Cardiovascular Rehabilitation Program Research Articles

, , , , ,

, , , , ,

Comparing the Effect of Combining Exercise with Rosuvastatin versus Atorvastatin on Lipid Profile and Functional Capacity: A Retrospective Cohort Study

Background Statins and exercise are recommended for managing hypercholesterolemia. However, statin types may vary in their interaction with exercise. We compared rosuvastatin versus atorvastatin combination with exercise on lipid profile and functional capacity. Methods A retrospective cohort study using data from a 12-week cardiovascular rehabilitation program between 2014 and 2016. Statin use was determined through prescriptions, and the average exercise minutes/week were computed from exercise logs. The outcomes were changes in total cholesterol, low- and high-density lipoproteins (LDL and HDL), triglycerides, and functional capacity (6-minute walk test (6MWT)). Directed acyclic graphs were used to identify potential confounders, accounted for using multiple linear regression modeling. Results The cohort included 282 patients from 106 atorvastatin and 176 rosuvastatin users. The average exercise minutes/week was 109.4 ± 66.1 among atorvastatin and 106.7 ± 49.1 among rosuvastatin users. Interaction models suggested that a higher number of exercise minutes/week were more favorable among atorvastatin users on total cholesterol and LDL (0.004, 95% CI: 0.001, 0.008 and 0.004, 95% CI: 0.001, 0.007, respectively) but did not reach significance for HDL and triglycerides. Rosuvastatin use was associated with greater increases in 6MWT; however, we observed no between-group differences in interaction estimates by the type of statin used. Conclusion Rosuvastatin use could blunt the beneficial effect of exercise on LDL and total cholesterol compared to atorvastatin. No significant differences were observed in triglycerides, HDL, and functional capacity levels. Additional studies are warranted with randomized treatments and larger samples. Healthcare providers should continue prescribing statins alongside recommending exercise modalities, with a careful follow-up for rosuvastatin users.

Um relato de caso sobre exercício físico e Diabetes Mellitus Tipo II: ainda podemos nos surpreender?

INTRODUÇÃO: O Diabetes mellitus tipo 2(DM2) é fator de risco independente para o desenvolvimento de doenças cardiovasculares. O exercício físico é uma terapêutica adjuvante e eficaz no controle do DM2, pois evita o declínio funcional, complicações cardiovasculares e melhora a qualidade de vida. OBJETIVO: Apresentar a repercussão de um programa de reabilitação cardiovascular e metabólica sobre o controle glicêmico e capacidade funcional em uma paciente com DM2 e insuficiência cardíaca classe II. MÉTODOS: Trata-se de um relato de caso envolvendo uma mulher de 63 anos, irregularmente ativa, eutrófica, sarcopênica, hipertensa e com DM2 em uso de insulina (NPH e ultrarrápida) há 6 anos, com diagnóstico de insuficiência cardíaca(IC) classe funcional II. Ingressa em programa de reabilitação cardiovascular e metabólica supervisionado. Realiza avaliação de perfil lipídico, hemoglobina glicada, teste de caminhada de 6 minutos (TC6), glicemia de jejum. Durante a sessão foi monitorizada a glicemia capilar, pressão arterial sistêmica (PAS) e o traçado eletrocardiográfico. O protocolo consistia em alongamento, exercícios neuromusculares e esteira ergométrica realizados com carga de 12-14 da escala de Borg. O programa durou 16 semanas, sendo realizado 2 vezes na semana totalizando 80 min por sessão. RESULTADOS: Houve acréscimo de 128,57% no TC6 (350 vs 800m). Os valores da hemoglobina glicada pré e pós-programa de treinamento foram 12%-vs-7,5%; glicemia de jejum 346mg/dL-vs-105mg/dL; colesterol total 158mg/dL-vs-108mg/dL; lipoproteína de baixa densidade(LDL) 95mg/dL-vs-58mg/dL; lipoproteína de alta densidade(HDL) 31mg/dL-vs-41mg/dL; triglicerídeos 115mg/dL-vs-97mg/dL e PA 185x95mmHg vs 139x85mmHg. Ao final do programa foi retirada a utilização da insulina subcutânea. CONCLUSÃO: O programa demonstrou-se adequado na melhora da capacidade funcional submáxima e no controle dos níveis glicêmicos e lipídicos plasmáticos.

Cardiopulmonary exercise testing in cardiovascular rehabilitation of post-myocardial infarction patients

Cardiovascular rehabilitation represents a very important measure in post myocardial infarction patients for both, improving their quality of life and preventing other acute cardiovascular events. It is important to accurately assess functional capacity of patients after acute coronary events, in order to optimize the results of cardiac rehabilitation program. Cardiopulmonary exercise testing (CPET) represents the gold standard in functional capacity assessment. We present 3 clinical cases of post STEMI patients, with coronary revascularization interventions, addressed to cardiovascular rehabilitation. They underwent CPET evaluation at baseline and during rehabilitation program. This method proved important utility for individualization of cardiovascular rehabilitation program, as well as for monitoring the long term evolution after myocardial infarction.

Psychological evaluation by using the Hamilton depression and anxiety rating scales in coronary artery bypass grafting patients undergoing cardiovascular rehabilitation treatment

Cardiovascular disease is one of the leading causes of morbid-mortality, although better outcomes and lower mortality of age-adjusted coronary artery disease were registered since 1980s, especially in high-income populations, sustaining the cost effective of cardiac prevention methods. The aim of this prospective study was to evaluate the role of cardiac rehabilitation in improving psycho-emotional risk scores: the Hamilton Depression (HAM-D) and Anxiety Rating Scale (HAM-A) in coronary artery bypass grafting (CABG) patients, in less than one week after cardiovascular surgery and in 6 months follow-up after the engagement in the cardiac recovery program. Methods – During 01.05.2015 – 01.03.2017, CABG was performed in 100 patients, aged 40-80 years old, who followed rehabilitation in the Cardiovascular Rehabilitation Clinic. The mean age of the patients under study was 65.70 ± 9.91 years old. Results – In the fi rst phase of the cardiovascular rehabilitation program, the mean values were: 16 points for HAM-D, and 25 points on HAM-A scale. By comparing the Phase I and Phase III results, the median HAM-D score improved more than 50%, and HAM-A about 36% (p<0.05). Conclusion – The study highlighted the role of early rehabilitation after CABG surgery and the HAM-D and HAM-A scores improvement, emphasizing the importance of including psycho-emotional status assessment in the management of the patient who benefi ted from cardiac surgery. Apart from clinical data and the cardiovascular risk scores, the psycho-emotional risk stratification can provide important information regarding outcomes and prognosis.

The control of cardiovascular risk factors – an essential component of the rehabilitation of patients with ischemic heart disease. What are the current targets?

Cardiovascular diseases continue to cause the highest mortality in Europe, among both men and women. Ischemic heart disease is responsible for most of these deaths. An important role in decreasing mortality and improving the prognosis of patients diagnosed with this disorder is played by cardiovascular rehabilitation programs. The short hospitalization period of patients with acute coronary syndromes who undergo revascularization procedures (in-hospital rehabilitation) becomes extremely useful to determine the cardiovascular risk factors underlying the development of these diseases and to implement lifestyle changing measures. Patients with ischemic heart disease included in rehabilitation programs will not only have the advantage of an increased exercise capacity, but they will also be monitored by qualified medical personnel for the evolution of cardiovascular risk factors. We aim to summarize the objectives to be targeted regarding these risk factors in the presence of a patient with ischemic heart disease included in cardiovascular rehabilitation programs. Key words: cardiovascular risk factors, cardiovascular rehabilitation,

Submaximal Exercise Testing in Cardiovascular Rehabilitation Settings (BEST Study).

BackgroundThis study compared changes in measured versus predicted peak aerobic power (V̇O2peak) following cardiovascular rehabilitation (CR). Peak cardiopulmonary exercise testing (CPET) results were compared to four V̇O2peak estimation methods: the submaximal modified Bruce treadmill, Astrand-Ryhming cycle ergometer, and Chester step tests, and the Duke Activity Status Index (DASI).MethodsAdults with cardiovascular disease (CVD) who completed a 12-week CR program were assessed at baseline and 12 weeks follow-up. CPET, the DASI and three subsequent submaximal exercise tests were performed in a random order.ResultsOf the 50 adults (age: 57 ± 11 years) who participated, 46 completed the 12-week CR program and exercise tests. At baseline 69, 68, and 38% of the treadmill, step and cycle tests were successfully completed, respectively. At follow-up 67, 80, and 46% of the treadmill, step and cycle tests were successfully completed, respectively. No severe adverse events occurred. Significant improvements in V̇O2peak were observed with CPET (3.6 ± 5.5 mL.kg–1.min–1, p < 0.001) and the DASI (2.3 ± 4.2 mL.kg–1.min–1, p < 0.001). Bland-Altman plots of the change in V̇O2peak between CPET and the four V̇O2peak estimation methods revealed the following: a proportional bias and heteroscedastic 95% limits of agreement (95% LoA) for the treadmill test, and for the cycle and step tests and DASI, mean bias’ and 95% LoA of 1.0 mL.kg–1.min–1 (21.3, −19.3), 1.4 mL.kg–1.min–1 (15.0, −12.3) and 1.0 mL.kg–1.min–1 (13.8, −11.8), respectively.ConclusionGiven the greater number of successful tests, no serious adverse events and acceptable mean bias, the step test appears to be a valid and safe method for assessing group-level mean changes in V̇O2peak among patients in CR. The DASI also appears to be a valid and practical questionnaire. Wide limits of agreement, however, limit their use to predict individual-level changes.

Influence of the hydration on autonomic modulation and cardiorespiratory parameters of coronary heart disease patients submitted to a cardiovascular rehabilitation session: crossover clinical trial protocol

Abstract Aims: The influence of fluid replacement, realized during and after the exercise on individuals with coronary artery disease (CAD) remains poorly understood. To investigate the influence of hydration on cardiac autonomic modulation, cardiorespiratory parameters and perceived exertion and discommodity, of coronary heart patients submitted to cardiac rehabilitation (CR) session. Methods: This cross-over clinical trial, will recruit 31 adults with more than 45 years old, participants of a cardiovascular rehabilitation program, with CAD diagnosis. The participants will be submitted to an experimental protocol composed of three phases: I) Maximal stress test; II) Control protocol (CP); and III) Hydration protocol (HP). The CP and HP will consist of 10 min of rest in a supine position, 15 min of warming, 40 min of treadmill exercise, 5 min of cooling down and 60 min of rest in a supine position. In the HP, the participants will be hydrated with mineral water, based on the bodyweight reduction of the CP. The water intake will be divided into eight equal portions, offered during the treadmill exercise and recovery period. On CP and HP will be evaluated linear and nonlinear indices of heart rate variability, the heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen partial saturation, perceived exertion and discommodity on specifics moments. Conclusion: The results of this study will allow us to identify if the proposed protocol will be able to positively influence the outcomes and, consequently, if could be implement in the clinical practice.

Management of patients with type 2 diabetes in cardiovascular rehabilitation.

The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy.

Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology.

The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.

P4385Diaphragm dysfunction following cardiac surgery: role of ultrasound imaging for initial and follow-up assessment during cardiac rehabilitation

Abstract Background Diaphragm dysfunction is a common complication of cardiac surgery, often underdiagnosed. Ultrasonography (US) is a promising technique for diaphragmatic assessment. Few trials have been conducted using US after heart surgery and no clear data exist on the recovery of diaphragm function after cardiovascular rehabilitation (CR). Purpose The aim of this study is to evaluate post-cardiac surgery diaphragm dysfunction using US and to assess the impact of an inpatient CR programme on its functional recovery. Methods In a single-centre prospective cohort study 97 consecutive patients hospitalised in our CR Unit were enrolled. 14 patients underwent aortic valve replacement, 38 mitral valve repair or replacement, 14 coronary artery bypass grafting (CABG), 22 combined surgery, and 9 other surgical interventions. We performed diaphragm US at admission and after 10 rehabilitative sessions. The following parameters were assessed: thickening fraction (TF) in B-mode on the right intercostal projections, and excursion, time of inspiration, time of a respiratory cycle and contraction velocity in M-mode on right anterior subcostal projections. Results After cardiac surgery, the incidence of diaphragm dysfunction and paralysis were 60% and 1%, respectively. Patients with TF &lt;20% at admission showed a significant improvement in TF (13.30%, IQR 8.69–17.39 vs 27.27%, IQR 21.05–31.58; p&lt;0.001), excursion (1.67cm, IQR 1.3–2.1 vs 2.23cm, IQR 1.9–2.7; p&lt;0.001), time of inspiration (0.9s, IQR 0.9–1.07 vs 1.01s, IQR 0.87–1.13; p=0.005), time of a respiratory cycle (2.67s, IQR 2.38–3.05 vs 3.07s, IQR 2.68–3.35; p&lt;0.001) and velocity (1.81cm/s, IQR 1.14–2.33 vs 2.24cm/s, IQR 1.92–2.76; p&lt;0.001). On the contrary, in patients with a TF&gt;20%, no additional improvement was observed. In both groups, there was a significant improvement in the parameters of physical performance. In particular, in the group with a TF&lt;20%, the distance covered during the 6MWT (300m, IQR 205–370 vs 555m, IQR 450–612; p&lt;0.001) and the energy cost of physical activity (2.60, IQR 2.13–2.92 vs 4.09, IQR 3.44–4.50; p&lt;0.001) increased while the perception of exertion (Borg Scale 11, IQR 11–13 vs 13, IQR 12–13; p=0.011) was reduced. At the 10th day assessment, 51.5% of the total population had a recovery of diaphragm function, whilst 48.5% had a failure of recovery (TF relative change between admission and discharge &lt;60%). The multivariate analysis identified CABG as an independent predictor of failure of diaphragm recovery (OR 5.44; CI 1.10–26.84, p=0.037). Conclusion US might be a valuable part of routine clinical practice for initial and follow-up assessment of patients after open-heart surgery. CR showed to be an effective strategy to improve diaphragm parameters in patients with post-surgical dysfunction. Progressive evaluation of diaphragm function may drive personalised rehabilitation programmes.

P2522A new scoring system to stratify post-surgical valvular patients during cardiovascular rehabilitation: derivation and validation study

Abstract Background Guidelines underline the importance of Cardiovascular Rehabilitation (CR) in post-surgical valvular patients both for the functional recovery and the monitoring of complications. However, there are no established indicators to better categorise their risk and to identify the real probability of recovery. Purpose The aim of this study is to propose and validate a scoring system to appropriately stratify post-surgical valvular patients in order to individualise CR programmes. Methods A retrospective study was conducted on 1480 post-surgical valvular patients hospitalized in our CR Unit (902 M – 578 F; median age of 64 years, IQR 53–73). 485 patients underwent single heart valve repair, 408 single heart valve replacement, 237 single heart valve surgery and additional interventions, 249 multiple valve interventions and 101 multiple heart valves and additional interventions. Subjects were randomised in two groups for data analysis: a Derivation (D; n=1000) and a Validation (V; n=480) group. Initially, in group D we assessed the predictive value of anamnestic, clinical and laboratory variables for major complications and functional recovery. We created two scoring systems for these outcomes and, subsequently, we validated them on group V. Finally, we interlaced them in an operative algorithm. Results Chronic kidney disease (OR 2.588; 95% CI 1.232–5.436; p=0.012), sternal surgical re-synthesis (OR 7.757; 95% CI 2.042–29.471; p=0.003), post-surgical transfusions (OR 2.419; 95% CI 1.407–4.161; p=0.001) and Troponin T peak &gt;1400 μg/L (OR 2.441; 95% CI 1.418–4.200; p=0.001) were independent predictors for the occurrence of major complications in group D. Age (OR 0.958; 95% CI 0.9339–0.977; p&lt;0.001), post- surgical transfusions (OR 1.981; 95% CI 1.160–3.380; p&lt;0.001) and METS at admission (OR 0.032; 95% CI 0.017–0.061; p&lt;0.001) were independent predictors of a higher functional recovery in group D. When the two scoring systems were validated on group V, we obtained a z score of 0.07 (p=0.941) for the major complications risk score and a z score of 1.23 (p=0.219) for the functional recovery stratification system, respectively, indicating a very reliable model. We proceeded to build an operative algorithm to stratify patients and propose personalised CR strategies. Conclusions We identified predictors to stratify the risk of complications and to define the probability of recovery in post-surgical valvular patients undergoing CR. The proposed final operative algorithm may be a unique tool to support the cardiologist to tailor rehabilitation programmes. This may lead to better outcomes and reduction of healthcare expenditure with optimisation in the use of available resources. Acknowledgement/Funding None

Referral from vascular surgery to cardiovascular rehabilitation and related outcomes in patients with peripheral arterial disease: the THINKPAD-RELOADED survey.

The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p<0.05). LEPAD patients entering the CR programme were similar to those who did not according to sex, age, the vascular surgery setting of evaluation, and localization of arterial lesions. Patients with moderate intermittent claudication and patients with acute limb ischemia as index event were more represented among those who attended CR (41% vs 21% and 9% vs 2% respectively, p<0.05). Patients referred to CR had five times more episodes of acute coronary syndrome and heart failure as complication of the index event. The cardiovascular risk profile (obesity 29.5% vs 11%, p<0.05; hypercholesterolemia 80% vs 61%, p<0.05) was much worse in LEPAD patients referred to CR, but conversely, they better achieved secondary prevention targets, particularly for blood pressure control (97% vs 57%, p<0.05). All-cause 2-year mortality in the whole patients' population was 6%. Patients entering the CR programme displayed less events (13.5% vs 37.7%, p<0.05), mainly death (3.1% vs 11.3%, p<0.05) and limb-related events (4.2% vs 15.2%, p<0.05). The results of our study suggest that when a cohesive network of vascular surgery and CR facilities becomes available, the referral rate to rehabilitation may increase up to one third of eligible patients. Patients with higher comorbidity and cardiovascular risk seem to have priority in the referral process, nevertheless those with peripheral revascularization are still underestimated. Entering CR may ensure better cardiovascular risk profile and cardiovascular prognosis in LEPAD patients, and consequently the systematic adoption of this care model needs to be strongly recommended and facilitated.

Cardiovascular disease prevention and rehabilitation programmes – indispensable but are they meeting standards?

Cardiovascular disease prevention and rehabilitation programmes – indispensable but are they meeting standards?

Osteopathic approach with a patient undergoing cardiac transplantation: the five diaphragms.

The case report presents a patient with a possible neuropathic sternal pain associated with a recent heart transplant procedure. The patient could not breathe deeply and move the upper limbs, with a trunk torsion, feeling a sharp pain under and around the left breastbone. A fascial osteopathic approach in the treatment of the pelvic floor, the respiratory diaphragm, the thoracic outlet, the tongue and the tentorium cerebelli allowed the patient to access to a cardiovascular rehabilitation program. In osteopathic medicine, these anatomical parts of the body are called the five diaphragms. To our best knowledge, this is the first case report that uses osteopathic treatment in a patient with sternal pain associated with an undergoing cardiac transplantation. The clinical importance of the case report is added to other osteopathic research with patients undergoing cardiac surgery (coronary artery bypass graft) and with multiple benefits, without side effects. One of the main goals of osteopathic treatment is to provide the patient with well-being, from many clinical points of view, allowing the person to be discharged from the hospital more quickly and/or with less pain.

A systematic review and meta-analysis of the effects of cardiac rehabilitation interventions on cognitive impairment following stroke

Purpose The cardiac rehabilitation model has potential as an approach to providing rehabilitation following stroke. This review aims to identify evidence for the participation of stroke patients in cardiac/cardiovascular rehabilitation programs internationally, whether or not such programs offer a cognitive intervention as part of treatment, and the impact of rehabilitation on post-stroke cognitive function. Method Five electronic databases were searched from inception to 1 May 2019, namely: MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and the Web of Science. Eligible studies included both randomized and non-randomized studies of cardiac rehabilitation-type interventions which measured cognitive function in patients with transient ischemic attack (TIA) or stroke. Results Of 14,153 records reviewed, nine studies which delivered cardiac rehabilitation-type interventions to stroke patients were finally included. Only three of these studies delivered cognitive rehabilitation as part of the intervention. Cardiac rehabilitation had no statistically significant effect on cognitive function in five randomized controlled trials (standardized mean difference= 0.28, 95% CI= −0.16 to 0.73) or in three one group pre-post studies (standardized mean difference= 0.15, 95% CI= −0.03 to 0.33). Conclusions This review highlights that there are very few studies of delivery of cardiac rehabilitation to stroke patients and that the inclusion of cognitive interventions is even less common, despite the high prevalence of post-stroke cognitive impairment. IMPLICATIONS FOR REHABILITATION The cardiac rehabilitation model has the potential to be expanded to include patients post-stroke given the commonality of secondary prevention needs, thereby becoming a cardiovascular rehabilitation model. Up to half of patients experience cognitive impairment after stroke; suggesting that a post-stroke cardiovascular rehabilitation model should incorporate specific cognitive strategies for patients. This systematic review identified three cardiovascular rehabilitation programmes which delivered cognitive rehabilitation as part of treatment; however, evidence for efficacy is weak.

Barreiras Scale for Cardiac Rehabilitation in a Cardiovascular Rehabilitation Programs

Barreiras Scale for Cardiac Rehabilitation in a Cardiovascular Rehabilitation Programs

70 years of cardiac rehabilitation in Switzerland and Europe – from history to new horizons

Cardiovascular prevention and rehabilitation programmes aim to reach out to persons at risk and patients with established disease, and to help achieve long-term maintenance of a healthy lifestyle.

Influence of an exercise program on cardiac remodeling and functional capacity in patients with stroke (CRONuS trial): study protocol for a randomized controlled trial

BackgroundCardiovascular rehabilitation is one of the treatment options for post-stroke individuals in order to improve functional independence in activities of daily life and reduce energy expenditure. The aim of this trial is to evaluate the effect of an exercise program on the echocardiographic variables, functional capacity, inflammatory response, neurological status, nutritional status, cardiologic evaluation, and quality of life of patients after stroke.Methods/designThis is a randomized controlled trial including patients with ischemic stroke in the chronic phase. The patients will be evaluated at the beginning of the study and after 16 weeks. This will include clinical and physical evaluation, 6-min walk test, neurological assessment, nutritional assessment, ambulatory blood pressure monitoring, transthoracic echocardiography, and assessment of the quality of life. The sample size has been determined as 40 patients, who will be divided into two groups: control group (CG; n = 20) and intervention group (IG; n = 20). The CG will undergo conventional physiotherapy for 45 min, three times a week, up to 16 weeks, while the IG will be put on a cardiovascular rehabilitation program consisting of heating, aerobic exercise, and muscle strengthening for 45 min, three times a week, for 16 weeks. The primary endpoint will be functional capacity following a 6-min walk test (delta maxVO2) and morphofunctional echocardiographic variables (indexed left ventricular mass) before and after the intervention.DiscussionWe expect to observe an improvement in cardiac structural and functional abnormalities in the IG, on echocardiography and biochemical examination, and that the improvement of these parameters after cardiovascular rehabilitation will have a favorable impact on the functional capacity and quality of life of patients after stroke.Trial registrationREBEC, RBR-4wk4b3. Registered on 19 September 2016.

Collaborative platform development in nutrition as support for cardiovascular patients’ rehabilitation

Abstract Introduction. Enrollment of patients with cardiovascular disease in rehabilitation programs may contribute to implementation of a healthy lifestyle, including by promotion of a diet adequate for each patient’s profile. In this context, the current study is aimed at creating a traffic light system model allowing to obtain the development, innovation and diversification of menus and to improve the nutritional programs for this category of patients. Material and method. Based on the data provided by USDA Food Composition Databases, the composition in terms of different nutritive principles was determined for each ingredient and for each final menu. Comparison of menus depending on each nutritive principle, as well as comparison between menus and nutrient requirements according to indications for patients attending cardiovascular rehabilitation programs was made. Results. The traffic light system was developed, using color codes, comparing daily nutrient requirements with preparations’ content. Conclusions. The major benefit of the traffic light system would reside in the fact that starting from classic menus, an intervention on these can be achieved, and healthier, more nutritionally balanced models can be created, according to healthy nutrition principles. These new menus will be calorically and nutritionally adapted for patients attending cardiovascular rehabilitation programs. Key words: nutrition, rehabilitation, traffic light system,