Cardiac Rehabilitation Program In Patients Research Articles

Feasibility, Safety, Adherence and Efficacy of High-Intensity Interval Training Cardiac Rehabilitation Programs for Patients with Coronary Heart Disease

There are reservations regarding the clinical application of high-intensity interval training (HIIT) in real-world cardiac rehabilitation settings. This study investigated HIIT compared with moderate-intensity continuous training (MICT) within a standard hospital cardiac rehabilitation program. Two hundred and sixty adults with angiographically proven coronary artery disease undergoing a standard 4-week cardiac rehabilitation program were approached. Ninety-three patients were subsequently randomised to: 1) HIIT (n = 46): 4 x 4-minute high-intensity intervals at 15–18 rating of perceived exertion (RPE, range 6–20) interspersed with 3-minute active recovery periods; or 2) MICT (n = 47): usual-care exercise involving 40-minutes of aerobic exercise at 11–13 RPE. Participants completed two supervised sessions and one home-based session per week. Feasibility was assessed using staff and participant questionnaires. The incidence and seriousness of adverse events were recorded to evaluate safety. Adherence to the exercise protocol was assessed from exercise records and self-report logs. Average training RPE was significantly higher for HIIT (16 ± 1 vs 12 ± 1) and resulted in a significant improvement in peak oxygen uptake compared to MICT (+2.9 ± 3.5 vs +1.1 ± 0.0 mL/kg/minute, p = 0.012). There was no difference in the incidence of serious adverse events between HIIT (n = 2) and MICT (n = 2). Adherence to the exercise protocol was high in both groups (HIIT 80% vs MICT 87%). Feasibility scores were equal between groups (98%) regarding desire to continue their randomised training. Staff acceptance of the HIIT program was high. Compared to usual care (MICT), HIIT was safe, feasible, and more efficacious for improving fitness without loss of exercise adherence.

Cardiorehabilitation of Patients with Acute Coronary Syndrome Who Were Performed Coronary Arteries Revascularization

In patients with acute coronary syndrome who were performed coronary arteries’ revascularization, in the postoperative period disorders of hemodynamics and heart rate variability often develop. The aim of our work was to optimize the cardiac rehabilitation of such patients by individualization of physical activity depending on the state of systolic and diastolic left ventricular dysfunction and heart rate variability. 40 patients with acute coronary syndrome and coronary artery revascularization were included into the experimental group. The control group consisted of 20 patients of the same age, clinical and laboratory manifestations of ACS who were treated according to the protocol of Ministry of Health of Ukraine. In both groups of patients clinical efficacy of cardiac rehabilitation process was evaluated according to the dynamics of clinical symptoms, systolic and diastolic left ventricular function and heart rate variability. In patients with acute coronary syndrome and coronary artery revascularization in the initial state the clinical and laboratory signs of myocardial ischemia disappear, but subclinical and clinical manifestations of heart failure remain. During the first month of training, the original accelerated cardiac rehabilitation program leads to the decrease of systolic and diastolic signs of cardiac dysfunction and improves heart rate variability, which significantly improves the quality of life of these patients. For monitoring the efficacy and safety of the performance of cardiac rehabilitation program in patients with acute coronary syndrome and coronary artery revascularization, in addition to conventional methods (determination of heart rate, blood pressure, 6-minute test), it is useful to diagnose subclinical stage of heart failure by examination of systolic, diastolic function and vegetative regulation.

P2490Comparing a 6 week-high contact frequency to a 12 week-low contact frequency cardiac rehabilitation program in patients with stable coronary artery disease

P2490Comparing a 6 week-high contact frequency to a 12 week-low contact frequency cardiac rehabilitation program in patients with stable coronary artery disease

P290The role and outcome of cardiac rehabilitation program in patients with atrial fibrillation

P290The role and outcome of cardiac rehabilitation program in patients with atrial fibrillation

Reabilitação cardiovascular melhora capacidade funcional de pacientes cardiopatas após 3 anos de seguimento

Objetivo: Acompanhar os parâmetros cardiovasculares e funcionais de pacientes cardiopatas submetidos à reabilitação cardiovascular (fase 4) durante 3 anos. Materiais e Métodos: Trata-se de um estudo retrospectivo, no qual foram incluídos 11 pacientes submetidos a programa de reabilitação cardiovascular supervisionada por 3 anos. Os dados foram coletados de prontuários referentes às avaliações realizadas ao final do primeiro e do terceiro ano de reabilitação, realizada 2x/semana, sendo 60 minutos por sessão. Análise estatística: A normalidade dos dados foi testada pelo teste de Shapiro-Wilk. A comparação entre as variáveis paramétricas foi realizada pelo teste t-Student e, para as variáveis não paramétricas, foi aplicado teste de Mann-Whitney. O nível de significância adotado foi de 5%. Resultados: Hipertensão foi a patologia cardiovascular mais frequente no grupo estudado, presente em 11 pacientes (100%). Os pacientes foram considerados sobrepeso (25,89 ± 2,51 kg/m2). Foi observada melhora significativa da capacidade funcional (TC6M 1ª avaliação: 454,4 ± 110,4 m; 2ª avaliação: 588,0 ± 100,2 m, p=0,006). As demais variáveis não diferiram entre os dois momentos. Conclusão: O treinamento físico contínuo melhorou a capacidade funcional dos pacientes após 3 anos de seguimento de reabilitação cardiovascular.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation.

BackgroundThe absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients.ObjectiveTo develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease.MethodsA total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis.ResultsThe final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension.ConclusionThe instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG

Introduction: Although cardiac rehabilitation is known as a tool to reduce the overall risk of cardiovascular complications, its specific role in the reduction of hs-CRP as a marker of inflammation and a proven marker of cardiovascular risk needs further investigation. Aim: The present study aims at elucidating the effects of a full course of conventional cardiac rehabilitation program for the period of eight weeks, on the levels of hs-CRP in patients who underwent isolated coronary artery bypass surgery. Material and Methods: In this case study, 30 consecutive patients who underwent isolated coronary artery bypass surgery (isolated CABGS), and a full 8-week cardiac rehabilitation program in Tehran Heart Center, were investigated. A group of 30 similar patients, who enrolled in the same period of rehabilitation program but did not participate in practice, was considered as a control group. Serum levels of hs-CRP in both groups were measured retrospectively and in similar days before the start of rehabilitation program and at the end of it (or 8 weeks after initial registration for the control group). Results: Levels of hs-CRP in the rehabilitation group and control group were 5.9 7.7 and 6.3 6.9 respectively before start of the program which was not statistically meaningful (P-Value = 0.833). However, after the program, level of hs-CRP in the two tested groups changed to 2.3 5.1 and 5.7 6.1 respectively which showed a meaningful correlation (P-Value = 0.023). These results also showed that decrease in hs-CRP level in the rehabilitated group but not in the control group was statistically meaningful (with P-Value of 0.037 and 0.0723 respectively). Conclusion: In patients undergoing coronary bypass surgery, participating in a full course of cardiac rehabilitation for 8 weeks has resulted in a significant reduction in hs-CRP levels as a marker of cardiovascular risk.

Efficacy of an early home-based cardiac rehabilitation program for patients after acute myocardial infarction: A three-dimensional speckle tracking echocardiography randomized trial.

Background:The effect of an early short-term home-based cardiac rehabilitation (CR) program on ventricular function in acute myocardial infarction (AMI) patients is not yet clear. The purpose of this study was to evaluate the efficacy of our CR program on the improvement of myocardial function using three-dimensional speckle tracking echocardiography (3D-STE) in AMI patients.Methods:Fifty-two AMI patients were randomly assigned to 2 groups after discharge: the rehabilitation group, which participated in an early, home-based CR program, and the control group, which received only usual care. All subjects in both groups underwent 3D-STE examinations of the left ventricle within 48 hours of percutaneous coronary intervention and again 4 weeks after discharge. Global longitudinal strain (GLS), global radial strain (GRS), global area strain (GAS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), and segmental strains were computed. The CR program was initially conducted with supervised inpatient training, followed by an unsupervised home-based training program during a 4-week follow-up.Results:We obtained segmental strains from 832 segments, of which 319 were defined as interventional segments, 179 as ischemic segments, and the remaining segments as normal segments. At the 4-week follow-up, when controlling for baseline values, the rehabilitation group showed significant improvements in GLS, GRS, GCS, GAS, LVEF, and in all of the segmental strains of the 3 subgroups compared with the control group (P <0.05).Conclusion:Our study suggests that an early, home-based CR program can greatly improve the ventricular function of AMI patients in a short period of time.

Should Tai Chi be part of cardiac rehabilitation programme for patients with chronic heart failure?

Should Tai Chi be part of cardiac rehabilitation programme for patients with chronic heart failure?

Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation.

In heart failure (HF), cardiac rehabilitation (CR) may reduce decompensations, hospitalization, and ultimately mortality in long term. Many studies over the past decade have demonstrated that aerobic exercise training is effective and safe in stable patients with HF. Exercise CR resulted in a clinically important improvement in the QOL. Several clinical and psychosocial factors are associated with decreased participation in CR programs of elderly HF patients, such as perception of exercise as tiring or painful, comorbidities, lack of physician encouragement, and opinion that CR will not improve their health status. Besides low functional capacity, and chronic deconditioning may also deter patients from participating in CR programs. Recent data suggest that current smoking, a BMI ≥30 kg/m2, diabetes mellitus, and cognitive dysfunction are associated with failure to enroll in outpatient CR in older age group. Moreover the lack of availability of CR facilities or the absence of financial refunds for enrolment of CHF patients in cardiac rehabilitation programs can play a crucial role. Many of this factors are modifiable through patient education and self care strategy instruction, health providers sensibilization, and implementing economic measures in order to make CR affordable.

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study.

The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

PT089 Cardiac Rehabilitation Program in Patients at High Risk

PT089 Cardiac Rehabilitation Program in Patients at High Risk

Baduanjin Exercise Prevents post-Myocardial Infarction Left Ventricular Remodeling (BE-PREMIER trial): Design and Rationale of a Pragmatic Randomized Controlled Trial.

Left ventricular (LV) remodeling following myocardial infarction (MI) is an established prognostic factor for adverse cardiovascular events and the leading cause of heart failure. Empirical observations have suggested that Baduanjin exercise, an important component of traditional Chinese Qigong, may exert potential benefits on cardiopulmonary function. However, the impact of a Baduanjin exercise-based cardiac rehabilitation program for patients recovering from a recent MI has yet to be assessed. The aim of this trial is to evaluate the potential role of Baduanjin exercise in preventing the maladaptive progression to adverse LV remodeling in patients post-MI. A total of 110 clinically stable patients following an MI after undergoing successful infarct-related artery reperfusion will be randomly assigned to the Baduanjin exercise group or usual exercise control group. In addition to usual physical activity, participants in the Baduanjin exercise group will participate in a 45min Baduanjin exercise training session twice a week, for a total of 12weeks. The primary endpoint will be the percentage change in LV end-diastolic volume index (LVEDVi) assessed using echocardiography from baseline to 6months. The results of this study may provide novel evidence on the efficacy of Baduanjin exercise therapy in post-MI patients in reversing adverse LV remodeling and improving clinical outcome. Clinical Trials.gov: NCT02693795.

The Health Benefits of a 12-Week Home-Based Interval Training Cardiac Rehabilitation Program in Patients With Heart Failure

BackgroundRecently, high-intensity interval training has been advocated for the rehabilitation of persons living with heart failure (HF). Home-based training is more convenient for many patients and could augment compliance. However, the safety and efficacy of home-based interval training remains unclear. MethodsWe evaluated the safety and efficacy of a supervised home-based exercise program involving a combination of interval and resistance training. Measures of aerobic power, endurance capacity, ventilatory threshold, and quality of life in 40 patients with HF, were taken at baseline and after 12 weeks. Patients were matched and randomized to either control (CTL; n = 20) or experimental (EXP; n = 20) conditions. The EXP group underwent a 12-week high-intensity interval and resistance training program while the CTL group maintained their usual activities of daily living. ResultsIn the EXP group, we found a significant improvement in aerobic power, endurance capacity, ventilatory threshold, and quality of life. There were no significant changes in the CTL group. ConclusionsWe have shown that a home-based cardiac rehabilitation program involving interval and resistance training is associated with improved aerobic capacity and quality of life in patients with HF. This research has important implications for the treatment of HF.

The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results

BackgroundSpontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear. MethodsWe designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered. ResultsWe report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001). ConclusionsThis is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.

Visit-to-Visit Variability and Reduction in Blood Pressure After a 3-Month Cardiac Rehabilitation Program in Patients With Cardiovascular Disease.

Visit-to-visit variability (VVV) in blood pressure (BP) has been shown to be a predictor of cardiovascular events. It is unknown whether CR can improve VVV in BP as well as reducing BP. We enrolled 84 patients who had cardiovascular disease (CVD) and participated in a 3-month CR program. We measured systolic and diastolic BP (SBP and DBP), pulse pressure (PP), and heart rate (HR) before exercise training at each visit and determined VVV in BP or HR expressed as the standard deviation of the average BP or HR. Patients who had uncontrolled BP at baseline and who did not change their antihypertensive drugs throughout the study period showed a significant reduction of both SBP and DBP with a decrease in PP after 3 months. Patients who did not change their antihypertensive drugs were divided into larger (L-) and smaller (S-) VVV in the SBP groups and L- and S-VVV in the DBP groups according to the average value of VVV in SBP or DBP. In the L-VVV in the SBP and DBP groups, VVV in SBP and DBP in the 1st month was significantly decreased after the 3rd month in both groups. HR at baseline was significantly decreased after 3 months. In addition, CR induced a significant increase in the level of high-density lipoprotein cholesterol (HDL-C) in blood. In conclusion, CR improved VVV in BP in patients with L-VVV in BP and evoked a significant reduction in HR and an increase in HDL-C. These effects due to the CR program may be cardioprotective.

Prognostic value of new left atrial volume index severity partition cutoffs after cardiac rehabilitation program in patients undergoing cardiac surgery.

BackgroundPrevious studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography.MethodsWe created a retrospective registry of 1703 consecutive patients who underwent cardiovascular rehabilitation program after cardiac surgery, including CABG, valve surgery and valve + CABG surgery. LAVi was calculated as ratio of left atrium volume to body surface area, in ml/m2 at discharge; 563 patients with available LAVi data were included in the study.ResultsIn the whole population LAVi was 36 ± 14 ml/m2 (mean ± SD) and the follow-up time was 5 ± 1.5 years. Increased LAVi (>34 ml/m2) predicted major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 2.1; CI95 %: 1.4–3.1; p < 0.001) and cardiovascular mortality (HR = 2.2; CI95 %: 1.0–4.5; p = 0.032). An increased LAVi remained MACCEs predictor after adjustement for age, gender, diabetes, atrial fibrillation at discharge, echocardiographic E/A ratio and left ventricular ejection fraction (HR = 1.8; CI95 %: 1.0–3.0; p = 0.036). When the study population was split according to increasing LAVi values, left atrium enlargement resulted a predictor of progressively worse adverse outcome.ConclusionsLAVi is a predictor of long-term adverse cardiovascular outcome after cardiac surgery, even after correction for main clinical and echocardiographic variables. The recently recommended LAVi severity cutoffs appear adequate to effectively stratify outcome in patients undergoing rehabilitation after cardiac surgery.

Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease--protocol.

BackgroundCardiovascular diseases (CVDs), including myocardial infarction, heart failure, peripheral arterial disease and strokes, are highly prevalent conditions and are associated with high morbidity and mortality. Cardiac rehabilitation (CR) is an effective form of secondary prevention for CVD but there is a lack of information regarding which specific behaviour change techniques (BCTs) are included in programmes that are associated with improvements in cardiovascular risk factors. This systematic review will describe the BCTs which are utilised within home-based CR programmes that are effective at reducing a spectrum of CVD risk factors.Methods/designThe review will be reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of home-based CR initiated following a vascular event (myocardial infarction, heart failure, peripheral arterial disease and stroke patients) will be included. Articles will be identified through a comprehensive search of MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Database guided by a medical librarian. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data, identifying which specific BCTs are included in programmes that are associated with improvements in particular modifiable vascular risk factors.DiscussionThis review will be of value to clinicians and healthcare professionals working with cardiovascular patients by identifying specific BCTs which are used within effective home-based CR. It will also inform the future design and evaluation of complex health service interventions aimed at secondary prevention in CVD.Systematic review registrationPROSPERO registration CRD42015027036.

Tai Chi Chuan improves functional capacity after myocardial infarction: A randomized clinical trial

Patients with a recent myocardial infarction (MI) present a reduction in functional capacity expressed as a decrease in peak oxygen consumption (Vo2 peak). The impact of a Tai Chi Chuan (TCC) cardiac rehabilitation program for patients recovering from recent MI has yet to be assessed. Our goal is to evaluate functional capacity after a TCC-based cardiac rehabilitation program in patients with recent MI. A single-blind randomized clinical trial was conducted. The researchers who performed the tests were blinded to group allocation. Between the 14th and 21st days after hospital discharge, all patients performed a cardiopulmonary exercise testing and a laboratory blood workup. Mean age was similar (56±9 years in the TCC group and 60±9 years in the control group). Patients allocated to the intervention group performed 3 weekly sessions of TCC Beijin style for 12 weeks (n=31). The control group participated in 3 weekly sessions of full-body stretching exercises (n=30). After the 12-week study period, participants in the TCC group experienced a significant 14% increase in Vo2 peak from baseline (21.6 ± 5.2 to 24.6 ± 5.2 mL/kg per minute), whereas control participants had a nonsignificant 5% decline in Vo2 peak (20.4 ± 5.1 to 19.4 ± 4.4 mL/kg per minute). There was a significant difference between the 2 groups (P<.0001). Tai Chi Chuan practice was associated with an increase in Vo2 peak in patients with a recent MI and may constitute an effective form of cardiac rehabilitation in this patient population.

Differences in Recovery of Functional Status Achieved by a Phase I Cardiac Rehabilitation Program in Patients with Heart Failure with Preserved Ejection Fraction and with Reduced Ejection Fraction

The purpose of this study was to investigate whether recovery of functional status achieved by a phase I cardiac rehabilitation (Ph-I CR) program is different between types of chronic heart failure (CHF) defined by left ventricular (LV) systolic and diastolic properties.