilitation program, including an individualized exercise component tailored to functional ability and social circumstances. The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner. This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs. During the study period, patients in the intervention group were less likely to have been admitted to hospital for any cause (44 vs. 69%, P = 0.01) or after a major acute coronary event (24 vs. 55%, P = 0.001). Participants in the intervention group were more likely to be alive at 12 months, (93 vs. 79%; P = 0.03) (odds ratio = 3.85; 95% confidence interval=1.03-14.42; P = 0.0042). Quality of life scores improved at 3 months compared with baseline (intervention t = o/-4.37, P<0.0001; control t = /-3.52, P<0.01). Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group (t = 3.40; P = 0.01). This study shows that a multidisciplinary heart failure cardiac rehabilitation program, including an individualized exercise component, coordinated by a specialist heart failure nurse can substantially reduce both all-cause and cardiovascular readmission rates, improve functional status at 3 months and exercise tolerance.

The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial

Background Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence. Objective To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD. Methods A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time. Results Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores ( F(2, 446) = 4.42, p = .013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time ( F(2, 446) = 2.00, p = .137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test ( F(1, 223) = 50.34, p < .001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline ( F(1, 223) = 19.25, p < .001). Conclusion This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.

Sexual Dysfunction before and after Cardiac Rehabilitation

Background. The aim of this study was to assess sexual function before and after cardiac rehabilitation in relation to medical variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR) between April 1999 and December 2007. Exercise capacity (ExC) and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm) from 18% to 23% (P < .0001) during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR.

The Influence of Cardiac Rehabilitation on Inflammation and Metabolic Syndrome in Women With Coronary Heart Disease

Metabolic syndrome (MetS) and increased inflammatory markers, both predictors of future cardiovascular events, are more prevalent in women with coronary heart disease (CHD). The influence of cardiac rehabilitation (CR) on MetS and inflammatory biomarkers is not well characterized for women. : The purpose of this article was to examine the effects of a 12-week behaviorally enhanced CR exclusively for women compared with traditional CR on components of the MetS and inflammatory markers in women with CHD. The randomized clinical trial used 2 treatment groups, both receiving a comprehensive 12-week CR program, with 1 group receiving a motivationally enhanced intervention exclusively for women. A subset of 91 women (mean age, 61.6 years) from the parent study provided serum samples to examine the effects of CR on high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and intercellular adhesion molecule-1 (ICAM-1). After CR, the total sample of women demonstrated significant reductions in hsCRP (P =.002), IL-6 (P <.001), TNF-alpha (P =.010), and ICAM-1 (P =.016). Women in the gender-tailored CR program significantly improved all biomarker levels compared with baseline (P <.05 for all), whereas those in the traditional group improved only hsCRP (P <.05) and IL-6 (P <.05) levels. The combined study group demonstrated improvements in several components of MetS (triglycerides, waist circumference, and systolic blood pressure) but not in others (high-density lipoprotein cholesterol, fasting glucose, and diastolic blood pressure). Cardiac rehabilitation promotes greater improvements in inflammatory biomarkers than in components of MetS for women with CHD. Improvements in body composition or weight may not be a precondition for the benefits of exercise because of loss of abdominal fat. Examining components of MetS as continuous variables is recommended to prevent lost information inherent in dichotomization.

Gender Differences in Cardiac Rehabilitation Outcomes: Do Women Benefit Equally in Psychological Health?

Psychological factors are important in the etiology and prognosis of coronary heart disease (CHD). Cardiac rehabilitation (CR) aims to reduce psychological distress, besides other somatic risk factors. Studies have shown that CR is effective in reducing psychological distress, but little is known about gender-specific outcome differences. Our objective was to examine whether women and men benefit equally from outpatient CR in terms of reduction in psychological distress and whether women show more impaired psychological health at baseline of CR than do men. We enrolled 441 CHD patients (mean age 58+/-11 years, 79.8% men) who underwent a 12-week outpatient CR program. Psychological dimensions, namely, anxiety, depression, vital exhaustion, social inhibition, and negative affect, were assessed at baseline and post-CR. Multivariate analysis of variance (MANOVA), controlling for age, disease severity, and exercise capacity, was applied to test for gender-specific differences at baseline and change between baseline and post-CR. In addition, gender-specific effect sizes were calculated for the change on psychological dimensions. Women and men did not differ on any psychological measure at baseline of CR. The effect sizes show small to moderate treatment effects on the psychological dimensions assessed. Gender had a significant impact on change on the dimensions vital exhaustion (F=5.040(df=1), p<0.05) and social inhibition (F=5.74(df=1), p<0.05). Women showed larger change on social inhibition and smaller change on vital exhaustion than men. Women and men do not differ in the extent of psychological distress at baseline of CR, which could be explained also by the exclusion of highly distressed women from treatment. CR is less effective among women with regard to vital exhaustion and more effective with regard to social inhibition compared with men in a sample of low distressed patients.

The Effect of Cardiac Rehabilitation With Relaxation Therapy on Psychological, Hemodynamic, and Hospital Admission Outcome Variables

To examine the effect of a cardiac rehabilitation program with relaxation therapy (CPRT) in comparison with cardiac rehabilitation alone on psychological stress, hemodynamic variables, cardiac risk factors, and cardiac-related hospital admissions in patients with coronary artery disease. Patients (N = 81) were randomly assigned to either a 12-week cardiac rehabilitation program alone (CPA) or a CPRT. Perceived stress, blood pressure, heart rate, rate-pressure product value, total cholesterol level, body mass index, smoking status, and physical activity were recorded at baseline and following the 12-week intervention. Cardiac-related hospital admissions were analyzed in a 2-year follow-up. Perceived stress declined in both groups, although this improvement was significantly superior in the CPRT (31.5 +/- 4.9 vs 23.4 +/- 4.1; P <or= .0001). CPRT, but not CPA, had significantly lower heart rate, blood pressure, and rate-pressure product values after the program (P <or= .0001). Both groups improved smoking status, physical activity, body mass index, and total cholesterol level. During follow-up, the odds of being admitted to the hospital with cardiac-related problems, after adjusting for heart rate, blood pressure, smoking status, physical activity status, and total cholesterol (OR, 0.37; 95% CI, 0.045-2.98), was not significantly different between groups. Relaxation therapy was associated with a positive effect on psychological stress and hemodynamic variables beyond that promoted by cardiac rehabilitation alone.

Effect of Exercise Training in Supervised Cardiac Rehabilitation Programs on Prognostic Variables From the Exercise Tolerance Test

Meta-analyses showed that exercise training decreased mortality in patients after myocardial infarction, but no single adequately powered trial has shown this benefit. The purpose of this study was to evaluate the effect of cardiac rehabilitative exercise training on prognostic variables derived from the exercise tolerance test and whether these changes had an effect on predicted cardiovascular and all-cause mortality using externally validated risk scores. Two hundred ten consecutive patients who completed a 12-week cardiac rehabilitation program were analyzed. Peak MET level, heart rate recovery, chronotropic index, Duke prognostic score, and Cleveland Clinic Foundation risk score obtained at program entry and exit were compared. All prognostic variables and risk score-derived predicted 5-year mortality rates improved significantly after cardiac rehabilitation. Exercise capacity increased by 32% (6.6 +/- 2.7 to 8.7 +/- 2.9 METS; p <0.0001), heart rate recovery increased by 20% (15 +/- 9 to 18 +/- 10 beats/min; p <0.0001), and chronotropic index increased by 11% (56 +/- 22% to 62 +/- 22%; p <0.0001). Duke prognostic score 5-year predicted cardiovascular mortality rate decreased by 33% (6 +/- 4% to 4 +/- 2%; p <0.0001), and Cleveland Clinic Foundation risk score 5-year predicted total mortality rate decreased by 40% (5 +/- 7% to 3 +/- 5%; p <0.0001). These improvements remained significant in high-risk subgroups. When controlled for age, gender, diabetes, MET level achieved, ejection fraction, and beta-blocker use, changes remained significant (p <0.0001) for each outcome measure. In conclusion, exercise training in supervised cardiac rehabilitation programs significantly improved exercise capacity, measures of chronotropic dynamics, and prognostic risk scores. These differences translate into a decrease in predicted mortality.

Cardiac Rehabilitation Improves Heart Rate Recovery Following Peak Exercise in Children with Repaired Congenital Heart Disease

We assessed heart rate (HR) recovery following peak exercise before and after a 12-week cardiac rehabilitation program in 14 children, 12.1+/-1.8 years of age, with repaired complex congenital heart disease (CHD; 11 with Fontan surgery) and impaired exercise performance. Exercise testing using bicycle ergometry was performed at baseline, after completion of the rehab program and 1.0+/-0.2 years after the baseline test. These data were compared to HR recovery in 15 controls (age, 12.7+/-2.4 years) with CHD (13 with Fontan surgery) with two serial exercise tests at an interval of 1.1+/- 0.3 years. There was no change in peak HR between the two serial tests in either group. Peak VO2 improved in the rehab group (26.3+/-9.6 ml/kg/min at baseline vs 30.9+/-9.6 ml/kg/min after rehab, p=0.01) but remained unchanged in controls on serial testing. One-minute HR recovery (in beats per minute) improved significantly following completion of the rehab program (27+/-15 at baseline vs 40+/-23 after rehab, p=0.01). Partial improvement in 1-minute HR recovery in the rehab group persisted 1 year later (1-minute HR recovery, 35+/-19; p=0.1 compared to baseline). There was no change in 1-minute HR recovery over time in the control group (37+/-16 vs 40+/-13, p = not significant). In conclusion, HR recovery following peak exercise improves in children with CHD after participation in a cardiac rehab program.

Sustained Effects of Cardiac Rehabilitation in Children With Serious Congenital Heart Disease

Past studies have documented the acute benefits of cardiac rehabilitation in children with congenital heart disease. It is not known whether these benefits persist. Fifteen patients, ages 8 to 17 years, with complex congenital heart disease, whose exercise function immediately after a 12-week cardiac rehabilitation program was superior to that present on a precardiac rehabilitation exercise test, were restudied 6.9 +/- 1.6 months after completion of the cardiac rehabilitation program (approximately 1 year after the precardiac rehabilitation study). Changes in exercise function relative to baseline, precardiac rehabilitation exercise tests were also compared with changes observed in a group of 18 control subjects, with similar diagnoses, who also had 2 exercise tests separated by a year but did not undergo cardiac rehabilitation. The cardiac rehabilitation patients' exercise function did not change significantly over the 6.9-month period after the completion of the cardiac rehabilitation program; percentage of predicted peak oxygen consumption and peak work rate remained significantly superior to baseline, precardiac rehabilitation values. These changes were also associated with improvements in self-esteem, behavior, and emotional state. In contrast, among the control subjects, small, but statistically insignificant declines in peak oxygen consumption and peak work rate were observed on the final exercise test compared with values obtained at baseline, 1 year earlier. The improvements realized by the cardiac rehabilitation patients differed significantly from the concurrent changes observed among the control subjects and appeared to be a result of an increase in the oxygen pulse at peak exercise; significant changes in peak heart rate were not observed. In patients with congenital heart disease, cardiac rehabilitation produces significant, sustained improvements in exercise function, behavior, self-esteem, and emotional state.

The Effects of a 12-week Cardiac Rehabilitation Program on Four Measures of Health Outcomes

PURPOSE: To assess the effects of a 12-week supervised phase 2 and 3 Cardiac Rehabilitation Program on 4 health outcomes (physical functioning, physical health, vitality, and general health). Method: Self-administered health status was assessed using the SF-36 survey at the beginning and after approximately 12 weeks of participation in the program. The subjects were men (n = 102) between the ages of 50 and 69 years (Mean 59.9 ± 5.2 yrs) after a recent CAD incident (bypass, myocardial infarct, or angioplasty). The Cardiac Rehabilitation Program consisted of supervised exercise sessions twice a week for 1.5 hours (including a warm up, 40 minutes of cardio-vascular training, 20 minutes of strength training, and 5 minutes of cool down with stretching) plus educational sessions on healthy eating, stress management, physiology of the heart, importance of exercise, and facts about CAD medications. RESULTS: Dependent t-tests revealed statistically significant (p<0.001) improvements in all four measures: physical functioning (denned as limitations in physical activities, such as walking, climbing stairs, bending, lifting, and moderate to vigorous exercise), physical health (denned as the ability to perform daily activities like work or house chores), vitality (denned as the degree of feeling energetic), and general health (denned as a personal evaluation of health, including current health, health outlook, and resistance to illness). The effect sizes (effect size d) for all four measures are between −0.33 and −0.52, indicating a small to moderate difference between the initial survey outcome at the beginning of the program and after 12 weeks of participation. CONCLUSION: These findings indicate that a 12-week Cardiac Rehabilitation Program with multi-factorial interventions may increase physical functioning, physical health, vitality, and general health in male patients with a recent cardiac event.

Heart Rate Recovery in Heart Failure Patients After a 12-Week Cardiac Rehabilitation Program

Heart rate recovery (HRR) after maximal exercise is a predictor of all-cause mortality. It was hypothesized that aerobic exercise training would increase HRR in patients with heart failure (HF), because it has been shown to be accelerated in athletes and improved in patients with coronary artery disease after cardiac rehabilitation. To date, no study has examined the effects of exercise training on HRR in HF. This was a retrospective study of patients with HF who had completed a phase II aerobic cardiac rehabilitation program with entry and exit maximal stress tests (n = 46). Thirty-five patients exhibited a training effect, 18 had abnormal HRR of < or =12 beats/min and the lowest initial functional capacity (L12), and 17 had HRR of >12 beats/min before training (G12). A group of 11 other patients did not achieve a training effect. After training, the L12 and G12 groups improved their estimated peak oxygen uptake (by 6.7 +/- 3.1 and 8.6 ml/kg/min, respectively) and treadmill time (by 117 +/- 62 and 181 +/- 108 seconds, respectively) compared with the no-training effect group (p <0.05). Only the L12 group demonstrated improvement in HRR (7 +/- 1 to 12 +/- 2 beats/min). In conclusion, the results indicate that short-term aerobic training can favorably modify HRR in patients with HF with low exercise capacity.

Psychosocial predictors of cardiac rehabilitation quality-of-life outcomes

Objective This study investigated hostility, social support, coping, depression, and their contributions to concurrent and posttreatment quality of life (QoL) among a group of patients participating in a 6-week cardiac rehabilitation program. Method Both direct and mediational relationships among psychosocial factors, QoL baseline, and QoL outcome were examined using structural equation modeling analysis, while age, education, and severity of illness (risk for future event) were controlled. Results The final model was well supported ( χ 2=64.88, df=56, P>.05; CFI=.99, RMSEA=.04). Results indicated that baseline QoL, hostility, and depressive symptom severity directly and independently predicted QoL outcome, while depression and hostility were also associated with baseline QoL. Hostility, social support, and maladaptive coping also contributed to baseline and follow-up QoL by their associations with depression. Conclusion Psychosocial characteristics were interrelated, and they predicted postrehabilitation QoL outcome directly or indirectly through depression symptom severity.