Exercise-based Cardiac Rehabilitation In Patients Research Articles

Effectiveness of exercise-based cardiac rehabilitation for patients with left ventricular assist device: A systematic review and meta-analysis.

Exercise-based cardiac rehabilitation (EBCR) improves functional capacity in heart failure (HF). However, data on the effect of EBCR in patients with advanced HF and left ventricular assist devices (LVADs) are limited. This meta-analysis aimed to evaluate the impact of EBCR on the functional ability of LVAD patients by comparing the corresponding outcome indicators between the EBCR and ST groups. PubMed, Embase, Clinical Trials, and Cochrane Library databases were searched for studies assessing and comparing the effects of EBCR and standard therapy (ST) in patients following LVAD implantation. Using pre-defined criteria, appropriate studies were identified and selected. Data from selected studies were extracted in a standardized fashion, and a meta-analysis was performed using a fixed-effects model. The protocol was registered on INPLASY (202340073). In total, 12 trials involving 477 patients were identified. The mean age of the participants was 52.9 years, and 78.6% were male. The initiation of EBCR varied from LVAD implantation during the index hospitalization to 11months post-LVAD implantation. The median rehabilitation period ranged from 2weeks to 18months. EBCR was associated with improved peak oxygen uptake (VO2) in all trials. Quantitative analysis was performed in six randomized studies involving 214 patients (EBCR: n = 130, ST: n = 84). EBCR was associated with a significantly high peak VO2 (weighted mean difference [WMD] = 1.64mL/kg/min; 95% confidence interval [CI], 0.20-3.08; p = .03). Similarly, 6-min walk distance (6MWD) showed significantly greater improvement in the EBCR group than in the ST group (WMD = 34.54m; 95% CI, 12.47-56.42; p = .002) in 266 patients (EBCR, n = 140; ST, n = 126). Heterogeneity was low among the included trials. None of the included studies reported serious adverse events related to EBCR, indicating the safety of EBCR after LVAD implantation. This study demonstrated that EBCR following LVAD implantation is associated with greater improvement in functional capacity compared with ST as reflected by the improved peak VO2 and 6MWD values. Considering the small number of patients in this analysis, further research on the clinical impact of EBCR in LVAD patients is warranted.

Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure - A Systematic Review and Meta-Analysis.

This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure.Methods and Results: Patients were divided into groups according to intervention duration (<6 and ≥6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (V̇O2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak V̇O2and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and ≥6 months) revealed a similar trend. Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Which Components of The International Classification of Functioning, Disability and Health (ICF) are Covered by Cardiac Rehabilitation Assessment Tools among Individuals with Heart Failure?

BackgroundThe therapeutic assessment of functioning in cardiac rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF) can provide a biopsychosocial approach to health care. However, it is unclear which components are reflected in the instruments used for cardiac rehabilitation in individuals with heart failure (HF). ObjectivesTo investigate which ICF components (body function, structures, activities, participation, environmental factors, and personal factors) are represented in the assessment instruments used in individuals with HF and to identify the most appropriate instrument to use based on the inclusion of these factors. MethodsForty-four clinical trials included in an updated Cochrane systematic review that investigated the effects of exercise-based cardiac rehabilitation in patients with HF were reviewed. The instruments were analyzed to extract significant concepts linked to the ICF codes. ResultsA total of 12 outcomes and 40 instruments were identified. The concepts were linked to 2466 codes in the following ICF components: body functions (41.8%), activities (29.7%), participation (8.4%), environmental factors (3.8%), personal factors (1.3%), and body structures (1.0%); other concepts (13.9%) were classified as not covered by ICF. None of the instruments presented concepts linked to all ICF components. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), however, demonstrated comprehensive coverage of the ICF components, with the exception of body structure. ConclusionsBody function was the most frequently detected ICF component. Individual instruments did not provide a comprehensive perspective on the functioning level of individuals with HF. The MLHFQ provided the greatest coverage of ICF components.

Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People with Heart Failure: A Systematic Review and Meta-Analysis.

The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure. PubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance). Eleven randomized controlled trials including 1523 participants ranging from 45 to 80years old and an intervention duration ranging from 2 to 26weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups. Results of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in non-cardiac rehabilitation settings, or no exercise. Heart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.

Outcomes after cardiac rehabilitation in patients following repair of thoracic aortic aneurysm or dissection: a protocol for a systematic review and meta-analysis

BackgroundPatients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), undergoing major surgery, as well as long-term exercise restrictions thereafter. Despite the known risks of exercise, it is vital that patients regain physical activity in order to recover their daily functioning and quality of life. Cardiac rehabilitation could be a safe and effective treatment to support patients to become physically active by providing exercise training, comprehensive rehabilitation services, and safety recommendations. Despite new insights in recent literature and clinical practice, international guidelines do not recommend cardiac rehabilitation due to limited evidence. We aim to fill this knowledge gap by performing a systematic review and meta-analysis on the effectiveness of cardiac rehabilitation in patients following thoracic aortic repair.MethodsThis protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, Embase, and CINAHL will be searched for eligible observational and interventional studies from inception up to April 2022. Screening (title/abstract and full text), data extraction, risk of bias assessment, and therapeutic validity rating will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse performance-based outcomes, patient-reported outcomes, clinician-reported outcomes, and researcher-reported outcomes. Subsequently, meta-bias and confidence in evidence will be analysed by two independent reviewers.DiscussionTo exercise or not to exercise in patients following thoracic aortic repair has been a topic of discussion for years. The intended systematic review and meta-analysis will provide comprehensive evidence on the effectiveness of phase III outpatient exercise-based cardiac rehabilitation in patients following thoracic aortic repair. Findings from this review may inform future guidelines for the management of patients with thoracic aortic disease.Systematic review registrationPROSPERO CRD42022301204.

Cardiometabolic Responses to Exercise-Based Cardiac Rehabilitation in Patients With Cardiovascular Diseases

Cardiometabolic Responses to Exercise-Based Cardiac Rehabilitation in Patients With Cardiovascular Diseases

Sedentary behaviour and physical activity following multimodal exercise-based cardiac rehabilitation in patients with coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Background Despite high levels of sedentary behaviour (SB) in patients with coronary artery disease (CAD), there is still limited evidence on the efficacy of multimodal exercise interventions combined with physical activity (PA) counselling on SB and PA in cardiac rehabilitation (CR). Such combined modalities in CR may provide additional benefits for PA and SB, although this remains to be investigated. Purpose The aim of our study was to investigate the effects of multimodal exercise training combined with brief PA counselling on PA and SB according to sedentary status of patients with CAD. Methods We randomised 79 patients with CAD to low-load (LL) resistance training (RT) + aerobic training (AT) (30%-40% of one repetition maximum [1-RM]), high load RT+AT (70%-80% of 1-RM) and AT alone. The study was completed by 57 patients, with [mean (SD)] age = 61 (8) years, height = 171.8 (8.5) cm, weight = 85.12 (15.59) kg and left ventricular ejection fraction = 53 % (45,60) [median (first, third quartile)]. During the study, each patient received an hour of PA counselling and written PA brochure. Step count, daily SB, light intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) were measured at baseline and post-training using triaxial accelerometer. Following baseline measurement, we stratified patients to quartiles based on their levels of SB: most sedentary, sedentary, less sedentary, least sedentary. Results Upon enrolment to CR patients have surpassed daily PA recommendation (+21 min, p &amp;lt; 0.001). All measures of PA and SB remained unchanged following training intervention (all p &amp;gt; 0.388). Patients classified as the most sedentary have decreased SB (-52 min/day, p = 0.001) and increased LIPA (+27 min/day, p = 0.009), while the least sedentary patients increased SB (+69 min/day, p = 0.006) and decreased LIPA (-25 min/day, p = 0.038) following the intervention. The improvement in PA was greater in the most sedentary patients (SB: +27%, p = 0.002; LIPA: +24%, p = 0.004) and in sedentary patients (SB: +24%, p = 0.009) compared to the least sedentary patients. After the training intervention, LIPA was improved more in less sedentary patients compared to the least sedentary patients (+19 %, p = 0.031). Two-way analysis of variance has demonstrated non-significant effect of time x training modality interaction on all PA and SB variables (p = 0.285-0.819). Conclusions The addition of RT and brief PA counselling to standard CR showed limited effects on post-training improvement in SB and MVPA. Individually tailored PA behavioural counselling based on patients’ sedentary status along with regular PA monitoring during CR should be implemented to enhance the effects of combined RT and AT in patients with CAD.

The Future of Exercise-Based Cardiac Rehabilitation for Patients With Heart Failure.

Cardiac rehabilitation (CR) is a comprehensive program that includes exercise training, titration of medical therapy, lifestyle modification, educational support, and psychosocial assessment. All these components are safe and beneficial resulting in significant improvements in quality of life, functional capacity, mortality, and hospital readmission. Current guidelines support its use in a broad spectrum of cardiac disease. This review focuses on exercise-based CR for heart failure (HF) patients in whom CR is a recommended treatment. Exercise should be prescribed according to a personalized approach, optimizing, and tailoring the rehabilitative program to the patient's characteristics. Specific CR programs are dedicated to older patients, those with HF and preserved ejection fraction, and recipients of cardiac implantable electronic devices or left ventricular assistance device. Telemedicine may increase CR participation and overcome some of the barriers that limit its utilization.

Exercise Training for Heart Failure With Preserved Ejection Fraction (ExTraMATCH III): Protocol for an Individual Patient Data Meta-Analysis

ABSTRACT Background: We will undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation in patients with heart failure with preserved ejection fraction (HFpEF) on mortality and hospitalization and quality of life of exercise-based cardiac rehabilitation according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. Despite emerging evidence supporting exercise training in HFpEF, uncertainties remain in the interpretation and understanding of this evidence base. Clinicians and health care providers seek definitive estimates of impact on mortality, hospitalization and health-related quality of life (HRQoL). This work is, therefore, important as HFpEF treatment options are evolving; however, efficacy of some medications is equivocal, so optimizing exercise rehabilitation is vital. Methods: We conducted a systematic search to identify randomized trials of exercise training for at least 3 weeks compared with no exercise control with 6-month follow up or longer, providing IPD time to event on mortality or hospitalization (all-cause or heart failure-specific). IPD will be combined into a single dataset. We will use Cox proportional hazards models to investigate the effect of exercise-based cardiac rehabilitation and the interactions between exercise-based cardiac rehabilitation and participant characteristics. We will use a mix of one-stage and two-stage models. Original IPD will be requested from the authors of all eligible trials; we will check original data and compile a master dataset. IPD meta-analyses will be conducted using a one-step approach where the IPD from all studies are modeled simultaneously while accounting for the clustering of participants with studies. Results: We expect our analyses to show improved mortality, hospitalization, cardiorespiratory fitness, and health-related quality of life. Conclusion: This work will clarify exercise-based rehabilitation delivery methods to optimize benefits for people with HFpEF.

Investigating the Influence of the Shared Decision-Making Perception on the Patient Adherence of the Home- and Exercise-Based Cardiac Rehabilitation After Percutaneous Coronary Intervention.

BackgroundIn 2016, the Global Burden of Disease study pointed out that cardiovascular disease (CVDs) were the most common causes of death and accounted for the largest disease burden worldwide. Percutaneous coronary intervention (PCI) is one of the main treatments for coronary artery disease (CAD). Moreover, home- and exercise-based cardiac rehabilitation (CR) is of great importance for improving the prognosis of patients undergoing PCI. However, poor adherence to CR remains a challenging problem in these patients.AimThis study aimed to investigate the current status of adherence to home- and exercise-based CR in patients undergoing PCI and to explore the factors affecting patient adherence to home- and exercise-based CR.MethodsThis study was a prospective longitudinal survey that included 300 patients who met the established criteria. The selected patients completed a pre-hospital discharge questionnaire, which targeted factors that may affect patient adherence to home- and exercise-based CR. All patients were followed up 1 month after the discharge from hospitals.ResultsThis study analyzed 283 questionnaires and found that only 64.66% of patients had good adherence to home- and exercise-based CR. Eight independent variables, namely, shared decision-making (SDM), age, dimension of risk factors, predisposing factors, treatment methods, secondary prevention in the Perceived Knowledge Scale for CAD, and dimension of life and emotional management in the Scale of Self-Management with Coronary Artery Disease, were identified as the main factors affecting patient adherence to home- and exercise-based CR, which explains 88.9% variation (Nagel kerke R2 = 0.889).ConclusionPatients who underwent PCI had poor adherence to home- and exercise-based CR. Age, SDM, knowledge about CAD, and self-management behavior were identified as independent factors affecting patient adherence to CR after PCI.

A scoping review of exercise-based cardiac rehabilitation for patients with aortic dissection.

Our objective was to provide evidence for exercise-based cardiac rehabilitation (ECR) for patients with aortic dissection (AD), so as to better improve the prognosis of patients and improve the quality of life (QoL) after discharge. The database PubMed, Embase, MEDLINE, Web of Science, Cochrane Library, WanFang Chinese database, ZhiWang Chinese database, Chinese Clinical Trials Registry from establishment of each database until February 2021 were included. A total of 1684 records were found by searching the database and clinical trial registry, 178 duplicate records were deleted, and 11 records met the inclusion criteria according to the screening process. We can conclude that ECR for patients with AD can effectively reduce complications and shorten the course of the disease. In addition, it is very safe because there are no serious adverse events occurring. Further research should be developed from three aspects, including the development of systematic evaluation indicators and standardized clinical exercise rehabilitation pathway, more randomized controlled trials, and the development of individualized exercise program so as to help patients with AD better improve the prognosis and QoL.

Effects of exercise-based cardiac rehabilitation in patients with acute coronary syndrome aged 80 years and older

Abstract Background The beneficial effects of exercise-based cardiac rehabilitation (exCR) in patients with acute coronary syndromes (ACS) are well known. Patients aged 80+ have, however, been underrepresented in randomized controlled trials. Purpose The primary aim was to evaluate effects of exCR in patients with ACS 80+ in terms of maximum aerobic capacity, compared with a control group. Secondary aims were to evaluate effects of exCR between groups regarding muscular endurance, submaximal aerobic capacity, physical function and self-reported health. Methods A total of 26 patients (58% men), with ACS, median age 82.5 (25th-75th percentiles, 81–84) years, were included at a university hospital. Patients were randomized to hospital-based exCR, including aerobic, resistance- and balance exercises 2 times/week and a home-based exercise program 1 time/week or to a control group (C-group) for 4 months. We report differences in changes (0–4 months) between the groups regarding maximum aerobic capacity (exercise ECG), 6MWT, muscle endurance tests (shoulder flexion and heel-lifts), timed-up and go (TUG), Short Physical Performance Battery (SPPB), one leg stand test and self-reported health (one item question). T-tests, Mann-Whitney U tests and Chi2-tests were used as appropriate to describe differences between groups. Results There were no significant differences between groups at baseline, except for age with the exCR-group being older. At 4 months, we found no significant differences between the groups in maximum aerobic capacity. However, the exCR-group significantly improved their 6-min walking distance more, with a median of 39 m (17–57.5), compared to 16.5 m (−15.5–33) in the C-group, p=0.04. In addition, the exCR-group significantly improved in muscle endurance (maximum reps) while the C-group declined; heel-lift right, mean 2.3±3.8 vs −1.6±4.5, p=0.04 and left, mean 2.9±3.9 vs −4.6±4.6, p=0.001, shoulder flexion mean 5.5±4.5 vs −3.1±3.1, p≤0.001. Moreover, the exCR-group significantly improved their physical function in terms of SPPB total score with in median 1.5 (1–2) points, compared to 0 (−1–1) in the C-group, p=0.02 and one leg stand test 1.5 (0–2) points, compared to a decline with −0.5 (−2–0) points in the C-group, p&amp;lt;0.001. There were no significant differences between groups in shoulder abduction, TUG and self-reported health. Conclusions We report introductory results that patients with ACS, aged 80+, participating in an exCR program can improve walking distance, muscle endurance and physical function, however not maximum aerobic capacity. Therefore, we encourage an increased referral to exCR of this increasing group of patients to potentially enable more elderly to preserve mobility and independence in their daily living. These results must, however, be confirmed in larger studies. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Swedish Heart- and Lung Association

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure.

Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

The role of the characteristics of exercise-based cardiac rehabilitation program in the improvement of lipid profile level: A systematic review and meta-analysis.

BACKGROUNDThe current study aimed to update prior systematic review and meta-analyses (SRMA) in order to determine the effects of supervised exercise-based cardiac rehabilitation (EBCR) and introduce a suitable exercise protocol for management of lipid profile abnormalities in patients with cardiovascular disease (CVD).METHODSPubMed, Scopus, and Web of Science databases were searched from 1980 to December 2018. All published, randomized controlled trials (RCTs) reporting the efficacy of supervised EBCR in patients with CVD and measuring at least 1 component of lipid profile were included. The quality of articles was assessed based on the Physiotherapy Evidence Database (PEDro) scale. Random effect model was used to calculate the effect size of post-intervention data.RESULTSInitially 774 RCTs were reviewed, 14 of them were included in the study. In comparison with the control group, supervised EBCR was associated with higher serum levels of high-density lipoprotein (HDL) [weight mean difference (WMD): 1.297; 95% confidence interval (CI): -1.620, 4.214] and lower serum level of low-density lipoprotein (LDL) (WMD: -7.797; 95%CI: -14.005, -1.588), total cholesterol (TC) (WMD: -11.029; 95%CI: -20.716, -1.342), and triglyceride (TG) (WMD: -14.602; 95%CI: -28.992, -0.212).CONCLUSIONIt seems that EBCR is correlated with an insignificant increase in HDL serum level and a significant decrease in LDL, TC, and TG serum levels. Considering subgroup analysis results, it is suggested that long duration, moderate exercise volume (EV), and combination of aerobic exercise (AE) and resistance exercise (RE) be used to improve HDL and TG serum levels. Short duration, high EV, and AE+RE seem to significantly reduce LDL serum level. Moreover, moderate EV is associated with a significant reduction in TC level.

The application of medical alliance mode inexercise rehabilitation management of patients after percutaneous coronary interventioninchest paincenter

Objective: To explore the comprehensive effect of exercise-based cardia crehabilitation in patients managed with medical alliance who have undergone percutaneous coronary intervention (PCI) from Chest Pain Center. Methods: A total of 91 post PCI patients with coronary atherosclerotic heart disease were enrolled into the study. Fifty-four patients were in exercise rehabilitation group and 37 patients were in control group according to whether they were managed with medical alliance. Scores of Short Form -36 Health Survey (SF-36),qualified rate of blood pressure, blood glucose, blood lipid and incidence of MACEs of patients were compared at discharge, 1 month after discharge and 3 months after discharge between two groups. Results: The qualified rate of blood lipid of patients in exercise rehabilitation group was significantly higher than that in control group 3 months after discharge (P<0.05). There was significant difference in Scores of physical functioning, role-physical (RP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), mental health (MH) and Quality of Life (QL) between the two groups 1 month after discharge(P<0.05)and there was significant difference in Scores of RP, GH, VT, SF, RE, MH and QL between the two groups 3 months after discharge(P<0.05). Conclusion: Medical alliance management has positive effects on patients who have undergone PCI from Chest Pain Center, improves the motor function and quality of life. Therefore, it is worthy of promotion with the support of the policy.

Functional Performance in Patients with Mechanical Circulatory Support Systems at Discharge from Exercise-Based Inpatient Cardiac Rehabilitation

Following MCS implantation adequate functional performance is crucial for participation in self-determined social life. Exercise-based cardiac rehabilitation (CR) is intended to make an important contribution to recovery before patients can be discharged home. It was our aim to evaluate functional performance measured with the six-minute walking distance (6MWD) at the end of inpatient CR and possible influencing factors. Retrospective analysis of monocentric quality assurance data: we included patients (≥18 years old) who underwent MCS implantation between 2006 and 2016 and subsequently completed exercise-based inpatient CR. 6MWD was measured routinely at begin and end of CR. In total the results of 435 patients (54±12 yrs old, 16% female, 42%DCM, 43% ICM, 9% myocarditis) with MCS support (413 LVAD, 17 BVAD, 2 RVAD, 3 TAH) could be analyzed. CR began 54±42 days after implantation and lasted 24±6 days. Overall the 6MWD improved significantly from 292±109 to a total of 375±109 m (p<0.01). Analysis of variances (ANOVA) revealed no significant changes between the different support types (LVAD, BVAD, RVAD, TAH) in terms of reached improvements and total distances. Patients with ICM achieved a worse 6MWD (p<0.01) compared to patients with DCM (351±102 vs. 392±111 m). Highest 6MWD was achieved by patients after myocarditis (427±103 m) reflecting both possible cardiac reserve and also younger age compared to ICM group (p<0.01). Patients with atrial fibrillation (22%) achieved a lower 6MWD compared to patients with sinus rhythm (342±97 vs. 384±112 m). Patients with at least intermittent opening of aortic valve (59%) reached greater improvements in 6MWD during CR compared to patients without aortic valve opening (p<0.05). Possible influences of MCS exchange (4%) or implantation of different cardiac rhythm devices (CRT, ICD, PM) (in total 84%) did not affect functional performance. In patients with MCS systems 6MWD improved significantly during exercise-based inpatient CR regardless from different support types. The reached distance of about 375 m reflects adequate functional performance as prerequisite for the activities of daily living. In the future, randomized and controlled studies should be sought to verify and confirm the effects of exercise-based CR in patients with MCS.

Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome

Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome

4951Long-term prognostic value of adherence to leisure time physical activity prescription in patients undergoing exercise-based cardiac rehabilitation: an inverse dose-response relationship

Abstract Background The benefits associated with leisure time physical activity (LTPA) in primary and secondary cardiovascular prevention has been known for decades. Although several studies demonstrated that exercise-based cardiac rehabilitation (CR) programs reduce mortality, the long-term prognostic value of adherence to LTPA presciption after exercise-based CR has not been well estrablished. Purpose Evaluate the long-term prognostic value of adherence to LTPA presciption after exercise-based CR in patients undergoing myocardial revascularization and/or cardiac valve surgery. Methods A prospective registry of 2.340 consecutive patients, admitted to the Cardiovascular Prevention and Rehabilitation Unit was created. All patients completed a standard in-hospital CR program. Data regarding LTPA and outcomes were collected. End points were: overall and cardiovascular (CV) mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). The population has been classified into: 1) Physical inactivity: almost completely sedentary or occasional physical activity; 2) Physical activity: regular aerobic LTPA. The amount of LTPA was further collected according to minutes per week. Results A total of 1.892 patients with available data on LTPA and outcomes were included in the study; mean follow-up was 50±23 months. One-thousand and twenty-two (54%) patients underwent myocardial revascularization (CABG), 662 (35%) cardiac valve surgery, 208 (11%) combined valve and CABG surgery. Adherence to a regular LTPA was found in the 42% (792 participants) of the population, while 58% (1.100 patients) reported occasional LTPA or a complete physical inactivity. Kaplan-Meier survival curve showed a lower overall mortality (p&lt;0.0001), CV mortality (p&lt;0.0001), and MACCEs (p&lt;0.0001) in LTPA group (figure). After adjustment for age, gender, arterial hypertension, diabetes, type of intervention, glomerular filtration rate and left ventricular ejection fraction, both overall and CV mortality were significantly lower in the LTPA groups (OR=0.24; p&lt;0.0001 and OR=0.35; p&lt;0.046, respectively), as well as combined MACCEs (OR=0.36; p&lt;0.0001). Moreover, an inverse relationship between the increase of minutes per week of LTPA and the decrease of overall (HR 0.990; p&lt;0.0001), CV mortality (HR 0.991; p&lt;0.0001) and MACCEs (HR 0.996; p&lt;0.0001) was found, with 1% reduction of relative risk of events for each minute per week increase of physical activity. Finally, comparing LTPA to standard medical therapy in our population, LTPA showed the lowest number needed to treat (NNT) to save a life (NTT=12). Central figure Conclusion Adherence to leisure time physical activity prescription is independently associated with significant reduction of overall mortality, CV mortality and MACCEs on top of exercise-based CR program after myocardial revascularization and/or cardiac valve surgery. Acknowledgement/Funding None

Analysis of the Cochrane Review: Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease. Cochrane Database Syst Rev. 2016;1:CD001800

Coronary heart disease is the single most common cause of death globally, accounting for one-third of all deaths. However, with falling coronary heart disease mortality rates, an increasing number of people live with the disease and may need support to manage their symptoms and prognosis. A complex intervention that may involve a variety of therapies, cardiac rehabilitation includes exercise, risk factor education, behavioral change, psychological support, and strategies that are aimed at targeting traditional risk factors for cardiovascular disease. Cardiac rehabilitation is an essential part of contemporary heart disease care and is considered a priority in countries with a high prevalence of coronary heart disease. This Cochrane systematic review constitutes an update of a Cochrane review published in 2011, having identified 16 new trials (3872 participants), predominantly post-myocardial infarction and post-revascularization patients. Therefore, it included 63 randomized trials looking at the effectiveness and cost-effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. The quality of the evidence ranged from low to moderate. The main results highlight the effect of cardiac rehabilitation, in comparison with absence of physical exercise, in the reduction in cardiovascular mortality, with no reduction, however, in total mortality. The overall risk of hospital admissions was reduced with cardiac rehabilitation but there was no significant impact on the risk of myocardial infarction, coronary artery bypass graft or percutaneous coronary intervention. This paper aims to summarize and discuss the main results and conclusions of this systematic review, as well as its implications for the daily clinical practice.