Cardiac Rehabilitation Classes Research Articles

Patient education in multilingual groups of cardiac patients: Mission (im)possible?

ObjectiveIn Norway, cardiac rehabilitation with patient education is usually accessible only to patients who understand Norwegian. The Cardiac Care Class (CCC) in focus in this article is a unique healthcare service in that, via interpreting services, it provides patient education to patients with limited Norwegian proficiency (LNP). This article examines the adaptations carried out to make cardiac rehabilitation accessible to LNP patients. MethodsThe data stem from a qualitative study with participant observation during interpreter-mediated CCCs and from interviews with healthcare professionals, patients, and interpreters conducted by an interdisciplinary team. The collaborative data analysis focused on identifying various forms of adaptations. ResultsProviding interpreting in CCCs required organizational, logistical, and pedagogical adaptations, including having fewer class participants, engaging qualified interpreters, conducting pre-class meetings with the interpreters, and adjusting the course content and language. Communication was found to be satisfactory, although some critical issues (e.g., interpreters' working conditions) were raised. ConclusionThis study showed that interpreter-mediated CCCs can reach multilingual groups provided that the necessary adaptations are made. InnovationThis research is the first to show how a cardiac rehabilitation class in Norway is made accessible to multilingual patient groups by providing interpreting.

Emerging Data Support Benefits of Yoga for Patients With Heart Disease.

Diaphragmatic breathing techniques that 1 patient learned during a yoga-based cardiac rehabilitation class helped him overcome the stress and anxiety he often felt in the waiting room of his cardiologist’s office. The patient, like many seen by Sara Chambers, RN, BSN, assistant nurse manager in Cardiac Rehabilitation at Palm Beach Gardens Medical Center, said yoga helped him learn valuable coping techniques he uses in daily life. “Cardiac patients in particular tend to have a lot of stress,” said Chambers, who is is among the >20 million, or 9.5%, of US individuals who practice yoga, according to the 2012 National Health Interview Survey. Now, an emerging body of evidence suggests that yoga, which combines breathing exercises, strengthening and stretching poses, and relaxation techniques, can be beneficial for individuals with heart conditions or other chronic diseases. It seems to have comparable safety to other forms of exercise. “There are multiple studies that [suggest] that regular yoga practice with breathing exercises can increase lung volume, decrease heart rate and blood pressure, help regulate the parasympathetic and sympathetic nervous systems, lower anxiety, and physical endurance,” said Chambers. Although many forms of exercise can be beneficial for patients with chronic diseases, the unique aspect of yoga “is the strong focus on breathing technique and …

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

The cardiac model of rehabilitation for reducing cardiovascular risk factors post transient ischaemic attack and stroke: a randomized controlled trial

Objective: To evaluate the feasibility and effectiveness of a standard National Health Service cardiac rehabilitation programme on risk factor reduction for patients after a minor stroke and transient ischaemic attack. Design: Single-blind randomized controlled trial. Setting: Cardiac rehabilitation classes. Subjects: Twenty-four patients. Intervention: All participants received standard care. In addition, the intervention group undertook an eight-week cardiac rehabilitation programme consisting of weekly exercise and education classes. Outcome measures: Cardiovascular disease risk score; lipid profiles; resting blood pressure; C-reactive protein (measured with a high sensitive assay) and fibrinogen levels; blood glucose; obesity; physical activity levels; subjective health status (SF-36); Hospital Anxiety and Depression Scale. Results: Group comparison with independent t-tests showed a significantly greater improvement in the cardiovascular disease risk score for participants in the intervention group compared to standard care (intervention 25.7 ± 22.8 to 23.15 ± 18.3, control 25.03 ± 15.4 to 27.12 ± 16.1, t = −1.81, P < 0.05). There were also significant improvements for the intervention group in activity levels (intervention 9.41 ± 7.7 to 8.08 ± 5.7, control 14.50 ± 5.5 to 9.83 ± 6.6, t = −2.00, P < 0.05) and the SF-36 domains of physical functioning (intervention 70 ± 24.6 to 75.4 ± 11.1, control 90.00 ± 12.4 to 83.16 ± 17.3, t = −2.72, P < 0.05) and mental health (intervention 84 ± 40 to 92 ± 40, control 88.00 ± 60 to 84 ± 44, z = −2.06, P < 0.05). Conclusion: The results suggest that standard cardiac rehabilitation programmes are a feasible and effective means of reducing the risk of future cardiovascular events for patients after minor stroke and transient ischaemic attack.

Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later

The current study evaluates the levels of comparative optimism among patients with coronary heart disease (CHD) and examines its relationship to health outcomes 12months later. 164 patients completed self-report questionnaires at the end of cardiac rehabilitation and the number of adverse clinical events in the following 12months were recorded. Comparative optimism was assessed in relation to a typical other who has not had cardiac event, a typical other who has had the same cardiac event as the respondent, and a typical member of the cardiac rehabilitation class. Clinical-demographic details and distress were assessed. Participants were comparatively optimistic in all three ratings. Logistic regression (controlling for age, gender, co-morbidities, and distress) revealed that higher levels of adverse events were associated with older age, being male, and lower levels of overall comparative optimism. Comparative optimism was associated with decreased risk of adverse clinical events in the year following cardiac rehabilitation attendance.

Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial

Objective To further develop and trial a brief in-hospital illness perception intervention for myocardial infarction (MI) patients. Methods One hundred and three patients admitted with acute MI were randomized to receive either standard care or standard care plus an illness perception intervention, which consisted of three half-hour patient sessions and one half-hour patient-and-spouse session delivered in hospital. Patients were followed up to 6 months. The main outcome was the difference between groups in rate of return to work. Results The intervention group had a faster rate of return to work than the control group, and more patients in the intervention group had returned to full time work by 3 months than in the control group. At discharge, patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived understanding of their condition, which remained at the 6-month follow-up. They also reported a better understanding of the information given in hospital, higher intentions to attend cardiac rehabilitation classes, lower anxiety about returning to work, greater increases in exercise, and made fewer phone calls to their general practitioner about their heart condition at follow-up. Conclusion This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients. It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infarcts.

Exercise motives of long-term phase IV cardiac rehabilitation participants

Objectives To identify the exercise motives of long-term phase IV cardiac rehabilitation participants. Design A two-stage triangulation approach was used where more than one methodology is used, either sequentially or concurrently, in a study. Setting Phase IV cardiac rehabilitation classes held in the community. Participants Fifty-five phase IV participants (30 men aged 66 ± 7.4 years and 25 women aged 69 ± 6.5 years) completed the Exercise Motivation Inventory (EMI-2). Four women and five men were in the focus groups (men aged 65 ± 5.7 years and women aged 68 ± 5.4 years). All the participants had attended phase IV exercise sessions for at least 5 years. Results Motivational drivers of ill-health avoidance and positive health were consistently rated highly by men and women, as were social support and fun. Intrinsic motivational drivers of nimbleness, enjoyment and revitalisation were also rated highly by men and women. Only two areas were rated significantly higher by men [i.e. attachment to the group), 3 (2.5 to 3.8) for males and 2.5 (2.0 to 3.0) for females ( P = 0.022); and stress management, 3.3 (1.4 to 4.3) for males and 2 (1.4 to 3.0) for females ( P = 0.028). Weight management, competition, challenge, appearance and social recognition were consistently given a low rating by men and women. Conclusions Key motivational factors influence exercise participation. For rehabilitation providers, it is important to have an understanding of these factors and furthermore be able to shape and adapt programmes to promote uptake and maintain exercise adherence.

The Brief Illness Perception Questionnaire

Objective This study evaluates the Brief Illness Perception Questionnaire (Brief IPQ), a nine-item scale designed to rapidly assess the cognitive and emotional representations of illness. Methods We assessed the test–retest reliability of the scale in 132 renal outpatients. We assessed concurrent validity by comparing the Brief IPQ with the Illness Perception Questionnaire–Revised (IPQ-R) and other relevant measures in 309 asthma, 132 renal, and 119 diabetes outpatients. Predictive validity was established by examining the relationship of Brief IPQ scores to outcomes in a sample of 103 myocardial infarction (MI) patients. Discriminant validity was examined by comparing scores on the Brief IPQ between five different illness groups. Results The Brief IPQ showed good test–retest reliability and concurrent validity with relevant measures. The scale also demonstrated good predictive validity in patients recovering from MI with individual items being related to mental and physical functioning at 3 months' follow-up, cardiac rehabilitation class attendance, and speed of return to work. The discriminant validity of the Brief IPQ was supported by its ability to distinguish between different illnesses. Conclusion The Brief IPQ provides a rapid assessment of illness perceptions, which could be particularly helpful in ill populations, large-scale studies, and in repeated measures research designs.

CHANGES IN HEMORHEOLOGICAL PROFILE OF MEN WITH CHD ENTERING A PHASE I/II CARDIAC REHABILITATION PROGRAM

The purpose of this study was to determine if several hemorheological parameters remained constant for older men entering a phase I/II cardiac rehabilitation program. Ten nonsmoking men with known ischemic heart disease (IHD) not taking diuretics (mean age = 60.2 ± 11.6 yrs) volunteered to participate in this study. Initial blood samples were taken during the cardiac rehabilitation admission clinic and analyzed for plasma fibrinogen concentration (FIB)(3.2 ± 0.5 g/l), hematocrit (HC) (39.2 ± 3.5), and plasma viscosity (PV)(1.28 ± 0.09 mPa's). Subjects were returned to the community while they waited to start the formal cardiac rehabilitation classes. During this time (mean interval = 39.1 ± 13.0 days) no formal exercise prescription was followed nor was there any significant change to their pharmacological therapy. Subjects were then re-tested for FIB (3.1 ± 0.5 g/l), HC (36.7 ± 4.6) and PV (1.21 ± 0.7 mPa · s) just prior to starting the cardiac rehabilitation classes. Two tailed, paired t-test revealed a significant change to PV (p < 0.01) and HC (p < 0.01) but no significant change to FIB (p = 0.41). Further analysis revealed a significant correlation between the change in PV and the change in FIB (r = 0.71, p < 0.01), and a significant correlation between the change in PV and the change in HC (r = 0.51, p = 0.05). The findings suggest: 1) PV and HC did not remain constant over the time period, 2) a significant relationship indicates the change in PV can be accounted for by the change in FIB, 3) the common decrease in HC and FIB (both concentration measures) suggest that there was a change in plasma volume.

A survey of patients' education and support needs while waiting for cardiac surgery

Objectives: 1) To survey all patients waiting for cardiac surgery to ascertain if patients wanted further education and support than was already being provided. 2) To use the results of this survey to plan future provision of services.Design: A cross sectional survey design was used.Setting: The waiting list for cardiac surgery at an NHS Trust specializing in cardiac and respiratory disorders.Participants: All 679 patients waiting for cardiac surgery were sent the questionnaire with a 66% (n=445) response rate.Main outcome measures: The survey measured attendance at cardiac rehabilitation classes. It asked for patients' information needs, whether they wanted more contact with a cardiac nurse while on the waiting list and in what form they would like that contact.Results: The survey found that 87% (n=383) of patients had never attended cardiac rehabilitation clinics. Over half the patients surveyed wanted more education on diet, medication, exercise and surgery. Patients who wanted more contact from the Trust proved to be 72% (n=297).Conclusions: These results showed that the patients surveyed would value more contact and education while waiting for cardiac surgery. More research also needs to be done to evaluate the effectiveness of educating and supporting patients while they wait for cardiac surgery by measuring the effect on patients' risk factors and quality of life.

Cardiac rehabilitation in Dumfries and Galloway: a model for rural areas?

Summary Objective: To ensure that patients are not excluded from cardiac rehabilitation simply because they live at a distance from their local hospital. Design : a series of developments over six years that have included use of the Heart Manual; training of 80 community-based Heart Manual Facilitators; creation of an outreach Cardiac Rehabilitation Sister's post; development of a patient-held discharge record and follow-up form; extension of outpatient cardiac rehabilitation to six centres. Setting : Dumfries and Galloway, in south west Scotland — a predominantly rural area with a widely dispersed population of 148 000. Patients : All men and women admitted to the Medical Intensive Care Unit in Dumfries with suspected myocardial infarction. Main outcome measures : The proportion of myocardial infarction patients who received inpatient and outpatient cardiac rehabilitation, and the proportion of those discharged with a Heart Manual who received a home visit. Results : An audit of cardiac rehabilitation activity in 1994, at a time when we held outpatient classes in three centres rather than six, showed that 86% of myocardial infarction survivors received inpatient cardiac rehabilitation, and that 35% of this group completed at least five sessions of an eight-week outpatient cardiac rehabilitation class (or four or more sessions of a six-week class for over-65s). Women were as likely to receive inpatient cardiac rehabilitation as men but less likely to complete outpatient cardiac rehabilitation. Similar trends were seen for the elderly. During the latter half of 1994, 83% of myocardial infarction patients who had been discharged with a Heart Manual were visited at home by a Heart Manual Facilitator. Conclusions : We believe that our model of cardiac rehabilitation has established a vital link between hospital and community. Not only should this facilitate the universal provision of cardiac rehabilitation across a large rural area, but also it should enable patients at highest risk to be targeted for treatment. This may answer the criticism that cardiac rehabilitation programmes select only low-risk patients, for whom the benefits of cardiac rehabilitation may be marginal.

A self-medication scheme in a post-coronary care unit.

The drug knowledge of 107 patients was determined before and after entering a self-medication scheme on the post-coronary care unit (PCCU) at City Hospital, Birmingham, and approximately 6 weeks post-discharge when these patients attended their cardiac rehabilitation classes. Fifty-two completed questionnaires were returned. The results indicated a general increase in patients knowledge about the names and side-effects of their drugs, the times at which they take them and the reasons for taking them, following self-medication. A smaller number of questionnaires (19) were completed 6 weeks after discharge. The responses to these suggested that patients who self-medicated in hospital showed greater drug knowledge, especially with regard to potential side-effects, than those who had not. Patients' confidence in their ability to self-medicate safely at home showed no relation to their actual knowledge. It is suggested that self-medication on the PCCU is an important part of the cardiac rehabilitation programme.