Cardiac Rehabilitation Program In Patients Research Articles

Outcomes of Genetic Testing-Based Cardiac Rehabilitation Program in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention.

Objective There can be extreme variability between individual responses to exercise training, and the identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We aimed to screen the exercise-related gene sensitivity of patients with acute myocardial infarction after PCI by establishing the gene spectrum of aerobic exercise and cardiopulmonary function sensitivity, test the effect of individualized precision exercise therapy, and provide evidence for the establishment of a precision medicine program for clinical research. Methods Aerobic exercise- and cardiopulmonary function-related genes and single-nucleotide polymorphisms (SNPs) were obtained by data mining utilizing a major publicly available biomedical repository, the NCBI PubMed database. Biological samples from all participants underwent DNA testing. We performed SNP detection using Samtools. A total of 122 patients who underwent PCI were enrolled in the study. We screened the first 24 cases with a high mutation frequency for aerobic exercise- and cardiopulmonary function-related genes and the last 24 cases with a low mutation frequency and separated them into two groups for the exercise intervention experiment. Results In both the low mutation frequency group and the high mutation frequency group, after 8 weeks of exercise intervention, 6 MWT distance, 6 MWT%, VO2/kg at peak, and VO2/kg at AT were significantly improved, and the effect in the high mutation frequency group was significantly higher than that in the low mutation frequency group (6 MWT distance: 468 vs. 439, P=0.003; 6 MWT%: 85 vs. 77, P=0.002, VO2/kg at peak: 14.7 vs. 13.3, P=0.002; VO2/kg at AT: 11.9 vs. 13.3, P=0.003). Conclusions There is extreme variability between individual responses to exercise training. The identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We found that the subjects with a high mutation frequency in aerobic exercise and cardiopulmonary function-related genes achieved more cardiorespiratory fitness benefits in the aerobic exercise rehabilitation program and provided evidence for the establishment of a precision medicine program for clinical research.

Improving referral rates and utilization of a pediatric cardiac rehabilitation program for patients with congenital and pediatric acquired heart disease

BackgroundCardiac Rehabilitation Programs specifically for young patients with congenital and pediatric acquired heart disease are known to be beneficial but are relatively new. Referral, utilization, and insurance approval rates for a cardiac rehabilitation program that serves pediatric congenital and acquired heart disease populations have yet to be examined, but it is known that cardiac rehabilitation programs for adults with atherosclerotic disease have historically poor utilization. This study evaluated program metrics and barriers to participation for the congenital and pediatric acquired heart disease population. ObjectivesThe purpose of this study was to analyze rates of referral, utilization, and insurance approval as well as capture reasons for attrition. MethodsOutpatients ≥8 years old seen at Boston Children's Hospital with eligible diagnoses were captured from 01/2017 to 12/2020. Referral and participation numbers were compared to the total eligible and analyzed using frequency and percent counts. Patient demographics, diagnoses, insurance providers and authorizations, and reasons for attrition were tracked and analyzed. Results7558 unique patients met eligibility criteria; 175 total patients were referred to the cardiac rehabilitation program yielding a 2 % referral rate. Most of the referrals (69 %) had congenital heart disease (CHD), and the rest had pediatric acquired conditions. Insurance coverage was approved by 91 % of total participants contacted. Out of 175 referred, 75 (43 %) unique patients participated in the program (<1 % utilization rate). The majority (73 %) of participating patients were <21 years old. ConclusionDespite the proven benefit, referral and utilization rates for cardiac rehabilitation for patients with congenital and pediatric acquired heart disease are alarmingly low and up to 35-fold worse than the known low utilization rates for coronary heart disease. Insurance coverage was surprisingly not a barrier, and improving the insurance process and increasing awareness of referring providers emerged as important targets to address.

Barriers and facilitators to implementation of a home-based cardiac rehabilitation programme for patients with heart failure in the NHS: a mixed-methods study

ObjectivesThis study aimed to identify barriers to, and facilitators of, implementation of the Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme within existing cardiac rehabilitation services, and develop and refine...

The safety of exercise-based cardiac rehabilitation program in patients after Myocardial Infarction

Objective: The aim of the present review is to identify the safety of an exercise-based cardiac rehabilitation program in patients after myocardial infarction. Materials and Methods: The PubMed/Medline and Scopus/Elsevier electronic databases were searched. A search strategy was developed based on the intersection of 2 search themes: cardiac rehabilitation program and exercise safety. Results: The articles that finally met all the inclusion criteria and were analyzed, after the screening of the title, the summary and the whole text, were 4. A total of 180.946 patients who received cardiac rehabilitation were examined in this review and 124 complications were occurred: 71 cardiac arrests (11 fatal), 15 myocardial infarctions (2 fatal), and 31 non-life-threatening patients: angina, ventricular tachycardia, 1 orthopedic injury and 4 deaths from cardiorespiratory disorder. Discussion: The present review has demonstrated that individualized and prescribed exercise-based cardiac rehabilitation is safe and recommended. The complications of these programs appear to be of low risk and with no statistical importance. The exercise-based cardiac rehabilitation when combined with patient participation, proper equipment and educated physicians present a very safe clinical approach to cardiovascular patients.

Abstract 218: Aerobic And Strength Training Improves Functional Capacity In Diabetic Patients Undergoing Cardiac Rehabilitation

Background: Traditional cardiac rehabilitation (CR) focuses on aerobic training to improve functional capacity and recovery after cardiovascular events. The use of combined aerobic and strength training is not yet standard of care despite its potential for improving functional capacity. The aim of this study was to characterize the effectiveness of a combined aerobic and strength training CR program for patients living with diabetes in comparison to patients without diabetes. Methods: We retrospectively reviewed initial and final functional assessments for 167 patients participating in CR between 12/2019 - 9/2021. Functional capacity was assessed by the metabolic equivalent of task (METs) in a 6-minute walk test (6-MWT), arm curl reps, chair-to-stand reps, and timed up and go test. P-values were determined by the Mann Whitney U test and Wilcoxon signed rank test. Results: Cohort characteristics and outcomes are listed in Table 1. Diabetic and non-diabetic patients improved in all measures of functional capacity, with arm curls and chair-to-stand exhibiting the greatest change. There was no statistical difference in outcomes between groups. Conclusions: Diabetic patients had equivalent improvements in both aerobic and strength measures as their non-diabetic counterparts. This is an early dataset that highlights the effectiveness of combined aerobic and strength training to improve the quality of CR care for diabetic patients.

The Contribution of Exercise in Telemedicine Monitoring in Reducing the Modifiable Factors of Hypertension-A Multidisciplinary Approach.

The aim of this review was to explore the contribution of physical activity and exercise in the control and reduction of modifiable factors of arterial hypertension in telemedicine programs, assuming a multidisciplinary perspective. Searches were carried out following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and the research question defined using the PICOS approach (Population, Intervention, Comparator, Outcomes, Study design). The search strategy applied the following terms: blood pressure OR hypertension AND exercise OR physical activity AND telemedicine. The initial search identified 2190 records, but only 19 studies were considered eligible after checking for the inclusion and exclusion criteria. The following training variables were generally included: heart rate and heart rate reserve, respiratory rate, rate of perceived exertion and oxygen consumption, but no resistance training variables were found. The significant improvements on blood pressure parameters of participants diagnosed with hypertension tended to be transient. The exercise prescription was commonly based on general instructions and recommendations for exercise and hypertension. On the other hand, most of the studies including patients in cardiac rehabilitation programs used a personalized training program based on a baseline assessment, particularly following a cardiopulmonary exercise test. The inclusion of exercise professionals in multidisciplinary teams could provide a more person-oriented approach and the long-term maintenance of a healthy lifestyle.

Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis.

Background: Exercise-based cardiac rehabilitation (CR) programs are used for improving prognosis and quality of life in patients with cardiovascular disease (CVD). Nonetheless, adherence to these programs is low, and exercise-based CR programs based on virtual reality (i.e., exergaming) have been proposed as an alternative to conventional CR programs. However, whether exergaming programs are superior to conventional CR programs in patients with CVD is not known. Objective: This systematic review with meta-analysis was conducted to explore whether exergaming enhances exercise capacity, quality of life, mental health, motivation, and exercise adherence to a greater extent than conventional CR programs in patients with CVD. Method: Electronic searches were carried out in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases up to June 2021. Meta-analyses were performed using robust variance estimation with small-sample corrections. The effect sizes were calculated as the mean differences (MD) or standardized mean differences (SMD) as appropriate. The SMD magnitude was classified as trivial (<0.20), small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Heterogeneity was interpreted based on the I2 statistics as low (25%), moderate (50%), or high (75%). Results: Pooled analyses showed no differences between exergaming and conventional CR programs for enhancing exercise capacity (i.e., distance covered in the six-minute walk test) (MD+ = 14.07 m (95% confidence interval (CI) −38.18 to 66.32 m); p = 0.426) and mental health (SMD+ = 0.17 (95% CI −0.36 to 0.70); p = 0.358). The results showed a small, statistically nonsignificant improvement in quality of life in favor of exergaming (SMD+ = 0.22 (95% CI = −0.37 to 0.81); p = 0.294). Moderate heterogeneity was found for exercise capacity (I2 = 53.7%), while no heterogeneity was found for quality of life (I2 = 3.3%) and mental health (I2 = 0.0%). Conclusions: Exergaming seems not to be superior to conventional CR programs for improving exercise capacity, quality of life, or mental health in patients with CVD.

Cardiac Rehabilitation in Patients with Peripheral Artery Disease-A Literature Review in COVID-19 Era.

Cardiac rehabilitation (CR) is an integral part of the management of various cardiovascular disease such as coronary artery disease (CAD), peripheral artery disease (PAD), or chronic heart failure (CHF), with proven morbidity and mortality benefits. This article aims to review and summarize the scientific literature related to cardiac rehabilitation programs for patients with PAD and how they were adapted during the COVID-19 pandemic. The implementation of CR programs has been problematic since the COVID-19 pandemic due to social distancing and work-related restrictions. One of the main challenges for physicians and health systems alike has been the management of PAD patients. COVID-19 predisposes to coagulation disorders that can lead to severe thrombotic events. Home-based walking exercises are more accessible and easier to accept than supervised exercise programs. Cycling or other forms of exercise are more entertaining or challenging alternatives to exercise therapy. Besides treadmill exercises, upper- and lower-extremity ergometry also has great functional benefits, especially regarding walking endurance. Supervised exercise therapy has a positive impact on both functional capacity and also on the quality of life of such patients. The most effective manner to acquire this seems to be by combining revascularization therapy and supervised exercise. Rehabilitation programs proved to be a mandatory part of the integrative approach in these cases, increasing quality of life, and decreasing stress levels, depression, and anxiety.

Hybrid telerehabilitation in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction and preserved left ventricular ejection fraction-the randomised clinical trial

Abstract Background Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and its diagnosis is often associated with limited physical activity. Little is known about cardiac rehabilitation programs for patients with HCM. Therefore the novel hybrid cardiac telerehabilitation (HCTR) model consisting of hospital-based rehabilitation and home-based telemonitored rehabilitation might be an option to improve physical capacity in patients with HCM. Purpose To evaluate the safety, effectiveness and adherence to HCTR in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction. Methods The study group comprised 60 patients with HCM (51.1±13.3 years; NYHA II-III; LV ejection fraction 66.1±6.9%). Patients were randomised (1:1) to either HCTR program (hospital-based rehabilitation [1 month] based on cycloergometer training and home-based telemonitored rehabilitation [2 months] based on Nordic walking, five times a week, at 40–70% of maximal estimated heart rate) - training group (TG), or to a control group (CG). All patients had implantable cardioverter-defibrillator. In order to perform home-based telemonitored rehabilitation, a special device was used which enabled patients to: (1) do Nordic walking training according to a preprogrammed plan, (2) record and send electrocardiograms (ECGs) via mobile phone network to the monitoring centre. The moments of automatic ECGs registration were pre-set and coordinated with exercise training. The effectiveness of HCTR was assessed by changes - delta (Δ) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) as a result of comparing t (s), pVO2 (ml/kg/min), 6-MWT (m) from the beginning and the end of the program. Results Safety of HCTR. Neither death nor other serious adverse events occurred during HCTR. We did not observe any ICDs intervention during the HCTR. Effectiveness of HCTR: Within-group analysis: t, pVO2, 6-MWT increased significantly in TG: t 657±183 vs 766±181 (p&amp;lt;0.001), pVO2 19.2±5.0 vs 20.6±4.9 (p=0.007), 6-MWT 445±88 vs 551±77 (p&amp;lt;0.001). In the untrained CG, the unfavourable results were observed: 695±198 vs 717±187 (p=0.114), pVO2 21.2±5.1 vs 21.1±5.6 (p=0.723), 6-MWT 512±83 vs 536±84 (p=0.061). Between-group analysis: The differences between TG and CG were statistically significant: in Δt (p&amp;lt;0.001); ΔpVO2 (p=0.012); Δ6-MWT (p&amp;lt;0.001). Adherence to HCTR: In TG 28 patients (93%) completed the HCTR program. Two patients did no undergo HCTR because of personal issues. Conclusion Hybrid cardiac telerehabilitation in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction is safe and effective. The adherence to HCTR is high. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Statutory work in The Cardinal Stefan Wyszyński National Institute of Cardiology in Warsaw, Poland

Short- and long-term effects of a cardiac rehabilitation program in patients implanted with a left ventricular assist device.

The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in LVAD as HTx patients in the short term and whether its effects in LVAD patients persist over time. Twenty-five LVAD patients were evaluated by functional and psychological tests at admission (T0) and discharge (T1) of a 4-week inpatient structured rehabilitation program, and follow-ups 3 (T2), 6 (T3), and 12 months (T4) after discharge. Twenty-five matched HTx patients were also studied from T0 to T1 to compare the improvements in the six-minute walk test (6MWT). The quality-of-life scores substantially improved in LVAD patients and the 6MWT showed the same functional recovery as in HTx patients from T0 to T1. After T1, numerous LVAD patients withdrew from the study. However, the 6MWT outcome increased further from T1 to T3, with a positive trend during the follow-ups. Hemoglobin and the ventilatory performance increased, and the psychological perception of heart-failure symptoms and pain further improved at T2. In conclusion, exercise-based rehabilitation programs provide similar beneficial effects in LVAD and HTx patients, without deterioration in LVAD patients up to 12 months after discharge.

C23. CARDIAC REHABILITATION AFTER CONGENITAL HEART DISEASE SURGERY

Abstract Background The survival rates of children with congenital heart disease (CHD) have dramatically increased due to the contribution of advance in medical and surgical care. Nonetheless, patients often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac rehabilitation programs in patients after CHD surgery have shown improvement in peak-VO2 and cardio respiratory fitness . Paradoxically, only a minority of CHD patients receives formal cardiac rehabilitation and are often encouraged towards a sedentary lifestyle as a result of overprotection and uncertainty as to which physical activities and with what intensity should be recommended. We therefore present case report about cardiac rehabilitation after CHD surgery based on current evidence to show the importance and benefit in CHD patient Case Illustration A 17 years old female patient came to Rehab clinic after Valve replacement and ASD surgical closure for severe mitral and tricuspid regurgitation, ASD secundum and Cor triatiatum. Her last stay in hospital was prolonged due to several complications. Her appearance was frail and she even was not able to walk. After a thorough examination and 6 minutes walk test, she went phase II rehabilitation. After Cardiac rehabilitation, she got better and her cardio respiratory fitness was improved. Based on her result in 6 minutes walk test and calculation, She was capable to do daily activity life on her own and ready to continue phase III rehabilitation. Discussion Patient who have underwent cardiac rehabilitation after congenital heart disease surgery have been presented. Systematic Examination should be performed prior cardiac rehabilitation in order to give an individualized exercise prescription.

C23. CARDIAC REHABILITATION AFTER CONGENITAL HEART DISEASE SURGERY

Abstract Background The survival rates of children with congenital heart disease (CHD) have dramatically increased due to the contribution of advance in medical and surgical care. Nonetheless, patients often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac rehabilitation programs in patients after CHD surgery have shown improvement in peak-VO2 and cardio respiratory fitness . Paradoxically, only a minority of CHD patients receives formal cardiac rehabilitation and are often encouraged towards a sedentary lifestyle as a result of overprotection and uncertainty as to which physical activities and with what intensity should be recommended. We therefore present case report about cardiac rehabilitation after CHD surgery based on current evidence to show the importance and benefit in CHD patient Case Illustration A 17 years old female patient came to Rehab clinic after Valve replacement and ASD surgical closure for severe mitral and tricuspid regurgitation, ASD secundum and Cor triatiatum. Her last stay in hospital was prolonged due to several complications. Her appearance was frail and she even was not able to walk. After a thorough examination and 6 minutes walk test, she went phase II rehabilitation. After Cardiac rehabilitation, she got better and her cardio respiratory fitness was improved. Based on her result in 6 minutes walk test and calculation, She was capable to do daily activity life on her own and ready to continue phase III rehabilitation. Discussion Patient who have underwent cardiac rehabilitation after congenital heart disease surgery have been presented. Systematic Examination should be performed prior cardiac rehabilitation in order to give an individualized exercise prescription.

Hybrid telerehabilitation in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction and preserved left ventricular ejection fraction-the randomised clinical trial

Abstract Background Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and its diagnosis is often associated with limited physical activity. Little is known about cardiac rehabilitation programs for patients with HCM. Therefore the novel hybrid cardiac telerehabilitation (HCTR) model consisting of hospital-based rehabilitation and home-based telemonitored rehabilitation might be an option to improve physical capacity in patients with HCM. Purpose To evaluate the safety, effectiveness and adherence to HCTR in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction. Methods The study group comprised 60 patients with HCM (51.1±13.3 years; NYHA II-III; LV ejection fraction 66.1±6.9%). Patients were randomised (1:1) to either HCTR program (hospital-based rehabilitation [1 month] based on cycloergometer training and home-based telemonitored rehabilitation [2 months] based on Nordic walking, five times a week, at 40–70% of maximal estimated heart rate) - training group (TG), or to a control group (CG). All patients had implantable cardioverter-defibrillator. In order to perform home-based telemonitored rehabilitation, a special device was used which enabled patients to: (1) do Nordic walking training according to a preprogrammed plan, (2) record and send electrocardiograms (ECGs) via mobile phone network to the monitoring centre. The moments of automatic ECGs registration were pre-set and coordinated with exercise training. The effectiveness of HCTR was assessed by changes - delta (Δ) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) as a result of comparing t (s), pVO2 (ml/kg/min), 6-MWT (m) from the beginning and the end of the program. Results Safety of HCTR. Neither death nor other serious adverse events occurred during HCTR. We did not observe any ICDs intervention during the HCTR. Effectiveness of HCTR: Within-group analysis: t, pVO2, 6-MWT increased significantly in TG: t 657±183 vs 766±181 (p&amp;lt;0.001), pVO2 19.2±5.0 vs 20.6±4.9 (p=0.007), 6-MWT 445±88 vs 551±77 (p&amp;lt;0.001). In the untrained CG, the unfavourable results were observed: 695±198 vs 717±187 (p=0.114), pVO2 21.2±5.1 vs 21.1±5.6 (p=0.723), 6-MWT 512±83 vs 536±84 (p=0.061). Between-group analysis: The differences between TG and CG were statistically significant: in Δt (p&amp;lt;0.001); ΔpVO2 (p=0.012); Δ6-MWT (p&amp;lt;0.001). Adherence to HCTR: In TG 28 patients (93%) completed the HCTR program. Two patients did no undergo HCTR because of personal issues. Conclusion Hybrid cardiac telerehabilitation in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction is safe and effective. The adherence to HCTR is high. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Statutory work in The Cardinal Stefan Wyszyński National Institute of Cardiology in Warsaw, Poland

Standardizing Exercise Prescription Parameters for Patients with LVAD Placement as a Destination Device: A Scoping Review of Effectiveness and Impact on Functional Capacity and Quality of Life

<h3>Objective(s)</h3> To summarize current knowledge regarding the impact of exercise training in patients supported by LVADs and serve as a foundation for clinicians to reference when tailoring interventions to improve FC in patients treated with modern durable LVADs. <h3>Data Sources</h3> Author searched PubMed, Ovid, CCTR, CDSR, CINAHL, Proquest, and Google Scholar starting on January 31, 2021. <h3>Study Selection</h3> Studies from 2015 to current, written in English, subjects at least 18 years of age with end-stage HF, ineligible for heart transplantation, who received an LVAD with the intent of destination or terminal therapy, and various forms of publication (systematic reviews, RCT, cohort studies, cross-sectional studies, observational studies, meta-analyses, retrospective studies, and case reports), were included. <h3>Data Extraction</h3> Arksey and O'Malley's framework and the PRISMA Extension for Scoping Reviews guided data synthesis. Collected data independently extracted by one owner. <h3>Data Synthesis</h3> 15,179 articles found in the three search strategy attempts, 22 were included. Studies assessing the impact of exercise training on quality of life (QofL) reported that moderate intensity is safe and effective in improving cardiopulmonary outcomes and is associated with favorable QofL parameters. Majority of included studies also indicated that LVADs can support submaximal exercise, but are not sufficient during peak exertion. <h3>Conclusions</h3> Cardiac rehabilitation programs for patients with LVAD placement as a destination therapy require a multimodal approach with specific exercise training parameters. Methods of delivery should encompass both aerobic exercises and aerobic strength training with special attention to working at a moderate level intensity in order to improve cardiopulmonary outcomes without adverse events. In addition, implementation of a cardiac rehabilitation program can lead to major improvement in patient's perceived QofL. <h3>Author(s) Disclosures</h3> No conflicts of interest.

The impact of the cardiac rehabilitation program in patients with mid-range heart failure (40-50%) in improving cardio respiratory predictors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central Methods We studied 30 patients (P) with ejection fraction (EF) 40-50%, in a number of 198 P that participated in cardiac rehabilitation program (CRP). Of these P, 24 (80%) male and 6 (20%) female, 20 P were diagnosed myocardial infarction with ST-segment elevation, 2 P myocardial infarction non ST and 8 P with myocardial hypertrophy non ischemic. Of these P 30% were diabetics, 56% hypertension, 70% dyslipidemia, 36% smokers previous to CRP and body mass index 26,3 medium. All P were submitted to previous echocardiogram, cardiopulmonary exercise testing (CET) and a rehabilitation program minimum 4 sessions and maximum 52 sessions. At the end of the total sessions the echocardiogram and CET were repeated. Results Of the 30 P that participated in CRP only 20 completed the program, while the other 10 P dropped out because of social and economic problems. Of the P that completed the CRP, 70% got better on EF, 80% improved VE/VCO2 slope &amp;lt; 33 therefore are classified VC-II in ventilatory classification (VC), 5% VE/VCO2 slope &amp;gt; 40 VC-III classification, and 15% maintained the initial classification. 50% of the P increased at least one level metabolic equivalent of task (MET) from the first CET. Only 3 of the 20 patients came, once, to the hospital after the CRP with heart failure, and one died but did not fulfill the program. Conclusion Patients with mid-range heart failure submitted to a CRP can improve cardiorespiratory predictors, leading to a better quality of life. However, it is important to find solutions to minimize the causes that make patients to give up CRP.

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review.

BackgroundExercise intensity in exercise training programs is an important determinant of program efficacy, such as improvement in exercise capacity and quality of life (QOL). It is not well known whether differently applied exercise intensities are efficacious when used in exercise-based cardiac rehabilitation programs for patients with pulmonary arterial hypertension (PAH).MethodsThree databases (PubMed, EMBASE, and CINAHL) were searched with the following inclusion criteria: comparative study of exercise interventions for patients with pulmonary arterial hypertension. Three clinical specialists (a physician, nurse, and exercise physiologist) selected the included articles using the process of systematic review. Included articles were grouped according to aerobic exercise intensity: low, moderate-to-vigorous, and vigorous. The level of evidence for each study was rated using Sackett’s levels of evidence.ResultsOf 1,452 studies reviewed, 8 were included according to the inclusion criteria (3 randomized controlled trials (RCTs), 3 prospective studies, and 2 case series). Exercise capacity for a six-minute walk distance (mean: 57.7 m) and QOL improved in the above moderate intensity group, while the low intensity group did not show improvement after intervention. For termination criteria, data obtained from the reviewed articles were not sufficient to suggest any exercise intensity recommendations for patients with pulmonary arterial hypertension.DiscussionThe findings in this study suggest that at least moderate aerobic exercise intensity is needed to significantly improve six-minute walk distance and QOL in individuals diagnosed with World Health Organization Group 1 of pulmonary arterial hypertension. There is a need for prospective RCTs comparing different exercise intensities in this patient population.

Cardiovascular Rehabilitation Increases Walking Distance in Patients With Intermittent Claudication. Results of the CIPIC Rehab Study: A Randomised Controlled Trial

To examine whether a cardiac rehabilitation programme in a community based setting for patients with intermittent claudication (IC) affects walking ability, quality of life, and changes in health behaviour. The trial investigated a cross sector cardiovascular rehabilitation programme compared with usual care for patients having non-operative management. The trial allocated 118 patients, with 1:1 individual randomisation to either an intervention or control group. Data were collected at a department of vascular surgery and at a healthcare centre in Denmark. The rehabilitation intervention consisted of usual care plus 12 weeks of exercise training, pedometer, health education, and text messages. The primary outcome was maximum walking distance at six months measured by treadmill walking test. The secondary outcomes were maximum walking distance at 12 months and pain free walking distance measured by treadmill walking test, healthy diet, level of physical activity, and quality of life (QoL) at six and 12 months. In the intervention group, 46 participants were analysed, with 47 in the control group. Following three months of rehabilitation, a 37% difference (95% CI 1.10 - 1.70; p= .005) was found between groups in maximum walking distance at six and 12 months, in favour of the intervention group. The same positive effect was found in physical activity, QoL, and healthy diet, but was not statistically significant in pain free walking distance and smoking. A specialised community based cardiac rehabilitation programme for patients with IC showed statistically and clinically significant effects on maximum walking distance, physical activity, quality of life, and healthy diet, but not on pain free walking distance and smoking, compared with usual care without rehabilitation.

Motivating patients in cardiac rehabilitation programs: A multicenter randomized controlled trial.

Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.

Impact of exercise based cardiac rehabilitation program in patients with transcatheter aortic valve replacement

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Due to the increase in global prevalence of degenerative valve disease, aortic stenosis (AS) has played a preponderant role in the cardiovascular scenario, especially in patients undergoing transcatheter aortic valve replacement (TAVR). An alternative management for this patients are the cardiac rehabilitation programs (CRP); however, their effect has not been completely understood, both in exercise capacity and quality of life, but neither in the improvement of cardiopulmonary performance and other cardiovascular outcomes. Purpose: To evaluate the effect of the CRP on exercise tolerance and cardiopulmonary performance in patients with AS undergoing TAVR. Methods: A cohort study was conducted including 26 patients with AS undergoing TAVR and divided into an intervention group who performed a 4-week supervised training program in the Cardiac Rehabilitation Service and a control group to whom instructions and recommendations to performed unsupervised exercise at home were given. Demographic and clinical data (VO2Max, METS12, oxygen pulse, heart rate, double product, left ventricular ejection fraction, body mass index) were collected at baseline and after a 4-week follow-up. Results: 15 patients were included in the intervention group and 11 patients in the control group. There were no baseline significant differences between groups. After the intervention, significant differences were observed in the METS 12 final gain variable between the control and intervention group (4.55 vs 3.1 p = 0.01). Intergroup analysis showed significant differences (percentage changes) in the intervention group with an increase of METS12 (67.4%, p = 0.001), oxygen pulse (18.21%, p = 0.01), final METS (39.47% p = 0.001) and a decrease in VO2 recovery time (-12.5%, p = 0.05), in the ergometric performance index by heart rate (-38.17%, p = 0.001) and by double product (-38.1%, p = 0.001). Conclusions A 4-week cardiac rehabilitation program is effective to improve exercise tolerance and cardiopulmonary response in patients with AS undergoing TAVR; improvement was statistically significant in METS12, oxygen pulse, VO2 recovery time, METS-load and ergometric performance index for heart rate and double product. METS12 final gain was statistically significant in intervention group in comparison with the control group. Abstract Figure. Control vs Intervention Group (METS12)

Influence of inspiratory muscle strength on exercise capacity before and after cardiac rehabilitation

Background/Aims Coronary artery bypass grafting is a complex procedure that triggers a series of clinical and functional complications. The reduction of inspiratory muscle strength that persists during the late postoperative period has been suggested as an important determinant of functional capacity after coronary artery bypass grafting. The aim of this study was to investigate whether inspiratory muscle strength, functional capacity and quality of life are determinants of exercise capacity before and after a short-term phase II cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery. Methods A prospective quasi-experimental study was undertaken with 20 patients who had recevied coronary artery bypass surgery. All patients completed a short-term, moderate-to-high intensity inspiratory muscle training programme, followed by aerobic and resistance exercise, two times a week for 12 weeks, totalling 24 sessions, under the direct supervision of a physical therapist. Results Pre-intervention, peak oxygen consumption (peak VO2) was associated with maximum inspiratory pressure (β=0.037; 95% confidence interval 0.01–0.06; P=0.002). Post-intervention, peak VO2 was associated with maximum inspiratory pressure (β=0.03; 95% confidence interval 0.007–0.053; P=0.014) and the 6-Minute Walk Test (β=0.007; 95% confidence interval, 0.001–0.013; P=0.024). Conclusions Inspiratory muscle strength influences exercise capacity before and after a short-term cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery.