phase-II Cardiac Rehabilitation Research Articles

Long-Term Follow-Up of HRQoL up to Six Years after Outpatient Phase-II Cardiac Rehabilitation

Long-Term Follow-Up of HRQoL up to Six Years after Outpatient Phase-II Cardiac Rehabilitation

Assessment of clinical depression metrics in cardiac patients using the patient health Questionnaire-9 before and after phase-II cardiac rehabilitation

Cardiovascular disease remains a leading cause of morbidity and mortality, a fact that is commonly associated with co-morbidities such as clinical depression. While phase II cardiac rehabilitation is an established intervention for those with cardiovascular disease, its effect on patients who also suffer from depression are under studied. Aim: To quantify Pre- and Post-cardiac rehabilitation questionnaire scores collected from a large patient data registry. For this investigation, 27 ​670 patients completed Patient Health Questionnaire-9 questionnaires both Pre- and Post-rehabilitation (averaging [28.0 ​± ​8.7] phase II sessions). Findings reveal that questionnaire scores decreased by 40%–48% across all groups, a finding that was independent of assigned sex, race, and ethnicity. Moreover, when data were stratified for questionnaire scores that may indicate major and minor depressive disorder, phase II cardiac rehabilitation outcomes were lower by 61% and 49% respectively. While all groups exhibited lower questionnaire scores following cardiac rehabilitation participation, numerical differences at Pre- and Post-rehabilitation time points indicate that males and White patients have more favorable scores. This latter observation, while not confirmed currently, appears to be linked to referral rates to phase II cardiac rehabilitation, which remain poor for females, racial and ethnic minorities.

Effectiveness of additional resistance and balance training and telephone support program in exercise-based cardiac rehabilitation on quality of life and physical activity: Randomized control trial

Objectives To evaluate 20 days and 3 months follow-up effectiveness of cardiac rehabilitation (CR) enhanced by resistance/balance training and telephone-support program compared to usual CR care in improving quality of life, clinical course and physical activity behavior. Design Single-centre randomized controlled trial. Setting Inpatient CR clinic Subjects 116 (76.1 ± 6.7 years, 50% male) patients 14.5 ± 5.9 days after valve surgery/intervention were randomized to intervention group (IG, n = 60) or control group (CG, n = 56). Intervention Additional resistance/balance training (3 days/week) during phase-II CR and telephone-support program during 3-month follow-up. CG patients were provided with usual CR care. Main measures Short Form 36 Health Survey scales, European Quality of Life 5 Dimensions 3 Level Version QoL index, visual analog scale, clinical course, and physical activity behavior assessed with standardized questionnaires. Results IG reported statistically significant higher mental component score (48.5 ± 6.91 vs. 40.3 ± 11.21 at the baseline, 50.8 ± 9.76 vs. 42.6 ± 9.82 after 20 days, 49.4 ± 8.45 vs. 40.5 ± 8.9 after 12 weeks follow up), general health (48.6 ± 3.17 vs. 45.0 ± 2.95 at the baseline, 53.6 ± 3.02 vs. 43.8 ± 2.55 after 20 days, 53.2 ± 3.11 vs. 44.2 ± 3.07 after 12 weeks) and role limitations due to emotional problems (48.5 ± 15.2 vs. 27.7 ± 11.5 at the baseline, 72.7 ± 12.6 vs. 30.5 ± 11.2 after 20 days, 66.6 ± 14.2 vs. 36.1 ± 11.2 after 12 weeks) in all three assessments (p < 0.05). CG patients had more documented hospital admissions (4 (8%) vs 10 (25%), p = 0.027), atrial fibrillation paroxysms (3 (6.0%) vs. 10 (35.0%), p = 0.011) and blood pressure swings (13 (26%) vs. 20 (50%), p = 0.019). IG patients chose more different physical activities (1.7 ± 0.7 vs. 1.25 ± 0.63, p = 0.002), spent more time being physical active every day (195.6 ± 78.6 vs. 157.29 ± 78.8, p = 0.002) Conclusions The addition of resistance/balance exercises and telephone-support program 12 weeks after to the CR could linked to higher physical activity levels and fewer clinical complications but did not lead to a significant improvement in quality of life.

Type 2 Diabetes Mellitus, Glycated Hemoglobin Levels, and Cardiopulmonary Exercise Capacity in Patients With Ischemic Heart Disease.

Diabetes mellitus (DM) is associated with long-term cardiovascular complications, including ischemic heart disease (IHD). Nonetheless, DM may directly impair myocardial and lung structure and function. The aim of this study was to assess the impact of type 2 DM (T2DM) and glycemic control on cardiopulmonary exercise capacity in patients with IHD. The study involved a cross-sectional analysis of 91 consecutive patients (57 ± 10 yr, 90% men) who underwent a cardiopulmonary exercise test at the beginning of an exercise-based standard phase-II cardiac rehabilitation program, 2 to 3 mo after an acute coronary syndrome. Association of T2DM with cardiopulmonary exercise test parameters was assessed using multiple linear regression analysis controlling for prespecified potential confounders. There were 26 (29%) diabetic subjects among IHD patients included in the study. After adjustment, T2DM was an independent predictor of a reduced peak oxygen uptake ((Equation is included in full-text article.)O2peak) (P = .005), a reduced pulse O2 trajectory (P = .001), a steeper minute ventilation to carbon dioxide output (VE/(Equation is included in full-text article.)CO2) slope (P = .046), and an increased dead space-to-tidal volume ratio (VD/VT) at peak exercise (P = .049). Glycated hemoglobin (HbA1c) levels were significantly associated with a reduced forced expiratory volume in the first second of expiration (FEV1) (P = .013), VE (P = .001), and VT (P = .007). (Equation is included in full-text article.)O2peak (P trend < .001), (Equation is included in full-text article.)O2 at anaerobic threshold (P trend < .001), and pulse O2 trajectory (P trend < .001) decreased among HbA1c tertiles. Patients with IHD and a previous diagnosis of T2DM had a reduced aerobic capacity and a ventilation- perfusion mismatch compared with nondiabetic patients. Poor glycemic control in men further deteriorates aerobic capacity probably due to ventilatory inefficiency.

P3104Complementary impact of glycated haemoglobin and B-natriuretic peptide on cardiopulmonary exercise capacity in patients with ischemic heart disease

Abstract Background Glycemic control, even in non-diabetes mellitus (DM) patients, has been associated with ventilation pump inefficiency leading to an impaired aerobic capacity. Brain natriuretic peptide (BNP) levels have also been correlated with exercise capacity, particularly in patients with heart failure. Purpose Assess the complementary impact of glycated haemoglobin (HbA1c) and BNP levels on cardiopulmonary exercise capacity in patients with ischemic heart disease (IHD). Methods Retrospecive cohort of 91 consecutive patients (57±10 years, 90% men; 29% type 2 DM) who underwent a cardiopulmonary exercise testing (CPX) at the beginning of an standard phase-II cardiac rehabilitation program, 2–3 months after an acute coronary syndrome. Results HbA1c and BNP levels correlated with peak oxygen uptake (VO2), anaerobic threshold (AT) and pulse O2 trajectory (Table). HbA1c correlated with ventilation CPX parameters (Table) and independently predicted minute ventilation (VE) and tidal volume (VT), regardless of age, waist circumference and β-blocker therapy. BNP levels correlated with echocardiographic (LVEF, left atrium size and pulmonary artery systolic pressure) and ventilation-perfusion (V/Q) mismatch parameters (Table), and independently predicted VE/VCO2-slope (P=0.037) regardless of age, echocardiographic parameters and β-blocker therapy. Patients were divided into three groups according to HbA1c levels above or below the DM diagnosis cut-off point (6.5%) and median value of BNP levels (44.6 pg/mL). VO2 and AT significantly decreased with elevated HbA1c and/or BNP levels (Figure). CPX parameters HbA1c (%) BNP (pg/mL) r P value r P value Peak VO2 (mL/min/kg) −0.421 &lt;0.001 −0.295 0.005 VO2 at AT (mL/min/kg) −0.352 0.001 −0.271 0.009 O2 pulse trajectory (mL/beat) −0.345 0.001 −0.235 0.025 Minute ventilation (VE) (L/min)* −0.377 &lt;0.001 – NS Tidal volume (VT) (L)* −0.348 0.001 – NS VE/VCO2-slope – NS 0.375 &lt;0.001 PETCO2 at AT (mmHg) – NS −0.315 0.002 HR/VO2-slope – NS 0.307 0.003 *At peak exercise. NS: Non-significant. Conclusions HbA1c and BNP levels were associated with a reduced cardiopulmonary capacity in IHD patients, mediated by a ventilation impairment and a ventilation-perfusion mismatching, respectively. HbA1c and BNP are independent and additive predictors of cardiopulmonary capacity.

Evaluation of a Community Based Cardiac Rehabilitation Programme

The transition from hospital-based (phase II) to community-based (phase III) cardiac rehabilitation (CR) is an important step in the long-term maintenance of positive health behaviour change. PURPOSE: To evaluate the effect of participation in a phase III, community-based CR (CBCR) programme on selected fitness indices in comparison to a control group that received usual care advice and to explore participant experiences and perceived benefits in transitioning from hospital-based phase II CR to CBCR. METHODS: Following completion of phase-II CR, 95 individuals were referred to a 10-week CBCR exercise programme (intervention). A total of 22 (73% male) participants were unable to attend CBCR classes and were assigned to the control group. The remaining 73 (67% male) were assigned to the CBCR exercise program. Aerobic fitness (6MWT), functional upper (hand grip) and lower (timed sit to stand) limb strength, flexibility (sit and reach test) and body composition (waist & hip girth and BMI) were measured pre and post the intervention. All participants from the intervention group were invited to attend a focus group on completion and a thematic analysis was conducted. RESULTS: A total of 51 participants (69% male) completed the 10-week program (70% compliance). There was a significant improvement (p<0.05) in the timed sit to stand (26.5±7.21 v 21.4±5.65sec), 6MWT (505±66.6 v 534±71.9m),) and waist circumference (100.9±13.09 v 98.5±13.37cm) in the intervention group. There was no significant change in any of the fitness indices in the control group. The focus groups were attended by 20 participants (60% male). The main themes identified included the strong sense of need for CBCR programmes and the reassurance provided by the link between the hospital and community provider. Physical, psychological and social benefits were described including moving from fear to confidence in their ability to exercise. CONCLUSION: Participation in a 10-week CBCR programme resulted in improved lower limb strength, aerobic fitness and waist circumference with maintenance of all other measured fitness components. Participants self-reported an increased ability and motivation to undertake exercise. This study provides an important insight into the experience and benefits, both perceived and actual, in the early transition to CBCR.

Baduanjin exercise for patients with ischemic heart failure on phase-II cardiac rehabilitation (BEAR trial): study protocol for a prospective randomized controlled trial

BackgroundPreliminary evidence based on clinical observations suggests that meditative exercise may offer potential benefits for patients with chronic heart failure (CHF). Cardiac rehabilitation (CR), as a class-IA indication in clinical practice guidelines, has been established as an effective strategy to improve quality of life and prognosis of CHF patients. Baduanjin exercise is an important component of traditional Chinese Qigong exercises. However, its benefits for CHF have not been rigorously tested. We sought to investigate whether Baduanjin, as an adjunct to standard care, improves cardiopulmonary function, exercise tolerance, and quality of life in patients with CHF caused by coronary artery disease (CAD).Methods/designIn this randomized controlled trial, 120 patients will be randomly allocated in a 1:1 ratio to Baduanjin exercise combined with conventional exercise of CR (Baduanjin exercise group) or conventional exercise of CR alone (conventional exercise group). In addition to conventional physical activity, participants in the Baduanjin exercise group will participate in a 45-min Baduanjin exercise training session twice a week, for 12 weeks. The primary outcome is walking distance in the 6-min Walk Test (6MWT), and the secondary outcomes are peak oxygen uptake (VO2 peak), ventilatory anerobic threshold (VAT), The minute ventilation to carbon dioxide production relationship (VE/VCO2 slope), left ventricular end-diastolic volume index (LVEDVi), left ventricular ejection fraction (LVEF), quality of life assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), amino-terminal pro-brain natriuretic peptide (NT-proBNP), hs-CRP, heart rate variability (HRV), New York Heart Association (NYHA) classification, and major adverse cardiovascular events.DiscussionThis is the first trial to evaluate the effects of a Baduanjin exercise-based CR program on cardiopulmonary function and exercise tolerance in ischemic CHF patients. If successful, it will prove the value of Baduanjin exercise in improving cardiopulmonary function and exercise tolerance in patients with ischemic heart failure on phase-II CR, and may further develop a Chinese Qigong exercise-based CR framework.Trial registrationClinicalTrials.gov, ID: NCT03229681. Registered retrospectively on 23 July 2017.

DETERMINING THE POTENCY OF CARDIAC REHABILITATION PHASE- II IN CVD PATIENTS WITH CO-MORBIDITIES

Globally, cardiovascular disease is a leading cause of mortality and it is estimated that CVD is a cause of approximately 29.6% of all the deaths worldwide. According to a research published in 2015 in American journal of Cardiology it is a time to “rebrand and reinvigorate” the cardiac rehabilitation program as the existing program appears to be neither financially practicable nor maintainable mainly due to affordability barriers. A Quasi experimental study was conducted on 40 participants whom were diagnosed with cardiovascular disease with comorbidities (diabetes mellitus and dyslipidemia). Participants were asked to enroll in phase-II cardiac rehabilitation program on the recommendation of the cardiologist and were given intervention based on the guideline of American College of Sports medicine. Six weeks of supervised exercise protocol was conducted and its dosage was measured via Frequency, Intensity, Time and Type (FITT) protocol. While for determining the potency of phase-II Cardiac Rehabilitation program assessment of the outcome measures were made after every sessions and the results obtained from the assessment had revealed that for a CVD patients with diabetes 24 hours of exercise which would be performed for not less than four weeks provides a maximal result which carried on for further two weeks whereas for CVD patients with Dyslipidemia 20 hours of exercise had provided a desired result carried on for the remaining weeks. The study concluded that exercises based cardiac rehabilitation had a significant impact in improving the patient condition where a six week of training protocol improves the outcome measures included in the study.

The Differences requency of Lower Extremities Muscle Strength and Functional Capacity on the difference Supervised Exercise Frequency in Post Cardiac Bypass Graft Surgery

Introduction: The optimal time to do exercise in adaptation phase was 36 to 72 hours. Patients with cardiovasculardisease may have an extended adaptation phase to 96 hours and above. It was necessary to know the mosteffective supervised exercise in phase II cardiac rehabilitation between three times/week for 36-hours, and twotimes/week for 96-hours.Method: This study involved 30 patients post-Cardiac Bypass Graft Surgery (CABG) participated in phase IIcardiac rehabilitation at Hasan Sadikin Hospital, Bandung. Subjects divided into two groups; that have done twotimes/week (group 1) and three times/week of the supervised exercised (group 2) for four weeks. The Lowerextremity muscle strength (LEMS) examined by conducting a chair standing test, while functional capacity (FC)evaluated by the 6-minute walking test.Result:Subjects were 58,54±5,90 y.o (group 1) and 61,66±6,36(group 2). The FC and the LEMS before andafter exercise were 10,98 and 15,96 ml/kg(&lt;0,001) on the FC; 7,8 and 12,9 times (&lt;0,001) on the LEMS in group1, besides 9,6 and 14,9 ml/kg(&lt;0,001) on the FC; 8,7 and 13,0 times (&lt;0,001) on group 2,Conclusion. Both groups have increased of the FC and the LEMS after exercise. There were no differencebetween 2 times and 3 times of supervised exercises a week on post CABG pasientsKeywords: coronary artery bypass graft, the frequency of exercise, functional capacity, muscle strength =

Predictors of Suboptimal Gain in Exercise Capacity After Cardiac Rehabilitation

Cardiac rehabilitation (CR) improves exercise capacity (EC), but not all CR participants achieve such improvements. Our primary aim was to develop a tool to identify those with suboptimal improvement in EC after CR. We retrospectively analyzed 541 patients enrolled in a phase-II CR program after a cardiac event or intervention from 2003 to 2014. EC was assessed with the 6-minute walk test. We developed a multivariate linear regression model and corresponding nomogram to predict EC after CR. The predictors included in the final model were age, gender, baseline EC, primary referral diagnosis, body mass index, systolic blood pressure at rest, triglycerides, low-density lipoprotein cholesterol, lipid-lowering medication use, and an interaction term of low-density lipoprotein cholesterol with lipid-lowering therapy. The prediction model was internally validated using bootstrap methods, and a nomogram was created for ease of use. In conclusion, this tool helps to identify those patients with suboptimal improvement in EC who could be targeted for individualized interventions to increase their performance.

Health literacy predicts cardiac knowledge gains in cardiac rehabilitation participants

Objective: Health literacy is increasingly recognised as a potentially important patient characteristic related to patient education efforts. We evaluated whether health literacy would predict gains in knowledge after completion of patient education in cardiac rehabilitation. Method: This was a re-post observational analysis study design based on Summa Health System’s Phase-II cardiac rehabilitation programme in Akron, Ohio, USA. The Medical Term Recognition Test, the Short Test of Functional Health Literacy in Adults, and the Newest Vital Sign were administered to 191 patients enrolled in cardiac rehabilitation between May 2010–April 2011. The Cardiac Knowledge Assessment Tool is routinely administered at the beginning and prior to discharge from cardiac rehabilitation. Consent was obtained in order to access patients’ cardiac rehabilitation medical chart for information such as age and education level. Results: Participants were 72% men with a mean of 66.4 years of age, and with an average level of education of 13.7 years. Health literacy was strongly related to cardiac knowledge at both the beginning and end of cardiac rehabilitation ( r=0.46, p&lt;0.001; r=0.41, p&lt;0.001). Controlling for cardiac knowledge at the beginning of cardiac rehabilitation, health literacy predicted gains in cardiac knowledge at the end of cardiac rehabilitation ( p&lt;0.01). Conclusion: Health literacy can be used to predict gains in knowledge from patient education programming in cardiac rehabilitation. Health literacy screening may help to identify those who may struggle with patient-education portions of cardiac rehabilitation or who may need additional education to reach a desired knowledge level.

High-Intensity, Occupation-Specific Training in a Series of Firefighters During Phase Ii Cardiac Rehabilitation

Six male firefighters who were referred to phase II cardiac rehabilitation after coronary revascularization participated in a specialized regimen of high-intensity, occupation-specific training (HIOST) that simulated firefighting tasks. During each session, the electrocardiogram, heart rate, and blood pressure were monitored, and the patients were observed for adverse symptoms. No patient had to discontinue HIOST because of adverse arrhythmias or symptoms. For physicians who must make decisions about return to work, the information collected over multiple HIOST sessions might be more thorough and conclusive than the information gained during a single treadmill exercise stress test (the recommended evaluation method).

Depression predicts failure to complete phase-II cardiac rehabilitation

Reduced adherence to medical treatment regimens may help to explain the higher risk of mortality among depressed cardiac patients. Participation in cardiac rehabilitation is a highly recommended part of the medical treatment regimen for cardiac patients. This study examined if elevated depressive symptomology, as measured by the Beck Depression Inventory (BDI), predicted failure to complete a 12-week phase II cardiac rehabilitation program for 600 patients. Logistic regression analysis showed that patients with elevated levels of depressive symptomology (BDI scores > or = 10) were 2.2 times less likely to complete cardiac rehabilitation compared to patients without depression (BDI < 10), after controlling for age, gender, body mass index, and employment. Somatic symptoms predicted non-completion due to medical reasons, whereas younger age predicted failure to complete cardiac rehabilitation due to non-medical reasons. Given the difficulty of reducing mortality by treating depression directly, interventions targeting behavior change to improve medical treatment adherence might be an effective complementary strategy.

How Cardiac Rehabilitation Relates to Quality of Life

The purpose of this study is to determine the relationship between adherence to cardiac rehabilitation (CR) and improvements in health-related quality of life (HRQL) with a 12-week, Phase-II CR program. Previously collected data from 153 CR patients (114 males, 39 females; 69.1 years of age +/- 11.5) were utilized to complete this retrospective study. Patients completed the Medical Outcomes Survey Short Form-36 to assess HRQL at the beginning of CR (N = 153), at 3 months (N = 152), and at 1 year (N = 94). Pearson correlation coefficients were generated to assess the relationship between CR attendance and HRQL. Paired sample t-tests helped determine the effect of CR on HRQL at 3 months and 1 year. No relationship was found between CR adherence and improvements in HRQL. Significant improvements in HRQL were found among all patients from baseline to 3 months and 1 year. Study findings demonstrate the effectiveness of CR in improving patient short- and long-term HRQL regardless of patient adherence rate.