Standard Cardiac Rehabilitation Research Articles

The Effect of Peer-Mentor Support for Older Vulnerable Patients With Ischemic Heart Disease-A 24-Week Randomized Controlled Trial.

The positive effects of cardiac rehabilitation (CR) are well established; however, among older and vulnerable patients, nonattendance and dropout are prevalent problems. The objective of this study is to explore if a 24-week peer-mentor intervention increases initial and long-term CR attendance. Secondary aims are whether peer-mentor intervention improves lifestyle (diet and physical activity) and psychological outcomes (self-efficacy, anxiety, depression, and quality of life) among older vulnerable patients with ischemic heart disease. The study was designed as a 2-arm, single-center, parallel, 24-week, randomized controlled trial (RCT) with follow-up at 12 and 24 weeks. Patients were randomized at a ratio of 1:1 to receive either the peer-mentor intervention (in addition to standard CR) or standard CR along (control arm). Between August 2021 and March 2023, 117 older, vulnerable patients were enrolled and randomized (59 randomized to peer-mentor intervention and 58 to usual care). The peer-mentor intervention significantly increased CR attendance. This applies to both initial participation in 1 CR session of physical training or dietary advice (78.0% vs 58.6%; P = .03), and long-term attendance in ≥50% dietary advice sessions (50.8% vs 27.6%; P = .01) and completed ≥50% (64.4% vs 41.4% P = .01) or ≥75% of the physical training sessions (59.3% vs 37.9%; P = .02). The study found no statistically significant effect on secondary outcomes. Low CR attendance is a well-known problem, especially among older, vulnerable patients; however, we tested a low-cost, peer-mentor intervention that significantly increased both initial CR participation and long-term attendance in CR sessions in this group of patients.

Potential preservative mechanisms of cardiac rehabilitation pathways on endothelial function in coronary heart disease.

Cardiac rehabilitation, a comprehensive exercise-based lifestyle and medical management, is effective in decreasing morbidity and improving life quality in patients with coronary heart disease. Endothelial function, an irreplaceable indicator in coronary heart disease progression, is measured by various methods in traditional cardiac rehabilitation pathways, including medicinal treatment, aerobic training, and smoking cessation. Nevertheless, studies on the effect of some emerging cardiac rehabilitation programs on endothelial function are limited. This article briefly reviewed the endothelium-beneficial effects of different cardiac rehabilitation pathways, including exercise training, lifestyle modification and psychological intervention in patients with coronary heart disease, and related experimental models, and summarized both uncovered and potential cellular and molecular mechanisms of the beneficial roles of various cardiac rehabilitation pathways on endothelial function. In exercise training and some lifestyle interventions, the enhanced bioavailability of nitric oxide, increased circulating endothelial progenitor cells (EPCs), and decreased oxidative stress are major contributors to preventing endothelial dysfunction in coronary heart disease. Moreover, the preservation of endothelial-dependent hyperpolarizing factors and inflammatory suppression play roles. On the one hand, to develop more endothelium-protective rehabilitation methods in coronary heart disease, adequately designed and sized randomized multicenter clinical trials should be advanced using standardized cardiac rehabilitation programs and existing assessment methods. On the other hand, additional studies using suitable experimental models are warranted to elucidate the relationship between some new interventions and endothelial protection in both macro- and microvasculature.

A multi-site prospective controlled pilot evaluation of Cardiac College for Women in the cardiac rehabilitation setting

ObjectiveTo test the limited efficacy of women-focused educational materials within supervised cardiac rehabilitation (CR) for the first time when compared to standard co-educational CR. MethodsA multi-site, prospective, pilot study with blinded outcome assessment was conducted at two Canadian CR programs. At intake, participants selected women-only CR with women-focused education (12 weeks) or a standard co-educational program (16 weeks). Both were comprehensive programs, with one education session/week. Outcomes were disease-related knowledge, functional capacity, quality of life, and heart-health behaviours. ResultsOf 114 women approached, 62 (54.4 %) consented. Forty elected the women-only CR program. Pre-CR medication adherence was high. Participants attended approximately 60 % of sessions; 55 (88.7 %) were retained at follow-up. Significant improvements in knowledge, quality of life, and functional capacity were observed in both groups (all p < .05). With adjustment for pre-CR scores, participants in women-only CR exhibited significantly greater improvements in knowledge (p < .05) and adherence to the Mediterranean diet (p = .04) post-program compared to control participants. ConclusionResults support of the utility of this women-focused education in the CR setting. Practice implicationsIntegrating women-focused education in CR can enhance health outcomes and address specific needs of female patients.

The impact of cardiac rehabilitation on atrial fibrillation recurrence after pulmonary vein isolation: results of a retrospective study

Abstract Background Although pulmonary vein isolation (PVI) is an extensively utilized atrial fibrillation (AF) treatment, many patients still experience AF recurrences. Multimorbidity care, including physical activity, may reduce recurrences. In Belgium, patients undergoing an ablation are entitled to a cardiac rehabilitation (CR) program after PVI, but not all do participate. More evidence that such (standardized) CR programs for AF patients after ablation can positively impact rhythm control is desirable. Purpose This study retrospectively investigated the impact of CR on AF recurrence after PVI. Methods We analysed an extensive database of a large Belgian tertiary care center with patients who underwent a primary PVI between 2007 and 2020 and who had a follow-up of at least 1 year. General cardiology follow-up included a 24h Holter monitoring 3 and 12 months after PVI. Patients were retrospectively divided into an intervention and control group based on their choice to participate in a standardized CR program. The Kaplan-Meier method was used to estimate the time-to-recurrence and event-free survival curves after the primary ablation. Differences between curves were tested with the log-rank test. Mann-Whitney U test was used to analyze continuous variables and the Chi-square test for categorical variables. Results In total, 1767 patients were included, of which 589 participated to CR and 1178 served as controls (median 64 (56-70) y, 68.9% male, median BMI 27.5 (24.7-30.7) kg/m2). There was no significant difference between CR and controls in median age (64y vs. 63y respectively; p=0.203), the proportion of male (57.9% vs. 47.0% respectively; p=0.111) and the proportion of paroxysmal AF (66.4% vs. 70.6% respectively; p=0.210). The proportion with recurrent AF at the end of study follow-up (with a three-month initial blanking period) in the CR and control group was similar (32.6% vs. 35.1% respectively; p=0.288), and also survival analysis demonstrated no significant difference (p=0.827; Figure 1). We noted a cross-over of the recurrence curves after about 1500 days, but the rate of AF recurrence was not different among CR and controls within the first year post-ablation (p=0.136) nor when analysed from day 365 until the end of the study (p=0.341) (Figure 2). There was no significant difference in AF recurrences between CR and controls for either paroxysmal AF (p= 0.551) or persistent AF (p=0.181) based on the survival analysis. Conclusions This retrospective analysis could not demonstrate reduced AF recurrence in post-PVI patients following a structured CR program. The unexpected crossover of curves could point to earlier AF detection in CR patients, while there might be long-term benefit of physical activity. Multivariable analysis will have to evaluate whether impact of CR is related to certain clinical patient characteristics, which might also have contributed to inclusion bias.Figure 1Figure 2

Sex differences in the physiological responses to cardiac rehabilitation: a systematic review

BackgroundHeart disease is one of the leading causes of death in Canada. Many heart disease patients are referred for cardiac rehabilitation, a multidisciplinary outpatient program often consisting of exercise training. Cardiac rehabilitation has been proven to be a successful secondary preventative measure in reducing mortality and improving overall health in heart disease patients, and its completion is important for both sexes as there is growing evidence that women benefit as much as men, if not more, with regard to mortality. It is important to note that previous studies have shown that healthy men and women respond differently to aerobic and resistance training, possibly due to hormones, body composition, autonomic and/or cardiovascular differences. However, evaluating sex differences in the efficacy of standard cardiac rehabilitation programs has not yet been fully explored with many studies investigating clinical or anthropometric data but not physiological outcomes. This systematic review aimed to investigate physiological differences in male and female heart disease patients after cardiac rehabilitation. The inclusion criteria were purposefully broad to encompass many cardiac rehabilitation scenarios, many cardiac disease states, and various program lengths and intensities with the intention of highlighting strengths and weaknesses of the current body of literature.MethodsTo conduct a synthesis without meta-analysis, a search strategy was generated to examine the relationships between heart disease patients, a supervised exercise program, physiological outcomes, and sex differences. The review was registered (Prospero: CRD42021251614) and the following databases were searched from inception to 19 December 2023: APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), Embase (Ovid), Emcare Nursing (Ovid), Medline All (Ovid; includes PubMed non-Medline), and Web of Science Core Collection. Eighty-eight studies pertaining to fitness, metabolism, body composition, respiratory function, cardiac function and C-reactive protein underwent data extraction.Results and conclusionsImportantly, this review suggests that men and women respond similarly to a wide-range of cardiac rehabilitation programs in most physiological variables. However, many studies discussing maximal oxygen consumption, functional capacity, six-minute walk distances, and grip strength suggest that men benefit more. Further research is required to address certain limitations, such as appropriate statistical methods and type/intensity of exercise interventions.

Prehabilitation Using a Cardiac Rehabilitation Program for a Patient With a Total Artificial Heart Prior to Heart Transplantation.

The last few decades have been marked by significant advances in mechanical cardiocirculatory support. A total artificial heart (TAH) became a viable therapeutic option for numerous patients as a bridge to heart transplantation, particularly for those in end-stage heart failure. This technology aims to address the various subsequent shortfalls of organs. This report reviews the impact of a prehabilitation on a patient with an Aeson TAH (Carmat). We assessed improvements in functional capacity and quality of life (QoL) in a newly implanted patient following standard cardiac rehabilitation as a prehabilitation program, using 6-min walk test and the Short Form-12 (SF-12) health survey, respectively. Similar functional improvements were observed over a short period of 2 wk compared with a longer protocol for patients with a heart transplant, and superior effects on QoL. The patient was successfully transplanted 5 mo after the TAH implantation. Prehabilitation of a patient with a TAH increased both their physical capacity and QoL.

Improving adherence to rehabilitation for heart failure patients through immersive virtual reality (VIRTUAL-HF): A protocol for a randomized controlled trial

BackgroundTo improve symptoms and reduce poor outcomes related to heart failure (HF), international guidelines recommend cardiac rehabilitation (CR), particularly for those with a reduced ejection fraction. Unfortunately, patient adherence to rehabilitation programs remains suboptimal, with dropouts ranging from 15.4 to 63.3%. An innovative and promising intervention that could improve adherence to rehabilitation is virtual reality (VR). This study aims to evaluate the effects of VR in patients with HF who undergo CR using this technology in terms of adherence (primary outcome), functional capacity, perceived exertion, angina, quality of life, heart rate, oxygen saturation, blood pressure, maximum oxygen uptake, minute ventilation/carbon dioxide production slope, oxygen pulse, blood values of NT-proBNP and HF related rehospitalization rates (secondary outcomes). MethodsA randomized controlled trial will be conducted in a sample of 80 patients referred to CR. Participants will be enrolled in a cardiological rehabilitation unit of a large university hospital in Italy and randomized (1:1) to the experimental intervention consisting of CR performed with high-quality immersive VR with PICO 4® Head Mounted Display headset and TREADMILL XR® software (Arm 1) or standard CR (Arm 2). Patients, according to guidelines, will perform 30-min of CR sessions with moderate intensity, twice a week for one month. ResultsSignificant improvements in primary and secondary outcomes are expected in patients in the intervention group. ConclusionsIf proven to be effective, VR could be an innovative, safe, and easy digital health intervention to improve adherence to CR in patients with HF, as well as important clinical outcomes.

Patient-reported experiences of cardiac rehabilitation services and the Country Heart Attack Prevention model of care

Background/Aims Patient-centred care is the delivery of a high-quality healthcare service that appropriately responds to the needs and preferences of patients. Addressing participants' needs and preferences in healthcare services is essential to improving patients' experiences and clinical outcomes. This article aimed to evaluate patient-reported experiences of standard cardiac rehabilitation programmes and the Country Heart Attack Prevention model of care, as well as design and standardise patient-reported experience measures. Methods This was a cross-sectional study with a multi-method analysis. Participants (n=818) ≥18 years old with cardiovascular disease who attended cardiac rehabilitation programmes across all modes of delivery before (1 January 2017 to 30 June 2021), during (1 July 2021 to 30 June 2022) and after implementation of the Country Heart Attack Prevention model (1 July 2022 to 30 December 2022) responded to the patient satisfaction surveys. Participant data from before and after implementation of the model were categorised as ‘not exposed’, while those who received cardiac rehabilitation during this period were categorised as ‘exposed’. A total of 170 participants provided qualitative feedback. Summary t-test was used to compare the means of the quantitative responses, and thematic analysis was used to generate themes from the qualitative feedback. Results The overall patient-reported satisfaction scores for those not exposed (n=685) and exposed (n=133) to the Country Heart Attack Prevention model of care were 77.1% and 85.9%, respectively (mean difference=−8.8; 95% confidence interval=−10.2, −7.4; P≤0.05). Themes for positive feedback included education and information, communication and friendly advice. Themes for improvement included follow-up duration, more face-to-face contact and waiting time. Conclusions Overall patient-reported satisfaction scores were significantly higher for participants who were exposed to the Country Heart Attack Prevention model of care compared with those who were not exposed. Addressing feedback on areas for improvement in cardiac rehabilitation services can promote attendance, completion and improved health outcomes of patients.

Does psychoeducation added to standard cardiac rehabilitation reduce subsequent mortality or cardiovascular disease events?

Does psychoeducation added to standard cardiac rehabilitation reduce subsequent mortality or cardiovascular disease events?

Эффективность программы ранней реабилитации с применением дистанционных технологий на амбулаторном этапе у пациентов после хирургической коррекции приобретенных клапанных пороков сердца

Aim: to investigate the clinical safety and efficacy of a combined rehabilitation consisting of early rehabilitation with physical training in the hospital and remote rehabilitation using a mobile application in the outpatient setting after surgery for acquired valvular heart disease (VHD) using bypass Patients and Methods: the study involved 68 patients who underwent surgery for VHD, with 34 patients in the study group and 34 patients in the control group, based on their rehabilitation approach The study group consisted of two subgroups based on the type of rehabilitation. The subgroup that underwent complex rehabilitation (n=16) participated in treadmill training for 2 weeks in the inpatient setting at least 8 days after surgery, followed by remote rehabilitation in the outpatient setting using a mobile application. The subgroup that underwent remote rehabilitation (n=18) did not undergo early inpatient treadmill training. The control group only received standard cardiac rehabilitation methods Results: there were no significant differences in the rate or type of complications during the early postoperative period A more significant improvement in functional status was reported in the subgroup that underwent complex rehabilitation 24 days after surgery, compared to patients who did not receive early physical training as part of their rehabilitation program. The subgroup undergoing complex rehabilitation showed a significantly greater improvement in exercise tolerance (p=0.03) and peak oxygen uptake (p=0.04) 24 days after surgery. These indices continued to increase (p=0.04; p=0.03) by month 4 of the follow-up compared to postoperative day 7. These changes were more significant in the complex rehabilitation group than in the remote rehabilitation group. Patients who underwent complex rehabilitation showed better adherence to using the mobile application for remote rehabilitation than patients who underwent remote rehabilitation (50% vs. 38.8%; p=0.04). Conclusion: the rehabilitation program for patients after surgery for VHD, which includes early moderate-intensity physical treadmill training followed by outpatient distance rehabilitation using a mobile application, is safe and effective This is demonstrated by a significant improvement in functional status Additionally, early initiation of physical training is associated with better adherence to further use of distance rehabilitation technologies KEYWORDS: valvular heart disease, heart surgery, postoperative cardiac rehabilitation, early rehabilitation, remote rehabilitation FOR CITATION: Lyapina I.N., Argunova Yu.A., Dren E.V.', Chereneva L.A., Barbarash O.L. Effectiveness of early rehabilitation program with remote technologies in the outpatient setting after surgery for acquired valvular heart disease. Russian Medical Inquiry. 2024;8(1):16–25 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-3.

Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial.

Obesity is aknown and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of adedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.

Abstract 13995: Remote, Smart Device Based Cardiac Rehabilitation After Myocardial Infarction - Smart Rehab Study

Introduction: After myocardial infarction (MI), increasing functional capacity is an important goal of cardiac rehabilitation, that improves prognosis. However, standard cardiac rehabilitation is not accessible to many patients. Telemedicine programs are emerging as promising alternatives to in-person programs, but evidence confirming its benefits is lacking. Hypothesis: Smart device based remote cardiac rehabilitation can improve functional capacity assessed by VO2peak after MI. Methods: Patients were offered participation at the time of hospitalization for MI. One month after MI, patients underwent a cardiopulmonary exercise test, 6-minute walking test (6MWT) and were randomized 1:1. In the intervention group, patients received a smart watch to track the recommended number of steps, that was derived from the 6MWT. Adherence to the recommendations was telemonitored by a study nurse, with an over the phone motivation talk if compliance was unsatisfactory. In the control group, patients were recommended 150 minutes/week of moderate intensity exercise. Exercise stress tests were repeated after 3 months. Results: In total, 59 patients (mean age 51.5±10.4 years, 10.2% women, 67.8% STEMI, 96.6% PCI, mean discharge EF 48±10%) were included in the study. At baseline, there was no difference in clinical characteristics and functional capacity between the intervention (n=29) and control (n=30) groups. After 3 months of the intervention, VO2peak improved in the intervention arm with between group difference of 1.56 ml/kg/min (95%CI 0.06-3.05, p=0.041), with no difference in 6-minute walking distance (p=0.11). The effect of intervention differed by baseline functional capacity (p for interaction &lt;0.01). Among patients with VO2peak at baseline ≤95% predicted, the between-group VO2peak difference after 3 months was 2.46 ml/kg/min (95% CI 0.78-4.13, p=0.005), and also oxygen uptake efficiency slope (between group difference 235, 95% CI 43-428, p=0.02) and 6-minute walking distance improved (between group difference 60m, 95% CI 1.5-119, p=0.045). Conclusions: Smart device based remote cardiac rehabilitation improves functional capacity after myocardial infarction, particularly in those with decreased functional capacity. NCT03926312

Dynamics of anxiety, depression, and quality of life after early physical rehabilitation of patients who underwent surgical correction of acquired mitral valve defect: clinical prospective randomized study

BACKGROUND: The activation of the patient from the day after an acquired mitral valve (MV) defect with standard cardiorehabilitation surgery and further physical training at an early uncomplicated inpatient stage of the postoperative period appears promising to improve not only the functional status but also the quality of life (QL).&#x0D; AIM: Our aim was to examine the effect of early physical rehabilitation on the dynamics of anxiety, depression, and QL in patients after surgical correction of the MV defect.&#x0D; MATERIALS AND METHODS: The study included 80 patients (median age 60.8 [47.5; 69.0] years) who underwent surgical correction of an acquired MV defect. Starting from the 7th day after the surgery, patients were assessed for functional status, and the intensity of the training load was selected, and this was done again on the 24th day after the surgery. Moreover, the QL parameters on the SF-36 scale and levels of anxiety and depression on the Hospital Anxiety and Depression Scale (HADS) were evaluated. The control group (n=47) underwent a standard cardiac rehabilitation program from 1st day after surgery. In the main group (n=33), based on the results of the cardiopulmonary exercise testing, physical training on a treadmill was initiated for 14 days, from the 8th day after the surgery, in addition to a personalized training program.&#x0D; RESULTS: In addition to improving the functional state, early physical training improved the dynamics of QL indicators in the main group. After 14 days of treadmill training, the physical health component increased from a median of 35.1 to 64.4 (p=0.03), and the mental health component from a median of 49.1 to 82.1 (p=0.03). In addition, after the early physical rehabilitation program in the main group, the number of people without anxiety and depression, according to the HADS scale, significantly increased from 9% to 27.3% (p=0.04), whereas the dynamics of the QL, anxiety, and depression levels in the control group were not significant.&#x0D; CONCLUSION: Early physical rehabilitation, including moderate-intensity workouts with an individual calculation of the speed / angle of the treadmill, starting from 8 days after surgical correction of the acquired MV defect demonstrated efficacy in improving the QL and reducing anxiety and depression levels 24 days after surgery.

Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior and Physical Fitness: the OPTICARE XL Randomized Controlled Trial.

Previously published results of the OPTICARE XL open label randomized controlled trial showed no added value of OPTICARE XL CR, a dedicated cardiac rehabilitation (CR) program for patients with obesity, with respect to health-related quality of life (primary outcome). This clinical trial studied the effects of OPTICARE XL CR on several secondary outcomes, which included body weight, physical activity, sedentary behavior, and physical fitness. Patients with coronary artery disease or atrial fibrillation and body mass index (BMI) ≥ 30 were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). OPTICARE XL CR is a 1-year group intervention, specifically designed for patients with obesity, and included aerobic and strength exercise, behavioral coaching, and an aftercare program. Standard CR consisted of a 6- to 12-week group aerobic exercise program, supplemented with cardiovascular lifestyle education. Study end points included body weight, physical activity, sedentary behavior (accelerometer), and physical fitness (6-Minute Walk Test and handgrip strength), which were evaluated 6months after the end of CR (primary end point) and 3months after the start of CR. Six months after completion of either program, improvements in body weight, physical activity, sedentary behavior, and physical fitness were similar between groups. Three months after CR start, patients randomized to OPTICARE XL CR showed greater weight loss (mean change = -3.6 vs -1.8kg) and a larger improvement in physical activity (+880 vs +481 steps per day) than patients randomized to standard CR. Patients allocated to OPTICARE XL CR lost significantly more body weight and showed promising results with respect to physical activity 3months after the start of CR; however, these short-term results were not expanded or sustained in the longer term. Patients with obesity do not benefit from standard CR programs. The new OPTICARE XL CR program showed its effects in the short term on weight loss and physical activity, and, therefore, redesign of the aftercare phase is recommended.

Te Kaahui Ora Māori Health Team Offering Whanau Ora and Secondary Prevention in Te Whatu Ora – Counties Manukau

Cardiac rehabilitation (CR) is an important evidence-based secondary prevention intervention following acute coronary syndrome (ACS). In this catchment, Māori uptake of CR is persistently low. A partnership with the Māori health team was introduced during the COVID pandemic to deliver a Te Kaahui Ora model of care. Using the ACS and CR database, 100 consecutive Māori patients—50 preintervention and 50 postintervention—were retrospectively audited. All patients were discharged alive after ACS with similar characteristics: 78% vs 72%, revascularised, 93% vs 94% discharged on standard ACS medications. Risk factors: smoking 53% vs 56%, mean SBP 145.4 vs 146.3, LDL >2, 86.3% vs 74%, BMI >30 67% vs 63%, and diabetes 34% vs 34%. The majority were male 64% vs 68% and mean age was 54 vs 58.6 years. Cardiac rehabilitation attendance declined 44% vs 28%; however, 96% in the intervention cohort received 20% home visits and 100% telephone support with often multiple contacts. The introduction of a wide-ranging intervention in Māori post-ACS patients resulted in a decrease in traditional CR attendance but also a significant increase in phase 1 and 2 contacts, and addressed a wide range of issues unlikely to be addressed in standard CR interventions.

Feasibility of Integrating MEditatioN inTO heaRt Disease (the MENTOR Study): A Phase II Randomized Controlled Trial.

Comorbid depression and/or anxiety symptoms occur in 25% of patients attending cardiac rehabilitation (CR) programs and are associated with poorer prognosis. There is a need to evaluate psychological interventions, including meditation, that have potential to improve psychological health in CR programs. The aim of this study was to determine the feasibility and acceptability of integrating a meditation intervention into an existing Australian CR program for the reduction of depression and anxiety symptoms. This was a mixed-methods feasibility randomized controlled trial. Thirty-one patients with CVD and, at a minimum, mild depression and/or anxiety symptoms were randomized to meditation and standard CR or to standard CR alone. A 16-minute guided group meditation was delivered face-to-face once a week for 6 weeks, with daily self-guided meditation practice between sessions. Feasibility outcomes included screening, recruitment, and retention. Semistructured interviews of patients' (n = 10) and health professionals' (n = 18) perspectives of intervention participation and delivery were undertaken to assess acceptability. Between-group differences in depression, anxiety, stress, self-efficacy for mindfulness, and health status at 6 and 12 weeks were also assessed. Meditation was considered feasible, with 83% (12/15) of the intervention group completing an average of 3.13 (SD, 2.56) out of 6 group meditation sessions and 5.28 (SD, 8.50) self-guided sessions. Meditation was considered acceptable by patients, clinicians, and health managers. Between-group differences in the number of CR sessions completed favored the intervention group in per-protocol analyses (intervention group vs control group, 12 vs 9 sessions; P = .014), which suggests that meditation may be useful to improve patients' adherence to exercise-based CR program.

Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study

No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122.

Cognitive-behavioral rehabilitation in patients with cardiovascular diseases: a randomized controlled trial (CBR-CARDIO, DRKS00029295)

BackgroundDepression, generalized and cardiac anxiety, and posttraumatic stress disorder negatively affect disease severity, participation, and mortality in patients with cardiovascular disease. Psychological treatments within cardiac rehabilitation may improve the outcomes of these patients. We therefore developed a cognitive-behavioral rehabilitation program for patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. In Germany, similar programs are well established in musculoskeletal rehabilitation and cancer rehabilitation. However, no randomized controlled trials have evaluated if such programs achieve better outcomes in patients with cardiovascular disease compared with standard cardiac rehabilitation.MethodsOur randomized controlled trial compares cognitive-behavioral cardiac rehabilitation with standard cardiac rehabilitation. The cognitive-behavioral program complements standard cardiac rehabilitation with additional psychological and exercise interventions. Both rehabilitation programs last for four weeks. We enroll 410 patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion aged 18 to 65 years. Half of the individuals are randomly assigned to cognitive-behavioral rehabilitation and the other half to standard cardiac rehabilitation. Our primary outcome is cardiac anxiety 12 months after the end of rehabilitation. Cardiac anxiety is assessed with the German 17-item version of the Cardiac Anxiety Questionnaire. Secondary outcomes cover outcomes assessed by clinical examinations and medical assessments and a range of patient-reported outcome measures.DiscussionThis randomized controlled trial is designed to determine the effectiveness of cognitive-behavioral rehabilitation at decreasing cardiac anxiety in patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion.Trial registrationGerman Clinical Trials Register (DRKS00029295, June 21, 2022).

The development and randomised feasibility trial of a Nurse-led lifestyle modification follow-up programme among post-myocardial infarction patients.

Cardiovascular disease is the most often occurring disease in India accounting for 24.8% of deaths. Myocardial infarction contributes to this. A higher risk of cardiovascular disease exists due to comorbidities or the unawareness of existing illness among the Indian population. There is a shortage of published research on cardiovascular disease and a lack of standard cardiac rehabilitation programmes in India. Our study aims to develop a Nurse-led lifestyle modification follow-up programme, to assess and compare the effectiveness of the programme on health outcomes and quality of life among post-myocardial infarction patients. A two arm, single-blinded, randomised feasibility trial was conducted by developing a Nurse-led lifestyle modification follow-up programme. The interventional programme was based on the information-motivation-behavioural skill model and included health education, an educational booklet, and telephone follow-up. For feasibility testing of intervention, 12 patients were randomly allocated (n = 6/group). Patients in the control group were provided with routine care, while the intervention group was given routine care along with a Nurse-led lifestyle modification follow-up programme. It was possible to use this tool. In addition to determining the tool's feasibility for use we found that the intervention group showed a significant improvement in systolic blood pressure (BP) (p = 0.001), diastolic BP (p = 0.016), Body Mass Index (BMI) (p = 0.004), and quality of life in all the subscales - physical, emotional and social (p < 0.001) after 12 weeks of discharge. Findings from this study will help to reinforce designing a cost-effective care delivery system in the care of post-myocardial infarction patients. This programme is a novel approach to improve preventive, curative and rehabilitative services for the post-myocardial infarction patients in India.

An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program

BackgroundTo retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. MethodsA total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. ResultsAt pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. ConclusionsAlong with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.