Cardiac Rehabilitation Training Research Articles

A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up

Objective: To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. Design: Assessor-blinded randomized controlled trial with 12-months follow-up. Setting: Aarhus University Hospital, Aarhus, Denmark. Subjects: A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. Interventions: Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. Main measures: Primary outcome was changes in VO2peak. Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. Results: After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO2peak 2.6 (mL kg−1 min−1) (95% confidence interval (CI): 0.4–4.8), maximal workload 0.3 W kg−1 (95%CI: 0.02–0.5), isometric muscle strength 0.7 N m kg−1 (95%CI: 0.1–1.2) and muscle power 0.3 W kg−1 (95%CI: 0.04–0.6). After 12 months, a significant between-group difference only persisted in VO2peak and maximal workload. Conclusion: A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO2peak and maximal workload. Although the effect was small, it is an important finding because VO2peak is the most important predictor of all-cause mortality in cardiac patients.

Randomised controlled trial in women with coronary artery disease investigating the effects of aerobic interval training versus moderate intensity continuous exercise in cardiac rehabilitation: CAT versus MICE study

BackgroundThe primary aim of the present study was to investigate the effects of aerobic interval training (AIT) versus moderate intensity continuous exercise (MICE) on aerobic exercise capacity (V̇O2peak), in women...

High-Intensity Interval Training in Cardiac Rehabilitation: Impact on Fat Mass in Patients With Myocardial Infarction

ObjectiveTo examine the effect of high-intensity interval training (HIIT) on body fat mass and distribution in patients with myocardial infarction (MI) who underwent cardiac rehabilitation (CR). Patients and MethodsWe retrospectively screened 391 consecutive patients with MI enrolled in CR between September 1, 2015, and February 28, 2018. We included 120 patients who completed 36 CR sessions and underwent pretest-posttest dual-energy x-ray absorptiometry; 90 engaged in HIIT, and 30 engaged in moderate-intensity continuous training (MICT). High-intensity interval training included 4 to 8 alternating intervals of high- (30-60 seconds at a rating of perceived exertion [RPE] of 15-17 [Borg scale range, 6-20]) and low-intensity (1-5 minutes at RPE <14), and MICT performed for 20 to 45 minutes of exercise at an RPE of 12 to 14. Body weight, fat mass, and lean mass were measured via dual-energy x-ray absorptiometry with lipid profile measured via clinical procedures. ResultsThe HIIT and MICT groups were similar in age (67 vs 67 years), sex (26.7% [24 of 90 patients in the HIIT group] vs 26.7% [8 of 30 in the MICT group), and body mass index (30.3 vs 29.5 kg/m2) at baseline. The HIIT group had greater reductions in body fat percentage (P<.001), fat mass (P<.001), abdominal fat percentage (P<.001), waist circumference (P=.01), total cholesterol (P=.002), low-density lipoprotein cholesterol (P<.001), and triglycerides (P=.006). Improvements in total body mass and body mass index were not different across groups. After matching exercise duration, exercise intensity, and energy expenditure, HIIT-induced improvements in total fat mass (P=.02), body fat percentage (P=.01), and abdominal fat percentage (P=.02) persisted. ConclusionOur data suggest that supervised HIIT results in significant reductions in total fat mass (P<.001) and abdominal fat percentage (P<.001) and improved lipid profile in patients with MI who undergo CR.

Effects of Eight Weeks of Cardiac Rehabilitation Training on Serum Levels of Sirtuin1 and Functional Capacity of Post- Coronary Artery Bypass Grafting Patients

Effects of Eight Weeks of Cardiac Rehabilitation Training on Serum Levels of Sirtuin1 and Functional Capacity of Post- Coronary Artery Bypass Grafting Patients

Dose–effect relationship of resistance training in cardiac rehabilitation program for patients with coronary artery disease: a systematic review

Resistant training is an essential and effective component of cardiac rehabilitation program (CRP) for patients with coronary artery disease (CAD). The aim of the study was to find out the dose–effect relationship of resistant training in CRP for patients with CAD for the purpose of determining the optimal dose prescription that balances between safety and effectiveness. The study design was a systematic review with searching the electronic database of PEDro guided by inclusion and exclusion criteria. The results showed that resistant training added value to the aerobic training in CRP of patients with CAD and that different elements were used regarding its dose description, including intensity, frequency, duration, volume, and type. Regardless of the intensity, resistant training showed improvement in different outcome measures even more than aerobic training alone. High-repetition low-intensity resistant training showed to be beneficial. Both the duration of resistant training and time of involvement of it in the cardiac rehabilitation have an influence on its effect. Both dynamic and isometric resistant training programs were effective, in favor of the isometric type, and both concentric and eccentric training programs were effective, in favor of the eccentric type. The dose–effect of the resistant training in cardiac rehabilitation of patients with coronary artery diseases is not dependent only on the 5 elements for dose prescription, but it is largely dependent on the interactions between these 5 elements.

Effects of the First Phase of Cardiac Rehabilitation Training on Self-Efficacy among Patients Undergoing Coronary Artery Bypass Graft Surgery

Background: Heart surgery is vital for patients with coronary artery diseases that do not respond to drug treatments. We aimed to determine the effects of the implementation of the first phase of a cardiac rehabilitation program on self-efficacy in patients after coronary artery bypass graft surgery (CABG). Methods: This clinical trial study was conducted on 60 post-CABG patients by convenience sampling method in 2016. Those selected were randomly assigned to intervention (n=30) and control group (n=30). Overall, 72 hours after CABG, the first phase of the cardiac rehabilitation program both in theory and in practice (face-to-face and group methods) was conducted. Data were collected using a self-efficacy questionnaire completed by the patients in 3 stages: before the intervention, at discharge, and at 1 month after discharge. Data was analyzed by using analysis of covariance and repeated measures. Results: The mean of age in the intervention and control groups was 61.60±11.72 and 57.97±13. 4 years, respectively. There were 16 (53.3%) male patients in each group. The mean score of self-efficacy was not significantly different between the 2 groups before the intervention (P=0.076), whereas it had a meaningful statistical difference between the 2 groups at discharge and 1 month afterward (P<0.001). Conclusion: The implementation of the first phase of the cardiac rehabilitation program not only augmented self-efficacy in regard to independent daily activities but also lessened the need for the second phase of the program among our post-CABG patients.

Effect of Cardiac Rehabilitation Training on ABCA1 Expression in Lymphocytes of Patients Undergoing Coronary Artery Bypass Graft Operation

Background: Reverse cholesterol transport (RCT) is a crucial procedure for preventing Atherosclerosis, and ATP-binding cassette 1 (ABCA1) is a key factor in it. Objectives: The purpose of this study was to examine the effects of two months of a cardiac rehabilitation program on ABCA1 gene expression and other indices of RCT in Coronary artery bypass grafting (CABG) patients. Methods: In this quasi-experimental study, 24 CABG patients were assigned to the cardiac rehabilitation (n = 12) and control (n = 12) groups. The CR group performed two months of cardiac rehabilitation program while the CON group was asked to stay sedentary at home. 48 hours before and after starting the program, 10 cc of blood was sampled for q-RT PCR and biochemical analysis. Results: ABCA1 expression and plasma HDL-C concentration elevated in the CR group following two months of rehabilitation program compared to the CON group (F = 23.66, P = 0.0002 and F = 5.52, P = 0.034, respectively). In addition, in the CR group, there was no significant change in plasma LDL-C and triglyceride (F = 1.89, P = 0.191 and F = 1.61, P = 0.213, respectively). Conclusions: Based on our findings, it can be concluded that two months of CR program elevate lymphocyte ABCA1 mRNA expression coinciding with increased levels of plasma HDL-C. The present results also indicated that the CR program must be seriously considered for CABG patients to improve reverse cholesterol transport and hence, attain the cardiovascular benefits.

Comparison of the Effects of Media-based and Face-to-face Cardiac Rehabilitation Training Programs on Self-efficacy in Patients Undergoing Coronary Artery Bypass Grafting

Background: Several complications may occur in patients after coronary artery bypass grafting (CABG) leading to decreased self-efficacy. Rehabilitation training is the best method for reducing the complications and increasing self-efficacy. Various educational techniques lead to different rehabilitation results and levels of self-efficacy. Improving these measures requires the selection of the most appropriate educational technique. Aim: This study aimed to compare the effect of two media-based and face-to-face cardiac rehabilitation training methods on self-efficacy in patients undergoing CABG. Method: This clinical trial was conducted among 60 patients, who were randomly assigned into two groups, in Imam Reza Hospital, Mashhad, Iran, 2017. Cardiac rehabilitation training program was implemented face-to-face or using a researcher-made multimedia upon admission, discharge, at the start of cardiac rehabilitation, and at the end of the 10th session for half-hour. A researcher-constructed questionnaire on self-efficacy was completed by the participants in the mentioned stages. Data analysis was performed in SPSS software, version 16. Results: The mean ages of the participants in the face-to-face and multimedia groups were 56.0±8.1 and 57.5±7.3 years old, respectively. No significant difference was observed in the self-efficacy scores of the patients upon admission (P=0.36). However, there was a significant difference between the groups at the post-intervention stage (P<0.001). Implications for Practice: Despite the lack of presence of an active teacher, media-based cardiac rehabilitation training improved the self-efficacy of patients undergoing CABG more than face-to-face method.

Interval Training In Cardiac Rehabilitation

Exercise training is a standard treatment for patients with coronary artery disease (CAD). Improvements in endurance capacity are an important aim of cardiac rehabilitation. PURPOSE: We assessed the use of high intensity interval training (HIT) on cardiorespiratory fitness (CRF) and body mass index (BMI) compared to the isocaloric conventional endurance exercise training. METHODS: After initial exercise test, 50 patients were randomized into HIT and a control groups (CG). In both groups, patients exercised for 12 wks, 4 x per wk. Between inclusion and week 6, patients exercised 4 x per wk and from wk 6 to 12, patients exercised 2 x per wk, both sessions were supervised in cardiac rehabilitation center and additionally 2 x per wk on individual basis at home. Patients in CG exercised continuously only, while patients in the HIT group completed 2 interval and 2 continuous exercise training sessions per wk, in alternate sequence. After 6 wks and at the end of the training phase, exercise tests were repeated. Exercise protocol consisted of 5min of warm-up followed by 30min of continuous cycling at 60% of Pmax. HIT exercise protocol consisted of 5min of warm-up, followed by 30min of interval training at: Pmean=60% Pmax; Ppeak=100% Pmax; Prec=20% Pmax; tpeak=60s; trec=60s where Pmean was the mean workload during the 30min of exercise, Ppeak was the peak workload intensity, Prec was the recovery workload, tpeak was the peak workload duration, and trec was the recovery duration. For weeks 7-12, power output for each training session was recalculated according to Pmax achieved in the second exercise test. RESULTS: The type of exercise training had a significant effect on BMI but not on absolute VO2max. The CG reduced the BMI (-0.95) compared to the HIT group after 6 weeks, and the BMI decreased even further (-1.2) after 12 wks. CONCLUSION: Our results suggest that despite equal energy expenditure, HIT may be more effective in increasing muscle mass than endurance capacity.

The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation.

Aerobic interval training (AIT) has recently emerged as a more effective strategy than moderate-intensity continuous exercise (MICE) for improving peak oxygen consumption (V˙O2peak) in coronary artery disease (CAD) patients. The primary purpose of this retrospective study was to describe the change in V˙O2peak, and cardiovascular (CV) risk profile characteristics (secondary outcomes) after progressive AIT practiced in the largest, outpatient cardiac rehabilitation (CR) program in North America compared with usual care CR involving MICE. Electronic database records were retrieved from consecutively enrolled patients with CAD who attended the Toronto Rehabilitation Institute, between January 1, 2005, and December 31, 2015. Patients were then separated into two, age and sex propensity score-matched groups: 772 patients were prescribed 26 wk of MICE (60%-80% of V˙O2peak, five times per week) as per usual care CR (56.0 ± 9.2 yr; 12% female/88% male; V˙O2peak: 20.8 ± 5.9 mL·kg·min), and 772 patients were prescribed 26 wk of progressive walk/jog intervals (15 min·mile walking pace, 12 min·mile jogging pace, five times per week) (55.9 ± 9.3 yr; 12% female/88% male; V˙O2peak: 24.8 ± 5.7 mL·kg ·min). Treatment effect analysis of AIT on V˙O2peak and CV risk profile characteristics was performed using multiple regression with baseline values as covariates. Treatment effect analysis revealed a 3.84-mL·kg·min superior improvement in V˙O2peak in the AIT group compared to usual care MICE group (P < 0.001). Furthermore, AIT significantly improved BMI, triglycerides, hip and abdominal girth, and depression score compared with MICE (P < 0.023 for all). Progressive AIT performed in a standard, outpatient CR program appears to be superior to usual care MICE for improving V˙O2peak, CV risk profile characteristics, and depression score in stable CAD patients. These findings may have important implications for exercise training guidelines in the rehabilitation setting, and in future studies.

Progression of Exercise Training in Early Outpatient Cardiac Rehabilitation: AN OFFICIAL STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION.

Aerobic and resistance exercise training is a cornerstone of early outpatient cardiac rehabilitation (CR) and provides impressive benefits for patients. The components of the exercise prescription for patients with cardiovascular diseases are provided in guideline documents from several professional organizations and include frequency (how many sessions per week); intensity (how hard to exercise); time (duration of the exercise training session); type (modalities of exercise training); volume (the total amount or dose of exercise); and progression (the rate of increasing the dose of exercise). The least discussed, least appreciated, and most challenging component of the exercise prescription for CR health care professionals is the rate of progression of the dose of exercise. One reason for this observation is the heterogeneity of patients who participate in CR. All components of the exercise prescription should be developed specifically for each individual patient. This statement provides an overview of the principles of exercise prescription for patients in CR with special emphasis on the rate of progression. General recommendations for progression are given and patient case examples are provided to illustrate the principles of progression in exercise training.

The long-term effects of individual cardiac rehabilitation in patients with coronary artery disease

BackgroundThe positive effects of cardiac rehabilitation have been repeatedly described and are well-known over the short- and middle-term periods. However there is less knowledge about long-term outcomes in patients with chronic stable coronary artery disease. AimThe aim of this study was to evaluate the long-term outcome of individual cardiac rehabilitation in patients with coronary artery disease. MethodsOne hundred fifty-two patients with stable coronary artery disease were retrospectively divided into two groups according to their adherence to individual physical activity recommendations, regardless of their participation in guided cardiac rehabilitation training. The IT+ group which participated in individual exercise programmes according to recommendations was compared with patients who declined these activities (the IT− group). The median follow-up period was 12.7 years. ResultsThe individual training had no long-term effect on survival after being checked for other possible contributing factors, but the multivariate analysis showed a significant association with the occurrence of cardiac events like myocardial infarction, unstable angina, coronary revascularization and hospitalization for heart failure: HR (95% CI) 0.51 (0.30–0.89); p=0.017. ConclusionHome based cardiac rehabilitation and regular physical activity significantly improve long-term cardiac morbidity in patients with coronary artery disease.

Effect of Eight Weeks of Cardiac Rehabilitation Training on PPAR-α Gene Expression in CABG Patients

Effect of Eight Weeks of Cardiac Rehabilitation Training on PPAR-α Gene Expression in CABG Patients

Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement

ABSTRACTA 30-year-old male roughneck worker on an oil rig underwent aortic valve replacement and subsequently enrolled in the Baylor Heart and Vascular Hospital exercise-based cardiac rehabilitation (CR) program. He expressed a strong desire to return to his physically demanding job. Based on his unique job requirements, CR staff designed and implemented comprehensive tests and a 5-week specific physical training program that included 6 exercises simulating his job functions. The selected exercises are not typically prescribed in traditional CR programs but mimicked the muscular strength/endurance required to perform his job. The goals set for each of the 6 specific exercises were accomplished and resulted in the patient rapidly regaining his muscular strength through the specially designed training program. The exercise regimen was successfully completed without adverse signs or symptoms and enabled the patient to return to work within approximately 2 months of completion.

Cardiac Rehabilitation and Exercise Training in the Elderly

With recent improvements in cardiovascular care and prevention, the demographic of individuals enrolled into cardiac rehabilitation (CR) is shifting towards an older set of individuals. Management plans for elderly cardiovascular patients must consider processes associated with aging, sarcopenia, cognitive impairment, and inflammation all contributing to declining functional capacity. Increased debility at baseline does not translate into a significantly higher risk associated with physical activity but does require better access. High-intensity interval training protocols have shown benefits while preserving safety over the standard of moderate-intensity continuous training. In elderly populations, CR needs to include more than just exercise; addressing psychosocial stress burdens as an independent part of CR has the potential to improve adherence and outcomes. Doing this through new programs and at home and through mobile devices has the potential to greatly increase adherence and access, and can help remedy current underutilization of CR in the US medical system.

Cardiac rehabilitation training program focused on risk factors of coronary artery disease

Aim: The aim of this study is to assess an impact of aerobic-resistance exercise on cardiorespiratory indicators in patients after acute coronary event, and evaluate monitored parameters as a result of a positive influence of a physical activity on the risk factors of coronary artery disease (CAD).

Efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model

Objective: To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model. Methods: This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group (n=52) received tertiary hospital(Peiking University Peoples' Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group (n=28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months. Results: Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P<0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P>0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P>0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P>0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P<0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P<0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P<0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P<0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P<0.05), know how to take medicines (44.52% vs. 5.00%, P<0.05), know how much exercise was right for yourself (26.43% vs.0, P<0.05) were significantly higher in rehabilitation group than in control group. There were no cardiac rehabilitation training related cardiovascular events. Conclusion: Tertiary hospital guided and community-driven family self-help cardiac rehabilitation model is an effective and safe management model of cardiovascular disease in chronic phase, and it is necessary to further expand the study population to verify the efficacy of this model.

Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW.

There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test. Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists. Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.

Influence of Graded Aerobic Exercise on Quality of Life in Post Surgical Mitral Valve Disease Individual-A Prospective Randomized Open Label Study

Background:&nbsp;Post surgical mitral valve disease individual focus their cardiac rehabilitation training on two major goal that is to improve cardiac output response exercises and place an important role in determining exercise tolerance and to improve quality of life. Cardiac rehabilitation programs involve prescribed exercise and education however various other method are being used to improve quality of life. But our study to find out the effectiveness of graded aerobic exercise protocol on ejection fraction and quality of life in post surgical mitral valve disease individuals.Methods:&nbsp;The study design was open label studies total of 100 post surgical mitral valve disease individuals patients from the age group of 20-60 years were recruited from SVIMS hospital. They were randomly divided into two groups. Group I underwent a twelve week structured graded individually tailored exercises. The group II received only none graded (not individualized) exercise training. The ejection fraction and quality of life was measured before and after 12 weeks of exercise training for two groups.Results:&nbsp;Repeated measures ANOVA was used to compare mean values of continuous variables between baseline and at the time of discharge and three months after surgery for each parameter. Comparison of means between groups was done by the unpaired student t test. Mean age of the subjects was 40.18±10.29. There was a significant increase in the ejection fraction in the group I(61.34±2.49 to 64.4±3.31) compared to with the group II (61.06±2.51. to 61.62 ±2.37.) QOL had improved in group I than group II at p&lt;0.05.Conclusion:&nbsp;A 12 week structured graded aerobic exercise training significantly improved ejection fraction and quality of life in post surgical mitral valve disease individuals.

Whole-body strength training with Huber Motion Lab and traditional strength training in cardiac rehabilitation: A randomized controlled study

BackgroundIsometric strengthening has been rarely studied in patients with coronary heart disease (CHD), mainly because of possible potential side effects and lack of appropriate and reliable devices. ObjectiveWe aimed to compare 2 different modes of resistance training, an isometric mode with the Huber Motion Lab (HML) and traditional strength training (TST), in CHD patients undergoing a cardiac rehabilitation program. DesignWe randomly assigned 50 patients to HML or TST. Patients underwent complete blinded evaluation before and after the rehabilitation program, including testing for cardiopulmonary exercise, maximal isometric voluntary contraction, endothelial function and body composition. ResultsAfter 4 weeks of training (16 sessions), the groups did not differ in body composition, anthropometric characteristics, or endothelial function. With HML, peak power output (P=0.035), maximal heart rate (P<0.01) and gain of force measured in the chest press position (P<0.02) were greater after versus before training. ConclusionBoth protocols appeared to be well tolerated, safe and feasible for these CHD patients. A training protocol involving 6s phases of isometric contractions with 10s of passive recovery on an HML device could be safely implemented in rehabilitation programs for patients with CHD and improve functional outcomes.