Cardiac Rehabilitation Research Articles

The Role of Wearable Devices in Chronic Disease Monitoring and Patient Care: A Comprehensive Review.

Wearable health devices are becoming vital in chronic disease management because they offer real-time monitoring and personalized care. This review explores their effectiveness and challenges across medical fields, including cardiology, respiratory health, neurology, endocrinology, orthopedics, oncology, and mental health. A thorough literature search identified studies focusing on wearable devices' impact on patient outcomes. In cardiology, wearables have proven effective for monitoring hypertension, detecting arrhythmias, and aiding cardiac rehabilitation. In respiratory health, these devices enhance asthma management and continuous monitoring of critical parameters. Neurological applications include seizure detection and Parkinson's disease management, with wearables showing promising results in improving patient outcomes. In endocrinology, wearable technology advances thyroid dysfunction monitoring, fertility tracking, and diabetes management. Orthopedic applications include improved postsurgical recovery and rehabilitation, while wearables help in early complication detection in oncology. Mental health benefits include anxiety detection, post-traumatic stress disorder management, and stress reduction through wearable biofeedback. In conclusion, wearable health devices offer transformative potential for managing chronic illnesses by enhancing real-time monitoring and patient engagement. Despite significant improvements in adherence and outcomes, challenges with data accuracy and privacy persist. However, with ongoing innovation and collaboration, we can all be part of the solution to maximize the benefits of wearable technologies in healthcare.

Effect of Masking Secondary to the COVID-19 Pandemic on Functional Capacity Improvement in Cardiac Rehabilitation.

Given the difficulty to perform exercise training wearing a mask, we examined differences in functional capacity improvement between masking during the coronavirus disease 2019 (COVID-19) pandemic and non-masking prior to the pandemic for patients undergoing cardiac rehabilitation (CR). Records of 660 patients who underwent and completed≥18 sessions of CR in 2018 (n=318, non-masking) and in 2022 (n=342, masking) at an academic health system were analyzed. The primary outcome was post-CR change in functional capacity in metabolic equivalents (MET) measured by exercise stress test. Sessions of CR participation and changes in depression, anxiety, and quality of life scores were secondary outcomes. We used multivariable linear regression to adjust for differences in baseline CR outcome measures, demographics, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk, and comorbid conditions. Baseline age (64.6±0.46yr), sex (28% female), and racial distribution (85% white) were similar between the masking and non-masking groups. Non-masking patients were more likely to be classified in the AACVPR high risk category and had lower anxiety scores at baseline compared to masking patients. After CR, both groups had similar and significant improvements in depression, anxiety, and quality of life scores, but the improvement in functional capacity was lower in the masking group (-0.62±0.12MET, P <.001) compared to the non-masking group. Results remained significant after multivariable adjustment. Cardiac rehabilitation patients requiring masking during the COVID-19 pandemic had less improvement in functional capacity than patients who did not wear masks during CR prior to the pandemic. Interventions to mitigate the potential side effects of masking for CR patients may require further exploration.

Effect of Cardiac Rehabilitation on Cardiorespiratory Fitness in Patients With Acute Myocardial Infarction: Role of Diabetes Mellitus and Glycated Hemoglobin Level.

Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels. Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period. In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9±1.5 vs. 3.7±3.2 mL/kg/min, P <.001). Among patients with DM, those with HbA1c levels<7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c≥7% (2.7±1.5 vs. 1.1±1.8 mL/kg/min, P <.001) during the follow-up period. Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.

Effectiveness of Home-Based Cardiac Rehabilitation with Optimized Exercise Prescriptions Using a Mobile Healthcare App in Patients with Acute Myocardial Infarction: A Randomized Controlled Trial.

Despite the effectiveness of cardiac rehabilitation (CR), the actual participation rate in CR is low. While home-based CR offers a viable alternative, it faces challenges in participation due to factors such as a lack of self-motivation and fear of exercising without supervision. Utilizing a mobile healthcare application (app) during counseling may be an effective strategy for patients. Therefore, the aim of this study was to assess whether 6 weeks of home-based CR with exercise readjustment using a mobile app is an effective therapy for patients with acute myocardial infarction (AMI). Post-AMI patients eligible for home-based CR were randomized into the intervention group (CR-Mobile) and the control group, which followed the usual home-based CR protocol (CR-Usual). Both groups participated in a 6-week home-based CR program, with exercise readjustment and encouragement carried out every 2 weeks. The CR-Mobile group was supervised using data recorded in the mobile app, while the CR-Usual group was supervised via phone consultations. The primary outcome measured was maximal oxygen consumption (VO2max). Within-group comparisons showed significant improvements in VO2max (PCR-Mobile = 0.011 vs. PCR-Usual = 0.020) and METs (PCR-Mobile = 0.011 vs. PCR-Usual = 0.011) for both groups. These findings suggest that a 6-week home-based CR program with exercise readjustment using a mobile app can potentially enhance exercise capacity as effectively as verbal supervision.

Healthy Lifestyle and Cardiac Rehabilitation for Weight Loss.

Considerable current interest is directed at pharmacological agents for producing significant weight loss. However, healthy lifestyle choices can also lead to clinically meaningful weight loss and improvements in cardiovascular disease (CVD) risk factors. In this review, we summarize the recent research from our PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) randomized controlled trial and review previous data on the potential benefits of cardiac rehabilitation and exercise training (CRET) programs to produce weight loss and improvements in CVD risk factors. Although obesity medications are becoming extremely attractive for secondary and even primary CVD prevention, high-intensity non-pharmacological therapies with healthy lifestyle choices reviewed herein can also lead to substantial health improvements in patients with obesity, including improvements in body weight and other body composition parameters as well as overall CVD risk.

Structured diabetes care routines in cardiac rehabilitation are associated with increased diabetes detection and improved treatment after myocardial infarction: a nationwide observational study

BackgroundDespite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI.MethodsCenter-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI.ResultsRoutine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014).ConclusionsHaving structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertain causality.

Impact of lifestyle interventions in cardiac rehabilitation for individuals with ischaemic heart disease: a prospective cohort study

Background/Aims Lifestyle interventions are recommended in cardiac rehabilitation guidelines to reduce cardiovascular risk and prevent heart attacks. Therefore, it is important to investigate their effectiveness in primary healthcare settings to improve outcomes in individuals with ischaemic heart disease. The aim of this study was to examine the association between adherence and completion of cardiac rehabilitation and outcomes related to waist circumference and physical performance in primary healthcare settings. Methods A total of 514 individuals diagnosed with ischaemic heart disease were enrolled from ten primary healthcare settings in the Central Denmark Region to participate in cardiac rehabilitation. Participants were categorised based on the completion of a dietary intervention. Changes in waist circumference from baseline to the 12-week follow-up were measured. Adherence to the exercise intervention was assessed based on participation in ≥80% or &lt;80% of training sessions. Changes in physical performance, specifically a 10% improvement in the Watt-max bicycle test, were evaluated over the same period. Linear and logistic regression analyses were conducted, both crude and adjusted for potential confounders. Results Of the 514 participants, 317 (70.8%) who completed the dietary intervention experienced an average reduction of –1.32 cm (95% confidence interval: –1.91 to –0.74 cm) in waist circumference, compared to –0.50 cm for non-completers (P=0.019). Additionally, 276 (56.2%) participants adhered to ≥80% of the exercise intervention, with 237 (66.7%) showing an improvement of ≥10% in Watt-max from baseline to follow-up. Individuals who adhered to ≥80% of the exercise intervention were twice as likely to achieve a ≥10% improvement in Watt-max compared to those with &lt;80% adherence (P=0.334). Conclusions Both dietary and exercise interventions administered in primary healthcare settings were associated with positive changes in waist circumference and physical performance. Implications for practice Dietitians should focus on motivating patients to complete dietary interventions, which can significantly reduce waist circumference. Physiotherapists should emphasise the importance of adherence to exercise programmes. Encouraging patients to meet adherence targets, both in structured rehabilitation and home-based activities, is vital to achieve long-term health benefits.

Evaluation of a digital patient education programme in patients with coronary artery disease, a survey-based study

IntroductionPatient education programmes focusing on risk factor modification and lifestyle changes are well established as part of cardiac rehabilitation in patients with coronary artery disease (CAD). As participation rates are low, digital patient education programmes (DPE) are interesting alternatives to increase access. Understanding patients’ perceptions of DPE are important in terms of successful implementation in clinical practice but are not well known. Therefore, the aim of this study was to assess patients’ perceptions of using a DPE in terms of end-user acceptance and usability, perceived significance for lifestyle changes and secondary preventive goal fulfilment in patients with CAD.MethodsThis was a cross-sectional survey-based study. The survey was distributed to all 1625 patients with acute coronary syndrome or chronic CAD with revascularisation, who were registered users of the DPE between 2020 and 2022 as part of cardiac rehabilitation. The survey contained 64 questions about e.g., acceptance and usability, perceived significance for making lifestyle changes and secondary preventive goal fulfilment. Patients who had never logged in to the DPE received questions about their reasons for not logging in. Data were analysed descriptively.ResultsA total of 366 patients (mean age: 69.1 ± 11.3 years, 20% female) completed the survey and among those 207 patients (57%) had used the DPE. Patients reported that the DPE was simple to use (80%) and improved access to healthcare (67–75%). A total of 69% of the patients were generally satisfied with the DPE, > 60% reported that the DPE increased their knowledge about secondary preventive treatment goals and approximately 60% reported having a healthy lifestyle today. On the other hand, 35% of the patients would have preferred a hospital-based education programme. Among the 159 patients (43%) who had never used the DPE, the most reported reason was a perceived need for more information about how to use the DPE (52%).ConclusionsThis study shows an overall high level of patient acceptance and usability of the DPE, which supports its continued development and long-term role in cardiac rehabilitation in patients with CAD. Future studies should assess associations between participation in the DPE and clinical outcomes, such as secondary preventive goal fulfilment and hospitalisation.

Opting out of cardiac rehabilitation in local community healthcare services: Patients'perspectives and reflections.

Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well-establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients'internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients'decision to opt out of CR was multidimensional and based on a combination of factors. Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.

Effectiveness of Cardiac Rehabilitation in Enhancing Clinical Outcomes for Coronary Artery Disease: A Systematic Analysis.

Cardiac rehabilitation (CR) is a structured intervention aimed at improving the clinical outcomes for patients with coronary artery disease (CAD). This systematic review assesseshow well different types of CR, such as high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), Nordic walking (NW), and home-based cardiac rehabilitation (HBCR), improve exercise capacity, quality of life, and lower death and illness rates. The objective is to assess the effectiveness of cardiovascular rehabilitation programs in enhancing clinical outcomes for patients diagnosed with CAD. A comprehensive literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model across Google Scholar, EMBASE, PubMed, Medline, and web browsers. Keywords such as "cardiac rehabilitation," "coronary artery disease," "exercise testing," "VO2 peak," and "physical activity" were used in different combinations. Studies were included if they were randomized controlled trials, observational studies, or longitudinal studies published after 2013 in English, with a focus on the impact of CR on CAD. Articles were excluded if they were reviews, meta-analyses, or did not meet the keyword requirements. A total of 375 articles were initially identified with relevant citations. After further screening, 10 studies met the inclusion criteria for analysis. The studies reviewed demonstrated that all forms of CR, including HIIT, MICT, NW, and HBCR, significantly improved exercise capacity and quality of life, and reduced depression severity among CAD patients. Nordic walking showed marked improvements in functional capacity, while HIIT resulted in higher VO2 peak levels compared to moderate-intensity exercise. Home-based CR showed greater adherence rates, especially among older patients and those with strong family support. The results also highlighted the importance of individualized exercise programs to enhance adherence and outcomes. Cardiac rehabilitation is a vital component of secondary prevention in CAD patients, significantly improving clinical outcomes, including exercise capacity, quality of life, and mortality rates. The findings underscore the importance of maintaining and expanding access to CR programs and tailoring interventions to patient needs to optimize long-term health outcomes. Future research should explore the comparative effectiveness of different CR modalities and strategies to increase patient adherence.

A Systematic Review of the Completion of Cardiac Rehabilitation Programs for Adults Aged 18-50 Years.

To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50yr and describe how core components were reported, measured, and tailored to those under 50yr. Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50yr) who had participated in a CR program. Out of the articles screened (n=24,517), 33 reports across 31 independent studies were considered eligible (n=1958 patients aged ≤50yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7d to 20wk, with most (65%) ranging between 6 and 12wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.

Assessing feasibility and sex-related inequity in the cardiac rehabilitation quality indicators in Manitoba.

The cardiac rehabilitation quality indicators (CRQIs) developed by the Canadian Cardiovascular Society provide a means to standardize program assessment and identify sex-related inequities. No formal evaluation of the CRQIs has been conducted in Manitoba. An environmental scan for the CRQIs was performed using data in the electronic medical record at two cardiac rehabilitation (CR) sites in Winnipeg for 2016-2019 referrals. Of the 8116 referrals, 7758 (5491 males and 2267 females) had geographical access and were eligible for CR. The Manitoba Centre for Health Policy Data Quality Framework informed the data quality assessment. Thirteen CRQIs were available; four were considered high quality; nine demonstrated moderate to significant missing data. In addition to missing values, potential misclassification of risk (CR-4) and physiologically implausible and invalid dates were assessed and identified (CR-13 and CR-17). Each site had a physician medical director (CR-31) and a documented emergency response strategy (CR-32). Only high-quality data were evaluated for sex-related differences using chi-square and median tests. Women had lower enrollment (CR-3), and more women enrolled after the median of 41 days (CR-2b). Engagement with CR partners, including frontline staff, and utilizing strategies to assess and limit physiologically implausible values and dates will enhance data capture and quality.

Cardiac rehabilitation is necessary for patients: Providing experiences from the launch of cardiac rehabilitation in a deprived province in Iran

Cardiac rehabilitation is necessary for patients: Providing experiences from the launch of cardiac rehabilitation in a deprived province in Iran

Understanding quality-of-life determinants in coronary arterial disease patients

The study aimed to examine the correlation of determinant factors of quality of life in coronary arterial disease (CAD) patients, including knowledge of disease, smoking cessation, physical activity, and dietary regulation. A quantitative, cross-sectional study using convenience was conducted among 216 CAD patients from the West Sumatra, Indonesia, outpatient cardiovascular center. Data were collected using the cardiovascular disease knowledge assessment questionnaire, smoking cessation, physical activity, diet questionnaire, and self-assessment questionnaire to measure knowledge of the disease, smoking cessation, physical activity, diet, and quality of life, respectively data analysis using Chi-square, Pearson correlation, and multivariate linear regression test. The result showed that dietary regulation was the most influential variable on the quality of life of CAD patients (B=1.670, SE=0.341), followed by smoking cessation, physical activity, and knowledge about the disease. Our data suggest that dietary regulation, smoking cessation, and regular physical activity as modifiable CAD risk factors and disease knowledge improve the quality of life of CAD patients. Future research and clinician intervention for CAD awareness of lifestyle modification should be expanded to focus on barriers and their challenges during cardiac rehabilitation.

Improving the Effectiveness of Psychological Interventions for Depression and Anxiety in Cardiac Rehabilitation: The PATHWAY Research Programme Including 4 RCTs

Improving the Effectiveness of Psychological Interventions for Depression and Anxiety in Cardiac Rehabilitation: The PATHWAY Research Programme Including 4 RCTs

Sex and gender specific pitfalls and challenges in cardiac rehabilitation: a working hypothesis towards better inclusivity in cardiac rehabilitation programmes.

Notwithstanding its acknowledged pivotal role for cardiovascular prevention, cardiac rehabilitation (CR) is still largely under prescribed, in almost 25% of patients owing an indication for. In addition, when considering differences concerning the two sexes, female individuals are underrepresented in CR programmes with lower referral rates, participation, and completion as compared to male counterpart. This picture becomes even more tangled with reference to gender, a complex socio-cultural construct characterized by four domains (gender identity, relation, role, and institutionalized gender). Indeed, each of them reveals several obstacles that considerably penalize CR adherence for different categories of people, especially those who are not identifiable with a non-binary gender. Aim of the present review is to identify the sex- (i.e. biological) and gender- (i.e. socio-cultural) specific obstacles to CR related to biological sex and sociocultural gender and then envision a likely viable solution through tailored treatments towards patients' well-being.

Definition of the Profile of Cognitive Deficit in Cardiac Surgery Patients Using the Optimal Clustering Method

An original clustering method based on discrete optimization of multidimensional objects according to many heterogeneous parameters: age, severity of carotid artery stenosis (CA), personal and cognitive characteristics was used to identify pre- and postoperative specificity of the profile of cognitive functions. The study involved 163 cardiac surgery patients. Determination of CA stenoses was carried out in the preoperative period using color duplex scanning and further classification of the lesion. Psychometric assessment of personal and situational anxiety, as well as psychomotor and executive functions, attention, short-term memory was performed 3–5 days before and 7–10 days after coronary artery bypass surgery (CABG). As a result of clustering arrays of 17 normalized indicators and subsequent analysis of three groups formed in this way, different dynamics of restoration of the profile of cognitive functions after coronary bypass surgery were discovered. One of the groups was designated as a group of cognitive reserves according to its best indicators of information selection and memory both in the preoperative and postoperative periods. Another selected group was characterized by a postoperative increase in the speed of information selection, but low memory scores. The third selected group demonstrated close relationships between indicators of attention, memory and the efficiency of a complex visual-motor reaction with age and the degree of stenosis of the CA, regardless of the pre- or postoperative testing period, which may indicate persistent disorganization of cognitive functions in such patients, requiring special attention when choosing neuro- and cardiac rehabilitation programs for them. The developed clustering method makes it possible to group patients according to a variety of heterogeneous parameters to identify the dynamics of their changes during the course of treatment.

Muscle function, exercise capacity, physical activity level and cardiovascular disease risk factor knowledge in patients with prolactinoma.

Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls. Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36). Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05). Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation. This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).

S06-4: How is organised the exercise training of the outpatient phase III cardiac rehabilitation in the Greater Region?

Abstract Purpose The phase III cardiac rehabilitation includes lifestyle modifications and exercise training. While the phase III cardiac rehabilitation is recommended, there is no clear recommendation regarding its organisation. To investigate how exercise training in phase III cardiac rehabilitation was organized, we conducted a pilot study in the Greater Region (an international region composed by territories from Belgium, France, Germany, and Luxembourg). Methods We emailed and called five organisations offering or coordinating the exercise training of the phase III cardiac rehabilitation in the Greater Region and investigated different parameters: status of the contacted organisations, profile of their participants, recruitment process, organisation of the exercise training classes. We also screened the websites and registration forms of the different contacted organisations. Results Non-profit organisations organised exercise training in phase III cardiac rehabilitation in all 4 territories of the Greater Region. The profile of the participants in the exercise training varied across the different territories from participants with cardiac diseases only to everybody. For the 1st registration, participants should provide a medical clearance or/and a referral letter from a medical doctor or a cardiologist. In some territories, a stress test was additionally required for participants with cardiac diseases and participants presenting risk factors for cardiovascular disease. Annual medical clearance was not mandatory in some territories. In two territories, participants may be referred into a starter programme at the beginning of phase III cardiac rehabilitation. After this starter programme, participants were invited to continue into the regular programme. In most cases, exercise training was supervised by physiotherapists or sports therapists. The medical surveillance of the exercise training by a medical doctor and/or a nurse was often recommended but rarely and heterogeneously implemented. Conclusions The exercise training of the outpatient phase III cardiac rehabilitation is organised differently in the 4 territories of the Greater Region. Variation exists in implementation of referrals, medical clearance, and medical surveillance. Guidelines based on the evidence and the good practice should be elaborated. It will help non-profit organisations to better organise and administrate exercise training of the phase III cardiac rehabilitation.

Impact of VO 2peak on the Clinical Outcomes of Older Patients With Coronary Heart Disease in China.

The aim of this study was to explore the role of cardiopulmonary exercise test parameters, especially peak oxygen uptake (VO 2peak ), in predicting the incidence of adverse cardiovascular events in older Chinese patients with coronary heart disease (CHD). Older patients with CHD who underwent cycle ergometer cardiopulmonary exercise test at the Cardiac Rehabilitation Clinic of Chinese PLA General Hospital from July 1, 2015 to January 31, 2020 were enrolled. The follow-up intervals were 6mo. Cox regression was used to analyze the relationship between VO 2peak and adverse cardiovascular events. Restricted cubic splines and subgroup analyses were used to observe the relationship between VO 2peak and the hazard ratio (HR) of the primary end point event (PEE), which included a composite of all-cause death, nonfatal recurrent myocardial infarction, unscheduled revascularization, and stroke. The composite end point event was the PEE combined with cardiac rehospitalization. A total of 1223 participants (mean age 68±5yr) were included. Median follow-up was 68mo. Mean VO 2peak was 16.5±4.0 mL/kg/min, and VO 2peak was an independent predictor of the PEE (HR=0.929; 95% CI, 0.891-0.970; P =.001). This association was further validated by restricted cubic spline and subgroup analyses. Peak oxygen uptake was also an independent risk factor for the composite end point event (HR=0.968; 95% CI, 0.941-0.996; P =.025). In conclusion, VO 2peak is an independent risk factor for adverse cardiovascular events in older Chinese patients with CHD, and more optimal therapy should be recommended to patients with lower VO 2peak .