Physical Activity In Secondary Prevention Research Articles

Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization

Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. ObjectivesTo test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. MethodsFrom February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. ResultsAt a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. ConclusionsHome rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.

A randomised controlled trial to enhance travel-related physical activity: A pilot study in patients with coronary heart disease

IntroductionPatients suffering from coronary heart disease (CHD) are frequently less active. Physical Activity (PA) could be increased through changes in routine travel behaviour. Achieving a certain PA amount is essential in the secondary prevention of CHD patients. ObjectiveThis study combines objective monitoring together with an intervention using advanced Information, Communication and Technology means in a framework to improve travel-related PA. This paper aims to describe an integrated research framework and tests the effectiveness of a theory-based (Trans-theoretical Model, TTM) intervention. MethodsA pilot Randomised Controlled Trial (70:30) was conducted in Belgium. Participating patients attended a preparatory work session intended to get their demographic information, assess their Stage of Change, and learn using a smartphone app (developed to monitor travel behaviour). After the work session, patients in the experimental group were monitored for three weeks and then received a customized feedback report. After feedback, the patients were monitored for another three weeks; while patients in the control arm were continuously monitored for 6 weeks without an intermediate feedback report. At the end of the study period, both groups received their feedback report. ResultsThe data of 25 patients were used in the trial, of which 18 were in the experimental group. The outcome measure used was the Active Travel Score (ATS), i.e. the PA achieved by walking and cycling trips. A significant (p<0.05) positive increase in ATS (X‾=14.2,95%,CIs=2.1−26.4) was observed after the intervention. Multiple pairwise comparisons confirmed that the effect of the intervention lasted for a week, indicating an important short-term effect. ConclusionObjective monitoring and TTM-based interventions can be useful to provide a low-cost solution to achieve an increase in PA in secondary prevention of cardiac patients. Although these results are promising, RCTs with larger sample sizes are required to confirm the current findings.

‘Moscow longevity’ program: effectiveness of physical activity in secondary prevention of hypertension

Regular aerobic exercise is recommended for the prevention and complex treatment of patients with hypertension. Increasing public awareness about modifiable risk factors and the introduction of various tools to help patients to improve these factors is one of the priority goals of modern healthcare. Regular physical activity lowers total blood cholesterol levels. ‘The Moscow longevity’ program helps patients of retirement age to increase their daily physical activity, to improve their mood, overall well-being and prognosis.

An Internet- and Mobile-Based Tailored Intervention to Enhance Maintenance of Physical Activity After Cardiac Rehabilitation: Short-Term Results of a Randomized Controlled Trial

BackgroundAn increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual.ObjectiveOur trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version.MethodsThe study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program.ResultsIncluded in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression.ConclusionsBecause of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention.Trial RegistrationClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).

Changing medical culture to promote physical activity in secondary prevention of coronary artery disease

This editorial refers to ‘Physical activity in patients with stable coronary heart disease: an international perspective’[†][1], by R. Stewart et al. , on page 3286 Stewart and colleagues analyse reasons why many patients with coronary artery disease (CAD) do not engage in regular physical activity (PA) despite considerable evidence describing its benefit and guidelines promoting it.1 Their study population was a large ( n = 15 486) international (39 countries) cohort of patients with stable CHD participating in a large randomized clinical trial (STABILITY).2 PA was assessed by the International Physical Activity Questionnaire;3 subjects estimated the number of hours of ‘mild’, ‘moderate’, and ‘vigorous’ PA in which they engaged during a typical week. Total PA was reported in metabolic equivalent (MET)-hours/week. Subjects indicated whether moderately vigorous PA occurred at work or during leisure time and whether PA levels changed after their first ‘heart problem’. Further, subjects were asked to identify limitations to walking 100 m, climbing one flight of stairs, or walking 1 km. The investigators found that 46% of subjects reported decreased PA after their first heart problem. A lower level of PA was associated with older age, poorer health, more co-morbidities, depressed mood, greater exercise limitation, lack of cardiac rehabilitation (CR), non-white race, middle vs. higher income country, and less formal education. Self-reporting of PA is the usual methodology, though objective assessment by motion sensors can provide varying results; self-reporting generally overestimates PA.4 While the methodology of combining all PA into MET-hours per week is commonly used in epidemiological investigations, it makes it difficult to understand whether subjects are meeting current guidelines. Recommendations in the American Heart Association/American College of Cardiology (AHA/ACC) guidelines5 and European Society of Cadiology (ESC) Guidelines6 ( Figure 1 ) are phrased in terms of total recommended minutes of exercise on … [1]: #fn-2

Physical activity and mortality in men and women with diagnosed cardiovascular disease

Existing information regarding the optimal types and amount of physical activity for secondary prevention is controversial. We examined the association between different types of physical activity (domestic, walking, sports) and mortality in participants with established cardiovascular disease (CVD). Data were collected from the Scottish Health Surveys (1995, 1998, 2003) that were linked to a patient-based database of CVD hospital admissions and deaths. There were 837 men and women with clinically confirmed CVD at baseline, of whom 175 died over an average of 5.6+/-3.1 years of follow-up. The lowest risks for all-cause mortality were seen in participants undertaking at least 20 min/week of sports activity (fully adjusted hazard ratio=0.32, 95% confidence interval=0.16-0.65) or walking (hazard ratio=0.74, 0.53-1.04). Similar associations were observed for CVD mortality. The physically active also showed lower levels of inflammatory risk markers and greater HDL cholesterol. Men and women with existing CVD who participate in moderate-to-vigorous activity for at least 20 min/week showed the lowest risks of all-cause and cardiovascular mortality. These findings support emerging data from controlled exercise training studies.