Conventional Cardiac Rehabilitation Program Research Articles

Impact of eccentric cycling in coronary rehabilitation program: a pragmatic randomized controlled trial versus conventional rehabilitation.

This randomized controlled trial examined the feasibility of adding eccentric exercise to a conventional cardiac rehabilitation program (CCRP) for coronary heart disease patients. Ninety-three patients were randomly assigned to either the MIX group (eccentric ergometer + CCRP) or the CON group (concentric ergometer + CCRP) for 7 weeks. Training effectiveness was assessed based on "good responders" showing improved functional capacities, such as 6-minute walk test (6MWT) distance and maximal voluntary contraction of the plantar flexors (ankle MVC). Safety was monitored with a visual analog scale for muscle soreness, perceived exertion, and heart rate during training. The proportion of good responders was similar between groups (26% in MIX, 29% in CON, P=0.744). Both groups improved in 6MWT (CON: 12.6%, MIX: 16.14%) and ankle MVC (CON: 15.5%, MIX: 11.30%), with no significant differences. Exercise tolerance did not differ significantly between the groups, but perceived effort was significantly lower in the MIX group (P<0.0001) compared to the CON group. Integrating eccentric exercise into cardiac rehabilitation is safe and well-tolerated. Nevertheless, this study did not find significant advantages over conventional programs for coronary heart disease patients. Further research should explore specific patient groups or conditions where eccentric exercise may be more beneficial, emphasizing personalized prescriptions and gradual workload progression for better cardiac rehabilitation outcomes.

The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support

BackgroundThis study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program. MethodThe sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program. ResultsThe experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value < 0.005). In addition, the experimental group had significantly greater improvements in quality of life, psychological well-being, and health-related quality of life than the control group (p-value < 0.001). ConclusionsA cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.

Hybrid Cardiac Telerehabilitation After Acute Coronary Syndrome: Self-selection Predictors and Outcomes.

To evaluate the effectiveness of a hybrid cardiac telerehabilitation (HCTR) program after acute coronary syndrome (ACS) on patient quality of life (QoL) and physical activity indices throughout phases 2-3 and establish predictors for hybrid program self-selection. This single-centre longitudinal retrospective study included patients who attended a cardiac rehabilitation program (CRP) between 2018-2021. Patients self-selected between two groups: Group 1 - conventional CRP (CCRP); Group 2 - HCTR. Baseline characteristics were registered. EuroQol-5D (EQ-5D) and International Physical Activity Questionnaire (IPAQ) were applied at three times: T0 - phase 2 onset; T1 - phase 3 onset; T2 - 3 months after T1. 59 patients participated (Group 1 - 27; Group 2 - 32). We found significant between-group differences regarding occupation (p=0.003). Diabetic patients were less likely to self-select into HCTR (OR=0.21; p<0.05). EQ-5D visual analogue scale and IPAQ result significantly improved between T0-T2 only for HCTR (p=0.001; p=0.021). HCTR was superior to CCRP on physical activity indices and QoL of ACS patients.

Differences in aerobic capacity evolution and cardiovascular risk factors between diabetic and non-diabetic patients at different stages of a cardiac rehabilitation

Abstract Introduction Type 2 diabetes mellitus (DM) is an important factor that is associated with increased cardiovascular morbidity, producing disorders in different devices and systems whose mechanisms are not entirely known. This study was conducted in order to understand the evolution of aerobic capacity and the different cardiovascular risk factors (CVRF) in diabetic patients compared to non-diabetic patients. Methodology Prospective observational study. A total of 301 patients were included consecutively in a conventional cardiac rehabilitation program from January 2017 to March 2020, after one month of having had acute coronary syndrome, phase II of which lasted 2 months, who had an analysis, ergometry with spire gas analysis, and anthropometric characteristics were included. Those who had signs of ischemia in ergometry were excluded from the study. The tests were conducted as recommended by the ATS/ACCP. Results 301 patients were included, with an average age of 57.6±9.1 years, diabetics 92 (30,6%), LVEF average 56.9±9.6%, women 13.6%. Among the basal characteristics, diabetic patients had the highest prevalence of dyslipemia (89.1% vs 68.4% p s &amp;lt;0.001), HTA (62% vs 47.8% p x 0.03) and lower FEVI (55.1±10.26 vs 57.8±8.9 p-0.03), in addition to lower peak oxygen consumption (VO2 ml/kg/min) (18.8±5.0 vs 22.9±6.3 p-&amp;lt;0.001); DM being an independent predictor to obtain a lower VO2 with an OR 1.25 [IC (95%) 1.31–1.19 p&amp;lt;0.001] (Table 1). At the end of Phase II, both groups gained better control of CVRF (Table 2) including an improvement in VO2; but in the DM group the gain rate was significantly lower (0.08±0.14 Vs 0.13±0.17 p=0.02). In phase III (average follow-up 7.3 months) the benefits in the control of CVRF (Table 2) were maintained in both groups with the highest rate of increase in VO2 in patients with DM (0.07±0.2 Vs 0.02±0.13 p=0.05) (Image 1). Conclusions In our study, patients with DM undergoing an RHC program achieve better control of FRCV and aerobic capacity in a similar way to non-diabetic patients, which is maintained at 7 months of follow-up in phase III, although initially the aerobic capacity gain in diabetics is slower, achieve a higher increase in VO2 in Phase III. Funding Acknowledgement Type of funding sources: None.

Implementation of a Behavioral Medicine Oriented Concept in Cardiological Rehabilitation

This study examined the implementation of a behavioral medicine oriented rehabilitation concept in a cardiological rehabilitation clinic. Psychotherapeutic interventions were based on an Acceptance and Commitment Therapy framework. Participants were treated in a behavioral cardiac rehabilitation program (BCR; n=149), or in a conventional cardiac rehabilitation program (CCR, n=100). We tested and compared the reach of the targeted group, the fidelity of the concept implementation in the BCR, as well as the completeness of the intervention (dose delivered) and the patient-reported behavioral medical treatment dose (dose received). Changes from beginning of rehabilitation until discharge with regard to mental and physical performance were assessed in both groups. BCR-patients were more impaired than CCR-patients, and they confirmed more behavioral medical content, a higher consistency of the behavioral medical strategy and a stronger gain of competence. Adherence ratings indicated a largely accurate implementation of the intervention. In both groups, depression, somatization, anxiety, heart anxiety, exercise self-efficacy expectation, and maximum power in bicycle ergometry improved statistically significant from admission to discharge. Large or nearly large effect sizes were found for avoidance behavior (d=0.78), somatization (d=0.82), depression (d=0.76), anxiety (d=0.72) and performance in bicycle ergometry (d=0.86) in the BCR. A further evaluation by means of a randomized controlled trial should follow this implementation study.

Abstract 12339: Robotic Assistance Improves Cardiovascular Function Compared To Conventional Cardiac Rehabilitation Programs

Introduction: This study investigates the impact of socially assistive robots and personalization in cardiac rehabilitation, in terms of physiological progress and perceptions of the patients and clinicians. Methods: We conducted a longitudinal study for 2.5 years with 43 patients. The intervention was classified into 3 conditions: control group (without a robot), a social robot and a personalized robot. Throughout the rehabilitation program (36 sessions), the initial heart rate, average heart rate during training, and heart rate recovery in the first minute. Heart rate recovery in the first minute was normalized with initial heart rate to homogenize the data: Heart rate recovery in the first minute normalized = heart rate recovery in the first minute/ initial heart rate. We apply Johansen's general formulation of the Welch-James statistic with approximate degrees of freedom on Heart rate recovery in the first minute normalized in 6 stages. Perceptions of the patients and clinicians are evaluated through surveys and interviews. Results: 26 patients completed the rehabilitation program. Heart rate recovery in the first minute normalized changed significantly in each stage of the program (TWJ (5, 305) = 14.36, p &lt; .001). Patients assisted by social and personalized robots achieved a higher improvement in cardiovascular functioning than the control group. Both robots improved motivation and trust due to continuous monitoring and immediate feedback, facilitated prompt detection of critical conditions, and were recommended for future use by clinicians and patients. Conclusions: Our results suggest that robots improve cardiovascular functioning compared to the conventional cardiac rehabilitation program. In addition, robots have motivational benefits for patients, and increase awareness of clinicians to detect complications, as a result, they were recommended for future use by patients and clinicians.

Hybrid cardiac telerehabilitation program as a potential strengthening factor in the quality of life in patients with coronary heart disease: a retrospective single-centre analysis

Abstract Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality in patients with coronary artery disease (CAD). However, underuse of CR and not sustained improvements have been noted. It has been proposed that telemonitored exercise-based CR, by the use of mobile applications, can improve patient adherence to CR programs providing better outcomes. The aim of this study was to investigate the effects of telemonitored cardiac rehabilitation on physical capacity, health-related quality of life and control of cardiovascular risk factors among patients with CAD on phase 2 of the Cardiac Rehabilitation Program (CRP). A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. Outcomes were Body Mass Index, Hospital Anxiety and Depression Scale (HADS), EuroQol-5D score (EQ-5D), International Physical Activity Questionnaire (IPAQ), estimated functional capacity in cardiac stress test, lipid panel and glycated hemoglobin. Patients were divided into two groups: group 1 followed the conventional strategy and group 2 followed a hybrid telemonitored CRP, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of the phase 2, around 3 months after. Group comparisons tests and multivariate logistic regression were performed. A p-value less than 0.05 is statistically significant. Statistical analysis was performed using SPSS software v25.0. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 44 patients in group 1 and 25 patients in group 2. Two groups have similar baseline characteristics, except for age (p=0.02). It appears that participation in the PRC led to an improvement in physical capacity, mental well-being, and in lipid panel, regardless of the strategy. The improvement in quality of life, quantified by EQ-5D, was significant only in group 2 (p=0.03). There is also no correlation between age and the differences recorded in EQ-5D (p=0.86). We hypothesise that, when compared to conventional CRP, cardiac telemonitored exercise using modern communication methods and on-demand coaching will result in an improved behavioural change, which translates to higher quality of life. Further studies including more patients and the phase 3 of CRP are needed to confirm these results. Funding Acknowledgement Type of funding sources: None.

Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial.

(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II.

Telerehabilitation with live-feed biomedical sensor signals for patients with heart failure: a pilot study.

Integrating biomedical sensors to a telerehabilitation platform allowed clinicians to receive real-time transmissions of the electrocardiogram (ECG) signal, oxygen saturation, and heart rate during an exercise program. These clinical data could be helpful to adjust and personalize the intensity of exercises to each patient's condition. The purpose of this study was to evaluate the feasibility and usefulness of biomedical sensors in telerehabilitation in patients with heart failure (HF). Four participants with HF (mean age 66 years) followed the 12-week cardiac program using telerehabilitation, including sensors to monitor real-time vital signs during sessions. The exercise program included cardiovascular, strengthening and flexibility exercises. Participants were evaluated before the intervention and one month after the end of the program. Functional capacity was measured with Cardiopulmonary Exercise Testing (CPX), the 6-minute walk test (6MWT), and the sit to stand test (STST). Quality of life was objectified using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Our main objective demonstrated that real-time biomedical sensors can be safely used by clinicians during a telerehabilitation session. Most participants showed a tendency to improve their physical capacities such as walking distance and lower limb muscular strength. As a main outcome of cardiac rehabilitation (CR), quality of life seems to improve after the 12-week intervention. This study proved the feasibility of using telerehabilitation with real-time biomedical sensors as an alternative or a complement to the conventional CR program. Use of sensors allowed a safe environment for the patient and an adequate and personalized exercise prescription. Limitation in one-to-one supervision must be challenged in future clinical trials to demonstrate that telerehabilitation could be efficient for cardiac patients requiring more individual supervision than group sessions in a gymnasium.

The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG): A Clinical Trial

Erectile dysfunction and stress are among common post-CABG surgery complications. The present study was conducted to assess the effect of modified cardiac rehabilitation on “erectile dysfunction” and “coping with stress”. In the present clinical trial study, 126 male patients undergoing CABG surgery were randomly assigned to treatment (63 patients) and control (63 patients) groups. Control group received conventional cardiac rehabilitation program over 26 sessions. Treatment group received modified cardiac rehabilitation program, including Kegel exercise and training on stress coping strategies in the first four sessions of their rehabilitation program. Patients were assessed before and after cardiac rehabilitation program using the International Index of Erectile Dysfunction (IIEF-5) questionnaire and Endler and Parker Coping with Stress Scale. Data were analyzed in SPSS using ANOVA, T, and Chi square tests. Mean erectile function score significantly increased in both treatment and control groups, but the difference in mean scores for improvement in erectile function was greater in treatment group (P < 0.001). Analysis showed no significant difference in mean differences between two groups in all subscales of stress coping. Intragroup analysis showed significant differences in both groups between mean differences before and after intervention in task-oriented styles {treatment group (P < 0.002), control group (P < 0.001)}, and social diversion-oriented. The results showed that conventional and modified cardiac rehabilitation can be effective in improving erectile dysfunction and stress coping in task-oriented and social diversion-oriented styles in the men patients with left ventricular ejection fraction over 30% following CABG surgery. However, modified cardiac rehabilitation has greater benefits for improving erectile dysfunction.

3086 Virtual World-based Cardiac Rehabilitation to Promote Healthy Lifestyle Among Cardiac Patients

OBJECTIVES/SPECIFIC AIMS: Our aim was to assess the feasibility and acceptability of a VW-based cardiac rehabilitation (CR) program (Destination Rehab) as an extension of a face-to-face conventional CR program. We hypothesized that a VW-based CR program could be successfully implemented as an extension of conventional CR and would have high acceptability among cardiac patients. METHODS/STUDY POPULATION: We recruited 30 adult cardiac patients (10/site) hospitalized at Mayo Clinic Hospitals in Rochester, MN, Jacksonville, FL or Scottsdale, AZ with a diagnosis for CR (eg, acute coronary syndrome (ACS), heart failure, elective percutaneous coronary intervention (PCI)). Other inclusion criteria included at least 1 modifiable, lifestyle risk factor target: sedentary lifestyle (&lt; 3 hours physical activity (PA)/week), unhealthy diet (&lt; 5 servings fruits and vegetables/day) or current smoking (&gt;1 year). Patients participated in an 8-week, health education program using a VW platform from a prior proof-of-concept study and provided intervention usability, usefulness and satisfaction feedback. We assessed cardiovascular (CV) health behaviors (diet, PA) and risk factors (eg, blood pressure (BP), lipids) at baseline and immediate post-intervention. RESULTS/ANTICIPATED RESULTS: Among 30 patients enrolled (mean age; 59 years; 50% women; 65% &lt;college graduate; 32% annual household income &lt;$50,000), 28 (98%) completed the study. The majority (64%) were enrolled in conventional CR with a high session completion rate (median 36 sessions, interquartile range 8-36). The most common CR indication was PCI (68%). There were statistically significant improvements in PA from baseline to post-intervention: vigorous PA, +10.7 (SD 11.7) minutes/day (p = 0.05) and flexibility exercises +0.9 (SD 0.9) days/week for men (p=0.05). There were favorable trends in risk factors: systolic BP (−6.8 mmHg, SD 29.8), total cholesterol (−31.6 mg/dL, SD 46.2) and LDL (−26 mg/dL, SD 44.8) from baseline to post-intervention, although not statistically significant. The majority reported that they would continue to use VW as a resource (76%) and agreed/strongly agreed that the program improved their heart health knowledge (86%) and assisted with adapting healthier lifestyle (100%). Overall, the VW CR program received a rating of 8 (scale 0-10). DISCUSSION/SIGNIFICANCE OF IMPACT: VW-based CR program is a feasible, highly acceptable and innovative platform to influence health behaviors and CV risk and can increase accessibility to disadvantaged populations with higher CVD burdens.

Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG

Introduction: Although cardiac rehabilitation is known as a tool to reduce the overall risk of cardiovascular complications, its specific role in the reduction of hs-CRP as a marker of inflammation and a proven marker of cardiovascular risk needs further investigation. Aim: The present study aims at elucidating the effects of a full course of conventional cardiac rehabilitation program for the period of eight weeks, on the levels of hs-CRP in patients who underwent isolated coronary artery bypass surgery. Material and Methods: In this case study, 30 consecutive patients who underwent isolated coronary artery bypass surgery (isolated CABGS), and a full 8-week cardiac rehabilitation program in Tehran Heart Center, were investigated. A group of 30 similar patients, who enrolled in the same period of rehabilitation program but did not participate in practice, was considered as a control group. Serum levels of hs-CRP in both groups were measured retrospectively and in similar days before the start of rehabilitation program and at the end of it (or 8 weeks after initial registration for the control group). Results: Levels of hs-CRP in the rehabilitation group and control group were 5.9 7.7 and 6.3 6.9 respectively before start of the program which was not statistically meaningful (P-Value = 0.833). However, after the program, level of hs-CRP in the two tested groups changed to 2.3 5.1 and 5.7 6.1 respectively which showed a meaningful correlation (P-Value = 0.023). These results also showed that decrease in hs-CRP level in the rehabilitated group but not in the control group was statistically meaningful (with P-Value of 0.037 and 0.0723 respectively). Conclusion: In patients undergoing coronary bypass surgery, participating in a full course of cardiac rehabilitation for 8 weeks has resulted in a significant reduction in hs-CRP levels as a marker of cardiovascular risk.

Evaluating the interactive web-based program, activate your heart, for cardiac rehabilitation patients: a pilot study.

BackgroundConventional cardiac rehabilitation (CR) programs are traditionally based on time-constrained, structured, group-based programs, usually set in hospitals or leisure centers. Uptake for CR remains poor, despite the ongoing evidence demonstrating its benefits. Additional alternative forms of CR are needed. An Internet-based approach may offer an alternative mode of delivering CR that may improve overall uptake. Activate Your Heart (AYH) is a Web-based CR program that has been designed to support individuals with coronary heart disease (CHD).ObjectiveThe aim of this pilot study was to observe the outcome for participants following the AYH program.MethodsWe conducted a prospective observational trial, recruiting low-risk patients with CHD. Measures of exercise, exercise capacity, using the Incremental Shuttle Walk Test (ISWT), dietary habits, and psychosocial well-being were conducted by a CR specialist at baseline and at 8 weeks following the Web-based intervention.ResultsWe recruited 41 participants; 33 completed the program. We documented significant improvements in the ISWT distance (mean change 49.69 meters, SD 68.8, P<.001), and Quality of Life (QOL) (mean change 0.28, SD 0.4, P<.001). Dietary habits improved with an increased proportion of patients consuming at least 5 portions of fruit and vegetables per day, (22 [71%] to 29 [94%] P=.01) and an increased proportion of patients consuming at least 2 portions of oily fish per week (14 [45%] to 21 [68%], P=.01). We did not detect changes in anxiety and depression scores or exercise behavior.ConclusionsWe observed important improvements in exercise capacity, QOL, and dietary habits in a group of participants following a Web-based CR program. The program may offer an alternative approach to CR. A mobile version has been developed and we need to conduct further trials to establish its value compared to supervised CR.

Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial

Conventional cardiac rehabilitation program consist of 15 min of warm-up, 30 min of aerobic exercise and followed by 15 min calisthenics exercise. The Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure (HF). Investigate the effects of Pilates on exercise capacity variables in HF. Sixteen pts with HF, left ventricular ejection fraction 27 ± 14%, NYHA class I-II were randomly assigned to conventional cardiac rehabilitation program (n = 8) or mat Pilates training (n = 8) for 16 weeks of 30 min of aerobic exercise followed by 20 min of the specific program. At 16 weeks, pts in the mat Pilates group and conventional group showed significantly increase on exercise time 11.9 ± 2.5 to 17.8 ± 4 and 11.7 ± 3.9 to 14.2 ± 4 min, respectively. However, only the Pilates group increased significantly the ventilation (from 56 ± 20 to 69 ± 17 L/min, P = 0.02), peak VO(2) (from 20.9 ± 6 to 24.8 ± 6 mL/kg/min, P = 0.01), and O(2) pulse (from 11.9 ± 2 to 13.8 ± 3 mL/bpm, P = 0.003). The Pilates group showed significantly increase in peak VO(2) when compared with conventional group (24.8 ± 6 vs. 18.3 ± 4, P = 0.02). The result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with HF who are already receiving standard medical therapy.