Attending Cardiac Rehabilitation Research Articles

Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction: A STUDY OF 158 991 MEDICARE BENEFICIARIES.

On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI). This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the International Classification of Diseases, Ninth Revision (ICD-9) codes in the Medicare Provider Analysis and Review (MEDPAR), Outpatient and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression. Overall, 14% (n = 22 735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n = 43 827) had a diagnosis of depression, with 96% of cases documented before enrollment in CR. Twenty-eight percent with a diagnosis of depression compared with 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% CI, 3.7-4.2) times more likely to attend CR compared with those without depression. Program completion (≥25 sessions) was more common in those with depression (56%) than in those without (35%) (P < .001). Diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.

Barriers to Intake Assessment in Women Referred for Cardiac Rehabilitation

Barriers to Intake Assessment in Women Referred for Cardiac Rehabilitation

PATIENTS’ PERCEPTIONS AND BELIEFS CONTRIBUTING TO NON-INTENTION TO ATTEND CARDIAC REHABILITATION PROGRAM: A LOCAL PERSPECTIVE

OBJECTIVE This study aimed to explore the perceptions and beliefs of patients contributing to non-intention to attend Cardiac Rehabilitation (CR). METHODS A cross-sectional study in which a total number of 148 voluntary patients were enrolled to local CR programs for the research. Purposive sampling method was used and the data was collected in 6 months. A structured questionnaire was used to collect data regarding socio-demographic characteristics and patients’ beliefs and perceptions related to non-intention to attend CR. RESULTS 64.8% of the 148 patients had intended to attend CR and mean age (± SD) of patients was 54.8 (± 12.3) years with 64.9% males. For categorical variables, Spearman Correlation test was used in which patients’ intention to attend CR was significantly associated with ethnicity (P &lt; 0.01), patient diagnosis and procedure (P &lt; 0.001) and residential area (P &lt; 0.001). Conversely, no association has been found between gender, age, educational status, and the use of tobacco with the patients’ intentions for CR. Misconceptions about CR were identified as the key barriers for non-intention to attend CR. These findings reflected patients’ lack of knowledge about CR course content (55.8%), misperceptions that exercise should be avoided to prevent fatigue in cardiac patients (71.2%), walking on treadmill would be more difficult than walking on floor (67.3%) and uncertainty about the suitability and necessity of exercise for their personal mode of heart disease (40.4%). Moreover, other barriers reported were transport difficulties (73.1%), unavailability of attendants to accompany (25%), and work responsibilities (17.3%). CONCLUSIONS Lack of knowledge about CR benefits and misperceptions about personal suitability are reported to as key barriers. Comprehensive information delivery about the benefits of CR, motivation and endorsement by the physician to attend CR programs and accessibility of CR sites nearby residence could be used to address barriers in attending CR.

Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence

Objective: Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence.Methods: A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes.Results: Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout.Conclusion: Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.

Effectiveness of a pedometer-based telephone coaching program on weight and physical activity for people referred to a cardiac rehabilitation program: a randomized controlled trial.

To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity. A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6-8 weeks), and medium-term (6-8 months). More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term. Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation.

Effects of Social Support and Stressful Life Events on Health-Related Quality of Life in Coronary Artery Disease Patients

The objective of this study was to examine the effects of social support and stressful life events on health-related quality of life (HRQoL) in coronary artery disease (CAD) patients. Five hundred sixty consecutive patients with CAD attending cardiac rehabilitation program were invited to participate in the study. Data on stressful life events, perceived social support, and HRQoL were collected from the self-administered questionnaires, Social Readjustment Rating Scale, Multidimensional Scale of Perceived Social Support, and 36-Item Short Form Medical Outcome Questionnaire, respectively. In male patients, multivariate linear regression analyses revealed that physical domains of the HRQoL, specifically physical functioning, were associated with clinical aspects of the CAD, such as New York Heart Association class and angina pectoris class, and psychological domains of the HRQoL such as mental health, energy/vitality, and social functioning were associated with social characteristics such as stressful life events and perceived social support. In women, both physical and psychological domains of the HRQoL were associated only with social characteristics, especially with perceived social support. Perceived social support and stressful life events have independent significant effects on the HRQoL in CAD patients, especially in female patients. When planning cardiac rehabilitation programs, special attention should be paid to patients who experience high levels of stress and have low social support.

Upper-Body Progressive Resistance Training Improves Strength and Household Physical Activity Performance in Women Attending Cardiac Rehabilitation

Upper-Body Progressive Resistance Training Improves Strength and Household Physical Activity Performance in Women Attending Cardiac Rehabilitation

Upper-Body Progressive Resistance Training Improves Strength and Household Physical Activity Performance in Women Attending Cardiac Rehabilitation

The purpose of this study was to examine the impact of moderate-intensity, progressive, upper-body resistance training (RT) on muscle strength and perceived performance of household physical activities (HPA) among women in cardiac rehabilitation. The 10-week, pretest-posttest, experiment randomized women to either usual care (UC) aerobic exercise or RT. Muscle strength for 5 upper-body RT exercises (chest press, shoulder press, biceps curl, lateral row, and triceps extension) was measured using the 1-Repetition Maximum Assessment. The RT group progressively increased weight lifted using 40%, 50%, and 60% of obtained 1-Repetition Maximum Assessment at 3-week intervals. Perceived performance of HPA was measured with the Kimble Household Activities Scale. The RT group (n = 16, mean age 64 +/- 11) significantly increased muscle strength in all 5 exercises in comparison with the UC group (n = 14, mean age 65 +/- 10) (chest press, 18% vs 11%; shoulder press, 24% vs 14%; biceps curl, 21% vs 12%; lateral row, 32% vs 9%; and triceps extension, 28% vs 20%, respectively). By study end, Household Activities Scale scores significantly increased (F = 13.878, P = .001) in the RT group (8.75 +/- 3.19 vs 11.25 +/- 2.14), whereas scores in the UC group decreased (8.60 +/- 3.11 vs 6.86 +/- 4.13). Progressive upper-body RT in women shows promise as an effective tool to increase muscle strength and improve the ability to perform HPA after a cardiac event. Beginning RT early after a cardiac event in a monitored cardiac rehabilitation environment can maximize the strengthening benefit.

The Enduring Impact of Social Factors on Exercise Tolerance in Men Attending Cardiac Rehabilitation

The Enduring Impact of Social Factors on Exercise Tolerance in Men Attending Cardiac Rehabilitation

The Enduring Impact of Social Factors on Exercise Tolerance in Men Attending Cardiac Rehabilitation

This study explored the influence of social support on a prognostic indicator among cardiac patients, exercise tolerance. The relationship of sociodemographic factors to social support was examined, as well as the role of social support as a potential mediator between sociodemographic factors and exercise tolerance. Archival data were collected from a sample of 254 men referred to cardiac rehabilitation. An exercise tolerance test was completed upon entry into cardiac rehabilitation, after 14 weeks, and after 9 months. Sociodemographic factors and social support reported upon entry into the cardiac rehabilitation program were related to initial and post-cardiac rehabilitation exercise tolerance, after controlling for admitting diagnoses, medical history, smoking, and perceived severity of illness. Overall, 28% of the variance in exercise tolerance was explained at baseline, 19% at 14 weeks, and 20% at 9 months. Specifically, older individuals had poorer exercise tolerance, whereas those with more income had better exercise tolerance. Social support was positively related to exercise tolerance at all 3 times. Older men reported less social support than younger men did, and those with more income reported more social support. However, social support did not mediate the relationship between sociodemographic factors and exercise tolerance. Results support the potential use of broad social factors in examining the determinants of prognostic factors for heart patients.

Progressive Resistance Training Improves Perceived Performance of Household Physical Activities Among Women Attending Cardiac Rehabilitation

Background Women often feel guilt after a cardiac event if they are unable to resume their household physical activities. Upper body muscle strength, necessary for these activities decreases not only as a natural aging process but also with physical inactivity post cardiac event. Purpose This ongoing study examines the impact of progressive upper body resistance training with free weights on muscle strength and perceived ability to perform household physical activities among women who participate in Phase II (Outpatient) Cardiac Rehabilitation. Methods This 10-week randomized parallel-group experiment consists of usual care (UC) aerobic exercise or aerobic exercise/resistance training exercise (RTE) groups. Muscle strength for 5 upper body resistance exercises (chest press, shoulder press, biceps curl, lateral row and triceps extension) is measured using the 1-Repetition Maximum Assessment (1-RM). The RTE progressively increased weight lifted based on 40%, 50% and 60% of obtained 1-RM assessment. Perceived performance of household physical activities was measured with the Household Activities Scale (HAS). The percent change in muscle strength between groups was calculated for each exercise. The HAS score is the percent of activities performed without difficulty out of the total number of household physical activities performed. The Wilcoxan test was used to determine between group differences for the HAS and Spearman's rho was used to determine correlation between muscle strength and HAS. Results The RTE group (n = 5) increased in muscle strength in all five exercises compared to the UC group (n = 5) including chest press (34% vs. 5%), shoulder press (40% vs. 39%), biceps curl (27% vs. 14%), lateral row (44% vs. 33%) and triceps extension (33% vs. 14%), respectively. Muscle strength difference in the lateral row was significantly correlated with the HAS (r = .759, p = .02). HAS percentage scores increased in the RTE group compared to the UC group (13% vs. −2%, respectively) although was not statistically significant (Z = 14.5, p = .176). Conclusions Progressive upper body resistance training with free weights shows promise in increasing muscle strength and improving women's ability to perform household physical activities post cardiac event. For this sample, difference in HAS scores was not significant, but the percent improvement in ability to perform household activities is clinically relevant. Beginning resistance training early after cardiac event in a monitored environment like CR can maximize the strengthening benefit for women.

Progressive Resistance Training Improves Perceived Performance of Household Physical Activities Among Women Attending Cardiac Rehabilitation

Background Women often feel guilt after a cardiac event if they are unable to resume their household physical activities. Upper body muscle strength, necessary for these activities decreases not only as a natural aging process but also with physical inactivity post cardiac event. Purpose This ongoing study examines the impact of progressive upper body resistance training with free weights on muscle strength and perceived ability to perform household physical activities among women who participate in Phase II (Outpatient) Cardiac Rehabilitation. Methods This 10-week randomized parallel-group experiment consists of usual care (UC) aerobic exercise or aerobic exercise/resistance training exercise (RTE) groups. Muscle strength for 5 upper body resistance exercises (chest press, shoulder press, biceps curl, lateral row and triceps extension) is measured using the 1-Repetition Maximum Assessment (1-RM). The RTE progressively increased weight lifted based on 40%, 50% and 60% of obtained 1-RM assessment. Perceived performance of household physical activities was measured with the Household Activities Scale (HAS). The percent change in muscle strength between groups was calculated for each exercise. The HAS score is the percent of activities performed without difficulty out of the total number of household physical activities performed. The Wilcoxan test was used to determine between group differences for the HAS and Spearman's rho was used to determine correlation between muscle strength and HAS. Results The RTE group (n = 5) increased in muscle strength in all five exercises compared to the UC group (n = 5) including chest press (34% vs. 5%), shoulder press (40% vs. 39%), biceps curl (27% vs. 14%), lateral row (44% vs. 33%) and triceps extension (33% vs. 14%), respectively. Muscle strength difference in the lateral row was significantly correlated with the HAS (r = .759, p = .02). HAS percentage scores increased in the RTE group compared to the UC group (13% vs. −2%, respectively) although was not statistically significant (Z = 14.5, p = .176). Conclusions Progressive upper body resistance training with free weights shows promise in increasing muscle strength and improving women's ability to perform household physical activities post cardiac event. For this sample, difference in HAS scores was not significant, but the percent improvement in ability to perform household activities is clinically relevant. Beginning resistance training early after cardiac event in a monitored environment like CR can maximize the strengthening benefit for women.

Prevalence of metabolic syndrome in cardiac rehabilitation/secondary prevention programs

Metabolic syndrome (MS) consists of a cluster of obesity-related risk factors that have been linked to the development and progression of coronary heart disease (CHD). The purpose of this study was to examine the prevalence of MS, as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol, in patients with CHD attending cardiac rehabilitation (CR) after a coronary event. We analyzed baseline data of 1912 individuals with established coronary artery disease entering CR in Burlington, Vt, and Boston, Mass. Overall, 50% of patients entering CR have MS. A significantly greater percentage of women than men have MS (54% vs 48, respectively, P < .001). This is due to higher prevalence of abdominal obesity, high triglycerides, and hypertension (all, P < .05) in women. In women, the prevalence of MS peaked in the eighth decade vs the fifth decade in men. The prevalence of MS in patients with CHD participating in CR is greater than twice that of the general population. The prevalence of MS is higher and occurs at an older age in women than men. This study highlights the need for CR programs to develop specific interventions to assist patients with risk factor modification primarily by targeting physical inactivity and weight control.

Predictors of women's attendance at cardiac rehabilitation programs.

This descriptive study was conducted to identify the factors that influence womens attendance at cardiac rehabilitation programs and womens adherence to risk factor modification following a cardiac event. Women (N=196) admitted to hospital for a cardiac event were followed-up at 12 weeks postdischarge. Despite eligibility, only 64% (n=112) had been referred to cardiac rehabilitation programs. By 12 weeks postdischarge only 32% of the total sample (n=57) attended programs and 12% of the total sample (n=21) had dropped out before completion. The odds of a woman attending cardiac rehabilitation were decreased by myocardial infarction diagnosis, lack of employment, <55 years or >70 years, and experiencing a personal stressful event during follow-up. Women were likely to adhere to smoking, medication, and stress modification guidelines but unlikely to adhere to modification guidelines for diet and exercise.