Comprehensive Cardiac Rehabilitation Program Research Articles

Indication for device therapy in heart failure patients after a comprehensive cardiac rehabilitation program

Background: Exercise based comprehensive Cardiac Rehabilitation (CR) has been shown to improve New York Heart Association (NYHA) functional class and Left Ventricular Ejection Fraction (LVEF) in Heart Failure (HF) patients. Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy Defibrillators (CRT-D) reduce mortality in selected patients with persistent symptoms and reduced LVEF. We sought to determine the proportion of patients with a remaining indication for device therapy after a 3 month CR program. Methods: We performed a retrospective, longitudinal study in HF patients with a LVEF ≤35% in NYHA functional class I to III, who successfully completed a 3 months CR program. The exercise training consisted of 36 sessions, including endurance and strength training. Medication was optimized during the program. LVEF, peak oxygen uptake (VO2), and Brain Natriuretic Peptide (BNP) were determined at baseline and after the program. Indications for device therapy were based on the European Society of Cardiology guidelines for management of HF (2012) and sudden cardiac death (2006). Results: A total of 300 patients were included in the analysis (mean age 59±11 years, 13.3% female). 50.7% had ischemic, 38.7% had idiopathic dilated cardiomyopathy, and 10.6% had other cardiomyopathies. At baseline, median (IQR) VO2 peak was 16.6 (5.1) ml/min/kg, LV ejection fraction was 25 (10)%, and BNP was 269 (377) pg/ml. After three months, all parameters improved significantly: peak VO2 to 17.9 (7.3) ml/min/kg, p<0.001; LFEF to 35 (15)%, p<0.001; and BNP to 180 (287) pg/ml, P<0.001. Beta-blockers and ACE-Inhibitor/angiotensin receptor blockers were used in 87.1% and 92.3%, respectively. 194 (64.7%) of patients remained with an LVEF≤35%. Of those patients, 116 (59.7%) were in NYHA functional class II and III. Dyssynchrony was present in 60 (30.9%) patients, 50 (25.8%) showed a left bundle branch block. 16 (8.2%) patients had atrial fibrillation. ICD and CRT-D devices were present in 39 (20.1%) and 9 (4.6%) patients, respectively. A formal class I or IIa indication for ICD implantation remained for 54 (27.8%) and 24 (12.4%) patients, respectively. For CRT-D implantation, class I and IIa indications were present in 26 (13.4%) and 9 (4.6%) patients, respectively. Conclusion: Despite beneficial effects of a comprehensive CR program on performance and LVEF, a persistent indication for device therapy remained in a substantial number of HF patients. To further improve prognosis and exercise capacity in these patients, follow-up should be performed in close cooperation with an electrophysiologist.

GW24-e3978 Effects of a comprehensive cardiac rehabilitation program on quality of life in patients with coronary artery disease

ObjectivesHealth-related quality of life (QOL) is an important factor to evaluate effects of different interventions in cardiovascular diseases. Improvement in QOL is an important goal for individuals participating in cardiac...

관상동맥질환자를 위한 위험요인관리 프로그램 분석

Purpose: This study was performed to analyse the trends of risk factor management programs for patients with coronary artery disease. Methods: Using PubMed, 35 intervention studies related to risk factor management programs among randomized controlled trials searched with the key words of coronary artery disease and coronary heart disease. Collected studies were analysed according to the characteristics of studies and participants, method and content of intervention, and outcome indicator and its effects. Results: The mean period of intervention was <TEX>$28.7{\pm}26.8$</TEX> weeks, the mean frequency was <TEX>$3.0{\pm}2.0$</TEX> times per week, and the duration of one session was below 60 minuets in 65.8% of the reviewed studies. The interventions were counselling, exercise, education, and cognitive behavior therapy. Counselling was applied most frequently in previous studies. The outcomes of intervention had been measured with anthropometric, physical, physiological, psychological, behavioral, and cognitive aspects, but the effect of the intervention was inconsistent among the studies. Conclusion: Based on the results of this study, systematic and comprehensive cardiac rehabilitation program consisted of counselling, exercise, and education should be developed and performed for health management and relapse prevention of patients with coronary artery disease.

The association of tobacco use and gender to cardiac rehabilitation outcomes: a preliminary investigation

Introduction: Cardiac rehabilitation (CR) outcomes are measured in terms of cardiovascular disease (CVD) risk factor reductions, and these predict long-term cardiac status. This report examines whether reported tobacco use has differential effects on successful cardiovascular risk factor modification, especially for women who have greater smoking-related CVD consequences than men. Methods: A retrospective cohort analysis was conducted on 1138 adults (74% male) with diagnosed CVD who participated in ≥7 weeks of a comprehensive CR program. Eleven CVD risk factors were assessed at CR entry and completion. Tobacco use was assessed by self-report at CR entry. The primary outcomes were attainment of goal levels for each risk factor. Results: Fewer current and former tobacco users reached the preset goal for maximal exercise capacity. Fewer women than men reached the preset goal for high-density lipoprotein cholesterol (HDL). Women who were current or former tobacco users were less likely to meet the target goals for triglycerides and more likely to meet target goals for total cholesterol and non-HDL cholesterol. Conclusions: This preliminary study suggests the importance of identifying the effect of tobacco use and gender on CR outcomes and the need to evaluate modification of key cardiovascular risk factors for subgroups of cardiac patients.

Short-term comprehensive cardiac rehabilitation after AMI is associated with reduced 1-year mortality: results from the OMEGA study

The prognostic effect of early, comprehensive short-term cardiac rehabilitation on top of current, guideline-adjusted treatment of acute myocardial infarction has not sufficiently been evaluated. Prospective cohort study. Within the OMEGA study population, the clinical course of 3560 patients still alive 3 months after acute myocardial infarction were evaluated by comparing patients who had attended to cardiac rehabilitation (70.6%) with those who did not. Total mortality and major adverse cerebrovascular and cardiovascular events, as well as non-fatal events, were evaluated within the time period of 4-12 months after hospital admission for acute myocardial infarction. The effect of cardiac rehabilitation on clinical events was estimated by using the propensity score method to adjust for confounding parameters in multivariate analysis. Patients participating in cardiac rehabilitation were younger, more often had acute revascularization, less often experienced non-ST-elevation myocardial infarction, and less often had a history of diabetes or cardiovascular events. Total mortality (OR 0.46, 95% CI 0.27-0.77) and major adverse cerebrovascular and cardiovascular events (OR 0.53, 95% CI 0.38-0.75) were significantly lower in the rehabilitation group. Subgroup analysis including major clinical characteristics also revealed significantly reduced rates of total death and major adverse cerebrovascular and cardiovascular events in the rehabilitation group. Attendance to early, comprehensive short-term cardiac rehabilitation programmes on top of current guideline-adjusted treatment of acute myocardial infarction is associated with a significantly improved 1-year prognosis.

Long-term Results of a 12-Week Comprehensive Ambulatory Cardiac Rehabilitation Program

To evaluate the long-term outcome of a 12-week outpatient cardiac rehabilitation (CR) program. In a prospective single-center interventional cohort study, 201 consecutive patients (133 patients after acute coronary syndrome, 32 patients after heart surgery, and 36 patients with heart failure) attending a 12-week comprehensive outpatient CR program were evaluated for exercise capacity, cardiovascular risk factors (CvRFs), and quality of life at entry, end, and 1.4 years after completion of the program (followup). Physical exercise capacity improved significantly from program entry to program end and remained at this level at followup (P ≤ .006). CvRFs at followup were significantly reduced with regard to smoking prevalence and blood lipids (P < .001). At program end and followup, MacNew heart disease-specific emotional, physical, and social quality of life were improved significantly compared with those at program entry (P < .001). Use of cardioprotective medication remained equally high over the entire study period. However, significantly fewer patients reached blood pressure (<140/90 mm Hg, P = .034) and body mass index (<30 kg/m, P = .017) goals at followup than at program end. The 12-week comprehensive outpatient CR program was successful at reducing important CvRFs long-term.

Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

BackgroundHeart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery.MethodsA randomised clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study.DiscussionThe study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015).Trial registrationClinicalTrials.gov (http://NCT01558765).

The Necessity of Participation of Patients with Chronic Heart Failure in Cardiac Rehabilitation

Cardiac rehabilitation (CR) is a well-documented and evidencebased course of long-term management for patients with chronic heart failure (CHF). The core components of comprehensive CR programs for CHF patients are exercise, education, counseling and psychosocial support, services which are delivered by a multidisciplinary team and are accompanied by excellent outcomes for both the patient and the healthcare system in general [1].

Effects of the Comprehensive Cardiac Rehabilitation Program on Psychological Factors and Quality of Life among Coronary Heart Disease Patients

The Comprehensive Lifestyle Intervention, which integrates psychological and educational intervention, is a program to improve self-efficacy, self-regulation, self-care, body mass index and quality of life of the patients with coronary heart disease during early stages following hospitalization. The purpose of this study was to investigate the effects of the Comprehensive Cardiac Rehabilitation Program affecting psychological factors including self-efficacy, self-regulation, self-care, quality of life (QoL), and body mass index (BMI). This study was a quasi-experimental research with a repeated one group design. Eighty patients with coronary artery disease were recruited from either the Medicine or Surgical Ward at the Phramongkutklao Hospital where the patients joined the Comprehensive Cardiac Rehabilitation Program, which included attending exercising practice and receiving face-to-face counseling while being admitted to the hospital. Telephone counseling was thereafter performed one week after being discharged from the hospital, followed by undergoing individual or group counseling at the Cardiac Rehabilitation Clinic the following week. The follow-up period was performed within six weeks after hospitalization. Data was collected on two occasions before discharging from the hospital (pretest) and six weeks after (post-test) by using the self-efficacy, self-regulation, and self-care questionnaires, as well as the Short Form(SF) -36 (Thai version). The results indicated that by six weeks, 50%, 58.80%, 46.20%, and 72.50% of patients, respectively, had experienced increases with self-efficacy, self-regulation, self-care, and quality of life scores, while 12.50% of patients had decreased their body mass index in comparison with the pretest score. From the paired t-test, the self-efficacy, self-regulation and quality of life scores were statistically significant, having increased to the p<0.01 level; self-care was statistically significant, having increased to the p<0.05 level along with body mass index, which was statistically significant having experienced a decrease to the p<0.01 level.

Abstract 9923: Cardiac Rehabilitation Reduces Levels of Oxidized LDL

Background: Oxidized LDLs have been shown to play an important role in atherosclerosis progression. However, no established methods are available for effectively reducing oxidized LDL levels. Comprehensive cardiac rehabilitation (CR) with exercise training prevents atherosclerosis progression. The purpose of the current study was to examine whether CR reduces oxidized LDL levels. Methods and Results: We measured the levels of malondialdehyde-modified LDL (MDA-LDL), a marker of oxidized LDL, in 118 patients who were enrolled for a 6-month CR program. Peak VO 2 and MDA-LDL levels were examined before and at 6 months after enrolment in 55 patients who completed the CR program (CR group) and in 63 patients who failed to continue the CR program (non-CR group). At 6 months, the peak VO 2 in the CR group was significantly higher than the baseline value (1131 ± 364 to 1327 ± 442 ml/min, p &lt; 0.01). At 6 months, the MDA-LDL level was significantly lower than the baseline value in the CR group (111 ± 43 to 89 ± 25 U/l, p &lt; 0.05) but this difference was not significant in the non-CR group. The increase in peak VO 2 was inversely correlated with the decrease in the MDA-LDL level (r = -0.40, p &lt; 0.01). This correlation was observed even in patients who had not just started statin therapy. Conclusion: The CR program significantly reduced oxidized LDL levels in association with increase in exercise capacity. Thus, CR may exert an anti-atherosclerotic effect through reduction of oxidized LDLs.

Effective secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey

Background and aimSecondary prevention is a priority after coronary revascularization. We investigate the impact of a cardiac rehabilitation (CR) program on lifestyle, risk factors and medication modifications and analyze predictors of poor behavioral changes and events in patients after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). MethodsMulticenter (n=62), prospective, longitudinal survey in post-CABG or -PCI consecutive patients after a comprehensive CR program. Cardiac risk factors, lifestyle habits, medication and 1year cardiovascular events were collected. Logistic regression analyzed the association between risk factors, events and predictors of non-adherence to treatment and lifestyle. ResultsAt 1year, of the 1262 patients (66±10years, CABG 69%, PCI 31%), 94% were taking antiplatelet agents (vs. 91.8% at CR admission and 91.7% at CR discharge, p=ns), 87% statins (vs. 67.5%, p<.0001, and 86.3%, p=ns), 80.7% beta-blockers (vs. 67.4%, p<.0001, and 88.8%, p=ns), and 81.1% ACE inhibitors (vs. 57.5% p<.0001, and 77.7%, p=ns). 89.9% of the patients showed good adherence to treatment, 72% adhered to diet and 51% to exercise recommendations; 74% of smokers stopped smoking. Younger age was predictive of smoking resumption (OR 8.9, CI 3.5–22.8). Pre-event sedentary lifestyle (OR 3.3, CI 1.3–8.7) was predictive of poor diet. Older patients with comorbidity (OR 3.1; CI, 1.8–5.2) tended to persist in sedentary lifestyle and discontinue therapy and diet recommendations. Age, diabetes, smoking and PCI indication were predictors of recurrent CV events which occurred in 142 patients. ConclusionParticipation in CR results in excellent treatment after revascularization, as well as a good lifestyle and medication adherence at 1year and provides further confirmation of the benefit of secondary prevention. Several clinical characteristics may predict poor behavioral changes.

Socially differentiated cardiac rehabilitation: Can we improve referral, attendance and adherence among patients with first myocardial infarction?

The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality in recruitment and participation among low educated and socially vulnerable patients must be addressed to lower inequality in post-MI health. Our aim was to improve referral, attendance, and adherence rates among socially vulnerable patients by systematic screening and by offering a socially differentiated cardiac rehabilitation programme. From 1 September 2002 to 31 December 2005, 388 first-incidence MI patients ≤75 years were hospitalised. Register check for newly hospitalised MI patients, screening interview, and systematic referral were conducted by a project nurse. Patients were referred to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements. Adherence was registered until the 1-year follow up. 86% were referred to the CR. A large share of elderly patients and women were excluded. The attendance and adherence rates were 80% and 71%, respectively among all hospitalised patients. Among referred patients, the attendance rate was 93%. Patients were equally distributed to the SRP and the ERP. No inequality was found in attendance and adherence among referred patients. It seems possible to overcome unequal referral, attendance, and adherence in cardiac rehabilitation by organisation of systematic screening and social differentiation.

Abstract P319: Improvement in Depressive Symptoms in Elderly Cardiac Patients after Cardiac Rehabilitation

BACKGROUND: Depression effects at least 18% of patients with known coronary artery disease (CAD) and is associated with an increased risk of future cardiac events. There is a strong association between depression and cardiac mortality in patients with known heart disease and these symptoms are very common in patients with acute coronary syndrome (ACS). With the significant prevalence of depression in cardiac patients studies have shown that comprehensive cardiac rehabilitation (CR) programs resulted in beneficial effects on clinical symptomatology and clinical depression in these patients. HYPOTHESIS: The purpose of this study was to assess the improvement of depressive symptoms using PHQ-9 mood scale among younger patients (≤ 55 years of age) and older patients (≥ 70 years of age) enrolled in the CR program at the Cardiac Health Center (CHC) of New York Hospital Queens (NYHQ). METHODS: The study sample comprised of 237 participants who were enrolled and completed 36 sessions of CR at the CHC from 2007-2009. Depressive symptoms were assessed using the PHQ-9 prior to admission and upon completion of the CR program. Patients were categorized into two groups in relation to their age as younger patients (≤ 55 years of age) and older patients (≥70 years of age). RESULTS: Out of 237 patients, 91 patients are ≤55 years of age (38.4%), and 51 patients are ≥ 70 years of age (21.5%). Prior to the start of CR the mood scores of younger patients were 10.11 ± 6.33 and the older patients were 9.00 ± 3.34. After the completion of CR the mood scores of younger patients were 6.11 ± 7.18 and the older patients were 2.94 ± 3.99. Both groups showed significant improvement in their mood scores after CR. Younger patients Δ 4.00 ± 2.16 and elder patients Δ 6.06 ± 1.15. CONCLUSIONS: The results of the study confirm that CR improves depressive symptoms in both younger and older patients groups. Although both groups started with comparable mood scores, older patients showed significant improvement in mood scores compared to younger patients. Studies have shown improvement in exercise capacity in the elderly population after CR. Elderly patients need to be encouraged to participate in CR programs as improvements in depressive symptoms along with functional capacity after CR translate into a more productive and satisfying lifestyle and improved quality of life.

Impact of Cardiac Rehabilitation on Metabolic Syndrome in Iranian Patients with Coronary Heart Disease: The Role of Obesity

Due to high prevalence of metabolic syndrome (MetS) and coronary heart disease (CHD) in Iran, and their mutual relationship, we evaluated how comprehensive cardiac rehabilitation (CR) can affect MetS in patients with CHD. In this study (1998-2003), we evaluated 547 patients with CHD undergoing comprehensive CR. Cases with MetS decreased from 42.8% to 33.3% after CR program (p<.001). Decrease in high fasting plasma glucose, triglyceridemia, systolic and diastolic blood pressures, and increase in HDL cholesterol, functional capacity, and left ventricular ejection fraction was more prominent in the "MetS but not obese" group. However, total cholesterol, low-density lipoprotein, weight, body mass index, and waist circumference showed a greater decrease in groups with obesity. Cardiac rehabilitation is an effective treatment of MetS, particularly in the absence of obesity. This represents an additional argument for the prevention of obesity and the linked insulin resistance.

The effect of the cardiac rehabilitation program on obese and non-obese females with coronary heart disease

Introduction:Obesity is strongly associated with coronary heart disease and it is known as an independent risk factor. So, the aim of this study was to investigate the effects of phase II comprehensive cardiac rehabilitation program on obesity indexes, functional capacity, lipid profiles, and fasting blood sugar in obese and non-obese female patients with coronary heart disease and to compare changes in these groups.Materials and Methods:Two hundred and five women with coronary heart disease participated in our study. At the beginning of study, body mass index, functional capacity, and lipid profiles and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had BMI≥30 were known as obese and who had BMI<30 were known as non-obese patients. All of them completed the period of cardiac rehabilitation program, and 2 months later, all risk factors were examined for the second time in each group. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t-tests and paired t-tests were used.Results:Data revealed that unless in weight (P=0.00) and functional capacity (P=0.001), there were no significant differences in obese and non-obese female patients, at baseline. As a result of the cardiac rehabilitation program, both groups had significant improvement in functional capacity (P=0.00), weight reduction (P=0.00), triglyceride (P=0.01 and P=0.02, respectively), low-density lipoprotein cholesterol (P=0.01), and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.00 and P=0.003, respectively). As well, significant improvement was observed in high-density lipoprotein (P=0.01) only in obese female, and non-obese female had significant differences in total cholesterol (P=0.003). However, there were not significant changes in total cholesterol (P=0.05) and fasting blood sugar (P=0.09) in obese female. Also, non-obese females didn’t have favorable differences in high-density lipoprotein cholesterol (P=0.23) and fasting blood sugar (P=0.13). In addition, comparing two groups didn’t show any significant differences in each risk factors except BMI (P=0.03).Conclusion:Our study revealed that comprehensive cardiac rehabilitation program results in significant improvement in cardiovascular risk factors and functional capacity at all levels of BMI in female with coronary heart disease.

Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction

BackgroundIt is widely believed that cardiac rehabilitation following acute myocardial infarction (MI) reduces mortality by approximately 20%. This belief is based on systematic reviews and meta-analyses of mostly small trials...

Safety and Benefits of Cardiac Rehabilitation for Patients with an Implantable Cardioverter Defibrillator (ICD)

Purpose: Patients with ICD are not routinely referred to cardiac rehabilitation (CR) due to fears that exercise may induce ventricular arrhythmias. This study was conducted to establish the safety and benefits of CR, including exercise training and testing, in patients with ICD. Methods: Consecutive patients with ICD who entered a single comprehensive tertiary CR program in Western Sydney from 1997 to 2010, with six months follow-up, were included. Prospective data was analysed including program mortality and morbidity, functional capacity (exercise stress testing (EST); six minute walk test (6MWT)), left ventricular ejection fraction (LVEF %), demographics, medications, and quality of life. Results: In this study, 161 patients with ICD had 178 presentations to CR (mean age: 61 ± 10.16; 85% male; LVEF (%) 30 ± 10.38). No admissions for mortality or morbidity were seen in this study group while exercising or having a functional capacity test. Completion rate was 62% (dropout rate for non medical reasons being 14%). There were four deaths (2%) in this study group. Hospital admissions, which occurred whilst on the CR program, were due to: ICD activations (0.5%), displaced lead (1%), acute heart failure (3%), percutaneous coronary interventions (1%), and stroke (0.5%). Functional capacity increased significantly (EST pre CR 6.9 ± 2.2 METS: post CR 9.6 ± 2.8 METS; p < 0.001; 6MWT pre CR 373 ± 121 m: post CR 430 ± 124 m, p = 0.04). Quality of life indicators also improved post CR. Conclusion: Exercise is deemed safe in this group of patients. The ICD patients also gained significant functional capacity and quality of life outcomes.

The long‐term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life

To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity, psychological well-being and quality of life in patients with coronary heart disease. Cardiac rehabilitation (CR) in short term improves exercise capacity and quality of life in patients with cardiac disease. However, the long-term benefits of CR are inconclusive. A prospective CR programme with repeated measures follow-up over 12 months. A six-week outpatient cardiac rehabilitation programme was conducted including 147 patients with coronary heart disease. Patients completed the physical activity energy expenditure (seven-day recall activity), MacNew Heart Disease Health-Related Quality of Life (MacNew) and Hospital Anxiety and Depression scale (HADs) at baseline, six weeks, six and 12 months. One hundred and five (71%) patients (76 male) mean age of 61.8 (SD 9.7) completed the four-measurement points. Analysis of variance revealed that total energy expenditure (F (2, 231) = 131, p < 0.001), HADs (F (2, 237) = 19.3, p < 0.001), depression score (F (2, 235) = 21.06, p < 0.001), anxiety score (F (2,237) = 17.02, p < 0.001) and MacNew (F (2, 197) = 77.02, p < 0.001) were all statistically significant over time. Bonferroni pairwise follow-up confirmed significant positive differences (p < 0.05) between baseline values and all subsequent measures over time. Depression was independently explained in 22% of the variance in quality of life at 6 or 12 months. The energy expenditure was significantly higher for men compared to women (F (1, 103) = 31, p < 0.001). A six-week cardiac rehabilitation programme is beneficial in improving quality of life, physical activity status, anxiety and depression. These benefits were maintained at 12 months. Elevated levels of depression were associated with impaired quality of life. All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme. Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes.

Women's Experiences Accessing a Women-Centered Cardiac Rehabilitation Program

The health benefits of cardiac rehabilitation (CR) for women living with heart disease are well documented, yet women remain underrepresented in traditionally structured CR programs. This health service delivery gap has been attributed to a number of sex-related factors experienced by women, including lower rates of physician referral, travel-related barriers, competing work and caregiving responsibilities, greater cardiovascular disease severity, and number of comorbid health conditions. Whether a program specifically designed for women is able to address these barriers and facilitate women's participation is a question that has seldom been explored in the CR literature. As part of a larger study exploring whether 6 predefined principles of women's health (empowerment of women, accessible programs, broad definition of health care, high-quality of care, collaborative planning, and innovative and creative approaches) are reflected in the practices of the Women's Cardiovascular Health Initiative (WCHI) (a comprehensive CR and primary prevention program designed for women), the objective of this analysis was to explore how the principle of "accessible programs" is experienced by women participating in the WCHI. Fourteen women previously enrolled in the WCHI program participated in a single, in-person qualitative interview. Transcripts were analyzed using a constant-comparative approach to identify relevant themes related to program accessibility. Key themes identified included participants' experiences with acquiring physician referral, negotiating transportation issues, and navigating program schedules. Women discussed how peer support and staff members' willingness to address their health-related concerns facilitated their participation. While a women-centered CR/primary prevention program may facilitate and encourage women's participation by providing flexible program schedules as well as peer and professional support, efforts are still required to address persistent barriers for women related to physician referral and transportation to programs.

The Influence of Cardiac Rehabilitation on Inflammation and Metabolic Syndrome in Women With Coronary Heart Disease

Metabolic syndrome (MetS) and increased inflammatory markers, both predictors of future cardiovascular events, are more prevalent in women with coronary heart disease (CHD). The influence of cardiac rehabilitation (CR) on MetS and inflammatory biomarkers is not well characterized for women. : The purpose of this article was to examine the effects of a 12-week behaviorally enhanced CR exclusively for women compared with traditional CR on components of the MetS and inflammatory markers in women with CHD. The randomized clinical trial used 2 treatment groups, both receiving a comprehensive 12-week CR program, with 1 group receiving a motivationally enhanced intervention exclusively for women. A subset of 91 women (mean age, 61.6 years) from the parent study provided serum samples to examine the effects of CR on high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and intercellular adhesion molecule-1 (ICAM-1). After CR, the total sample of women demonstrated significant reductions in hsCRP (P =.002), IL-6 (P <.001), TNF-alpha (P =.010), and ICAM-1 (P =.016). Women in the gender-tailored CR program significantly improved all biomarker levels compared with baseline (P <.05 for all), whereas those in the traditional group improved only hsCRP (P <.05) and IL-6 (P <.05) levels. The combined study group demonstrated improvements in several components of MetS (triglycerides, waist circumference, and systolic blood pressure) but not in others (high-density lipoprotein cholesterol, fasting glucose, and diastolic blood pressure). Cardiac rehabilitation promotes greater improvements in inflammatory biomarkers than in components of MetS for women with CHD. Improvements in body composition or weight may not be a precondition for the benefits of exercise because of loss of abdominal fat. Examining components of MetS as continuous variables is recommended to prevent lost information inherent in dichotomization.