12-week Cardiac Rehabilitation Research Articles

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

Subjective fitness relates to performance and can be improved by exercise in children and young adults with heart disease.

The Duke Activity Status Index is used to assess an individual patient's perception of their fitness abilities. It has been validated and shown to predict actual fitness in adults but has been studied less in the paediatric population, specifically those with heart disease. This study aims to assess if the Duke Activity Status Index is associated with measured markers of physical fitness in adolescents and young adults with heart disease. This retrospective single-centre cohort study includes patients who completed a minimum of 12 weeks of cardiac rehabilitation between 2016 and 2022. Cardiac rehabilitation outcomes included physical, performance, and psychosocial measures. A comparison between serial testing was performed using a paired t-test. Univariable and multivariable analyses for Duke Activity Status Index were performed. Data are reported as median [interquartile range]. Of the 118 participants (20 years-old [13.9-22.5], 53% male), 33 (28%) completed at least 12 weeks of cardiac rehabilitation. Median peak oxygen consumption was 60.1% predicted [49-72.8%], and Duke Activity Status Index was 32.6 [21.5-48.8]. On Pearson's correlation assessing the Duke Activity Status Index, there were significant associations with % predicted peak oxygen consumption (r = 0.49, p < 0.0001), 6-minute walk distance (r = 0.45, p < 0.0001), Duke Activity Status Index metabolic equivalents (r = 0.45, p < 0.0001), and dominant hand grip (r = 0.48, p < 0.0001). In multivariable analysis, the % predicted peak oxygen consumption (r = 0.40, p = 0.005) and dominant hand grip (r = 0.37, p = 0.005) remained statistically significant. Duke Activity Status Index is associated with measures of physical fitness in paediatric and young adults with heart disease who complete a cardiac rehabilitation program.

Factors influencing implementation of digital cardiac rehabilitation: A qualitative analysis of health workers perspectives.

Despite growing evidence for the effectiveness of digital cardiac rehabilitation (CR) uptake of this technology remains low. Understanding the factors that influence implementation of digital CR in clinical practice is a growing area of research. The aim of this nested qualitative study was to explore health worker perspectives on factors influencing implementation of a digital CR programme. Using convenience sampling, semi-structured interviews were conducted with health workers, including health care professionals (nurses, dietitians, physiotherapists) and those in administrative and managerial roles who were involved in delivering and referring patients to Croí MySláinte, a 12-week digital CR intervention delivered during the Coronavirus 2019 pandemic. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis. Interviews were conducted with 14 health workers. Factors influencing implementation of Croí MySláinte were multiple, with some operating independently and others in combination. They related to: (i) characteristics of individuals (e.g., senior leadership support, commitment and motivation of Health workers to meet patient needs, technical capability, workload and perceived fit with role); (ii) features of the programme (e.g., accessibility and convenience for patients, the digital platform, patient self- monitoring tools, the multidisciplinary team and core components); (iii) the external environment (e.g., partnership and connections between organisations, broadband and COVID-19); (iv) the internal environment (e.g., organisational culture, teamwork, resources including funding, digital infrastructure and staffing); and (v) the implementation process (e.g., engaging patients through provision of technical support). The study findings suggest that factors influencing implementation of digital CR operate at multiple levels. Therefore, multi-level implementation strategies are required if the true potential of digital health in improving equitable cardiac rehabilitation access, participation and patient outcomes is to be realised.

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).

The Age Factor in Cardiac Rehabilitation

Coronary artery disease (CAD) is a major global cause of death, and its risk increases with age. This study investigates the relationship between age, patient characteristics, and rehabilitation outcomes in the cardiac rehabilitation (CR) of CAD. A cross-sectional study analyzed 60 medical records of post-coronary artery bypass graft (CABG) or post-percutaneous coronary intervention (PCI) patients who underwent a 6-week CR program after a graded exercise test using the Modified Bruce Protocol. The CR consists of 90% male participants, with an average age of 59.25 ± 6.69 years and an overweight body mass index. CR increases metabolic equivalents in all subjects, while age has a weakly significant negative correlation with the result of CR, so it can be concluded that CR is advantageous for older post-CABG or post-PCI patients.

Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease.

Patients with congenital heart disease (CHD) often have pulmonary abnormalities and exercise intolerance following cardiac surgery. Cardiac rehabilitation (CR) improves exercise capacity in patients with CHD, but minimal study has been performed to see if resting and dynamic pulmonary performance improves following CR in those with prior cardiac surgery. This was a retrospective cohort study of all patients who completed ≥12 weeks of CR from 2018 through 2022. Demographic, cardiopulmonary exercise test (CPET), spirometry, 6-minute walk, functional strength measures, and outcomes data were collected. Data are presented as median[IQR]. A Student's t-test was used for comparisons between groups and serial measurements were measured with a paired t-test. A p < 0.05 was considered significant. There were a total of 37 patients [age 16.7 (14.2-20.1) years; 46% male] included. Patients with prior surgery (n = 26) were more likely to have abnormal spirometry data than those without heart disease (n = 11) (forced vital capacity [FVC] 76.7 [69.1-84.3]% vs. 96.4 [88.1-104.7]%, p = 0.002), but neither group experienced a significant change in spirometry. On CPET, peak oxygen consumption increased but there was no change in other pulmonary measures during exercise. Percent predicted FVC correlated with hand grip strength (r = 0.57, p = 0.0003) and percent predicted oxygen consumption (r = 0.43, p = 0.009). The number of prior sternotomies showed negative associations with both percent predicted FVC (r = -0.43, p = 0.04) and FEV1 (r = -0.47, p = 0.02). Youth and young adults with a prior history of cardiac surgery have resting and dynamic pulmonary abnormalities that do not improve following CR. Multiple sternotomies are associated with worse pulmonary function.

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.

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.

Low serum brain-derived neurotrophic factor may predict poor response to cardiac rehabilitation in patients with cardiovascular disease.

It has been shown that serum brain-derived neurotrophic factor (BDNF) is associated with skeletal muscle energy metabolism and that BDNF is a predictor of mortality in heart failure patients. However, little is known about the relationship between BDNF and cardiac rehabilitation (CR). Therefore, this study retrospectively investigated the effects of baseline serum BDNF levels on the CR-induced exercise capacity improvement in patients with cardiovascular disease (CVD). We assigned 99 CVD patients (mean age 71±12 years, male = 60) to Low, Middle, and High groups based on the tertiles of baseline BDNF levels. Cardiopulmonary exercise testing was done using supervised bicycle ergometer twice before and after 3 weeks of CR. Analysis of covariance (ANCOVA) followed by post-hoc analysis using Tukey's HSD test was conducted to assess the multivariate associations between baseline BDNF levels categorized by BDNF tertiles (as independent variable) and %increases in AT and peak VO2 after 3-week CR (as dependent variables) after adjustment for age and gender (as covariates), as a main statistical analysis of the present study. The higher the baseline BDNF levels, the better nutritional status evaluated by the CONUT score (p<0.0001). Baseline anaerobic threshold (AT) and peak oxygen uptake (peak VO2) were similar among the three groups. ANCOVA followed by post-hoc analysis revealed that age- and gender-adjusted %increases in peak VO2 after 3-week CR were positively associated with baseline BDNF levels (p = 0.0239) and Low BDNF group showed significantly lower %increase in peak VO2 than High BDNF group (p = 0.0197). Significant association was not found between baseline BDNF and %increase in AT (p = 0.1379). Low baseline BDNF levels were associated with malnutrition in CVD patients. A positive association between baseline BDNF levels and CR-induced increases in peak VO2 was found. It was suggested that CVD patients with low baseline BDNF levels may be poor responders to CR.

Impact of reduced group size on patient adherence and functional outcomes in cardiac rehabilitation: insights from a COVID-19 pandemic natural experiment.

Cardiac rehabilitation (CR) adherence and functional outcomes were measured after COVID-19 regulations reduced group sizes to one-on-one, modeling a natural experiment. A retrospective analysis using a natural experiment model measured participants in 12 weeks of CR during the 17 months before and after a COVID-19-related closure was conducted. The age, sex, race, ethnicity, and referral diagnoses of the pre-COVID-19 closure and post-COVID-19 closure groups were analyzed using a student's unpaired T-test. Adherence (completion rate of CR) and functional outcomes [change in six-minute walk test (6MWT)] were assessed between the two groups using unpaired two-tailed student T tests in GraphPad Prism and confidence intervals were calculated with the Baptista-Pike method. There were 204 patients in the pre-COVID-19 group and 51 patients in the post-COVID-19 group, due to the smaller group sizes in the post-COVID-19 group, with no significant differences in baseline characteristics between the groups. The pre-COVID-19 group had a higher patient-to-provider ratio [2.8 patients/provider (SD 0.74)] relative to the post-COVID-19 group [0.4 patients/provider (SD 0.12); p < 0.0001]. The post-COVID-19 group had a higher completion rate than pre-COVID-19 group [75% vs. 21%; OR 10.9 (95% CI, 5.3-21.3, p < 0.0001)]. Among those that completed CR, there was no significant difference between groups in 6MWT improvement [+377.9 ft. (n = 47; SD 275.67 ft.) vs. +346.9 ft. (n = 38; SD 196.27 ft.); p = 0.59]. The reduction in group size to one-on-one was associated with 10 times higher odds of CR completion. Among those that completed CR, functional outcomes were not influenced by group size. Thus, pursuit of one-on-one sessions may improve CR adherence.

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.

The effect of 12 weeks supervised exercise-based cardiac rehabilitation on resting and exercise blood pressure in males and females

Abstract Background Exercise is key in the prevention and management of hypertension. It remains unclear to what extent sex differences exist with regard to changes in blood pressure (BP) in patients following an exercise-based cardiac rehabilitation (CR) program. Purpose To investigate the effect of a 12 week supervised exercise-based CR program on resting BP (BPrest), peak exercise BP (BPmax) and systolic BP (SBP)/metabolic equivalents (MET)-slope and compare sex differences. Methods Of 2963 patients referred for CR at a singular test centre in Belgium during the years 2010-2019, those with missing BP data or with a submaximal (RER&amp;lt;1.1) cardiopulmonary exercise test (CPET) were excluded. Reasons for referral included post myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery and valve surgery. Patients underwent a bicycle CPET with BP measured at rest seated on the bike (BPrest) and throughout the test using an automated auscultatory BP machine at baseline and after 12 weeks of CR. BPrest, BPmax, peak oxygen uptake (VO2peak), peak workload (Wattpeak), resting heart rate (HRrest), maximal HR (HRmax) and the SBP/MET-slope were recorded from each test. CR incorporated 3 sessions of supervised aerobic and resistance exercise per week. Results A final sample of 2500 patients (20.4% females) were included for analysis with similar age (62±11 for males vs 61±11years for females, P=0.142). More males were on an ACE-inhibitor (55 vs 46% females, P&amp;lt;0.001) with a comparable prevalence of beta-blocker usage between sexes (75 vs 71% females, P=0.053). At both baseline and 12 weeks, females had a significantly lower body mass index, VO2peak, Wattpeak, BPmax and HRmax compared to males (P&amp;lt;0.001 for all) but a higher HRrest (P&amp;lt;0.001). However, both sexes had similar BPrest and SBP/MET-slope at baseline and 12 weeks. After 12 weeks of CR both males and females had a comparable mean±SD improvement in VO2peak (+4.1±3.2 and +3.1±2.6mL/kg/min), and Wattpeak (+33±22 and +22±15Watts), respectively (P&amp;lt;0.001 for all). This was associated with an increased SBPmax for males (171±30 to 181±30mmHg, P&amp;lt;0.001) and for females (159±29 to 167±30mmHg, P&amp;lt;0.001) from baseline to 12 weeks respectively. No change was seen in SBPrest between baseline and 12 weeks for males (128±20 to 128±19mmHg, P=0.39) and females (129±21 to 128±19mmHg, P=0.21) respectively. The SBP/MET-slope also remained unchanged after 12 weeks CR for males (8.97±5.48 to 9.04±4.81mmHg/MET, P=0.63) and for females (8.68±7.11 to 9.19±6.16mmHg/MET, P=0.13) respectively. Conclusion Twelve weeks of exercise-based CR was associated with an increase in SBPmax, although this was largely proportional to the improvement in exercise capacity demonstrated by the unchanged SBP/MET-slope and this was similar in both sexes. These routine clinical markers require further interrogation as to whether they parallel improvements in vascular health associated with exercise training.

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

Effects of cardiac rehabilitation on inflammatory biomarkers in unstable ischemic heart disease patients following percutaneous coronary intervention: a randomized controlled study.

Several blood inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), are linked to increased risk for cardiovascular diseases. This study aimed to evaluate these inflammatory markers after cardiac rehabilitation (CR) in patients with unstable ischemic heart disease (UIHD) who underwent successful percutaneous coronary intervention (PCI). A cohort of 115 patients with successful PCI due to UIHD enrolled in the study from January 2018 to March 2021. We used a permuted block stratified randomization technique (2 : 1 ratio). Seventy-seven patients were randomized to the CR group and 38 patients to the control group. The CR group underwent a 12-week pre-specified CR regimen. Blood samples were taken at baseline and follow-up at 12 weeks for both groups. Among the 115 patients, 33 patients were female. The mean age was (53 ± 5.55 years) in the control and (53 ± 6.09 years) in the CR group. The two groups were comparable regarding their baseline characteristics and the values of the inflammatory markers. By contrast, at 12 weeks, the inflammatory marker values were significantly lower in the CR group compared to the control group; hs-CRP: 0.11 [0.08-0.14] vs. 0.21 [0.19-0.21], P-value <0.001; NLR: 2.17 [1.42-2.43] vs. 2.26 [2.07-2.6], P-value: 0.016; PLR: 91.2821 [63.3333-103.2000] vs. 92.600 [84.6154-110.0000], P-value: 0.027. CR after PCI in UIHD patients may attenuate some inflammatory markers, which might benefit cardiovascular health. Further studies are required to evaluate these findings with longer follow-up and the powered to measure major cardiovascular event rates.

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.