Cardiopulmonary Rehabilitation Program Research Articles

Rehabilitation of cardiological patients with post-COVID syndrome: morphofunctional data report

INTRODUCTION. Post-COVID is a common complication of COVID-19, occurring in more than a third of patients, and condition will persist for more than 3 months after infection with the SARS-CoV-2. AIM. To evaluate impact and potential effectiveness of a comprehensive physical rehabilitation program on health of cardiac patients with complications of a previously suffered new coronavirus infection SARS-CoV-2 COVID-19. MATERIALS AND METHODS. The study involved 128 cardiology patients with post-COVID syndrome. The study participants comprised three groups depending on the 12-week physical rehabilitation program. The effectiveness of rehabilitation was assessed through parameters of cardiopulmonary testing, as well as the 6-minute walk exercise test and the degree of dyspnea according to modified mMRC dyspnea questionnaire. RESULTS. The mMCR index in CPR group was 1.0 [0.0–1.0] point, compared with 2.0 [1.0–2.0] in control and comparative groups (p 0.05); exercise tolerance VO2max increased by 8.3 ± 3.8 % (p 0.05); normalization of heart rate and blood pressure in response to physical activity after 12 weeks in intervention group was 5.0 ± 2.1 % compared to comparative and control groups; 6MWT test results 688 m, in the intervention group, versus 490 m, for participants in control group (p 0.05). DISCUSSION. A comparative analysis of previously conducted studies confirmed pattern between the inclusion of combined cardiorespiratory training in the protocol for 12-week rehabilitation of post-COVID complications among cardiac patients, and a decrease in the degree of shortness of breath, as well as an increase in exercise tolerance. CONCLUSIONS. Based on experimental data obtained, it is advisable to analyze the effects of Cardiopulmonary Physical Rehabilitation program in the framework of larger randomized clinical trials. This will allow a more detailed assessment of the clinical consequences, as well as the ability to adjust mode and dose of physical activity of proposed rehabilitation program.

Physical functional recovery in the early period after hospitalization for COVID-19: impact of hypertension and outcome prediction model

The aim – to study the influence of hypertension (HT) on the dynamics of natural recovery of physical functional status in the early period after hospitalization for COVID-19 and to develop a model for predicting recovery results at 1 month after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % women) were included in the study, 176 of whom underwent the 6-minute walk test (6MWT) using an extended protocol within 1-2 days before discharge. A repeat visit to assess the dynamics of natural recovery was performed at 1 month after discharge.Results and discussion. Pre-discharge 6-minute walk distance was 378±57 m in patients with HT and 418±75 m without it, p=0.001, during the second visit – 440±52 versus 478±68, p=0.002; the achieved percentage of the individually predicted distance was 67.4±10.5 vs. 69.5±13.6 % and 81.6±9.9 vs. 81.9±15.7 %, respectively, p>0.05 for both visits. The increase in heart rate during the test at visit 1 was 18.5±8.3 versus 30.1±19.3 bpm, p<0.001, the percentage of chronotropic reserve utilizatoin was 21.3±9.6 % versus 29.2±11.4 %, p<0.001. During the second visit, residual manifestations of this trend were observed, with an increase in HR by 24.0±9.5 vs. 30.8±12.1, p=0.003 and the use of chronotropic reserve of 28.1±10.1 % vs. 33.4±12.4 %, respectively, p=0.029. The developed multivariate linear regression model explained 59 % of the variability in the achieved percentage of the individually predicted 6-minute walk distance at 1 month after discharge. The use of machine learning allowed to create an artificial neural network based regression model that used age, height, use of remdesivir in treatment, and SBP and DBP values at the time of discharge as predictors, and explained 90 % of observed variability.Conclusions. Hospitalized patients with COVID-19 were characterized by a decrease in the general physical functional status as assessed by 6MWT at the time of discharge and incomplete recovery after 1 month. Presence of hypertension was associated with more pronounced disturbances of the autonomic regulation of heart rate, but did not affect the reached percentage of the distance walked. The proposed artificial neural network based regression model allows for a high accuracy prediction of the 6MWT results at 1 month after discharge, which can be used in the selection of candidates for cardiopulmonary rehabilitation programs.

Impairments of functional exercise capacity, muscle strength, balance and kinesiophobia in patients with chronic kidney disease: a cross-sectional study

BackgroundMuscle weakness, balance, and functional capacity are affected in patients with chronic kidney disease (CKD) in dialysis. However, studies about kinesiophobia, peripheral and respiratory muscle strength, balance, exercise capacity, fatigue, and physical activity level in patients with CKD 3–4 are limited. The study aimed to compare the functional exercise capacity, peripheral and respiratory muscle strength, pulmonary function, balance, kinesiophobia, physical activity, fatigue, and dyspnea between patients with CKD 3–4 and controls.MethodsThis cross-sectional study included 43 patients and 45 controls. Functional exercise capacity [6-Minute Walking Test (6MWT)], peripheral and respiratory muscle strength, pulmonary function, dyspnea, fatigue, physical activity, balance [Berg Balance Scale (BBS)], and kinesiophobia were evaluated.ResultsDemographic characteristics were similar in patients [53(50–57) y, 26 M/17F] and controls [51(4.506-55) y, 33 M/12F] (p > 0.05). The 6MWT, respiratory and peripheral muscle strength, pulmonary function, physical activity, and BBS were significantly lower, and the level of dyspnea and kinesiophobia were higher in patients compared with controls (p < 0.05).ConclusionsPatients had impaired functional exercise capacity, upper and lower extremity muscle strength, respiratory muscle strength, pulmonary function, and balance, increased perception of dyspnea and kinesiophobia, and reduced physical activity level compared with controls. Patients should be directed to cardiopulmonary rehabilitation programs.

Post-coronavirus disease-19: the impact of cardiopulmonary rehabilitation on arterial stiffness, left ventricular deformation, and ventricular-arterial coupling

Abstract Introduction Although coronavirus disease-19 (COVID-19) is a primarily a respiratory disease, impairment of cardiovascular function has been documented, even in the post-acute phase. Cardiopulmonary rehabilitation could represent an appealing approach in the management of cardiovascular sequelae of post-COVID-19, which may affect arterial and left ventricular function, ultimately influencing ventricular-arterial coupling (VAC). Purpose In this study, we assess the impact of a post-acute COVID-19 rehabilitation program on arterial stiffness, left ventricular deformation, and VAC. Methods We enrolled 60 convalescent patients from COVID-19 and one-month post-acute disease were randomized at 1:1 ratio in a 3-month cardiopulmonary rehabilitation program (study group) or not (control group). The levels of pro-inflammatory interleukin-1β (IL-1β) were determined. Arterial stiffness was evaluated by carotid-femoral Pulse wave velocity (cf-PWV) at 1 month and at 4 months post-acute disease. Transthoracic echocardiography was performed, and left ventricular global longitudinal strain (LV-GLS) was estimated. Finally, the ratio of cf-PWV/LV-GLS was calculated as an index of VAC. Results There were no significant differences in major risk factors across the studied groups (age, sex, body mass index, smoking, hypertension, diabetes mellitus, dyslipidemia). Moreover, patients across the study groups did not differ regarding the levels of IL-1β. Although cf-PWV was similar in the study and the control group at baseline, it was improved only in the study group (8.2±1.3m/sec vs. 6.6±1.0m/sec, p&amp;lt;0.001) but not in the control group (8.9±1.8m/sec vs. 8.8±1.9m/sec, p=0.74). Similarly, for GLS, no differences were noted at baseline. However, the study group exhibited a significant improvement during the study (-19.6±2.0% vs. -21.3±1.9%, p&amp;lt;0.001), while no changes were observed in the control group (-18.7±2.9% vs. -18.3±2.1%, p=0.15). Finally, VAC was significantly ameliorated only in patients receiving cardiopulmonary rehabilitation (-0.43±0.11m/s% vs. -0.31±0.06m/s%, p&amp;lt;0.001). When individuals undergoing cardiopulmonary rehabilitation were stratified according to median baseline IL-1β levels, those presenting with lower concentrations experienced a significant benefit in ΔVAC (IL-1β&amp;lt;8.4pg/ml: 0.14±0.08m/s% vs. IL-1β≥8.4pg/ml: 0.09±0.05m/s%, p=0.04). Conclusion A 3-month cardiopulmonary rehabilitation program following the acute phase of COVID-19 accelerates the recovering of arterial and ventricular function, especially in individuals with a lower baseline inflammatory burden.

Enhancing Quality of Life (QOL) And Cardiac Function in Heart Failure Patients Through Integrated Tele-Cardiopulmonary Rehabilitation And Psychological Support: A Prospective Study

Introduction: Herat failure (HF) is one global pandemic affecting millions of people across the globe. Patients with HF report decreased functional capacity, increased dyspnea and weariness, and a diminished ability to do daily tasks. In previous years there was much advancement in pharmacological therapy against heart failure. Several studies have shown that cardiopulmonary rehabilitation programs are safe and effective in improving functional capacity and quality of life while decreasing readmission rates and all-cause death in heart failure patients. However, heart failure patients' psychological status is often unknowingly neglected, leading to poor quality of life. Methods: This prospective Study was initiated in May 2022, was conducted for 18 months, and was completed in October 2022. This study is a prospective study of heart failure patients, the effect of an integrated approach of tele-cardiopulmonary rehabilitation along with psychologist-guided psychological support enhancing the quality of life. The patients satisfying the inclusion criteria without exclusion criteria were randomized to intervention and control groups. Results: The age group of the mean (years)+/- SD(67+/-14.4) in the Intervention Group and (66+/- 14) in the Control group. Both the groups comprised female participants, 63% in the Intervention group and 68% in the control group. The initial evaluation was done at the beginning of this prospective study. The follow-ups were done in 6 weeks, 12 weeks, and 24 weeks. Clinical examination, 6-Minute Walk Test, peak VO2 evaluation in a cardiopulmonary exercise test, and echocardiography with LVGLS measurements. During the study period, it was noted that there were substantial improvements in LVGLS, 6-Minute Walk Test distance, peak VO2, and Quality of Life. Conclusion: In Conclusion, based on the findings of this prospective study, the integrated approach of tele- cardiopulmonary rehabilitation and psychological support in heart failure patients has tremendous benefits and remarkable improvement in Quality of Life. As the life span improves, that leads to more heart failure patients presently and in the future. Along with pharmacotherapy against heart failure, telerehabilitation, and psychological support should be emphasized from the beginning of heart failure treatment to achieve a better quality of life. Considering the importance of Rehabilitation, through this study, it would not be wrong to suggest an additional pillar of heart failure treatment along with four other robust pillars in the guidelines

Adherence of females to Fitcor’s cardiopulmonary and metabolic rehabilitation program during 34 years

Introduction: In recent decades the number of deaths from heart disease among women in Brazil has increased a lot considerably, however those who accumulate more risk factors do not practice physical exercises. Objective: to investigate the adherence behavior of women aged between 12 and 80 years, to a specialized cardiac prevention and rehabilitation program (CPRP). Method: This cross-sectional descriptive study was carried out in a clinic specialized in cardiology diagnosis and CPRP between 1972 and 2006. Patients were separated into two groups, prevention (PG) and rehabilitation (RG) after physical evaluation and diagnosis. Both groups of women were separated by age and by the date of beginning CPRP. Results: Based on the entry diagnosis in the records of 958 women who attended the CPRP, we identified that 655 of them were in the prevention group (PG) and 303 in the rehabilitation group (PG). In both groups, the adherence to the program decreased with advancing age and worsening of risk factors. Conclusions: Contrary to the increase on statistics of women victims of cardiovascular diseases in Brazil, the number of those who seek CPRP through physical exercises has decreased and, what is worse, the number or places that facilitate women’s access to this type of intervention has also decreased.

Correlation between high sensitivity C reactive protein (Hs-CRP) and neutrophil-to- lymphocyte ratio (NLR) with functional capacity in post COVID-19 syndrome patients.

Post coronavirus disease 2019 (COVID-19) syndrome is one of the causes of reduced functional capacity and work productivity, in particular for healthcare workers. The pathophysiology of the post COVID-19 syndrome is related to complex and multisystem inflammatory mechanisms, and cardiopulmonary exercise rehabilitation program is one of the efforts to improve the recovery process for patients with post COVID-19 syndrome. The aim of this study was to determine the correlation between the level of high sensitivity C-reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity (VO2max) in individuals with post-COVID-19 syndrome who received moderate- and high-intensity supervised cardiopulmonary exercise. A prospective cohort study was conducted at the Integrated Cardiac Rehabilitation Center of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The supervised cardiopulmonary exercise was conducted for six weeks according to the participant's baseline VO2max. Spearman's and Pearson's correlation tests were used to assess the correlations. A total of 30 individuals (19 and 11 had moderate and high intensity exercise, respectively) were involved in this study. At moderate intensity exercise, the average Hs-CRP and NLR were 3.3 mg/L and 1.99, respectively; while at high intensity, the values were 3.8 mg/L and 1.79, respectively. No significant correlation between Hs-CRP level and functional capacity in both moderate-intensity and high intensity groups. In contrast, NLR was negatively correlated with functional capacity (r=-0.545, p=0.016) in moderate intensity exercise group. In conclusion, NLR value was negatively correlated with functional capacity in individuals with post-COVID-19 syndrome after receiving moderate intensity supervised cardiopulmonary exercise program. Therefore, moderate intensity of cardiopulmonary exercise maybe be used as a program to accelerate the recovery for those with post COVID-19 syndrome.

Non-invasive ventilatory support accelerates the oxygen uptake and heart rate kinetics and improves muscle oxygenation dynamics in COPD-HF patients

BackgroundThe aim of this study was to explore the effects of non-invasive positive pressure ventilation (NIPPV) associated with high-intensity exercise on heart rate (HR) and oxygen uptake (V̇O2) recovery kinetics in in patients with coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF). MethodsThis is a randomized, double blinded, sham-controlled study involving 14 HF-COPD patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NIPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin and deoxyhemoglobin were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, Netherland). ResultsThe kinetic variables of both V̇O2 and HR during the high-intensity constant workload protocol were significantly faster in the NIPPV protocol compared to Sham ventilation (P < 0.05). Also, there was a marked improvement in oxygenation and lower deoxygenation of both peripheral and respiratory musculature in TLim during NIPPV when contrasted with Sham ventilation. ConclusionsNIPPV applied during high-intensity dynamic exercise can effectively improve exercise tolerance, accelerate HR and V̇O2 kinetics, improve respiratory and peripheral muscle oxygenation in COPD-HF patients. These beneficial results from the effects of NIPPV may provide evidence and a basis for high-intensity physical training for these patients in cardiopulmonary rehabilitation programs.

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients.

Coronavirus disease (COVID-19) is a respiratory disease, although arterial function involvement has been documented. We assess the impact of a post-acute COVID-19 rehabilitation program on endothelium-dependent vasodilation and arterial wall properties. We enrolled 60 convalescent patients from COVID-19 and one-month post-acute disease, who were randomized at a 1:1 ratio in a 3-month cardiopulmonary rehabilitation program (study group) or not (control group). Endothelium-dependent vasodilation was evaluated by flow-mediated dilation (FMD), and arterial wall properties were evaluated by carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx) at 1 month and at 4 months post-acute disease. FMD was significantly improved in both the study (6.2 ± 1.8% vs. 8.6 ± 2.4%, p < 0.001) and control groups (5.9 ± 2.2% vs. 6.6 ± 1.8%, p = 0.009), but the improvement was significantly higher in the study group (rehabilitation) (p < 0.001). PWV was improved in the study group (8.2 ± 1.3 m/s vs. 6.6 ± 1.0 m/s, p < 0.001) but not in the control group (8.9 ± 1.8 m/s vs. 8.8 ± 1.9 m/s, p = 0.74). Similarly, AIx was improved in the study group (25.9 ± 9.8% vs. 21.1 ± 9.3%, p < 0.001) but not in the control group (27.6 ± 9.2% vs. 26.2 ± 9.8 m/s, p = 0.15). Convalescent COVID-19 subjects of the study group (rehabilitation) with increased serum levels of circulating IL-6 had a greater reduction in FMD. Conclusively, a 3-month cardiopulmonary post-acute COVID-19 rehabilitation program improves recovery of endothelium-dependent vasodilation and arteriosclerosis.

Functional capacity and cognitive performance of adults from Argentina in cardiopulmonary rehabilitation

Functional capacity is decreased in people with Cardiovascular Diseases and Chronic Respiratory Diseases. These diseases have also been associated with cognitive dysfunction. The study examines the efficacy of a cardiopulmonary rehabilitation program in the recovery of functional capacity and analyzes whether subjects with cardiopulmonary diseases suffer from cognitive dysfunction. Participated 50 adults with medium-high education who completed a cardiopulmonary rehabilitation program of between 3 and 6 months based on physical education, nutritional education, promotion of healthy habits and medication management. Functional capacity was evaluated with the Duke index at the beginning and end of the program. Memory and language tests were also administered, for the only time, at the beginning of the program, comparing the values obtained with Argentine normative studies. The data was analyzed with the Wilcoxon test, bivariate correlations, and linear regression. Functional capacity increased significantly at the end of the program. In any case, the post-program Duke value suggests that the functional capacity of the patients continues to be affected. On the other hand, a memory test explained 10,8% of the variance in the Duke index, and there are no findings of cognitive dysfunction. The functional capacity of cardiopulmonary patients improved with the rehabilitation program, although this improvement is clinically insufficient. Better memory performance predicted greater functional capacity, which is why it is suggested to add cognitive stimulation workshops to cardiopulmonary rehabilitation programs. This sample with cardiopulmonary disease does not present cognitive dysfunction, probably due to its high cognitive reserve.

Physicians' Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study.

Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians' perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions. Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors. Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% (n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR. CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians' perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians' and cardiac doctors' perspectives, respectively.

The results of inspiratory muscle training on cardiac, respiratory, musculoskeletal, and psychological status in patients with stable angina: a randomized controlled trial

Purpose To determine the effect of inspiratory muscle training (IMT) on respiratory and peripheral muscle strength, functional exercise capacity, health-related quality of life (HRQoL), fatigue, depression, and cardiac functions in patients with stable angina. Methods A randomized, controlled, single-blinded study. Twenty patients (59.95 ± 7.35 y, LVEF = 58.77 ± 7.49) with stable angina received IMT at the lowest load (10 cmH2O), and 20 patients (55.85 ± 7.60 y, LVEF = 62.26 ± 7.75) received training at 30% of maximal inspiratory pressure (MIP) seven days/8 weeks. Respiratory muscle strength (MIP; maximal expiratory pressure, MEP), peripheral muscle strength, pulmonary functions, functional exercise capacity (6-min walking test; exercise test), fatigue, HRQoL, depression, and cardiac functions were evaluated before and after. Results A statistical difference was found between groups in terms of respiratory and peripheral muscle strength, pulmonary functions, functional exercise capacity (p < 0.05). The results of fatigue, depression, HRQoL, and cardiac functions were similar between the groups (p > 0.05). Conclusions This study is the first to demonstrate the positive effects of IMT in patients with stable angina. IMT is a safe and effective method and is recommended to be added to cardiopulmonary rehabilitation programs and guidelines, as it results in increased peripheral muscle strength and functional exercise capacity in stable angina patients. Implications for rehabilitation Inspiratory muscle training (IMT) is a safe and effective method for coronary artery disease (CAD) patients with stable angina. IMT improved respiratory and peripheral muscle strength, functional exercise capacity, pulmonary functions, and health-related quality of life in CAD patients with stable angina. Perception of depression and fatigue were decreased with IMT in CAD patients with stable angina.

Nurses’ Beliefs and Barriers of Delivering Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study

Background: Patients with heart failure (HF) may benefit greatly from cardiopulmonary rehabilitation (CR), which is provided by a team of healthcare professionals that often includes nurses. There has been no research on how nurses perceive providing CR or the hurdles that may affect referrals. Methods: All registered nurses in Saudi Arabia’s Eastern Province were given access to a cross-sectional online survey consisting of nine multiple-choice questions that address attitudes, beliefs, and barriers to CR for HF patients in Saudi Arabia. Descriptive statistics were used to characterize the respondents. Results: Altogether, 439 registered nurses participated in the online survey, with men making up 194 (44%) and women 245 (56%). The mean and SD of years of clinical experience in caring for patients with HF were 6 ± 5 years. Out of 439 nurses, 107 (24%) strongly agree, and 255 (58%) agree that CR will enhance the physical fitness of patients. However, 94 (21.1%) strongly agree, and 248 (56.4%) agree that CR might alleviate dyspnea in HF patients. The vast majority of the nurses either strongly agree (90 (20.5%)) or agree (240 (55%)), that CR would help reduce palpitations and fatigue in HF patients. Indeed, 87 (19.81%) strongly agree, and 262 (59.68%) agree that CR would help improve HF patients’ ability to perform daily activities, while 51 (11.6%) strongly agree and 223 (51%) agree that CR would help in reducing hospital readmission. It was shown that 360 (82%) of the 439 nurses favored the delivery of CR programs in hospital-supervised programs, while 368 (83.8%) ranked information on HF disease as the most important aspect of the CR program, followed by information about medications at 305 (69.4%). The availability of CR facilities (36%), the cost of therapy (35%), and the absence of an established standardized referring strategy (34%) were identified as the most significant barriers affecting the referral of patients with HF for CR by nurses. Conclusion: Generally, nurses believed CR helped improve desired clinical outcomes in HF patients. Although a hospital-based program with close supervision is optimal for administering CR, few such options exist. Referrals of patients with HF were hampered by the lack of CR facilities, the cost of intervention, and the lack of a systematic approach to referrals.

Nurses' Perception of, and Barriers to, Delivering Cardiopulmonary Rehabilitation for Heart Failure Patients: A National Survey in Saudi Arabia.

Background: Heart failure (HF) patients require a holistic management approach to improve their clinical outcomes. Cardiopulmonary rehabilitation (CR) is a core component of HF patients’ management and is supervised by a multidisciplinary team including nurses. Nursing attitudes regarding CR delivery for patients with HF and the possible barriers and factors that potentially affect referral have not been explored. Therefore, this study seeks to evaluate nurses’ attitudes towards the delivery of CR programs and the possible barriers and factors that potentially influence the decision for a referral. Methods: An online survey with eight multiple-choice items was disseminated to all nurses between February and July 2022 in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 1056 nurses completed the online survey, of which 395 (37.40%) were male. Out of 1056 nurses, 414 (39.20%) strongly agreed that CR would improve patients’ physical fitness, and 392 (37.10%) strongly agreed that CR would reduce breathlessness in patients with HF. In total, 381 nurses strongly agreed (36.10%) that CR would improve HF patients’ palpitation and fatigue. Out of 1056 nurses, 396 (37.50%) strongly agreed that CR would improve HF patients’ ability to perform daily activities, and 326 (30.90%) strongly agreed that CPR would reduce the rate of hospital readmission. The at-home program was the preferred mode of delivering CR programs among 607 (57.50%) nurses. Apart from the exercise component, symptom management was perceived by 704 (66.70%) nurses as the fundamental component of CR programs. The most common patient-related factor that strongly affected the decisions regarding referral was “mobility affected by breathlessness” (57%). A lack of CR centers (46%) was the most common barrier. Conclusion: Nurses perceived CR as an effective management strategy for HF patients. Although a home-based program, with symptom management being an essential component, in addition to the exercise component, was perceived as the preferred mode of delivery, CR centers are lacking, which represented a significant barrier to CR referral from the nurses’ perspective.

Physiotherapists' Attitudes, and Barriers of Delivering Cardiopulmonary Rehabilitation for Patients with Heart Failure in Saudi Arabia: A Cross-Sectional Study.

BackgroundCardiopulmonary rehabilitation (CR) is an effective management approach for heart failure (HF) patients and is delivered by multidisciplinary teams including physiotherapists (PTs). PT attitudes about delivering CR and barriers that might affect referral have not been explored. Thus, this study is aimed to explore PT attitudes about delivering CR programs to patients with HF and identify factors and barriers that might affect referral decisions.MethodsA cross-sectional online survey was disseminated to all PTs in Saudi Arabia between 19 February and 27 June, 2022. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables.ResultsOverall, 553 PTs, 289 (52.30%) male and 264 (47.70%) females, completed the online survey. Of these, 360 (65.1%) strongly agreed that CR would improve patients’ physical fitness and 334 (60.4%) strongly agreed that CR would reduce breathlessness in patients with HF. The majority of PTs (321, 58%) strongly agreed that CR would improve HF patients’ palpitation and fatigue. Out of 553 PTs, 349 (63.1%) strongly agreed that CR would improve patients’ ability to perform daily activities. A hospital-supervised program was the preferred mode of delivering CR programs by 499 (90.20%) of the respondents. Apart from the exercise component, stress management was perceived by 455 (82.30%) as an essential component of CR programs. The most common patient-related factor that strongly influenced referral decisions was “fatigue related to disease” (42%). A lack of CR centers was reported by 59.90% as the most common referring barrier.ConclusionPTs perceived CR as a successful strategy for patients with HF. Although a supervised hospital-based program with stress management as an essential component aside from the exercise component was perceived as the preferred mode of delivery, CR was lacking, which caused a significant barrier to CR referral from the PTs’ perspective.

Cardiopulmonary Rehabilitation in Pulmonary Hypertension: Experience in a Referral Center

Background: Pulmonary hypertension (PH) comprises a heterogeneous group of diseases resulting in disability and increased morbidity and mortality. Cardiopulmonary rehabilitation (CR) is a therapeutic resource not widely used in this condition. Objective: The aim of this study was to evaluate the effects of a CR program on a walking test and on the quality of life in patients with group 1 and group 4 PH Methods: Patients were evaluated before and after the intervention with the six-minute walk test (6MWT) and Saint George's Respiratory Questionnaire (SGRQ). The program consisted of 8 weeks of supervised exercises within the institution. Results: Nineteen patients with precapillary PH diagnosed by right heart catheterization were included; 18 were women (94.7%) with a mean age of 45.5 ± 14.3 years. Thirteen (68.4%) patients had group 1 PH and 6 (31.6%) had group 4 PH. There were statistically significant changes in the 6MWT [mean difference (MD) 31 ±27.3 m; p&lt;0.001], and in the SGRQ (MD 8.2 ± 10.2; p&lt;0.01). No adverse events were reported during the program. Conclusions: Our study suggests that a supervised CR program in patients with PH could improve the distance walked and the quality of life.

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Background: Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs. Objective: To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation. Methods: In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally [...]

The most efficient types of training in cardiopulmonary rehabilitation programs: A narrative review

"Objective. This narrative review sought to identify the most frequently used types of exercises in cardiopulmonary rehabilitation programs and to verify the level of efficiency and feasibility of this treatment method in cardiovascular diseased patients. Methods. We conducted research via Pubmed over two months using specific keywords related to cardiorespiratory rehabilitation, cardiovascular rehabilitation, endurance exercises, and respiratory exercises. In addition, we included studies that involved physical training for patients diagnosed with coronary artery disease, chronic heart failure, valvular disease or valvular surgery, asthma, and chronic obstructive pulmonary disease. Results. A total of fifteen articles were included in this narrative review. Eight studies investigated the effect of aerobic training, alone or combined, in the rehabilitation process for patients with cardiovascular disease and/or pulmonary disease. It showed that this type of training is the most recommended and used for these specific pathologies. Seven studies showed the effects of the resistance training and progressive resistance training, alone or combined, and proved the importance of their integration in patients with skeletal muscle weakness and altered functional capacity. High-intensity interval training was not superior to moderate-intensity continuous training in improving aerobic capacity and changing ventricular remodeling in patients with chronic heart failure. However, the results were promising in patients with coronary artery disease. Combined training had the best results in improving the aerobic capacity, muscle strength, functional capacity, ventilatory responses, and enhancing the quality of life for cardiovascular patients. Conclusions. Combined training was found superior to aerobic training, resistance training, respiratory training, or inspiratory muscles training applied alone as a treatment in cardiopulmonary rehabilitation programs. Thus, every rehabilitation program should be individualized for every patient to increase the effort capacity using aerobic training and functional capacity of the skeletal muscles by increasing the muscle mass (hypertrophy) as an effect of resistance training or progressive resistance training "

Cardiopulmonary Rehabilitation in Long-COVID-19 Patients with Persistent Breathlessness and Fatigue: The COVID-Rehab Study.

(1) Background: Cardiopulmonary and brain functions are frequently impaired after COVID-19 infection. Exercise rehabilitation could have a major impact on the healing process of patients affected by long COVID-19. (2) Methods: The COVID-Rehab study will investigate the effectiveness of an eight-week cardiopulmonary rehabilitation program on cardiorespiratory fitness (O2max) in long-COVID-19 individuals. Secondary objectives will include functional capacity, quality of life, perceived stress, sleep quality (questionnaires), respiratory capacity (spirometry test), coagulation, inflammatory and oxidative-stress profile (blood draw), cognition (neuropsychological tests), neurovascular coupling and pulsatility (fNIRS). The COVID-Rehab project was a randomised clinical trial with two intervention arms (1:1 ratio) that will be blindly evaluated. It will recruit a total of 40 individuals: (1) rehabilitation: centre-based exercise-training program (eight weeks, three times per week); (2) control: individuals will have to maintain their daily habits. (3) Conclusions: Currently, there are no specific rehabilitation guidelines for long-COVID-19 patients, but preliminary studies show encouraging results. Clinicaltrials.gov (NCT05035628).

Short-term cardiopulmonary rehabilitation program in a post-COVID-19 patient: a case report

We aimed to report a successful clinical case of a short-term cardiopulmonary rehabilitation after hospital discharge due to COVID-19. Exploratory descriptive case study with a 58-year-old male, former smoker, and in need of supplemental oxygen after COVID-19 infection, admitted to a cardiopulmonary rehabilitation program of six weeks in a school clinic in the Federal District, Brasília, Brazil. Chest expansion, aerobic capacity, physical function, and quality of life were evaluated before and after the program using, respectively, thoracic cirtometry, 6-Minute Walk Test, 1-Minute Sit-To-Stand Test, and Short Form Health Survey. At the end of the cardiopulmonary rehabilitation, the patient presented increased chest expansion, increased walked distance with decreased perception of exertion, increased repetitions in the 1-minute sit-to-stand-test, and increased quality of life. Moreover, he was completely weaned from supplemental oxygen. A short-term duration cardiopulmonary rehabilitation protocol can contribute to improvement in aerobic and functional capacity, and in quality of life after COVID-19.