12-week Cardiac Rehabilitation Program Research Articles

THE IMPACT OF CARDIAC REHABILITATION ON QUALITY OF LIFE AND 6 MINUTE WALK TEST IN POST GLENN PATIENTS

Background: Patients with congenital heart disease (CHD), particularly those with single ventricular physiology undergoing Glenn shunt, often experience limited functional capacity and decreased quality of life (QoL). This study evaluates the impact of a 12-week cardiac rehabilitation (CR) program on functional capacity, measured by the 6-minute walk test (6MWT), and QoL in post-Glenn (PG) patients. Methods: This randomized controlled trial included 35 PG patients aged 6 years and above, randomized into two groups: the CR group (n=15) participated in a 12-week CR program, while the control group (n=20) received standard care. Pre- and post-rehabilitation assessments included echocardiography, the 6MWT, and QoL evaluation using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: After 3 months, the CR group showed significant improvements in 6MWT distance, increasing from 378.67 ± 53.97 m to 411.00 ± 61.01 m (p < 0.001), compared to a non-significant change in the control group. Heart rate (HR) decreased in the CR group (pre: 92.27 ± 8.02 bpm, post: 84.93 ± 8.48 bpm, p < 0.05). QoL scores improved in the CR group, with a median MLHFQ score decrease from 19 (IQR 18-24) to 16 (IQR 12-21) (p < 0.05). No significant changes in echocardiographic parameters were observed in either group. Conclusion: A 12-week CR program significantly improves functional capacity and QoL in PG patients. These findings support the implementation of CR programs in this population to enhance physical activity and overall well-being.

The role of digital health intervention in improving physical activity in cardiac rehabilitation center: a randomised controlled trial

Abstract Background Physical activity plays a crucial role in cardiac rehabilitation for secondary prevention. Despite its importance, participation rates in cardiac rehabilitation programs remain low. Telemedicine, particularly telerehabilitation, presents a viable solution by offering remote access to cardiac rehabilitation services. This innovative approach has the potential to significantly enhance patient outcomes. Purpose This study aimed to assess the effectiveness of digital health intervention in improving physical activity in cardiac rehabilitation center. Methods A prospective randomised controlled trial was conducted, enrolling 80 eligible cardiac rehabilitation patients. Participants were 1:1 randomised into two groups: a 12-week center-based cardiac rehabilitation program (control group), and a 12-week center-based cardiac rehabilitation program combined with a digital health intervention (intervention group). This digital health intervention consists of smartphone, web, and tablet applications to monitor physical activity outside of rehabilitation sessions and motivate patients to engage in more physical activities. Results Of the initial 80 patients, 70 completed the study, and the results are presented in Table 1. In the intervention group, there was a statistically significant improvement in peak rate of oxygen consumption (VO2 peak) (p < 0.01) and peak power output (W peak) (p < 0.01), as measured by cardiopulmonary exercise testing between the end and the beginning of the study at the significance level of 0.05. Similar improvements were also observed in the control group (p = 0.0002 for VO2 peak and p < 0.01 for W peak). After 12 weeks of intervention, significant between-group differences were found: We observe a greater improvement in VO2 peak, on average 1.39 (95% CI: 0.23-2.54) ml/kg, and in W peak, on average, 12.29 (95% CI: 4.12-20.45), higher in the intervention group compared to the control group. Regarding physical activity, the intervention group showed a significant improvement in step count (P = 0.002), measured by an accelerometer, whereas no significant improvement was observed in the control group (P = 0.9714). There is a statistically significant difference in the change of step count between the intervention and control group at the significance level of 0.05. We observe a greater improvement, on average 14 788 steps (95% CI: 4 246 – 25 331), in the intervention group compared to the control group. Conclusion This study shows that a combination of a digital health intervention based telerehabilitation with a center-based cardiac rehabilitation is more effective in increasing patient’s exercise capacity and physical activity compared with a center-based cardiac rehabilitation.Table 1:results

Impact of Cardiac Rehabilitation Program on the Quality of Life of Young Adults versus Elderly Egyptians with Ischemic Heart Disease

Abstract Background Exercise-based cardiac rehabilitation is underutilized in patients after myocardial infarction, especially in the elderly population. The ageing biology of this senior population is definitely unique, and they are more likely to experience different consequences for which cardiac rehabilitation can be especially useful. Objective To investigate the impact of a 12-week completed cardiac rehabilitation program on the quality of life of two different age groups with recent myocardial infarction. Methods This non-randomized prospective cohort study was conducted on 50 patients, divided into two groups; 25 patients for each, group1 included those more than 60 years, group 2 from 18 to 60 years. Both groups underwent cardiac rehabilitation programs during the period of May 2018 to August 2020 at Ain Shams university hospitals. Quality of life assessment was performed via RAND-36 questionnaire, while depression screening was done via PHQ-9 questionnaire. Results Both groups showed improvement in the quality of life after completion of the cardiac rehabilitation program. The younger group achieved better improvement in the domains related to physical functioning, general health, role limitation due to physical health, energy/fatigue, and also showed better improvement in depressive symptoms, dyslipidemia and left ventricular Ejection fraction, whereas the senior group showed better improvement regarding role limitation due to emotional problems. Conclusion Exercise training in the context of comprehensive CR program improves quality of life in young as well as elderly patients. The young population improved mainly in the domains related to physical health while the elderly group improved regarding emotional domain in the quality of life questionnaires.

The Impact of Cardiac Rehabilitation on Quality of Life and 6 Minute Walk Test in Post Glenn Patients

Abstract Background The impact of cardiac rehabilitation on quality of life and 6 minute walk test in post Glenn patients. The present study conducted on 35 patients of both sex and age of 6 years old and above and at least 6 month after Glenn surgery at Ain Shams university Hospitals recruited during the period of 6 month. Objective To investigate the impact of a 12-week completed cardiac rehabilitation program on 6-minute walk test and quality of life in-patients of post Glenn shunt. Methods This was a 2-arm parallel prospective, randomized, controlled Study conducted on 35 patients of both sex and age of 6 years old and above and at least 6 month after Glenn surgery at Ain Shams university Hospitals recruited during the period of 6 month. Results We found that a significant improvement of Quality of life with reduced functional capacity in exercised group only after 3 months from enrollment in CR program, while control group didn’t show any improvement. Improvement was not only in quality of life but also there was a significant improvement in 6MWD in CR group when compared with control group (32.33 vs 2.25, p = 0.032 respectively). Conclusion Completed CR program improves quality of life and 6MWD in patients with post Glenn shunt with restricted physical activity.

Cardiac rehabilitation in children and adolescents with long QT syndrome: the RYTHMO’FIT pilot study

BackgroundTo assess the feasibility, acceptability, safety, and short-term benefits of a tailored cardiac rehabilitation program for children and adolescents with long QT syndrome (LQTS).MethodsEight participants, aged between 6 and 18, with a positive LQTS genotype and impaired cardiorespiratory fitness, were enrolled in a 12-week centre-based cardiac rehabilitation program. The program included supervised exercise training group sessions (aerobic, resistance, and outdoor activities) and patient education workshops. Feasibility, acceptability, and safety of the program were prospectively monitored. Feedback from the parents, children, and professionals involved was collected from qualitative interviews. Short-term effects on cardiorespiratory fitness, muscle fitness, physical activity, and health-related quality of life (HRQoL) were measured between baseline and the end of the program.ResultsRetention (88% with one participant dropping out) and adherence (79%) rates were good, and no cardiac events occurred during the 12-week intervention period. Participants, parents, and healthcare professionals expressed a high level of satisfaction with the program. A significant increase between the beginning and the end of the program was observed for ventilatory anaerobic threshold (21.7±5.2 vs. 28.7±5.1 mL/kg/min, P=0.01, effect size=0.89), grip strength, (18±5.3 Kg vs. 20±4.7 Kg, P=0.02, effect size=0.90), lower limb explosive strength (142±36.5 cm vs. 148±24 cm, P=0.02, effect size=0.90), and parent-reported physical health dimension of HRQoL (65.6±9.75 vs. 84.4±20.35, P=0.03, effect size=0.87).ConclusionsA 12-week tailored centre-based cardiac rehabilitation program was feasible, acceptable, and safe for children with LQTS. Cardiac rehabilitation for children with LQTS presents a new approach aligned with secondary prevention in youth with cardiac diseases.Trial registrationThe trial was registered at Clinicaltrials.gov (NCT05964322, registration date: 27/07/2023).

Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: ARetrospective Cohort Study.

Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.

Effects of a Tai Chi rehabilitation program implemented using a hybrid online and offline mode on oxidative stress and inflammatory responses in patients with coronary heart disease: a randomized controlled trial.

Coronary heart disease (CHD) is the leading cause of death in both developed and many developing countries. Exercise training is a fundamental component of cardiac rehabilitation programs for patients with CHD. This study aims to investigate the effects of a Tai Chi rehabilitation program, which is provided through a hybrid online and offline mode, on oxidative stress and inflammatory responses in patients with CHD. A total of 34 patients with coronary heart disease were randomly assigned to two groups: an experiment group (n = 14, age 62.07 ± 9.076 years) and a control group (n = 20, age 61.90 ± 9.700 years). The experiment group underwent a 12-week Tai Chi cardiac rehabilitation program (TCCRP), while the control group followed a conventional exercise rehabilitation program (CERP) consisting of 1-h sessions, 3 times per week, for a total of 36 sessions. Participants were studied at baseline and post-intervention. The main assessments include the levels of Malondialdehyde (MDA), Superoxide dismutase (SOD), Tumor necrosis factor (TNF-α) and Interleukin-10 (IL - 10) in blood samples. Pearson correlation analysis was used, and the differences between the two groups were subsequently tested using two-way repeated ANOVA. Statistical significance was defined as a two-sided p-value of <0.05. The key finding of the study reveals that MDA was significantly reduced by 1.027 nmoL/mL. Additionally, the TCCRP showed significant improvements in SOD and IL-10, with values of 10.110 U/mL and 2.441 pg./mL, respectively. Notably, a significant positive correlation was found between SOD and IL-10 (r = 0.689, p = 0.006), while MDA showed a significant positive correlation with TNF-a (r = 0.542, p = 0.045). In contrast, the ECRP group only showed a significant improvement in SOD. The study conducted a 12-week program on TCCRP, which utilized a hybrid online and offline model for individuals with coronary heart disease. The program showed promising results in alleviating oxidative stress and inflammation, possibly by regulating the balance between oxidative and antioxidative factors, as well as pro-inflammatory and anti-inflammatory factors.

SURVEY INDICATES GREATER PATIENT PREFERENCE FOR AKTIIA'S CUFFLESS MONITOR OVER TRADITIONAL AMBULATORY BLOOD PRESSURE MONITOR IN A CARDIAC REHABILITATION PROGRAM

Objective: Cuffless blood pressure (BP) monitors have the potential to improve hypertension management and facilitate remote BP monitoring. The success and long-term adoption of these devices will significantly depend on patient preferences and their perceptions of using such technology. In the present work, we report patients’ preferences regarding a continuous cuffless BP monitor and cuff-based ambulatory BP monitoring (ABPM) during a 12-week cardiac rehabilitation (CR) program. Design and method: 63 subjects (NCT04548986, mean age 53.1±7.2 years, 21.2% female, arm circumference 29.0±2.5 cm) were enrolled in a 12-week CR program at RHNE – Réseau Hospitalier Neuchâtelois, Switzerland. Subjects wore a cuffless BP monitor (Aktiia SA, Switzerland) during the entire CR program, and conducted 24-h ABPM (Dyasis 3, Novacor, France) during the first and last days of CR. The analysis was conducted on experience surveys completed by subjects who successfully finished the CR program. Results: 57 subjects completed the CR program and filled the survey at the end of the program (Figure 1). From an open question for 3 adjectives regarding experience with the Aktiia monitor, the most cited terms were “discreet” (53% of the subjects), “light” (47%) and “comfortable” (28%), with more than 15% of the subjects describing it as “practical” and “pleasant”. For ABPM, the most cited terms were “bulky” (41%), “noisy” (26%) and “uncomfortable” (17%), with approximately 10% of subjects describing it as “embarrassing”, “unpleasant” and “heavy”. Nearly all subjects felt no discomfort when using the Aktiia monitor, and almost 90% of the subjects would repeat night measurements with Aktiia. Subjects were equally confident in the precision for both devices, and few subjects reported any disruption in their daily activities due to wearing Aktiia's bracelet. Conclusions: Among patients who used both the Akiia bracelet and ABPM and during the 12-weeks CR program, the vast majority found the cuffless monitor more convenient, more comfortable and with a similar perception of performance compared to ABPM. The results suggest that cuffless BP devices may facilitate continual 24-h BP monitoring compared to an ABPM setup and enhance patients’ adherence to BP monitoring.

Validity and reliability of automated treadmill six-minute walk test in patients entering exercise-based cardiac rehabilitation

Introduction: The six-minute walk test (6MWT) is a well-established tool for assessing submaximal functional capacity for cardiac patients, but space limitations challenge its implementation. Treadmill-based (TR) 6MWT is a promising alternative, but it requires patients to complete a familiarization test to adapt treadmill speed regulation. With the advancement of sensors, it is possible to automatically control speed for individual patients and thus overcome the space limitation or the speed control difficulty on the treadmill for each patient. Methods: This study investigated the validity and interchangeability of automated speed TR6MWT and standard hallway (HL) 6MWT. Eighteen patients were assessed at baseline of the 12-week cardiac rehabilitation program. Fourteen of them were assessed after rehabilitation. All patients performed three TR6MWTs and three HL6MWTs at baseline and one of each test after the program. Results: Patients well tolerated the TR6MWT. There was a strong correlation between both test methods (r = 0.79). However, patients performed significantly better in HL6MWT (514.8m ± 59.7m) than in TR6MWT (447.2 ± 79.1m) with 95% CI, 40.4-94.6m, p < 0.05. Both tests showed high test-retest reliability (intraclass correlation coefficient of 0.86). The TR6MWT showed a valuable comparison of the effect of the cardiac rehabilitation program (20% increase, effect size 1.1) even though it is not interchangeable with the HL6MWT. Conclusion: The automated speed TR6MWT appears to be an acceptable tool with adequate validity, reliability, and responsiveness for assessing functional capacity in patients utilizing cardiac rehabilitation programs.

Daytime blood pressure measurements performed by a cuffless blood pressure monitor compared to 24-hour ambulatory blood pressure monitor: preliminary comparative results of a single-centre study

Abstract Background Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. There is currently intense debate whether cuffless devices generate data comparable to ABPM. Purpose Here, we present preliminary results of daytime BP measurements performed by a validated and commercially available cuffless BP monitor compared to 24-hour ABPM. Methods 52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program. The patients used a validated, CE-marked, over-the-counter optical cuffless wrist BP monitor during the entire CR program, while 24-hour cuff-based ABPM was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of cuffless monitor (session 1: ABPM first day vs. cuffless monitor first week; session 2: ABPM last day vs. cuffless monitor last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study. Results 50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between the cuffless monitor and ABPM for daytime DBP was (mean ± SD [95% CI] ) -2.2±8.0 [-4.5, 0.1] mmHg, R2 = 0.66 (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between the cuffless monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg, R2 = 0.70 (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively. Conclusions The results suggest that 1-week monitoring with the investigated cuffless monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of cuffless BP monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.Figure 1

Home- versus centre-based EXercise InTervention in patients with Heart Failure (EXIT-HF trial): A pragmatic randomized controlled trial

IntroductionThe limited accessibility and the lack of adherence explain, in part, the low proportion of heart failure (HF) patients undergoing exercise-based cardiac rehabilitation (CR) programs. Home-based programs showed to be as effective and less costly than centre-based ones and might address those obstacles. Whether the evidence from international studies can be applied to our population is still unclear. ObjectivesTo compare the clinical and economic impact of a home-based versus centre-based CR intervention in HF patients. MethodsThis is a single-center, single-blind, parallel groups, non-inferiority pragmatic randomized control trial. Adult HF patients (n=120) will be randomized to either a centre-based or home-based CR program. In both groups’ patients will participate in a 12-week combined CR program with 2 sessions per week. Exercise training (ExT) protocol consists of a combination of endurance [(at 60%–80% of peak oxygen uptake (VO2peak)] and resistance training (elastic bands). Those allocated to the home-based program will start with 4–5 supervised ExT sessions to familiarize themselves with the training protocol and then will continue the remaining sessions at home. The primary endpoint is the change in VO2peak at the end of the 12-week program. Secondary outcomes include alterations in circulating biomarkers, physical fitness, physical activity, quality of life, diet, psychological wellbeing, dyspnea, and cost-effectiveness analyses. ResultsPatients are currently being recruited for the study. The study started in November 2019 and data collection is anticipated to be completed by December 2022. This is the first study in Portugal comparing the traditional CR program with a home-based program in HF patients. Our study results will better inform healthcare professionals who care for HF patients regarding CR.

The Effect of Cardiac Rehabilitation on Quality of Life and 6-Minute Walk Test in Breast Cancer Survivors

Background Breast cancer (BC) is the most diagnosed cancer in women, contributing to 24.6% of malignancies in females and responsible for 15% of all cancer-related deaths among women worldwide.[1] Over the last 20 years, BC survival rates have significantly improved.[1] However, this survivorship is often marked by fatigue, poor quality of life (QoL), reduced functional capacity along with treatment-related adverse effects.[2] The implementation of a model similar to cardiac rehabilitation (CR) program as a preventive strategy may provide a potential solution to improve functional capacity, quality of life and reduce cardiovascular disease (CVD) risk in cancer survivors.[3] Objective to investigate the effect of 12-week completed cardiac rehabilitation program on quality of life (using FACT-B questionnaire) and 6-minute walk test in breast cancer survivors. Patients and Methods In this 2-arm parallel prospective, randomized, controlled clinical trial, sixty breast cancer survivors 3 months to 1 year after completion of chemotherapy were recruited at Ain Shams University hospitals and divided into two groups Study group (n = 30); participated in 12-week CR program and Control group (n = 30) did not participate in CR program but still received the usual cancer care. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behavior and psychosocial management, Sexual activity education Smoking cessation. Functional capacity was assessed before and after study period by sixminute walk test (6MWT) and exercise test (using modified Bruce protocol). All patients were personally interviewed for assessment of quality of life before and after study period using (FACT-B) questionnaire. In addition patients underwent echocardiography assessment before and after study period. Result Sixty female breast cancer survivors were enrolled. Nine patients dropped from CR program, some due to social commitments (n = 2), others due to long distance issues (n = 2), and the remaining were not interested in continuing the program (n = 5). There were no significant differences between the two groups regarding age, baseline BMI, hemoglobin (Hb) levels, medical history, chemotherapy protocol, and radiation. When comparing two groups, the study group showed significant increase in age-predicted 6MWD (p = 0.02), ET (p &amp;lt; 0.001), METs (p &amp;lt; 0.001), QoL score (p &amp;lt; 0.001), along with significant decrease in SBP (p &amp;lt; 0.001), HR (p &amp;lt; 0.001), RPP (p &amp;lt; 0.001). Conclusion The results of this study demonstrated that completed cardiac rehabilitation program improves functional capacity and quality of life in breast cancer survivors. Recommendation We recommend that multicomponent supervised cardiac rehabilitation program should be incorporated within the usual care of breast cancer survivor

Physical activity and sedentary behaviour changes during and after cardiac rehabilitation: Can patients be clustered?

Objective: To identify clusters of patients according to changes in their physical behaviour during and after cardiac rehabilitation, and to predict cluster membership.Methods: The study included 533 patients (mean age 57.9 years; 18.2% females) with a recent acute coronary syndrome who participated in a 12-week multi-disciplinary cardiac rehabilitation programme, within a cohort study design. Physical behaviour (light physical activity, moderate-to vigorous physical activity, step count, and sedentary behaviour) was measured using accelerometry at 4 timepoints. To identify clusters of patients according to changes in physical behaviour during and after cardiac rehabilitation, latent class trajectory modelling was applied. Baseline factors to predict cluster membership were assessed using multinomial logistic regression.Results: During and after cardiac rehabilitation, 3 separate clusters were identified for all 4 physical behaviour outcomes: patients with steady levels (comprising 68–83% of the patients), and improving (6–21%) or deteriorating (4–23%) levels. Main predictor for membership to a specific cluster was baseline physical behaviour. Patients with higher starting physical behaviour were more likely to be a member of clusters with deteriorating levels.Conclusion: Separate clusters of physical behaviour changes during and after cardiac rehabilitation could be identified. Clusters were mainly distinguished by baseline physical behaviour level. LAY ABSTRACTPhysical behaviour is a construct including both physical activity and sedentary behaviour. Healthy levels of physical behaviour are important for cardiac patients. Cardiac rehabilitation programs are designed to promote a heart-healthy lifestyle for this group. Nevertheless, not all patients perform sufficient physical activity after cardiac rehabilitation. It is important to identify patients at risk for disappointing physical behaviour outcomes at an early stage to provide additional care. Outcomes of the current study show that cardiac patients can be clustered according to their change in physical behavior during and after cardiac rehabilitation. The majority showed steady levels and no improvements, but we could also identify groups of patients with improving and deteriorating levels. Patients with higher starting physical activity levels or low sedentary behaviour levels were more likely to be a member of clusters with deteriorating levels. These patients could benefit of additional interventions.

Remote cardiac rehabilitation program during the COVID-19 pandemic for patients with stable coronary artery disease after percutaneous coronary intervention: a prospective cohort study

ObjectiveThe coronavirus disease-19 (COVID-19) pandemic restricts rapid implementation of in-person delivery of cardiac rehabilitation (CR) at the center for coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI), thus enabling a cohort comparison of in-person vs. remote CR program. This study aims to investigate outcomes of exercise capacity, health-related quality of life (HRQL), mental health, and family burden of stable CAD patients undergoing PCI in low-to-moderate risk after different delivery models of CR program.MethodsThe study included a cohort of stable CAD patients undergoing PCI who had experienced two naturally occurring modes of CR program after hospital discharge at two time periods, January 2019 to December 2019 (in-person CR program) and May 2020 to May 2021 (remote CR program). The exercise capacity was assessed by means of 6-min walk test (6MWT), maximal oxygen uptake (VO2max) and the respiratory anaerobic threshold (VO2AT) before discharge, at the end of the 8-week and 12-week in-person or remote CR program after discharge.ResultsNo adverse events occurred during the CR period. CAD patients had a longer distance walked in 6 min with a higher VO2max after 8-week and 12-week CR program whether in-person or remote model (p < 0.05). The distance walked in 6 min was longer and the maximal oxygen uptake (VO2max) was higher at the end of the 12-week in-person or remote CR program than 8-week in-person or remote CR program (p < 0.05). The respiratory anaerobic threshold (VO2AT) of CAD patients was decreased after 8-week CR program whether in-person or remote model (p < 0.05). CAD patients receiving remote CR program exhibited higher HRQL scores in domains of vitality (p = 0.048), role emotional (p = 0.039), mental health (p = 0.014), and the summary score of the mental composite (p = 0.048) compared to in-person CR program after 8 weeks. The anxiety and depression scores of CAD patients undergoing PCI were decreased after 8-week CR program whether in-person or remote model (p < 0.05). The CAD patients receiving remote delivery showed lower anxiety and depression scores compared to those receiving in-person delivery at the end of the 8-week CR program (p < 0.05). It was found that the family burden scores of CAD patients undergoing PCI were reduced after 8-week and 12-week CR program whether in-person or remote model (p < 0.05). The CAD patients receiving remote CR program showed lower family burden scores than those receiving in-person CR program after whether 8 weeks or 12 weeks (p < 0.05).ConclusionThese data indicate that a properly designed and monitored remote delivery represents a feasible and safe model for low-to-moderate-risk, stable CAD patients undergoing PCI inaccessible to in-person CR during the COVID-19 pandemic.

DAYTIME BLOOD PRESSURE MEASUREMENTS PERFORMED BY AKTIIA CUFFLESS MONITOR AND 24-H AMBULATORY BLOOD PRESSURE MONITOR: PRELIMINARY COMPARATIVE RESULTS OF A SINGLE-CENTRE STUDY

Objective: Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. However, there is intense debate whether cuffless devices generate data comparable to ABPM. Here, we present preliminary results of daytime BP measurements performed by Aktiia cuffless BP monitor (Aktiia SA, Switzerland) compared to 24-hour ABPM. Design and method: 52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program (Réseau Hospitalier Neuchâtelois, Switzerland). The patients used the Aktiia monitor during the entire CR program, while 24-hour ABPM (Dyasis 3, Novacor, France) was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of Aktiia monitor (session 1: ABPM first day vs. Aktiia first week; session 2: ABPM last day vs. Aktiia last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study. Results: 50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between Aktiia monitor and ABPM for daytime DBP was (mean ± SD [95% CI]) -2.2±8.0 [-4.5, 0.1] mmHg (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between Aktiia monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively. Conclusions: The results suggest that 1-week Aktiia monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of Aktiia monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.

Effectiveness of a Sedentary Behaviour Intervention as a Personalised Secondary Prevention Strategy (SIT LESS) for patients with coronary artery disease: primary outcomes of the SIT LESS trial

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation. Background High levels of time spent sedentary are associated with increased risk of cardiovascular disease morbidity and mortality, even after accounting for traditional risk factors. A sedentary lifestyle is highly prevalent among patients with coronary artery disease (CAD). Purpose This clinical trial aimed to determine whether a multicomponent, hybrid (center- and home-based), sedentary behaviour change intervention as a personalized secondary prevention strategy (SIT LESS) reduces daily sedentary time among patients with CAD participating in cardiac rehabilitation. Methods Patients were randomised to usual care (n=104) or SIT LESS (n=108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with an activity tracker connected to a smartphone application. Primary outcome was the change in objectively measured sedentary time between pre- to post-rehabilitation. Results Patients (77% male) were 63±10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (−1.6 [−2.1 to −1.1] hours/day) and controls (−1.2 [ ─1.7 to −0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day, Central Figure). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥9.5 hours/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2-0.8)). No differences were observed in the other predefined secondary outcomes. Conclusions Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥9.5 hours/day was observed.

Association of admission frailty and frailty changes during cardiac rehabilitation with 5-year outcomes.

Examine the association between (1) admission frailty and (2) frailty changes during cardiac rehabilitation (CR) with 5-year outcomes (i.e. time to mortality, first hospitalization, first emergency department (ED) visit, and number of hospitalizations, hospital days, and ED visits). Data from patients admitted to a 12-week CR programme in Halifax, Nova Scotia, from May 2005 to April 2015 (n = 3371) were analysed. A 25-item frailty index (FI) estimated frailty levels at CR admission and completion. FI improvements were determined by calculating the difference between admission and discharge FI. CR data were linked to administrative health data to examine 5-year outcomes [due to all causes and cardiovascular diseases (CVDs)]. Cox regression, Fine-Gray models, and negative binomial hurdle models were used to determine the association between FI and outcomes. On average, patients were 61.9 (SD: 10.7) years old and 74% were male. Mean admission FI scores were 0.34 (SD: 0.13), which improved by 0.07 (SD: 0.09) by CR completion. Admission FI was associated with time to mortality [HRs/IRRs per 0.01 FI increase: all causes = 1.02(95% CI 1.01,1.04); CVD = 1.03(1.02,1.05)], hospitalization [all causes = 1.02(1.01,1.02); CVD = 1.02(1.01,1.02)], ED visit [all causes = 1.01(1.00,1.01)], and the number of hospitalizations [all causes = 1.02(95% CI 1.01,1.03); CVD = 1.02(1.00,1.04)], hospital days [all causes = 1.01(1.01,1.03)], and ED visits [all causes = 1.02(1.02,1.03)]. FI improvements during CR had a protective effect regarding time to all-cause hospitalization [0.99(0.98,0.99)] but were not associated with other outcomes. Frailty status at CR admission was related to long-term adverse outcomes. Frailty improvements during CR were associated with delayed all-cause hospitalization, in which a larger effect was associated with a greater chance of improved outcome.

Effectiveness of an intervention to reduce sedentary behaviour as a personalised secondary prevention strategy for patients with coronary artery disease: main outcomes of the SIT LESS randomised clinical trial

BackgroundA high sedentary time is associated with increased mortality risk. Previous studies indicate that replacement of sedentary time with light- and moderate-to-vigorous physical activity attenuates the risk for adverse outcomes and improves cardiovascular risk factors. Patients with cardiovascular disease are more sedentary compared to the general population, while daily time spent sedentary remains high following contemporary cardiac rehabilitation programmes. This clinical trial investigated the effectiveness of a sedentary behaviour intervention as a personalised secondary prevention strategy (SIT LESS) on changes in sedentary time among patients with coronary artery disease participating in cardiac rehabilitation.MethodsPatients were randomised to usual care (n = 104) or SIT LESS (n = 108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with a pocket-worn activity tracker connected to a smartphone application to continuously monitor sedentary time. Primary outcome was the change in device-based sedentary time between pre- to post-rehabilitation. Changes in sedentary time characteristics (prevalence of prolonged sedentary bouts and proportion of patients with sedentary time ≥ 9.5 h/day); time spent in light-intensity and moderate-to-vigorous physical activity; step count; quality of life; competencies for self-management; and cardiovascular risk score were assessed as secondary outcomes.ResultsPatients (77% male) were 63 ± 10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (− 1.6 [− 2.1 to − 1.1] hours/day) and controls (− 1.2 [ ─1.7 to − 0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥ 9.5 h/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2–0.8)). No differences were observed in the other predefined secondary outcomes.ConclusionsAmong patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥ 9.5 h/day was observed.Trial registrationNetherlands Trial Register: NL9263.Graphical Outcomes of the SIT LESS trial: changes in device-based sedentary time from pre-to post-cardiac rehabilitation (control group) and cardiac rehabilitation + SIT LESS (intervention group). SIT LESS reduced the odds of patients having a sedentary time >9.5 hours/day (upper limit of normal), although the absolute decrease in sedentary time did not significantly differ from controls. SIT LESS appears to be feasible, acceptable and potentially beneficial, but a larger cluster randomised trial is warranted to provide a more accurate estimate of its effects on sedentary time and clinical outcomes. CR: cardiac rehabilitation.

Impact of Cardiac Rehabilitation Programs Post Primary Percutaneous Coronary Intervention on Functional Capacity and Metabolic Profile Through Different Age Groups.

Modern cardiac rehabilitation (CR) is a thorough approach including multiple arms that aim at improving quality of life and functional capacity. To study the impact of age on the benefits of cardiac rehabilitation program post-successful primary percutaneous coronary intervention (PCI). This retrospective study includes 250 patients post primary percutaneous coronary intervention (PCI) who underwent a complete 12-week cardiac rehabilitation program. Functional capacity, metabolic profile, and parameters of diastolic function were assessed and compared at baseline and after completing the program. Four age strata were compared in terms of improvement of the various parameters studied. In the whole patient group, the workload achieved in metabolic equivalents (METS) and maximum exercise time significantly increased. Regarding metabolic profile, body mass index (BMI), total cholesterol, low-density lipoprotein (LDL), and Triglycerides significantly decreased. While high-density lipoproteins (HDL) increased but didn't reach significance. Echo data reflecting diastolic dysfunction also improved significantly. We found that the magnitude of improvement in all the earlier-mentioned parameters showed no statistically significant difference among the four age groups studied. Cardiac rehabilitation program post primary percutaneous coronary intervention (PCI) significantly improves functional capacity, metabolic profile, and diastolic function. It is never too old or too young to join the CR program. Different age groups benefit equally from rehabilitation.

Effects of Meditation on Cardiovascular and Muscular Responses in Patients during Cardiac Rehabilitation: A Randomized Pilot Study.

Background: Cardiovascular diseases are the world’s number one cause of death, with exceeding psychosocial stress load being considered a major risk factor. A stress management technique that has repeatedly shown positive effects on the cardiovascular system is the Transcendental Meditation (TM) technique. The present pilot study aimed to investigate the potential effect of TM on the recovery of cardiac patients. Objectives: We hypothesized that practicing TM in patients undergoing a 4-week cardiac rehabilitation program augments the recovery of cardiovascular parameters and reduces skeletal muscle tone after rehabilitation. Methods: Twenty cardiac patients were recruited and randomly assigned to either the control or the TM group. Cardiovascular parameters were assessed with the Task Force Monitor (TFM) and skeletal muscle contractile properties by Tensiomyography during a sit-stand test, performed at the beginning and end of a 4-week in-patient rehabilitation program. Results: Systolic blood pressure (SBP) was significantly lower after 4 weeks of cardiac rehabilitation, while the RR-interval (RRI) significantly increased. At the skeletal muscle level, the contraction time and maximal displacement increased, though only in the gastrocnemius medialis and biceps femoris muscles and not in vastus lateralis. Group interactions were not observed for hemodynamic parameters nor for muscle contractile properties. Discussion: Although significant improvements in hemodynamic and muscular parameters were observed after 4 weeks of rehabilitation, we could not provide evidence that TM improved rehabilitation after 4 weeks. TM may unfold its effects on the cardiovascular system in the longer term. Hence, future studies should comprise a long-term follow-up.