Cardiac Rehabilitation Program In Patients Research Articles

A prospective observational study examining changes in exercise capacity, physical activity, and motivation for physical activity 12 months after a cardiac rehabilitation programme in patients with coronary heart disease

A prospective observational study examining changes in exercise capacity, physical activity, and motivation for physical activity 12 months after a cardiac rehabilitation programme in patients with coronary heart disease

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p<0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

Effect of Adding Integrated Core and Graduated Upper Limb Exercises to Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary Artery Bypass Grafting: A Randomized Controlled Trial

ObjectiveTo evaluate the effect of adding integrated core and graduated resistance upper limb exercises to an inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG). DesignThis was a single-center, randomized, controlled, parallel-group intervention study. SettingThis study was conducted at the National Heart Institute. ParticipantsForty patients with post-CABG with sternal instability aged 50-60 years completed this study and were randomized into 2 groups: an intervention group (n=20) and an active control group (n=20). InterventionThe intervention group (A) received a routine inpatient rehabilitation program from the first postoperative day plus integrated core and graduated resistance upper limb exercises, which started from the seventh postoperative day for approximately 4 weeks, whereas the control group (B) received only the routine inpatient rehabilitation program. Main Outcome MeasuresSternal separation measured by ultrasonography, visual analog scale for measuring pain, and activities of daily living (ADL) index were main outcome measures. ResultsPatients in the intervention group (A) showed a significant reduction in sternal separation from the supine and long sitting positions, whereas those in the control group (B) showed a significant increase in sternal separation (P=.0001). Both groups showed a reduction in pain, and an increase in the ADL score was observed in group A. There was a significant interaction between the time and group effects (P=.0001). ConclusionAdding integrated core and graduated upper limb exercises to inpatient cardiac rehabilitation for patients with sternal instability after coronary artery bypass grafting significantly improved sternal healing, pain, and ADL.

Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food–Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study

BackgroundCardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVDs) and metabolic comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced 6-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission. MethodsThe study combined exercise training with a comprehensive nutritional intervention, emphasizing reduction in intake of ultraprocessed foods, adoption of a Mediterranean diet, and implementation of time-restricted eating. Baseline, 3-month, and 6-month assessments included segmental body-composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa AI app, and lifestyle questionnaires. Remission criteria included a return to an HbA1c level of < 5.7%, and < 3 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for prediabetes and metabolic syndrome, respectively. ResultsA total of 36 participants were recruited. The study demonstrated completion rates of 94.4% at 3 months, and 88.9% at 6 months, and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (–9.2 cm, P < 0.001) and weight (–8.0 kg, P < 0.001) were observed. Improvement in glycemic and lipid profiles, insulin-resistance marker levels, and liver health were noted. Participants enhanced their cardiorespiratory fitness, reduced their consumption of ultraprocessed food, and increased their adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission. ConclusionsThe study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients. Clinical Trial RegistrationClinicalTrials.gov, NCT05459987.

Physical and mental components after cardiac rehabilitation intervention: a systematic review and meta-analysis

Abstract Background Cardiovascular disease is a major public health problem associated with high mortality and morbidity, reduced exercise capacity, and Health-related quality of life (HRQol). Interventions in Cardiac Rehabilitation (CR) programmes have gained ground in optimising these indicators, using patient-reported outcome measures (PROMs) to assess the HRQol of patients participating in these programmes, allowing them to show their state of health and make more informed clinical decisions. Purpose To analyse, using PROMs, the effect of CR programmes on the HRQoL of patients after a cardiac event, depending on the time of assessment. Methods The search was carried out in the MEDLINE, CINAHL, CENTRAL and Web of Science databases after registering the protocol in PROSPERO. We included all randomized controlled trials (RCTs) that compared interventions in CR programmes with usual care after a cardiac event and that used PROMs to assess HRQoL over time. The risk of bias was assessed using the Cochrane tool (RoB2) and the quality of evidence using the GRADE system. A meta-analysis was carried out with studies that assessed HRQoL in patients with coronary pathology using the SF-12 PROM at 6 months after a CR programme. Results 17 studies with 4,993 patients participating in CR programmes were included. The PROMs used in these studies to assess HRQoL were SF-12 (n=7), SF-36 (n=2), EQ5D (n=5), KCCQ (n=3), MacNewHRQL (n=3) and HeartQol (n=1). In the 3 RCTs of the meta-analysis, and after applying the SF-12 PROM at 6 months after a CR programme in patients with coronary pathology, the effect of participation was positive on HRQoL only in the physical component (MD 7.02; 95%CI [0.41,13.62]; p=0.04). The results of our meta-analysis indicate a moderate overall quality of evidence, using the GRADE approach, when assessing HRQoL at 6 and 12 month after intervention in a CR program. Conclusions This study develops knowledge on CR by showing the different PROMs applied after a programme, demonstrating a positive effect of CR on HRQoL after evaluation by the same PROM. The importance of time for assessing HRQoL was demonstrated by applying the SF-12 after the CR programme in patients with coronary pathology, with statistically significant results in the physical domain at 6 months. Given the importance of these results in improving HRQoL, it will be important for healthcare organisations to implement PROMs, investing more time and resources in a utilisation strategy.

EFFECTS OF CARDIAC REHABILITATION IN PATIENTS WITH VENTRICULAR ASSIST DEVICES: A SCOPING REVIEW

Introduction Ventricular assist devices represent a treatment option for patients with advanced heart failure, offering control over various haemodynamic variables. Similarly, the prescription of exercise within a cardiac rehabilitation programme for heart failure patients is recommended to reduce symptoms, hospitalisations, improve cardiorespiratory fitness, and increase exercise tolerance. Therefore, exercise prescription can impact those with ventricular assist devices. Given the limited evidence on exercise-based cardiac rehabilitation programmes for this population, this review aims to describe the most commonly used strategies and their health benefits when physical exercise is included in a cardiac rehabilitation programme for patients with ventricular assist devices. Materials and Methods An exploratory review was conducted through searches in the databases: PubMed, SCOPUS, PeDro, and ScienceDirect. The search was limited to studies published between 2013 and 2023. Filters were applied independently by title, abstract, and full text. The included articles were analysed based on the description of the types of cardiac rehabilitation strategies used in patients with ventricular assist devices. Results Seven articles were included. Each programme employed a cardiopulmonary exercise test before prescribing physical exercise. The most commonly used strategy was aerobic exercise, predominantly high-intensity interval training (HIIT) with intensities close to 90% of peak VO2, followed by continuous moderate-intensity exercise. Limb strength exercises were included in three programmes. Conclusions The analysed literature suggests that cardiac rehabilitation in patients with ventricular assist devices is safe and can provide benefits in cardiorespiratory fitness and exercise tolerance. High-intensity interval training is identified as an appropriate strategy for achieving results, offering short-term improvements.

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

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

Implementation of Home-based Cardiac Rehabilitation Program in Patients with Coronary Artery Disease: A Literature Review

Introduction: Coronary artery disease (CAD) is the major cause of disability and death worldwide. The cardiac rehabilitation (CR) program is the management strategy for CAD patients with exercise as the main component to increase functional capacity. This program has been proven beneficial in reducing mortality and morbidity due to CAD. It also reduced the healthcare burden and improved the quality of life. Although the benefits of CR are widely proven, participation and adherence of CAD patients to this program are low. The home-based cardiac rehabilitation (HBCR) program is the strategy developed to increase the coverage of CR services. This program is equally effective as center-based cardiac rehabilitation (CBCR) and is considered safe. This review aimed to find out more about the HBCR program with a focus on its implementation in CAD patients.&#x0D; Methods: Original articles and systematic or narrative reviews were searched using PubMed, Google Scholar, and Research Gate databases. Further exploration of literature citations was also done to meet the inclusion criteria needed to explain the topic.&#x0D; Results: Compared to CBCR, the HBCR program provide comparable benefits, both in medical and functional outcomes. The HBCR program is proven to be feasible and safe with better adherence. The components of the HBCR program are generally the same as the CBCR program and direct supervision given in the CBCR program can be replaced by remote supervision through communication devices or home visits.&#x0D; Conclusion: The HBCR program can be used as an alternative to CBCR in managing patients with CAD.

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study.

Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation.

Myocardial work is an innovative echocardiographic tool to assess left ventricular performance. Emerging data have shown the added value of this method for evaluating cardiac function compared to traditional echocardiographic parameters and global longitudinal strain. However, few studies are present in the literature about the role of myocardial work during cardiac rehabilitation. Our aim was to assess the impact of a rehabilitation program on myocardial work indices in patients with preserved left ventricular ejection fraction and after coronary artery bypass grafting. In addition, we assessed the correlation between baseline myocardial work indices and their change after cardiac rehabilitation, establishing an optimal cut-off value to predict the improvement. An observational, single-center, and prospective study was conducted. We enrolled patients referred to cardiac rehabilitation after coronary artery bypass grafting and with preserved left ventricular ejection fraction. Before and after the cardiac rehabilitation program, a comprehensive patient assessment was performed, including traditional transthoracic echocardiography, myocardial work analysis, and a six-minute walk test. Eighty-four patients were enrolled; the mean age was 67.96 (±7.42) years and 78.6% were male. The left ventricular ejection fraction was preserved in all patients, and the global longitudinal strain was -16.18 ± 2.55%, the global work index was 1588.56 ± 345 mmHg%, the global constructive work was 1771.27 ± 366.36 mmHg%, the global wasted work was 105.8 ± 72.02 mmHg%, and the global work efficiency was 92.63 ± 3.9% at baseline. After the cardiac rehabilitation program, the global work index, the global constructive work, and the six-minute walk test improved significantly (1588.56 ± 345 vs. 1960.2 ± 377.03 mmHg%, p-value < 0.001; 1771.27 ± 366.36 vs. 2172.01 ± 418.73 mmHg%, p-value < 0.001; 70.71 ± 40.2 vs. 437.5 ± 108.70 m, p-value < 0.001, respectively). Myocardial work indices, specifically global work index and global constructive work, improve after cardiac rehabilitation program in patients undergoing coronary artery bypass grafting with preserved left ventricular ejection fraction.

Association between T2DM with high resting heart rate and abnormal heart rate recovery within one minute after treadmill exercise test in CHD patients

Background: Diabetes mellitus and coronary heart disease are chronic diseases that are very closely related. It has long been known that diabetes mellitus is a significant risk factor for coronary heart disease. The incidence of diabetes mellitus is increasing, according to data taken from the PERKENI consensus, WHO predicts an increase in the number of people with DM in Indonesia from 8.4 million in 2000 to around 21.3 million in 2030. The purpose of this study was to determine whether diabetes mellitus is related to cardiovascular autonomic neuropathy. Methods: This research method is helpful to know that diabetes mellitus is directly related to cardiovascular autonomic neuropathy so that it will affect a person's hemodynamic quality functionally. In addition, to functionally affecting a person's hemodynamic capacity, determining that a patient with cardiovascular autonomic neuropathy is determined from the high resting heart rate and abnormal recovery heart rate variables after the treadmill exercise test, we can provide information and education to patients regarding the importance of a cardiac rehabilitation program in patients with coronary heart disease. Results: A total of 45 people according to the calculation of the number of samples by type, male sex numbered 30 and female numbered 15 people. The number of patients who experienced impaired recovery of the 1-minute heart rate in this study was 25 people (55.5%) with the majority being male. And the number of sufferers who experience high heart rates at rest is 22 people (48.9%). In a bivariate analysis, patients with type 2 diabetes mellitus and without type 2 diabetes mellitus significantly worsened recovery heart rate (P value &lt;0.05). Conclusion: There is a significant relationship between diabetes mellitus on high resting heart rate and diabetes mellitus on poor heart rate recovery in 1 minute in patients with coronary heart disease.

Right Ventricular Function and Exercise Tolerance in Patients with ST-Elevation Myocardial Infarction.

Following ST-segment elevation myocardial infarction (STEMI), patients with cardiac dysfunction have limitations in performing physical activity. Right ventricular (RV) function is a determinant in improving functional capacity, and cardiac rehabilitation (CR) is essential for this patient cohort. To evaluate the association of RV function with exercise tolerance after a CR program in patients with STEMI. Retrospective cohort study in patients with STEMI from January to December 2019. They underwent an echocardiographic assessment of RV function before a 16-session CR program. A cardiopulmonary exercise (CPX) testing was performed before and after the CR program. We analyzed whether RV function measured before CR was significantly associated with exercise tolerance before and after the CR program and the degree of improvement. Comorbidity, demographic and anatomic variables were documented. A p-value < 0.05 was considered statistically significant. A total of 109 patients were included. Of all, 3.7% had global RV dysfunction, 10.1% had radial RV dysfunction, and 11% had longitudinal RV dysfunction. An association between radial or longitudinal RV dysfunction and the absence of improvement in cardiorespiratory fitness (> 1 peak VO2equivalents) was observed (p = 0.028, p = 0.008, respectively). A significant correlation was observed between longitudinal RV dysfunction with initial peak VO2equivalents (pVO2eq) (p = 0.046), final pVO2eq (p = 0.003), and difference in pVO2eq (p = 0.009). A correlation was also identified between global RV dysfunction and the initial pVO2eq (p = 0.045), final pVO2eq (p = 0.012), and difference in pVO2eq (p = 0.032). RV dysfunction is associated with a lower capacity to exercise; CR programs can be extended or modified in these patients.

Cardiac rehabilitation and caregivers challenges A scoping review

Abstract Funding Acknowledgements Type of funding sources: None. Objective Map the interventions directed to the caregiver of heart disease (HD)patients in cardiac rehabilitation programs (CRP) that promote their role and health. Methods Scoping Review guided by the Joanna Briggs Institute method. Two independent reviewers assessed articles for relevance and extracted and synthesized data. Inclusion criteria comprised articles published in English, Spanish and Portuguese since 1950. The following databases were searched: CINAHL Complete (Via EBSCO); Medline (via PubMed); Scopus, PEDro, e Repositórios Científicos de Acesso Aberto de Portugal (RCAAP). Results From 351 articles retrieved, ten were included in the review. Different interventions were identified directed to the caregiver of HD patients: educational interventions and lifestyle changes, physical exercise, psychological interventions/stress management, and a category "Other" with training interventions in basic life support, elaboration of guidelines/recommendations and training for the role of caregiver. Regarding the population, heart failure patient caregivers are the primary intervention targets, followed by caregivers of patients with ischemic disease and integrated into CRP. Regarding the context, there is a concern that the professional intervention with the caregivers should be mainly at home (home-based), using face-to-face and telehealth monitoring, often combined, with references also to the hospital context, primary health care and rehabilitation center. Conclusions and implications for the clinical practice: It was found that most of the identified cardiac rehabilitation interventions are aimed at the dyad HD patient and caregiver/family. Including specific interventions targeting caregivers improves the caregiver’s health and empowers him/her. Patients care planning should include interventions specifically aimed at them that result into health gains for caregivers and patients, aiming at the quality of care.

Adherence in Following Phase II Cardiac Rehabilitation Program in Patients with Coronary Artery Disease Post-revascularization

Purpose: The aim of this study is to describe the adherence of patients with coronary artery disease (CAD) after revascularization with Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) in initiating, sustaining, and completing phase II cardiac rehabilitation (CR) programs.Methods: This study is a descriptive cross sectional study design. Data is taken retrospectively using secondary data from medical records. The population of this study is post-revascularization CAD patients who undergo phase II CR in Dr. Hasan Sadikin General Hospital in 2019-2020 and all samples are taken using the total sampling method. The adherence is described as adherence with initiating, sustaining, and completing the CR program in the CABG and PCI groups and expressed in percentage.Results: There are 96 subjects who meet the inclusion and exclusion criteria in this study. The adherence for initiating the CR program is 94.6% in the CABG group and 100% in the PCI group. A total of 50 people (67.56%) in the CABG group and 16 people (72.72%) in the PCI group undergo each training session on time as programmed. A total of 57 people (77.02%) in the CABG group and 16 people (72.72%) in the PCI group complete12 training sessions regardless of the time required to complete them.Conclusion: Overall, the level of adherence following the CR phase II program in the CABG and PCI groups is quite high. Adherence to initiating and sustaining CR phase 2 in the PCI group was higher than in the CABG group.&#x0D; Keywords: adherence, cardiac rehabilitation, Coronary Artery Bypass Graft, Percutaneous Coronary Intervention

A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study

To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease. This study was a two-armparallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n=14), or the control group (n=14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks). Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27±19.41 out of 60 sessions (85.5%) compared to 36.46±23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention. The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improvingexercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term. ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.

Interdisciplinary management of obesity and overweight in cardiac rehabilitation: review of the Mexican Society for Heart Care (Sociedad Mexicana para el Cuidado del Corazón, SOMECCOR)

Obesity is a multifactorial disorder characterized by increased body adiposity with a wide prevalence in our country, at any age, and linked to major adverse consequences, including the development of heart disease. Cardiac rehabilitation (CR) programs are interdisciplinary interventions aimed not only at restoring the lost functionality of patients who have suffered a cardiovascular outcome, but also at correcting those risk factors that led to it and that interfere with its adaptive results. Obesity contributes to perpetuating heart disease risk and is often resistant to conventional lifestyle modifications. Establish guidelines in the recognition of obesity with care guidelines for patients with heart disease within CR programs and their interdisciplinary approach. Through an extensive bibliographical review and after an interdisciplinary discussion, this document was prepared to establish a position on the approach to obesity in the context of CR programs in patients with heart disease. Our Society recognizes the interdisciplinary approach of our patients with obesity and heart disease in its primary and secondary prevention, urges precision in its diagnosis and assessment, recommends that its primary axis must be based in the first instance on lifestyle modifications (physical training, nutritional care and psycho-emotional intervention), while pharmacological therapy and bariatric surgery could be coadjuvants in optimizing the results in selected patients.

Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior and Physical Fitness: the OPTICARE XL Randomized Controlled Trial.

Previously published results of the OPTICARE XL open label randomized controlled trial showed no added value of OPTICARE XL CR, a dedicated cardiac rehabilitation (CR) program for patients with obesity, with respect to health-related quality of life (primary outcome). This clinical trial studied the effects of OPTICARE XL CR on several secondary outcomes, which included body weight, physical activity, sedentary behavior, and physical fitness. Patients with coronary artery disease or atrial fibrillation and body mass index (BMI) ≥ 30 were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). OPTICARE XL CR is a 1-year group intervention, specifically designed for patients with obesity, and included aerobic and strength exercise, behavioral coaching, and an aftercare program. Standard CR consisted of a 6- to 12-week group aerobic exercise program, supplemented with cardiovascular lifestyle education. Study end points included body weight, physical activity, sedentary behavior (accelerometer), and physical fitness (6-Minute Walk Test and handgrip strength), which were evaluated 6months after the end of CR (primary end point) and 3months after the start of CR. Six months after completion of either program, improvements in body weight, physical activity, sedentary behavior, and physical fitness were similar between groups. Three months after CR start, patients randomized to OPTICARE XL CR showed greater weight loss (mean change = -3.6 vs -1.8kg) and a larger improvement in physical activity (+880 vs +481 steps per day) than patients randomized to standard CR. Patients allocated to OPTICARE XL CR lost significantly more body weight and showed promising results with respect to physical activity 3months after the start of CR; however, these short-term results were not expanded or sustained in the longer term. Patients with obesity do not benefit from standard CR programs. The new OPTICARE XL CR program showed its effects in the short term on weight loss and physical activity, and, therefore, redesign of the aftercare phase is recommended.

An Index for Evaluating Exercise Capacity Improvement After Cardiac Rehabilitation in Patients After Myocardial Infarction.

We investigated relationships among predictors of improvement in exercise capacity after cardiac rehabilitation programs in patients after acute myocardial infarction. We carried out a secondary analysis of data from 41 patients with a left ventricular ejection fraction ≥ 40% who underwent cardiac rehabilitation after the first myocardial infarction. Participants were assessed using a cardiopulmonary exercise test and stress echocardiography. A cluster analysis was performed, and the principal components were analyzed. Two distinct clusters with significantly different ( P = .005) proportions of response to treatment (peak VO 2 ≥ 1 mL/kg/min) were identified among patients. The first principal component explained 28.6% of the variance. We proposed an index composed of the top 5 variables from the first component to represent the improvement in exercise capacity. The index was the average of scaled O 2 uptake and CO 2 output at peak exercise, minute ventilation at peak, load achieved at peak exercise, and exercise time. The optimal cutoff for the improvement index was 0.12, which outperformed the peak VO 2 ≥ 1 mL/kg/min criterion in recognizing the clusters, with a C-statistic of 91.7% and 72.3%, respectively. The assessment of change in exercise capacity after cardiac rehabilitation could be improved using the composite index.

Hypoxic Conditioning in Rehabilitation and Secondary Prevention Programs in Cardiac Patients with Multimorbidity: a Review

INTORDUCTION. Patients with multiple chronic diseases are at higher risk of premature death, hospitalization, longer hospital stays, and reduced health-related quality of life compared to patients with a single disease. On the other hand, the presence of comorbid conditions limits the enrolment of traditional exercise-based cardiac rehabilitation programs. It is predicted that as life expectancy increases, the level of multimorbidity will increase, making it even more important to find new additional methods and technologies for the rehabilitation of cardiac patients with comorbidities. AIM. To analyze the data from the current publications or to define the validity and effectiveness of using different hypoxic conditioning regimens in cardiac patients with concomitant chronic pathology (arterial hypertension, obesity, diabetes mellitus, and chronic bronchopulmonary diseases) as well as in multimorbid elderly patients. MATERIAL AND METHODS. The search for relevant papers was carried out using the Medline, e-library, and Web of Science Core Collection databases, as well as the following keywords: “hypoxic conditioning”, “hypoxic training”, “hypoxic therapy”, “interval hypoxic therapy”, “intermittent hypoxia”, “hypoxic conditioning”, “interval hypoxia training”, and “hypoxic exposure”. The analysis included publications regarding the use of the hypoxic conditioning method in cardiac and elderly patients with multimorbid pathology, as well as publications on the use of the method in the rehabilitation of patients with certain nosologies to identify potential mechanisms in correcting bronchopulmonary violations and lipid and carbohydrate metabolism disorders. The last search date was April 05, 2022. RESULTS. Most of the analyzed studies proved that the hypoxic conditioning technology in passive interval exposure regimes is an effective method for non-pharmacological correction of cardiometabolic risks in cardiac patients with multimorbid pathology and can increase exercise tolerance, optimize hemodynamic parameters (HR, SBP and DBP), reduce the manifestations of bronchial obstruction and respiratory failure, and improve cognitive function and metabolic indicators. Personalized physical activity doses in oxygen-depleted ambient air appear to be promising, but require additional studies to establish optimal application protocols. CONCLUSION. The data presented may recommend hypoxic conditioning technologies for wider implementation in cardiac rehabilitation programs for patients with multimorbid pathologies.

Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial

Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia. Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures. Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression. Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).