Cardiovascular Rehabilitation Program Research Articles

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study.

The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by β coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). The intervention group presented higher costs with healthcare visits (β=+3317.3; p < 0.001), hospitalisation (β=+2810.4; p=0.02) and total cost (β=+6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (β=+2455.8; p < 0.001) and total cost (β=+4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0ml kg-1 min-1 of VO2peak . The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

Breast cancer survivors’ physical activity and experiences while transitioning to a virtual cardiovascular rehabilitation program during a pandemic (COVID-19)

Breast cancer accounts for 25% of all cancers among Canadian females. Despite successes of decreased mortality, adverse treatment effects, such as cardiotoxicity, contribute to a sedentary lifestyle and decreased quality of life. Physical activity (PA) is a possible therapy for the late effects; however, COVID-19 restricted access to in-person cardiovascular rehabilitation (CR) programs. The purposes are as follows: (1) compare PA of breast cancer survivors’ in-person CR to virtual CR following a transition during COVID-19 and (2) compare the PA of the pandemic cohort to a matched cohort who had completed the program in 2018/2019; (3) explore survivors’ experiences of transitioning to and engaging in virtual CR. Mixed methods included analysis of CR PA data from a pandemic cohort (n = 18) and a 2018/2019 cohort (n = 18) and semi-structured focus group interviews with the pandemic cohort (n = 9) in the context of the PRECEDE-PROCEED model. After the transition, there were no significant differences in mean activity duration, frequency, and cumulative activity (expressed as MET-minutes) (p > 0.05). However, variation of PA duration doubled following the transition from in-person to virtual (p = 0.029), while for the 2018/2019 cohort, variation remained unchanged. Focus groups revealed that women valued their CR experiences pre-COVID-19 and had feelings of anxiety during the transition. Perceived factors affecting participation were environmental, personal, and behavioural. Recommendations for virtual programs were to increase comradery, technology, and professional guidance. PA experiences during a transition to virtual care prompted by a pandemic vary among breast cancer survivors. Targeting individualised strategies and exercise prescriptions are important for improving PA programs and patient outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-07142-y.

THE ROLE OF TECHNOLOGY IN PERFORMING PHYSICAL ACTIVITY IN REHABILITATION PROGRAMS FOR PATIENTS WITH CARDIOVASCULAR DISEASES

This research aimed to investigate the results of a kinetotherapy program carried out through a virtual assistant and monitored by wearables. The study includes a group of 10 patients with recomendation to enroll in a cardiovascular rehabilitation program. The investigation was carried out at the clinical Emergency Hospital ‘Bagdasar-Arseni’ between October 2020 and June 2021. The patient enrollment process was dificult in the current epidemiological context. Patients were initially evaluated using the cardiopulmonary effort test to determine if they have contraindications for effort and monitored throughout the ambulatory inhospital physiotherapy sessions (EKG, blood pressure, heart frequency, oxygen saturation). At the end of the recovery sessions another cardiopulmonary test was performed to see the evolution of patient effort. Rehabilitation sessions included physical exercises using digital games / „serious-games” and progressive resistance exercises. Vital parameters (blood pressure, ventricular alura, oxygen saturation), weight excess, effort tolerance level have improved. On the first day of kinetotherapy, the mean systolic blood pressure was 138 mmHg and the mean diastolic pressure of 83 mmHg compared to the last day the patients attended the recovery session when the mean systolic blood pressure dropped to 120 mmHg, and the diastolic mean dropped to 73 mmHg. As for heart rate, an improvement in rest values was observed, that demonstrates an increase in tolerance to effort and a reduction in deconditioning. The data obtained from active participation in physiotherapy programs show a considerable improvement in the effort capacity, functional independence and quality of life of patients.

P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM

Abstract Background Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS Methods 39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training Conclusions - Results of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS

P370 INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE

Abstract Introduction COVID–19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym’s closure and the need to stay home didn’t allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home–based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home–based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara. Methods On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm–up, strenght and balance exercises alternate to indoor walking, cool–down. Patients received an explicative iconographic via e–mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection. Results All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred. Conclusions Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID–19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.

Patients with Minor Non-Disabling Stroke (MiNDS): results of a structured cardiovascular rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Background Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non-Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases. Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS. Methods 39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12-sessions in-hospital SPE program, and after 6- and 12-months follow-up during which they could continue their training schedule on their own. Results After in-hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6- and 12- months follow-up training, while regressed in the 7 patients who stopped training. Conclusions Results of the present study show that a SPE-based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS.

Usefulness of the 6-minute walk test vs cardiopulmonary exercise test for exercise prescription in coronary artery disease patients going into a phase III cardiac rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Determining the intensity of exercise is a very important component to obtain the dose-benefits associated with exercise, while maitaining the safaty of the patient with coronary artery disease (CAD) in a cardiovascular rehabilitation (CR) programme. The cardiopulmonary exercise test (CPET) is the gols standard for exercise prescription according to the intend intensisty of aerobic workout. However, its availability is not a reality in many CR centres. The 6-minute walk test (6MWT) is a valid and widely used method because it is low-cost and simple to apply. Nevertheless, it is still unknown the corresponding intensity reached on a 6MWT compared to the one reached on a CPET in already physically active patients with CAD starting a CR phase III programme. Purpose To use the peak heart rate (HR) of the 6MWT as a method to prescribe the intensity of aerobic exercise in CAD patients starting a phase III CR programme and to compare it with the ventilatory threshold (VT) of the CPET. Methods In this retrospective study, a cohort of patients with CAD enrolled in a phase III CR programme. At the beginning of the programme, all patients performed a 6MWT and a CPET in the same week with at least 48-hour difference. The HR on the 6MWT was recorded continuously using a HR polar (H10 Polar) and on CPET using a twelve-lead ECG. Other parameters were assessed such as objective physical activity (accelerometer) and body composition. Results Eighty patients (87.5% males, 60.8 ± 9.4 years old) with CAD were included in this study. Patients were, on average, physically active (361 ± 182 minutes/week of moderate to vigorous physical activity) and overweight (body mass index: 27.7 ± 3.5 kg/m2). The VO2 peak reached on the CPET was 20.3 ± 5.4 ml/kg/min and the percentage of predicted maximum HR was 78.3 ± 11.4 %. The first and second VT corresponded to 75.6 ± 7.8% and 91.2 ± 4.5% of the peak HR obtained with CPET, respectively. The 6MWT HR peak was 113 ± 16 bpm (90.0 ± 13.0 HR peak CPET) and did not differ from the HR of the second VT with a mean value of 115 ± 16 bpm (91.2 ± 4.5% HR peak CPET), p&amp;gt;0.05. Although, the 6MWT HR peak was significantly higher than the HR oh the first VT (95 ± 14 bpm, p&amp;lt;0.001). In a subgroup analysis, the patients who, during the 6MWT, reached more the 90% of the HR peak CPET (n=35, 44% oof the sample) were the ones with lower functional capacity (VO2 peak: 18.4 ± 5.4 ml/kg/min vs 21.7 ± 5.0 ml/kg/min, p=0.006) and higher age (64.4 ± 8.7 years old vs 60.8 ± 9.4 years old, p=0.002). Conclusion(s) In the absence of a CPET, the use of a 6MWT HR peak in physically active patients with CAD starting a phase III CR programme has shown to be an efficient method to prescribe moderate to vigorous exercise intensity, corresponding to the second VT. Higher intensities on the 6MWT might be reached in active elderly patients with reduced functional capacity.

Outcomes from a digital cardiovascular prevention and rehabilitation programme delivered in Ireland during COVID 19

Funding AcknowledgementsType of funding sources: Public grant(s) – National budget only. Main funding source(s): Government of Ireland's Sláintecare Integration Fund Health Research Board, IrelandBackground & AimCOVID 19 has accelerated the uptake and acceptance of digital health tools for the prevention and management of Cardiovascular Disease. With health systems being urged to learn from the pandemic and to reassess how they will deliver services in future, robust audit and evaluation of digital interventions are required to inform best practice.This study aims to evaluate the clinical outcomes of a digital CVD prevention and rehabilitation programme which was established during COVID 19 to provide cardiac patients with efficient and timely access to a home-based, structured, comprehensive programme of care.MethodsDeveloped and delivered by an interdisciplinary team (Nurse Prescriber, Physiotherapist, Dietitian, Cardiologist), the core components of this 12 week programme included, behavioural change support, lifestyle modification, medical risk factor management and electronic prescribing of cardio-protective medication. To support self-management, patients were provided with a Fitbit, blood pressure monitor and a workbook to support goal setting and overall tracking of progress. Patients were given access to a bespoke web-based platform and invited to attend weekly (2hr) group-based sessions, which included an exercise component and an interactive educational workshop.ResultsOver a 4 month period, 105 patients were referred with an uptake rate of 73% (n=77). Of these, 97% (n=75) enrolled in the programme, with an 85% (n=64) completion rate. Significant improvements in CVD risk factors were observed between initial and end of programme assessment. The proportion of patients meeting guideline-recommended physical activity targets increased from 14 to 82% (p<0.001), mean BMI (kg/m2) reduced from 28.7 to 27.7 (p<0.001), mean Mediterranean diet score improved from 5.2 to 7.3 (p<0.001), and anxiety and depression levels ≥8 (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The proportions achieving the recommended blood pressure (<130/80 mmHg) and LDL cholesterol targets (<1.4 mmol/L) increased from 24 to 68% (p<0.001) and 14 to 41% (p<0.001), respectively.ConclusionOutcomes from this programme demonstrate that digital CVD prevention and rehabilitation programmes can achieve the recommended lifestyle, medical and therapeutic targets associated with reduced CVD events and improved health outcomes. This programme represents a scalable, accessible and effective option to deliver vital CVD preventive care in the patient’s home.

Perceptions and preferences of patients with cardiac conditions to the inclusion of virtual reality-based therapy with conventional cardiovascular rehabilitation: A qualitative study

BackgroundVirtual reality-based therapy (VRBT) has been recently used in rehabilitation programs, as it can improve patient's adherence to treatment. However, patients’ acceptance of VRBT has been scarcely investigated. ObjectiveTo qualitatively analyze the perceptions and preferences of patients about the inclusion of VRBT to a conventional cardiovascular rehabilitation program (CRP). MethodsFifteen patients from a randomized clinical trial participated in focus groups for qualitative assessment. ResultsPatients demonstrated good acceptance and satisfaction of VRBT. Physical and psychosocial benefits were highlighted, and patients reported the perception of higher exercise intensity in VRBT then when doing conventional training. In addition, the frequency of VRBT (once a week), associated with conventional treatment was reported as satisfactory. Cognitive aspects that influenced participation to the new approach were also raised by study participants. ConclusionPatients with cardiac conditions demonstrated satisfaction with the inclusion of VRBT in a conventional CRP, demonstrating that VRBT has the potential to be a new approach for this patient population, allowing training diversification. Benefits perceived by patients include physical, mental, and social aspects. Trial RegisteredNCT04336306 (https://clinicaltrials.gov/ct2/show/NCT04336306)

From the Editor

I recently reviewed a report performed for the American College of Cardiology (ACC) titled Survey Report: Cardiac Rehab Industry Insights and Best Practices (1). Only a fraction of the cardiac rehabilitation (CR) programs in the United States were assessed (N = 72 of 800+ programs). The survey provided information on a wide array of topics including eligible patient participation, intensive versus traditional CR use (10% and 90%, respectively), the number sessions attended, maintenance program charges, “virtual” CR services (only 13% offering), other offerings (e.g., pulmonary, PAD, oncology), American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) program certification (75% certified), program revenues (50% reported positive net revenue), and barriers to growth.Another area of focus was on staffing. Two items related to the reporting of staffing caught my attention. First, and I have mentioned this previously, is the disappointment I had in the listing of “Exercise Physiologist” (EP) and not “Clinical Exercise Physiologist” (CEP). A goal of those individuals who belong to the organizations that allow access to this journal (CEPA, ESSA, and CSEP) should be to promote the specialty of clinical exercise physiology. The American College of Sports Medicine recognizes CEPs and EPs as distinctly separate professionals (2). The CEP is an allied healthcare professional with specific education and practical skills to guide those with existing chronic disease (many who are newly diagnosed and with complex comorbidities) through an exercise and lifestyle modification program. I urge anyone reading this article to recognize the differences between CEPs and EPs, and when the term EP is used when CEP should have been use, please notify the author or organization of this mistake. For example, I recently asked the current president of the AACVPR to change from EP to CEP on their registration to the annual meeting and provided rationale. It was met with acceptance, and he stated they will be making this change.The other area in the staffing section of the ACC CR survey had to do with use of various disciplines for program staffing. It was heartening to read that 95% of programs surveyed employed exercise professionals (stated as EPs in the survey—see above). CR remains the primary location of employment of the CEP, particularly in the United States. Additionally, 89% of the programs reported using a registered nurse. Nursing involvement in CR has been traditional since its inception. However, our program at Henry Ford Hospital has not used nurses for the past 20 years. We have relied solely on appropriately trained and experienced CEPs, with physician support, to implement programming and deal with the variety of medical situations that occur (blood glucose issues, chest pain, hypotensive responses, the need for CPR and/or defibrillation). We have been able to provide safe and effective CR programming in the settings of hospital and standalone clinic while serving an extremely sick and frail population. And this has also included the implementation of several important National Institutes of Health trials (HF-ACTION, CLEVER, iATTEND) (3). Importantly, staffing with only CEPs meets the 2006 Medicare and Medicaid definition for staffing of CR programs (4). I urge you to read the point:counterpoint from the 2015 issue of the Journal of Clinical Exercise Physiology (only 1 issue per year at that time and any article older than 18 months is freely available) in which I debate that the CEP is the best and logical choice for the majority of staffing in CR programs (5). My goal is to continue to promote the primary use of CEPs in all exercise settings catering to those with chronic disease.

Comparative effects of a cardiovascular rehabilitation program on functional capacity in patients with chronic chagasic cardiomyopathy with or without heart failure

Purpose The aim of the present study was to evaluate the effects of cardiovascular rehabilitation (CR) on functional capacity of patients with chronic chagasic cardiomyopathy (CCC) and to compare the responses between CCC patients without and with heart failure (HF). Materials and methods A longitudinal observational retrospective study was carried out including 36 patients with CCC without HF (stage B2 [n = 7]) and with HF (stage C [n = 29]), who participated in a CR program. Functional capacity was assessed by a maximal progressive cardiopulmonary exercise test performed on a treadmill. The longitudinal effects of the CR on functional capacity were determined by linear mixed models that included an interaction term to evaluate the differential responses between patients without and with HF. Results Significant improvements in peak oxygen consumption, resting heart rate and blood pressure, and maximum pulmonary ventilation were observed for the overall study sample, with no apparent differential effects according to the presence of HF. Conclusions CR significantly improved functional capacity of patients with CCC. The responses to CR appear to be similar among patients without and with HF, reinforcing the need for its inclusion as a standard treatment strategy of CCC. Implications for rehabilitation Exercise-based cardiovascular rehabilitation (CR) is a safe strategy that improves functional capacity, cardiac function, and quality of life in patients with several cardiovascular diseases, and recent studies also suggested a potential beneficial effect of CR in chronic chagasic cardiomyopathy (CCC). In this observational study, CR seems to equally improve exercise capacity, resting heart rate, resting blood pressure, and maximum pulmonary ventilation in patients with CCC without (stage B2) and with heart failure (stage C). Cardiovascular rehabilitation should be included as a standard treatment strategy for patients with CCC, regardless the severity of cardiomyopathy.

Remote Cardiovascular Rehabilitation at COVID-19 Times: Experience in a University Hospital

Multiple studies have shown that cardiovascular rehabilitation programs are safe and effective in improving functional capacity and quality of life and reducing re-Internation and mortality by all causes.

Desfechos entre diferentes questionários validados para a avaliação do nível de atividade física em cardiopatas adeptos a um programa de reabilitação

Abstract Introduction The International Physical Activity Ques-tionnaire (IPAQ) and Baecke inventory are commonly used in cardiovascular rehabilitation routines. Thus, it is understood that investigations on the equivalence of outcomes between these two tools may be relevant to measure the magnitude of possible reproducibility and correlations between them. Objective To compare in cardiac patients the level of physical activity obtained through the IPAQ and Baecke inventory and correlate outcomes obtained with a 6-minute walk test. Methods In total, 65 heart disease patients included in a cardiovascular rehabilitation program (40 male and 25 female) were included, with a mean age of 65.8 ± 10.5 years. The data were obtained from the application of a standardized form, containing the proposed study objects, which were the IPAQ and Baecke inventory. In addition, data regarding anthropometric measurements (body mass, height, and body mass index - BMI), waist-to-hip ratio, blood pressure, and performance in the 6-minute walk test were measured. Results The main outcomes refer to the weak association between the instruments evaluated, which showed a strong relationship only between free time physical activity (r = 1), while in the other categories and when compared to the 6-minute walk test, the verified agreement was not significant. Conclusion The questionnaires are strongly equivalent only for free time physical activity, in the other categories and when compared to the 6-minute walk test, the agreement was not significant. Thus, based on the results, implementation in clinical practice considering the use of these tools with equivalence is not recommended.

ICNP® terminology subset for the care of people with heart failure.

to develop an ICNP® terminology subset for the care of people with heart failure. this is a methodological study, which used the theoretical framework of the Mid-Range Nursing Theory for Cardiovascular Rehabilitation, with the steps: Construction of nursing diagnoses/outcomes and interventions statements and Cross-mapping of statements constructed. forty-two diagnosis/outcome statements and 179 nursing intervention statements were constructed, organized based on five theory concepts, with a higher prevalence of statements related to "Rehabilitative care", "Psychosocial support for patients and families" and "Supervised cardiovascular rehabilitation program". it was possible to build nursing diagnosis/outcome and intervention statements for developing a terminology subset for the care of people with heart failure, based on the chosen theory.

An Evaluation of the Role of the Exercise Dose for Changes in Cardiorespiratory Fitness During a Standard Cardiovascular Rehabilitation Program

An Evaluation of the Role of the Exercise Dose for Changes in Cardiorespiratory Fitness During a Standard Cardiovascular Rehabilitation Program

Effects of an intradialytic cardiovascular rehabilitation program on functional capacity and cardiac function: ICRP trial

Effects of an intradialytic cardiovascular rehabilitation program on functional capacity and cardiac function: ICRP trial

Effect of cardiac rehabilitation on exercise ventilatory oscillations in patients with chronic heart failure

Cardiovascular rehabilitation (CVR) is recommended in patients with heart failure (HF) to reduce mortality and new hospitalizations. A cardiopulmonary exercise testing (CPX) presents prognostic criteria such as the presence of exercise oscillatory ventilation (EOV). The aim of our study was to analyse the impact of CVR on EOV and the prognostic value of an evolution of EVO after CVR in a population of chronic heart failure patients. Retrospective, monocentric study including HF patients with reduced/intermediate left ventricular ejection fraction (i.e. < 50%) who participated to a CVR programme in our institution from July 2013 to November 2020, consisting of 21 sessions with a CPX at the first and last sessions. The presence of EOV at the CPX priori to CVR defined the EOV+ and EOV- groups. The main outcome of the study was the resolution of EOV after CVR. The secondary outcome was the occurrence of rehospitalisation for HF and/or death during follow-up, and according to the EOV status. Among the 142 patients included, 24 (17%) had EOV (EOV+ group). The VE/VCO2 slope before CVR was significantly increased in the EOV+ vs. EOV- patients (39.6 ± 5.9 vs. 36.8 ± 6.1 P = 0.05). Regarding the main outcome, EOV resolution was noted after CVR in 14 patients (58.3%, P < 0.01). The 10 patients (7%) with maintained EOV had a significant decrease of the length of the EOV cycle (40.2 ± 12.8 vs. 49.5 ± 15.3 sec, P = 0.005). After a mean follow-up of 31 ± 22 months, we found no difference in the rates of occurrence of the secondary outcome according to the post-CVR EOV status. Cardiovascular rehabilitation is associated with a substantial resolution of EOV (or EOV cycle length) in patients with chronic heart failure. However, the prognostic value of this phenomenon is uncertain.

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

To examine whether a cardiac rehabilitation programme in a community based setting for patients with intermittent claudication (IC) affects walking ability, quality of life, and changes in health behaviour. The trial investigated a cross sector cardiovascular rehabilitation programme compared with usual care for patients having non-operative management.

The effectiveness of M-Health associated with cardiac rehabilitation on functional capacity and cardiovascular risk factors: a systematic review and meta-analysis

Abstract Introduction Smartphone applications for health (M-Health) seem to overcome barriers to access Cardiovascular Rehabilitation Programs (CRP), because of their high degree of acceptance and also their potential to influence the frequency of physical exercise in weight loss. Objective To analyze the effectiveness of the combination of M-Health and CRP compared to CRP alone on functional capacity, adherence to CRP, management of cardiovascular risk factors in cardiac patients. Design Systematic Review and Meta-Analysis. Methods The following databases were used Medline via Ovid, EMBASE, Central, PEDro and SPORTDiscus via EBSCOhost from their inception until July/2020. We included randomized controlled trials investigating the effects of M-Health in combination with CRP compared to CRP alone in adults with heart disease, and the interventions with M-Health consisted of text messages, e-mails, and applications. The primary outcome of this review was functional capacity, measured by VO2peak, or self-reported physical activity (METs.min/week). PEDro scale was used to assess the methodological quality of the studies and the GRADE approach to assess the overall quality of evidence. Pooled estimates were calculated using a random effect model to obtain mean difference (MD) or standardized mean differences (SMD) and their respectives 95% confidence intervals (CI). Results Nineteen RCTs were eligible, the median risk of bias was 7 out of 10 points. The primary endpoint was analyzed by subgroups, time of intervention and kind of type CRP, eigthteen of these studies assessed functional capacity. CRP in combination with a m-health intervention was more effective than CRP alone in improving VO2peak, ml/min/kg, (MD: 0.84, CI: 0.30 to 1.38; I2=0%, high quality evidence, 12 trials, n=1889) at short-term follow-up, but at medium-term follow-up (MD: 0.84, CI: −0.26 to 1.41; I2=0%, high quality evidence, 8 trials, n=927,). Similarly, CRP associated with m-health was superior to CRP alone in increasing self-reported at short-term, METs.min/week, (MD:1.31, CI: −0.24 to 2.37; I2 = not aplicable, very low quality evidence, 1 trial, n=18), and at medium-term follow-up (MD: 0.18, CI: −0.01 to 0.36; I2=56%, moderate quality evidence, 4 trials, n=1107). Conclusion High quality of evidence shows that M-Health improves cardiorespiratory fitness at short-term follow-up. In addition, supervised program showed to be more effective than non-supervised. Funding Acknowledgement Type of funding sources: None.

Results of a hybrid cardiovascular rehabilitation program (in-hospital plus home) in patients with low income

Abstract Background One of the main problems facing cardiovascular rehabilitation (CR) is patient care and adherence. However, due to the low level of economic income of the patients who are cared for in our center, the possibility of going to CR in a conventional way is very difficult since they do not have the necessary resources to cover transportation, cost of the sessions, among others. It has been shown that the greater the number of sessions attended by the patient, the greater the reduction in cardiovascular risk, however the role of a hybrid program with a decreased number of face-to-face sessions has not been established. Purpose Present the results of a hybrid training program (in-hospital plus home) in a low-income population. Education through supervised sessions plus home physical training in a patient with bases for exercise can improve their adherence with better results. Methods A cohort of patients with heart disease who were referred to the Cardiovascular Rehabilitation program between May 2017 and February 2019 was included. The socioeconomic level was classified into 6 strata according to occupation, income, housing, economic dependents, place of origin and family health status. After risk stratification, the patients participated in a hybrid program that consisted of 6 in-hospital sessions, once a week, in which the training to be carried out at home was prescribed by means of a triptych. An exercise test was performed before and after completing the program, as well as psychological and nutritional intervention. Statistical analysis was performed using SPSS 21.0 software. All p values less than 0.05 were considered significant. Results In the study period, of the total number of patients discharged for heart disease from the hospital, 61% were referred to cardiovascular rehabilitation, of which only 45% (n=39) completed the program, the reasons for dropping out were multiple and the lowest socioeconomic level (1) was the most frequent (figure 1). The main referral diagnosis was ischemic heart disease in 82%. The majority of patients were men, 95%. A significant improvement was observed in load METs, maximum heart rate, heart rate recovery (figure 2). Conclusion The implementation of a hybrid cardiovascular rehabilitation program (in-hospital + home) was associated with an improvement in the exercise test parameters of patients who successfully completed the program. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2