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Oldridge, Neil B. "Cardiac Rehabilitation Exercise Programme." Sports Medicine 6, no. 1 (July 1988): 42–55. http://dx.doi.org/10.2165/00007256-198806010-00005.
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O'Doherty, Alasdair F., Helen Humphreys, Susan Dawkes, Aynsley Cowie, Sally Hinton, Peter H. Brubaker, Tom Butler, and Simon Nichols. "How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR." BMJ Open 11, no. 4 (April 2021): e046051. http://dx.doi.org/10.1136/bmjopen-2020-046051.
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ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.
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Al Quait, Abdulrahman, and Patrick Doherty. "Overview of Cardiac Rehabilitation Evidence, Benefits and Utilisation." Global Journal of Health Science 10, no. 2 (December 19, 2017): 38. http://dx.doi.org/10.5539/gjhs.v10n2p38.
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Historically, the main objective of cardiac rehabilitation (CR) as an exercise-based programme was to restore or improve patients’ regular physical activity after a cardiac event. Since then CR has evolved into a comprehensive secondary prevention programme, the objectives of CR, and indications and contraindications for its use have also developed in sophistication. Current CR programmes are designed to stabilise or even reverse the progression of heart disease by controlling all modifiable risk factors. They are also concerned with improving patients’ quality of life by restoring their wellbeing. All this should be achieved with the maximum safety levels to patients. The first part of this review details on how CR evolved from a simple exercise programme to a comprehensive secondary prevention programme in the past few decades. The second part sets an example of modern CR provision, pathway and guidelines in a top leading country in this field, the UK.
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Scalvini, Simonetta, Emanuela Zanelli, Laura Comini, Margherita Dalla Tomba, Giovanni Troise, and Amerigo Giordano. "Home-based exercise rehabilitation with telemedicine following cardiac surgery." Journal of Telemedicine and Telecare 15, no. 6 (August 31, 2009): 297–301. http://dx.doi.org/10.1258/jtt.2009.090208.
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We evaluated the feasibility of a home-based rehabilitation programme, which was designed to resemble an in-hospital rehabilitation programme. Patients who underwent cardiac surgery (EuroSCORE 0–10) followed a one-month home rehabilitation programme supervised by a nurse-tutor and a physiotherapist. Physiotherapy was performed at home with calisthenic exercises and bicycle-ergometer tests. Patients transmitted the recorded ECGs by telephone to a service centre. They also performed a 6-minute walking test and filled in a satisfaction questionnaire at the end of the programme. A total of 47 patients were enrolled in the study. There were 3050 telephone calls, of which 3012 (99%) were scheduled and 38 were unscheduled. No further action was required in 95% of calls. There were 809 sessions for calisthenic exercises and 1039 for exercise training. There was a significant increase in the 6-minute walking test distance at the end of the programme compared to the baseline (404 m vs. 307 m, P < 0.001). Patient satisfaction, as measured in a questionnaire, was about 95% overall. This type of home rehabilitation using telemedicine appears to be worth implementing in selected categories of patients.
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Ögmundsdottir Michelsen, Halldora, Ingela Sjölin, Mona Schlyter, Emil Hagström, Anna Kiessling, Peter Henriksson, Claes Held, et al. "Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study." European Journal of Preventive Cardiology 27, no. 1 (July 26, 2019): 18–27. http://dx.doi.org/10.1177/2047487319865729.
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Background While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described. Aim The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention. Method Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines. Results There was a wide variation in programme duration (2–14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% ( n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training ( n = 76, 97%) and group educational sessions ( n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% ( n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent ( n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% ( n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent ( n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases. Conclusion The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.
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Pratesi, Alessandra, Samuele Baldasseroni, Costanza Burgisser, Francesco Orso, Riccardo Barucci, Maria Vittoria Silverii, Simone Venturini, Andrea Ungar, Niccolò Marchionni, and Francesco Fattirolli. "Long-term functional outcomes after cardiac rehabilitation in older patients. Data from the Cardiac Rehabilitation in Advanced aGE: EXercise TRaining and Active follow-up (CR-AGE EXTRA) randomised study." European Journal of Preventive Cardiology 26, no. 14 (June 10, 2019): 1470–78. http://dx.doi.org/10.1177/2047487319854141.
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Aim Cardiac rehabilitation promotes functional recovery after cardiac events. Our study aimed at evaluating whether, compared to usual care, a home-based exercise programme with monthly reinforcement sessions adds long-term functional benefits to those obtained with cardiac rehabilitation in the elderly. Methods After a 4-week outpatient cardiac rehabilitation, 160 of 197 patients aged 75 years and older screened for eligibility with different indications for cardiac rehabilitation, were randomly assigned to a control (C) or an active treatment (T) group. During a 12-month follow-up, C patients received usual care, while T patients were prescribed a standardised set of home-based exercises with centre-based monthly reinforcements for the first 6 months. The main (peak oxygen consumption) and three secondary outcome measures (distance walked in 6 minutes, inferior limbs peak 90° Torque strength, health-related quality of life) were assessed at baseline, at random assignment and at 6 and 12-month follow-ups with the cardiopulmonary exercise test, 6-minute walking test, isokinetic dynamometer and the Short Form-36 questionnaire, respectively. Results Both C and T groups obtained a significant and similar improvement from baseline to the end of the 4-week cardiac rehabilitation programme in the three functional outcome measures. However, at univariable and age and gender-adjusted analysis of variance for repeated measures, changes from random assignment to 6 or 12-month follow-up in any outcome measure were similar in the C and T groups. Conclusion Results from this randomised study suggest that a home-based exercise programme with monthly reinforcements does not add any long-term functional benefit beyond those offered by a conventional, 4-week outpatient cardiac rehabilitation programme. Trial registration ClinicalTrial.gov Identifier: NCT00641134.
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Frewen, Sharon, Helgo Schomer, and Tim Dunne. "Health Belief Model Interpretation of Compliance Factors in a Weight Loss and Cardiac Rehabilitation Programme." South African Journal of Psychology 24, no. 1 (March 1994): 39–43. http://dx.doi.org/10.1177/008124639402400106.
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The aim of the research was to establish the common and/or different factors associated with compliance or noncompliance in either a weight loss or a cardiac rehabilitation programme. A questionnaire was designed from a revised formulation of the original Health Belief Model and a pilot study was run on 22 weight loss and 13 cardiac subjects. The modified questionnaire was then completed by 37 compliers and 19 noncompliers with a weight loss programme and 11 compliers and 19 noncompliers with a cardiac rehabilitation programme. Compliance was associated with exercise enjoyment, self-motivation, and the need to stay on the programme. The major reasons for noncompliance were the complexity of the required behaviour changes, inconvenience, time constraints, and the ability to cope independently of the programmes. Particularly regarding the weight loss programme, noncompliance arising from the required simultaneous changes to eating and exercise patterns could be reduced by teaching alternative coping skills and realistic goal setting. Cardiac patients are faced with the life-threatening nature of their disease, but there is a lack of overt disease symptoms among weight loss subjects. This results in a need to inform obese subjects, preferably using a multi-disciplinary approach, about the health risks resulting from noncompliance.
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Curran, Tracy, Naomi Gauthier, Susan M. Duty, and Rachele Pojednic. "Identifying elements for a comprehensive paediatric cardiac rehabilitation programme." Cardiology in the Young 30, no. 10 (August 11, 2020): 1473–81. http://dx.doi.org/10.1017/s1047951120002346.
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AbstractIntroduction:The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.Methods:A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.Results:Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.Conclusion:This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
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Jones, Amy V., Rachael A. Evans, William D.-C. Man, Charlotte E. Bolton, Samantha Breen, Patrick J. Doherty, Nikki Gardiner, et al. "Outcome measures in a combined exercise rehabilitation programme for adults with COPD and chronic heart failure: A preliminary stakeholder consensus event." Chronic Respiratory Disease 16 (January 1, 2019): 147997311986795. http://dx.doi.org/10.1177/1479973119867952.
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Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitation were presented by experts at a stakeholder consensus event and all stakeholders ( n = 18) were asked to (1) rank in order of importance a list of categories, (2) prioritise outcome measures and (3) prioritise baseline patient evaluation measures that should be assessed in a combined COPD and CHF rehabilitation programme. The tasks were completed anonymously and related to clinical rehabilitation programmes and associated research. Health-related quality of life, exercise capacity and symptom evaluation were voted as the most important categories to assess for clinical purposes (median rank: 1, 2 and 3 accordingly) and research purposes (median rank; 1, 3 and 4.5 accordingly) within combined exercise rehabilitation. All stakeholders agreed that profiling symptoms at baseline were ‘moderately’, ‘very’ or ‘extremely’ important to assess for clinical and research purposes in combined rehabilitation. Profiling of frailty was ranked of the same importance for clinical purposes in combined rehabilitation. Stakeholders identified a suite of multidisciplinary measures that may be important to assess in a combined COPD and CHF exercise rehabilitation programme.
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Fallon, Noeleen, Mary Quirke, Caroline Edgeworth, Rose O'Mahony, Nora Flynn, Patricia McGeary, Vincent Maher, Victoria Jones, and Gabrielle McKee. "Evaluation of the effectiveness of a phase three specialised heart failure cardiac rehabilitation programme on cardiovascular risk factor profile." British Journal of Cardiac Nursing 16, no. 8 (August 2, 2021): 1–10. http://dx.doi.org/10.12968/bjca.2021.0053.
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Background/Aims Cardiac rehabilitation has long been seen as effective for many cardiovascular diseases and, more recently, as having a positive impact on patients with heart failure. To evaluative the effectiveness of a phase three specialised heart failure cardiac rehabilitation programme on patients' cardiovascular risk factor profile. Methods This retrospective, longitudinal study examined profile factors of patients, pre- and post-cardiac rehabilitation programme. Patients with New York Heart Association class I–III, of any origin, were recruited through a specialised heart failure service to a 10-week exercise and education programme. Outcome variables included anxiety, depression, quality of life (Minnesota), 6-minute walking test result, blood pressure, weight, waist circumference, body mass index, Duke Activity Status Index and self-care, and were analysed with the Statistical Package for the Social Sciences using repeated measures t-test. Results 100 patients were eligible and 85 patients completed the programmes. Mean age was 66 years, 80% male, 59% were New York Heart Association class I and 73% had ejection fraction of ≤40%. There was a significant improvement in 6-minute walking test, systolic blood pressure, quality of life and anxiety post programme. Conclusions In-hospital and out of hospital cardiac care has developed significantly, especially in acute symptom control. More recently, emphasis has been put on the long-term control of other risk factors. This study contributes to the literature indicating that attendance at a hospital-based phase three cardiac rehabilitation programme providing supervised, tailored exercise, with intensive education and psychological support, is effective in reducing risk factors and improving quality of life in patients with lower grades of heart failure.
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Mckee, Gabrielle, Jo Bannon, Mary Kerins, and Geraldine Fitzgerald. "Changes in diet, exercise and stress behaviours using the stages of change model in cardiac rehabilitation patients." European Journal of Cardiovascular Nursing 6, no. 3 (September 2007): 233–40. http://dx.doi.org/10.1016/j.ejcnurse.2006.10.002.
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The behavioural changes initiated during Phase III cardiac rehabilitation programmes were recorded using Prochaska and Diclemente's “stages of change” model. This study aimed to ascertain if changes were initiated, maintained or further developed during Phase III programmes and 6 months after the programmes with a view to ascertaining the usefulness of this tool in providing stage matched individualised care. The risk factors examined were: exercise, diet and stress. The stages were recorded quantitatively and were numerically designated a value of 1–5. The results were analysed using SPSS. The sample number was one hundred and eighty seven patients. Significant improvements were made by the end of the programme (6 or 8 weeks) indicating that most patients had modified their behaviour during the programme. There was no significant additional improvement in the risk factors 6 months later. These results are a further indication of the need for support post Phase III programmes. Patients entered Phase III rehabilitation at different stages in their risk behaviours and with regard to exercise this stage at commencement influences the final stage achieved. “Stages of change” is a useful simple method of recording behavioural change and this type of routine monitoring of a patient could be used effectively as part of the individual care plan during the programme.
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Leslie, Rosalind, Sophie May, Christopher Scordis, Ian Swift, and Sharon Bradbury. "Recruitment of women to cardiac rehabilitation: uptake and outcome measures." British Journal of Cardiac Nursing 15, no. 7 (July 2, 2020): 1–9. http://dx.doi.org/10.12968/bjca.2019.0149.
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Background/Aims National Audit of Cardiac Rehabilitation reports consistently illustrate that cardiac rehabilitation programmes are failing to recruit women. Wolverhampton's cardiac rehabilitation service offers a choice of exercise localities and modalities, ladies-only classes plus a stress-management programme. The aims of this retrospective analysis were to undertake a service review to examine phase III uptake in females compared with males, and to compare outcome measures. Methods Retrospective data were analysed to examine uptake to core phase III services in males and females. Outcome measures were compared between genders. Results Uptake by females to core components of cardiac rehabilitation increased from 43% in 2015/2016 to 84% in 2017/2018. There were no significant gender differences in the outcome measures. Conclusions The percentage of female patients attending core components of phase III as a proportion of the total was comparable with those seen during phase I. Offering a choice of exercise localities and modalities, combined with psychological support increased uptake in women. Gender did not have a significant impact on outcome measures following core phase III.
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Tikkanen, Ana Ubeda, Ainhoa Rodriguez Oyaga, Olga Arroyo Riaño, Enrique Maroto Álvaro, and Jonathan Rhodes. "Paediatric cardiac rehabilitation in congenital heart disease: a systematic review." Cardiology in the Young 22, no. 3 (January 17, 2012): 241–50. http://dx.doi.org/10.1017/s1047951111002010.
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AbstractBackgroundAdvances in medical and surgical care have contributed to an important increase in the survival rates of children with congenital heart disease. However, survivors often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac Rehabilitation Programmes have been extensively studied in adults with acquired heart disease. In contrast, studies of children with congenital heart disease have been few and of limited scope. We therefore undertook a systematic review of the literature on cardiac rehabilitation in children with congenital heart disease to systematically assess the current evidence regarding the use, efficacy, benefits, and risks associated with this therapy and to identify the components of a successful programme.MethodsWe included studies that incorporated a cardiac rehabilitation programme with an exercise training component published between January, 1981 and November, 2010 in patients under 18 years of age.ResultsA total of 16 clinical studies were found and were the focus of this review. Heterogeneous methodology and variable quality was observed. Aerobic and resistance training was the core component of most studies. Diverse variables were used to quantify outcomes. No adverse events were reported.ConclusionsCardiac Rehabilitation Programmes in the paediatric population are greatly underutilised, and clinical research on this promising form of therapy has been limited. Questions remain regarding the optimal structure and efficacy of the programmes. The complex needs of this unique population also mandate that additional outcome measures, beyond serial cardiopulmonary exercise testing, be identified and studied.
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Nichols, Simon, Gordon McGregor, Jeff Breckon, and Lee Ingle. "Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure." International Journal of Sports Medicine 42, no. 01 (July 10, 2020): 19–26. http://dx.doi.org/10.1055/a-1198-5573.
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AbstractCardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient’s priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The ‘dose’ of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.
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Matthews, Susan, Martin Fox, Sarah Coy, Jane Whittaker, Gail Brough, Mohammad Yasin, and Susan Whittle. "Saving more lives and limbs: applying a cardiac rehabilitation model of structured exercise to symptomatic peripheral arterial disease." British Journal of Cardiac Nursing 16, no. 4 (April 2, 2021): 1–8. http://dx.doi.org/10.12968/bjca.2020.0086.
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Background/Aims Peripheral arterial disease is common among those aged 60 years or above and can cause debilitating intermittent claudication. This impacts quality of life and is a marker for increased morbidity and mortality, mainly from cardiovascular disease. Access to recommended exercise programmes for people with symptomatic peripheral arterial disease is poor in most areas of the UK. This study aimed to evaluate the benefits of expanding an established cardiac rehabilitation service to accommodate supervised exercise for people with peripheral arterial disease Methods The study evaluated 11 participants peripheral arterial disease and intermittent claudication who were referred by the Manchester leg circulation service. Participants underwent the programme involving eight weekly 1.5 hour sessions of supervised exercise and cardiovascular education with support, reassurance and motivation. The participants' blood pressure, walking impairment, quality of life, anxiety and depression were monitored and reviewed. Results Overall, the participants' walking distance, intermittent claudication, quality of life and blood pressure had improved. The participants' overall satisfaction with the programme was excellent. The programme also demonstrated clinical and cost-effectiveness. Conclusions A structured, supervised exercise programme can have considerable benefits for people with peripheral arterial disease, improving their symptoms and quality of life. It may also help to reduce the morbidity and mortality risks associated with inactivity in this patient group.
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Laustsen, Sussie, Lisa G. Oestergaard, Maurits van Tulder, Vibeke E. Hjortdal, and Annemette K. Petersen. "Telemonitored exercise-based cardiac rehabilitation improves physical capacity and health-related quality of life." Journal of Telemedicine and Telecare 26, no. 1-2 (August 22, 2018): 36–44. http://dx.doi.org/10.1177/1357633x18792808.
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Introduction Cardiac rehabilitation improves physical capacity, health-related quality of life, and reduces morbidity and mortality among cardiac patients. Telemonitored exercise-based cardiac rehabilitation may innovate existing programmes and increase participation rates. Objective The purpose of this study was to investigate if telemonitored exercise-based cardiac rehabilitation improves physical capacity, muscle endurance, muscle power, muscle strength and health-related quality of life in cardiac patients. Methods A follow-up study on moderate risk patients with ischaemic heart and heart valve disease referred to a 12-week telemonitored exercise-based cardiac rehabilitation intervention at Aarhus University Hospital (Denmark). Participants were encouraged to exercise 60 min three times weekly with moderate/high intensity for 20 min per session. Intensity and duration of training sessions were visualised on a smartphone and uploaded to a website. Participants received individual feedback from physiotherapists on their training efforts by telephone/email. Outcome measures were changes in physical capacity (peak oxygen uptake), muscle endurance, power, and strength, and health-related quality of life between baseline end of telemonitored exercise-based cardiac rehabilitation intervention, and at six and 12 months after end of telemonitored exercise-based cardiac rehabilitation. Results Thirty-four participants completed telemonitored exercise-based cardiac rehabilitation. We identified a significant increase in peak oxygen uptake of 10%, in muscle endurance of 17%, in muscle power of 7%, and in muscle strength of 10% after the telemonitored exercise-based cardiac rehabilitation programme. Health-related quality of life was significantly improved by 19% in the physical and 17% in the mental component scores. We found no significant improvement in peak oxygen uptake between baseline and 12 months follow-up, but a significant improvement in muscle endurance (0.3 watts/kg, 95% confidence interval; 0.2–0.4), muscle power (0.4 watts/kg; 0.2–0.5), muscle strength (0.5 N/m/kg; 0.1–0.9), physical health-related quality of life (five points; 2–8) and mental health-related quality of life (six points; 3–9). Discussion This study demonstrated that the self-elected type of physical exercise in cardiac rehabilitation with telemonitoring improved all outcome measures both on the short and long-term, except for peak oxygen uptake at 12 months follow-up.
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Brennan, R., and J. Gormley. "Adherence to recommended exercise during and after a cardiac rehabilitation programme." European Journal of Cardiovascular Prevention & Rehabilitation 13, Supplement 1 (May 2006): S10. http://dx.doi.org/10.1097/00149831-200605001-00040.
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Moholdt, Trine, Inger Lise Aamot, Ingrid Granøien, Lisbeth Gjerde, Gitte Myklebust, Liv Walderhaug, Line Brattbakk, et al. "Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study." Clinical Rehabilitation 26, no. 1 (September 21, 2011): 33–44. http://dx.doi.org/10.1177/0269215511405229.
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Objective: Exercise capacity strongly predicts survival and aerobic interval training (AIT) increases peak oxygen uptake effectively in cardiac patients. Usual care in Norway provides exercise training at the hospitals following myocardial infarction (MI), but the effect and actual intensity of these rehabilitation programmes are unknown. Design: Randomized controlled trial. Setting: Hospital cardiac rehabilitation. Subjects: One hundred and seven patients, recruited two to 12 weeks after MI, were randomized to usual care rehabilitation or treadmill AIT. Interventions: Usual care aerobic group exercise training or treadmill AIT as 4 × 4 minutes intervals at 85–95% of peak heart rate. Twice weekly exercise training for 12 weeks. Main measures: The primary outcome measure was peak oxygen uptake. Secondary outcome measures were endothelial function, blood markers of cardiovascular disease, quality of life, resting heart rate, and heart rate recovery. Results: Eighty-nine patients (74 men, 15 women, 57.4 ± 9.5 years) completed the programme. Peak oxygen uptake increased more ( P = 0.002) after AIT (from 31.6 ± 5.8 to 36.2 ± 8.6 mL·kg−1·min−1, P < 0.001) than after usual care rehabilitation (from 32.2 ± 6.7 to 34.7 ± 7.9 mL·kg−1·min−1, P < 0.001). The AIT group exercised with significantly higher intensity in the intervals compared to the highest intensity in the usual care group (87.3 ± 3.9% versus 78.7 ± 7.2% of peak heart rate, respectively, P < 0.001). Both programmes increased endothelial function, serum adiponectin, and quality of life, and reduced serum ferritin and resting heart rate. High-density lipoprotein cholesterol increased only after AIT. Conclusions: AIT increased peak oxygen uptake more than the usual care rehabilitation provided to MI patients by Norwegian hospitals.
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Avila, Andrea, Jomme Claes, Roselien Buys, May Azzawi, Luc Vanhees, and Veronique Cornelissen. "Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness?" European Journal of Preventive Cardiology 27, no. 4 (December 1, 2019): 367–77. http://dx.doi.org/10.1177/2047487319892201.
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Background Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. Objective The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. Methods Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. Results Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups ( Ptime > 0.05 for all), irrespective of the intervention ( Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity ( Ptime < 0.05). No interaction effect was found for physical activity. Conclusion Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. Trial registration ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942
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Digenio, Andres G., Avril Slavin, and Liz Daly. "CAN PATIENTS WITH MYOCARDIAL ISCHAEMIA BENEFIT FROM AN EXERCISE CARDIAC REHABILITATION PROGRAMME?" Journal of Cardiopulmonary Rehabilitation 14, no. 5 (September 1994): 345. http://dx.doi.org/10.1097/00008483-199409000-00059.
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Sarrafzadegan, Nizal, Hamid R. Habibi, Ahmad Mirdamadi, Safa Maghsodlo, and Kamran Sadegi. "P141 Cardiac rehabilitation exercise programme: return to work as an outcome assessment." Atherosclerosis 136 (March 1998): S84. http://dx.doi.org/10.1016/s0021-9150(97)84711-9.
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Brennan, R., and J. Gormley. "1384: Adherence to recommended exercise during and after a cardiac rehabilitation programme." European Journal of Cardiovascular Nursing 5, no. 1_suppl (May 2006): 39–40. http://dx.doi.org/10.1177/14745151060050s172.
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Salvi, Dario, Manuel Ottaviano, Salla Muuraiskangas, Alvaro Martínez-Romero, Cecilia Vera-Muñoz, Andreas Triantafyllidis, Maria Fernanda Cabrera Umpiérrez, et al. "An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise." Journal of Telemedicine and Telecare 24, no. 4 (March 28, 2017): 303–16. http://dx.doi.org/10.1177/1357633x17697501.
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Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping “desired behaviours” into specific system’s specifications, borrowing concepts from Fogg’s Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.
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Ibeggazene, Saïd, Chelsea Moore, Costas Tsakirides, Michelle Swainson, Theocharis Ispoglou, and Karen Birch. "UK cardiac rehabilitation fit for purpose? A community-based observational cohort study." BMJ Open 10, no. 10 (October 2020): e037980. http://dx.doi.org/10.1136/bmjopen-2020-037980.
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ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.ParticipantsSixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.Outcome measuresThe primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.ResultsThe mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05).ConclusionPatients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.
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dos Santos, Tamires Daros, Sergio Nunes Pereira, Luiz Osório Cruz Portela, Marisa Bastos Pereira, Adriane Schmidt Pasqualoto, Aron Ferreira da Silveira, and Isabella Martins de Albuquerque. "Influence of inspiratory muscle strength on exercise capacity before and after cardiac rehabilitation." International Journal of Therapy and Rehabilitation 28, no. 2 (February 2, 2021): 1–12. http://dx.doi.org/10.12968/ijtr.2020.0027.
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Background/Aims Coronary artery bypass grafting is a complex procedure that triggers a series of clinical and functional complications. The reduction of inspiratory muscle strength that persists during the late postoperative period has been suggested as an important determinant of functional capacity after coronary artery bypass grafting. The aim of this study was to investigate whether inspiratory muscle strength, functional capacity and quality of life are determinants of exercise capacity before and after a short-term phase II cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery. Methods A prospective quasi-experimental study was undertaken with 20 patients who had recevied coronary artery bypass surgery. All patients completed a short-term, moderate-to-high intensity inspiratory muscle training programme, followed by aerobic and resistance exercise, two times a week for 12 weeks, totalling 24 sessions, under the direct supervision of a physical therapist. Results Pre-intervention, peak oxygen consumption (peak VO2) was associated with maximum inspiratory pressure (β=0.037; 95% confidence interval 0.01–0.06; P=0.002). Post-intervention, peak VO2 was associated with maximum inspiratory pressure (β=0.03; 95% confidence interval 0.007–0.053; P=0.014) and the 6-Minute Walk Test (β=0.007; 95% confidence interval, 0.001–0.013; P=0.024). Conclusions Inspiratory muscle strength influences exercise capacity before and after a short-term cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery.
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Dagner, Viveka, Eva K. Clausson, and Liselotte Jakobsson. "Prescribed physical activity maintenance following exercise based cardiac rehabilitation: factors predicting low physical activity." European Journal of Cardiovascular Nursing 18, no. 1 (June 15, 2018): 21–27. http://dx.doi.org/10.1177/1474515118783936.
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Background: Physical activity is important to reduce mortality, morbidity and risk factors in patients with coronary heart disease. This report evaluates to what extent patients are still physically active following an exercise-based cardiac rehabilitation programme 12–14 months post-myocardial infarction and factors predicting why not. Methods: Data from the National Quality Registry Swedeheart with post-myocardial infarction patients ( n=368) admitted from July 2012 to November 2014 were collected with outcomes of physical activity after 12–14 months. Baseline data included demographics, clinical variables, participation in exercise programmes, prescribed physical activity, health-related quality of life and self-reported health (EQ-5D-3L/EQ-VAS). A direct binary logistic regression analysis was used to identify indicators of low physical activity. Results: Physical activity frequency per week (PA/week) was low, i.e. zero to three times, in older patients over 64 years ( P=0.00) and in those having problems with pain/discomfort (138 PA/week vs. 195) ( P=0.01), problems with mobility (60 PA/week vs.273) ( P=0.04) and anxiety/depression (128 PA/week vs. 205) ( P=0.04). Conclusion: Indicators predicting low physical activity can be used targeting improved post-myocardial infarction care outlining person-centred rehabilitation programmes and specialist nursing-led programmes.
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Sabbag, Avi, Israel Mazin, David Rott, Ilan Hay, Nelly Gang, Boaz Tzur, Ronen Goldkorn, Ilan Goldenberg, Robert Klempfner, and Ariel Israel. "The prognostic significance of improvement in exercise capacity in heart failure patients who participate in cardiac rehabilitation programme." European Journal of Preventive Cardiology 25, no. 4 (January 9, 2018): 354–61. http://dx.doi.org/10.1177/2047487317750427.
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Introduction There are limited contemporary data regarding the association between improvement in cardiovascular fitness in heart failure patients who participate in a cardiac rehabilitation programme and the risk of subsequent hospitalisations. Methods The study population comprised 421 patients with heart failure who participated in our cardiac rehabilitation programme between the years 2009 and 2016. All were evaluated by a standard exercise stress test before initiation, and underwent a second exercise stress test on completion of 3 ± 1 months of training. Participants were dichotomised by fitness level at baseline, according to the percentage of predicted age and sex norms achieved. Each group was further divided according to its degree of functional improvement, between the baseline and the follow-up exercise stress test. Major improvement was defined as improvement above the median value in each group. The combined primary endpoint was cardiac hospitalisation or all-cause mortality. Results A total of 211 (50%) patients had low baseline fitness (<73% (median)) for age and sex-predicted metabolic equivalents of task value. Compared to patients with higher fitness, those with a low baseline fitness were more commonly smokers, had diabetes and were obese ( P < 0.05 for all). Multivariable Cox proportional hazard regression analysis showed that, independent of baseline capacity, an improvement of 5% of predicted fitness was associated with a corresponding 10% reduced risk of cardiac hospitalisation or all-cause mortality ( P < 0.001). Conclusion In heart failure patients participating in a cardiac rehabilitation programme, improved cardiovascular fitness is associated with reduced mortality or cardiac hospitalisation risk during long-term follow-up, independent of baseline fitness.
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Taylor, A. "Cardiac rehabilitation: do exercise programmes make a difference?" Coronary Health Care 1, no. 4 (November 1997): 193–99. http://dx.doi.org/10.1016/s1362-3265(97)80017-x.
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González-Salvado, Violeta, Cristian Abelairas-Gómez, Francisco Gude, Carlos Peña-Gil, Carmen Neiro-Rey, José Ramón González-Juanatey, and Antonio Rodríguez-Núñez. "Targeting relatives: Impact of a cardiac rehabilitation programme including basic life support training on their skills and attitudes." European Journal of Preventive Cardiology 26, no. 8 (February 19, 2019): 795–805. http://dx.doi.org/10.1177/2047487319830190.
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Background Training families of patients at risk for sudden cardiac death in basic life support (BLS) has been recommended, but remains challenging. This research aimed to determine the impact of embedding resuscitation training for patients in a cardiac rehabilitation programme on relatives' BLS skill retention at six months. Design Intervention community study. Methods Relatives of patients suffering acute coronary syndrome or revascularization enrolled on an exercise-based cardiac rehabilitation programme were included. BLS skills of relatives linked to patients in a resuscitation-retraining programme (G-CPR) were compared with those of relatives of patients in a standard programme (G-Stan) at baseline, following brief instruction and six months after. Differences in skill performance and deterioration and self-perceived preparation between groups over time were assessed. Results Seventy-nine relatives were included and complete data from 66 (G-Stan=33, G-CPR=33) was analysed. Baseline BLS skills were equally poor, improved irregularly following brief instruction and decayed afterwards. G-CPR displayed six-month better performance and lessened skill deterioration over time compared with G-Stan, including enhanced compliance with the BLS sequence ( p = 0.006 for group*time interaction) and global resuscitation quality ( p = 0.007 for group*time interaction). Self-perceived preparation was higher in G-CPR ( p = 0.002). Conclusions Relatives of patients suffering acute coronary syndrome or revascularization enrolled on a cardiac rehabilitation programme showed poor BLS skills. A resuscitation-retraining cardiac rehabilitation programme resulted in relatives' higher BLS awareness, skill retention and confidence at six months compared with the standard programme. This may suggest a significant impact of this formula on the family setting and support the active role of patients to enhance health education in their environment.
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Maddison, Ralph, Jonathan Charles Rawstorn, Ralph A. H. Stewart, Jocelyne Benatar, Robyn Whittaker, Anna Rolleston, Yannan Jiang, et al. "Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial." Heart 105, no. 2 (August 27, 2018): 122–29. http://dx.doi.org/10.1136/heartjnl-2018-313189.
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ObjectiveCompare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD).MethodsParticipants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O2max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes.Results162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20).ConclusionREMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.
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Plaquevent-Hostache, Guillaume, Julianne Touron, Frédéric Costes, Hélène Perrault, Guillaume Clerfond, Christine Cuenin, Andreea Moisa, et al. "Effectiveness of combined eccentric and concentric exercise over traditional cardiac exercise rehabilitation programme in patients with chronic heart failure: protocol for a randomised controlled study." BMJ Open 9, no. 9 (September 2019): e028749. http://dx.doi.org/10.1136/bmjopen-2018-028749.
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IntroductionExercise-based rehabilitation is a standard feature of chronic heart failure management. The effectiveness of eccentric exercise could offer new opportunities for better tailoring rehabilitation programme to patients’ limitations. The goal of the study is to contrast the impact of a mixed eccentric and concentric cycling training programme, to that of conventional concentric cycling rehabilitation in patients with chronic heart failure (peak oxygen consumption (VO2Peak) < 15 mL⋅kg-1⋅min-1, ejection fraction <40%).Methods and analysisIt is a prospective, open, controlled and randomised study (2×25 subjects) carried out in a single centre. Subjects will perform five exercise sessions per week per the randomisation outcome, with the intervention group performing eccentric in three of the five weekly sessions while the control group will perform the five sessions of concentric exercise. Cycling intensity will be the same in both groups and fixed to the power associated with the first ventilatory threshold. Self-management education programme, callisthenics sessions and muscle strength trainings will also be carried out as for any heart failure patient normally included in the rehabilitation programme. The primary outcome will be the change in distance covered during the 6 min walk test. Secondary outcomes will include other physical mobility parameters, functional exercise capacities, quality of life and body composition as well as skeletal muscle properties including mitochondrial function parameters.Ethics and disseminationThe study has been approved by the institutional ethics review board (17.079) and the French regulatory authority for research (2017-A00969-44). Adverse events that could occur during the protocol will be reported to the principal investigator. The results will be published in an international peer-reviewed journal.Trial registration numberNCT03716778.
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Shields, Gemma E., Adrian Wells, Patrick Doherty, Anthony Heagerty, Deborah Buck, and Linda M. Davies. "Cost-effectiveness of cardiac rehabilitation: a systematic review." Heart 104, no. 17 (April 13, 2018): 1403–10. http://dx.doi.org/10.1136/heartjnl-2017-312809.
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Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.
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Brozic, Anka P., Susan Marzolini, and Jack M. Goodman. "Effects of an adapted cardiac rehabilitation programme on arterial stiffness in patients with type 2 diabetes without cardiac disease diagnosis." Diabetes and Vascular Disease Research 14, no. 2 (January 17, 2017): 104–12. http://dx.doi.org/10.1177/1479164116679078.
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Purpose: To determine the effects of a 12-week cardiac rehabilitation programme of aerobic and resistance exercise training on arterial stiffness, peak calf vasodilatory reserve, and haemostatic markers in patients with type 2 diabetes. Methods: Observational cohort study examining effects of 12 weeks of exercise training in 23 subjects (13 men, 10 women; mean age of 56.1 ± 10.1 years) with type 2 diabetes mellitus. Subjects performed exercise training for 12 weeks [aerobic training 5 days/week, 70%–75% peak cardiovascular fitness (VO2peak) and resistance training 2–3 days/week, 60% of one repetition maximum]. Vascular stiffness (pulse-wave velocity), augmentation index, peak calf vasodilatory reserve, and VO2peak were measured pre- and post-exercise training. Secondary outcomes included heart rate variability and haemostatic measures. Results: VO2peak increased by 16% (20.1 ± 5.5 vs 23.2 ± 8.8 mL/kg/min, p = 0.002) and abdominal circumference was reduced (101.9 ± 13.3 vs 97.9 ± 12.7 cm, p < 0.03). Vascular function was improved including central arterial stiffness (central pulse-wave velocity: 8.44 ± 1.75 vs 8.02 ± 1.60 m/s, p = 0.026) and the aortic augmentation index (21.7 ± 10.6% vs 18.3 ± 12.6%, p = 0.005); peak calf vasodilatory reserve increased from 30.3 ± 10.6 mL/100 mL/min to 38.0 ± 15.3 mL/100 mL/min ( p = 0.04). No changes were seen in heart rate variability, blood lipids, glycated haemoglobin and C-reactive protein. Conclusion: A 12-week cardiac rehabilitation programme of aerobic and resistance training significantly reduces arterial stiffness and improves aerobic fitness in individuals with type 2 diabetes mellitus.
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Evans, Rachael A. "Developing the model of pulmonary rehabilitation for chronic heart failure." Chronic Respiratory Disease 8, no. 4 (November 2011): 259–69. http://dx.doi.org/10.1177/1479972311423111.
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Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional symptoms of breathlessness and fatigue. The similar systemic manifestations of the conditions, including skeletal muscle dysfunction, are a major contributing factor to the limitation in exercise capacity. A period of exercise training has been shown to improve exercise performance and health-related quality of life for both conditions. Exercise training is a key component of pulmonary rehabilitation (PR) which is now a standard of care for patients with COPD and is symptom based. Although it may be assumed that patients with CHF could be incorporated into cardiac rehabilitation, this is predominantly a secondary prevention programme for patients who are largely asymptomatic. It has been shown that patients with CHF can be successfully trained together with patients with COPD by the same therapists within PR. There are comparable outcome measures that can be used for both COPD and CHF. Many patients with CHF still do not have access to an exercise rehabilitation programme and incorporating them into the PR model of care could be one solution. This article reviews the (1) similar symptoms, mechanisms and consequences between COPD and CHF, (2) rationale and evidence for exercise training in CHF, (3) model of PR, (4) safety of exercise training in CHF, (5) evidence for combined exercise rehabilitation for CHF and COPD, (6) adaptations necessary to include patients with CHF into PR, (7) the chronic care model and (8) summary.
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Segev, Daria, Devora Hellerstein, Rafi Carasso, and Ayelet Dunsky. "The effect of a stability and coordination training programme on balance in older adults with cardiovascular disease: a randomised exploratory study." European Journal of Cardiovascular Nursing 18, no. 8 (July 21, 2019): 736–43. http://dx.doi.org/10.1177/1474515119864201.
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Background: Cardiovascular diseases are considered a leading factor in mortality and morbidity. The older adult population with cardiovascular diseases has a higher risk of falls as compared to a matched age healthy population. Objective: To investigate the effect of stability and coordination training within a cardiac rehabilitation programme on fall risk in older adults with cardiovascular diseases enrolled in cardiac rehabilitation. Methods: Twenty-six people with cardiovascular diseases (age 74±8) were divided randomly into intervention and control groups. The intervention group received 20 min of stability and coordination exercises as part of their 80 min cardiac rehabilitation programme, while the control group performed the traditional cardiac rehabilitation programme, twice a week, for 12 weeks. Balance assessment was based on three tests: the Timed Up and Go, Functional Reach and Balance Error Scoring System, which were measured twice before the intervention, once following the intervention and once four weeks after the termination of the intervention. A two-way analysis of variance (group × time) with repeated measures was performed to examine differences between groups and between assessments. Results: Seventy per cent of participants in the intervention group adhered to the programme, with significant improvement post-intervention in the Timed Up and Go ( p < .01) and the Balance Error Scoring System ( p < .05) with no changes among the control group. Discussion: Stability and coordination training alongside a traditional cardiac rehabilitation programme may improve static and dynamic balance, and muscle strength, skills that are considered major components in postural control. Clinicians who work in cardiac rehabilitation centres should consider including this training alongside the routine cardiac rehabilitation programme.
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Bäck, Maria, Margret Leosdottir, Emil Hagström, Anna Norhammar, Emma Hag, Tomas Jernberg, Lars Wallentin, Bertil Lindahl, and Kristina Hambraeus. "The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)." European Heart Journal - Quality of Care and Clinical Outcomes 7, no. 5 (May 12, 2021): 431–37. http://dx.doi.org/10.1093/ehjqcco/qcab039.
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Abstract Aims The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed. Methods and results The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020. Conclusion The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.
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Thow, Morag K., Gillian Armstrong, and Danny Rafferty. "Non-cardiac Conditions and Physiotherapy in Phase III Cardiac Rehabilitation Exercise Programmes." Physiotherapy 89, no. 4 (April 2003): 233–37. http://dx.doi.org/10.1016/s0031-9406(05)60154-x.
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Houchen-Wolloff, Linzy, Nikki Gardiner, Reena Devi, Noelle Robertson, Kate Jolly, Tom Marshall, Gill Furze, et al. "Web-based cardiac REhabilitatioN alternative for those declining or dropping out of conventional rehabilitation: results of the WREN feasibility randomised controlled trial." Open Heart 5, no. 2 (October 2018): e000860. http://dx.doi.org/10.1136/openhrt-2018-000860.
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IntroductionCardiac rehabilitation (CR) is typically delivered in hospital-based classes and is recommended to help people reduce their risk of further cardiac events. However, many eligible people are not completing the programme. This study aimed to assess the feasibility of delivering a web-based CR intervention for those who decline/drop out from usual CR.InterventionA web-based CR programme for 6 months, facilitated with remote support.MethodsTwo-centre, randomised controlled feasibility trial. Patients were randomly allocated to web-based CR/usual care for 6 months. Data were collected to inform the design of a larger study: recruitment rates, quality of life (MacNew), exercise capacity (incremental shuttle walk test) and mood (Hospital Anxiety and Depression Scale). Feasibility of health utility collection was also evaluated.Results60 patients were randomised (90% male, mean age 62±9 years, 26% of those eligible). 82% completed all three assessment visits. 78% of the web group completed the programme. Quality of life improved in the web group by a clinically meaningful amount (0.5±1.1 units vs 0.2±0.7 units: control). Exercise capacity improved in both groups but mood did not change in either group. It was feasible to collect health utility data.ConclusionsIt was feasible to recruit and retention to the end of the study was good. The web group reported important improvements in quality of life. This intervention has the opportunity to increase access to CR for patients who would otherwise not attend. Promising outcomes and recruitment suggest feasibility for a full-scale trial.Trial registration number10726798.
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Khoury, Michael, Devin B. Phillips, Peter W. Wood, William R. Mott, Michael K. Stickland, Pierre Boulanger, Gwen R. Rempel, Jennifer Conway, Andrew S. Mackie, and Nee S. Khoo. "Cardiac rehabilitation in the paediatric Fontan population: development of a home-based high-intensity interval training programme." Cardiology in the Young 30, no. 10 (July 27, 2020): 1409–16. http://dx.doi.org/10.1017/s1047951120002097.
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AbstractIntroduction:We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology.Methods:The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology.Results:There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total.Conclusion:The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.
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Gremeaux, V., A. Hannequin, D. Laroche, G. Deley, J. Duclay, and JM Casillas. "Reproducibility, validity and responsiveness of the 200-metre fast walk test in patients undergoing cardiac rehabilitation." Clinical Rehabilitation 26, no. 8 (December 14, 2011): 733–40. http://dx.doi.org/10.1177/0269215511427750.
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Objective: To investigate the reliability, validity and responsiveness of the 200-metre fast walk test in patients with coronary artery disease engaged in a cardiac rehabilitation programme. Design: Descriptive study. Setting: Tertiary care hospital. Subjects: Thirty stable patients with coronary artery disease (51.9 ± 8.7 years), referred to the cardiac rehabilitation department after an acute coronary syndrome. Intervention: Not applicable. Main measures: Six-minute walk test distance, time to perform the 200-m fast walk test, peak power output of the graded maximal exercise test, before and after the programme; SF-36 quality of life questionnaire at baseline. Walk tests were performed twice at baseline to assess reliability. Results: The 200-m fast walk test was highly reliable (ICC = 0.97). It was significantly correlated with the graded maximal exercise test peak power and the 6-minute walk test at baseline ( r = −0.417; P < 0.05; and r = −0.566; P < 0.01, respectively) and after the training programme ( r = −0.460, P < 0.05; and r = −0.926; P < 0.01, respectively). At baseline, there was a strong correlation between the 200-m fast walk test time and the physical component score of the SF-36 ( r = −0.77; P < 0.01), but not between the 200-m fast walk test time and the SF-36 mental component score. Mean 200-m fast walk test time was significantly different between the patients performing ≤90 W ( n = 11) or ≥100 W ( n = 19) at the baseline graded maximal exercise test (121.7 ± 13.6 vs. 115.5 ± 10.1 seconds; P < 0.05). The responsiveness was strong with a standardized response mean at 1.11. Conclusion: The 200-m fast walk test is a reliable, valid and responsive high-intensity walk test in patients with coronary artery disease after an acute coronary syndrome. It can thus give additional information to that given by the 6-minute walk test and the graded maximal exercise test.
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Bierbauer, Walter, Urte Scholz, Tania Bermudez, Dries Debeer, Michael Coch, Ruth Fleisch-Silvestri, Claude-Alain Nacht, Hansueli Tschanz, Jean-Paul Schmid, and Matthias Hermann. "Improvements in exercise capacity of older adults during cardiac rehabilitation." European Journal of Preventive Cardiology 27, no. 16 (April 22, 2020): 1747–55. http://dx.doi.org/10.1177/2047487320914736.
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Aims Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. Method A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012–2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. Results Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen’s d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. Conclusion As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients’ age and sex.
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Buckley, Benjamin J. R., Stephanie L. Harrison, Elnara Fazio-Eynullayeva, Paula Underhill, Deirdre A. Lane, Dick H. J. Thijssen, and Gregory Y. H. Lip. "Association of Exercise-Based Cardiac Rehabilitation with Progression of Paroxysmal to Sustained Atrial Fibrillation." Journal of Clinical Medicine 10, no. 3 (January 23, 2021): 435. http://dx.doi.org/10.3390/jcm10030435.
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Progression of atrial fibrillation (AF) is associated with worsened prognosis for cardiovascular events and mortality. Exercise-based-cardiac rehabilitation programmes have shown preliminary promise for primary and secondary prevention of AF. Yet, such interventions are typically reserved for patients with acute coronary syndrome or undergoing revascularization. Using a retrospective cohort design, the present study investigated the association of exercise-based cardiac rehabilitation on the progression of paroxysmal to sustained AF, compared to propensity-matched controls. Patients with a diagnosis of paroxysmal AF were compared between those with and without an electronic medical record of exercise-based cardiac rehabilitation within 6-months of diagnosis. Using cox regression models, we ascertained odds of 2-year incidence for AF progression. This cohort of 9808 patients with paroxysmal AF demonstrated that exercise-based cardiac rehabilitation was associated with 26% lower odds of AF progression (odds ratio 0.74, 95% CI 0.66–0.83) compared to propensity-matched controls. This beneficial effect seemed to vary across patient subgroups. In conclusion, findings revealed that exercise-based cardiac rehabilitation was associated with significantly lower odds of progression from paroxysmal to sustained AF at 2-years follow-up compared to propensity-matched controls.
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Nichols, Simon, Fiona Nation, Toni Goodman, Andrew L. Clark, Sean Carroll, and Lee Ingle. "CARE CR-Cardiovascular and cardiorespiratory Adaptations to Routine Exercise-based Cardiac Rehabilitation: a study protocol for a community-based controlled study with criterion methods." BMJ Open 8, no. 1 (January 2018): e019216. http://dx.doi.org/10.1136/bmjopen-2017-019216.
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IntroductionCardiac rehabilitation (CR) reduces all-cause and cardiovascular mortality in patients with coronary heart disease (CHD). Much of this improvement has been attributed to the beneficial effects of structured exercise training. However, UK-based studies have not confirmed this. Improvements in survival and cardiovascular health are associated with concurrent improvements in cardiorespiratory fitness (CRF). It is therefore concerning that estimated CRF improvements resulting from UK-based CR are approximately one-third of those reported in international literature. Modest improvements in CRF suggest that UK CR exercise training programmes may require optimisation if long-term survival is to be improved. However, contemporary UK studies lack control data or use estimates of CRF change. Cardiovascular and cardiorespiratory Adaptations to Routine Exercise-based CR is a longitudinal, observational, controlled study designed to assess the short-term and long-term effect of CR on CRF, as well cardiovascular and cardiometabolic health.Methods and analysisPatients will be recruited following referral to their local CR programme and will either participate in a routine, low-to-moderate intensity, 8-week (16 sessions) exercise-based CR programme or freely abstain from supervised exercise. Initial assessment will be conducted prior to exercise training, or approximately 2 weeks after referral to CR if exercise training is declined. Reassessment will coincide with completion of exercise training or 10 weeks after initial assessment for control participants. Participants will receive a final follow-up 12 months after recruitment. The primary outcome will be peak oxygen consumption determined using maximal cardiopulmonary exercise testing. Secondary outcomes will include changes in subclinical atherosclerosis (carotid intima–media thickness and plaque characteristics), body composition (dual X-ray absorptiometry) and cardiometabolic biomarkers.Ethics and disseminationEthical approval for this non-randomised controlled study has been obtained from the Humber Bridge NHS Research Ethics Committee—Yorkshire and the Humber on the 27th September 2013, (12/YH/0278). Results will be presented at national conferences and published in peer-reviewed journals.
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Petersen, Annemette Krintel, Lisa Gregersen Oestergaard, Maurits van Tulder, and Sussie Laustsen. "A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up." Clinical Rehabilitation 34, no. 1 (October 23, 2019): 69–81. http://dx.doi.org/10.1177/0269215519883411.
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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.
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Spencer, D., and C. Shepherd. "A045 An Exercise Based Cardiac Rehabilitation Programme is Associated with Significant Improvement in Psychological Health." Heart, Lung and Circulation 29 (2020): S19. http://dx.doi.org/10.1016/j.hlc.2020.05.050.
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Tooth, Leigh, and Kryss McKenna. "Contemporary Issues in Cardiac Rehabilitation: Implications for Occupational Therapists." British Journal of Occupational Therapy 59, no. 3 (March 1996): 133–40. http://dx.doi.org/10.1177/030802269605900312.
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Since the acceptance of the beneficial effects of early mobilisation for patients after myocardial infarction, cardiac rehabilitation has undergone dramatic change. Highly structured and inflexible exercise programmes have given way to flexible and comprehensive modern programmes, which embrace the use of education, counselling and risk factor modification principles. Contemporary skills required by occupational therapists include being able to adapt services to a vast array of cardiac conditions, foster risk factor modification, enhance compliance, tailor education to learning and coping styles, assess the patient's level of risk and need for rehabilitation, and provide accelerated and alternate programmes. This article discusses the principles, directions and benefits of modern cardiac rehabilitation and the implications for occupational therapists.
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Siebert, J., D. Zielińska, B. Trzeciak, and S. Bakuła. "HAEMODYNAMIC RESPONSE DURING EXERCISE TESTING IN PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING A CARDIAC REHABILITATION PROGRAMME." Biology of Sport 28, no. 3 (September 14, 2011): 189–93. http://dx.doi.org/10.5604/959285.
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Marshall, Wendy, Cathy Gasparini, Yvonne Johansen, Susan Reed, Lisa Moodie, and Jocelyne Benatar. "Do Cardiac Rehabilitation Exercise Programmes in New Zealand Follow International Recommendations?" Heart, Lung and Circulation 27 (2018): S4. http://dx.doi.org/10.1016/j.hlc.2018.05.109.
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McSweeney, N. "173 Poster a Prospective Study on Changes in Body Composition during a Cardiac Rehabilitation Programme which Includes a Home Exercise Programme." European Journal of Cardiovascular Nursing 9, no. 1_suppl (March 2010): S37—S38. http://dx.doi.org/10.1016/s1474-5151(10)60133-8.
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Groeneveldt, Lara J., Rachel Garrod, Kwee L. Yong, Flora Dangwa, Andrew P. Jewell, Ken van Someren, Neil Rabin, Lisa Nicholls, and Shirley P. D’Sa. "An Exercise Training Programme Produces Significant Improvements in Quality of Life (QoL), Muscle Strength and Cardiorespiratory Function in Patients with Myeloma." Blood 110, no. 11 (November 16, 2007): 3323. http://dx.doi.org/10.1182/blood.v110.11.3323.3323.
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Abstract Cancer patients frequently suffer with anxiety, fatigue, loss of well-being and functionality. In myeloma patients this is compounded by the effects of lytic bone disease, causing chronic pain and impaired mobility. The result is a decrease in physical fitness and loss of confidence in carrying out day-to-day activities, contributing to a reduced QoL. The development of novel therapies has extended the survival of these patients, hence such issues are of increasing importance and effective rehabilitation programmes are urgently needed. We carried out a pilot study of a tailored exercise training programme in patients in stable plateau phase. The primary aims were to determine the feasibility, adherence rate, and the effects on QoL, physiological and cardiorespiratory functions. Eligible patients underwent radiological and cardiac screening prior to study entry. There was a 25% screening failure rate due to disease progression or fracture risk, these patients proceeding to prophylactic surgery or radiotherapy. Twenty-five patients were given a programme based on their current exercise capacity, level of functioning and individual rehabilitative needs. Patients undertook exercise training 3 times a week for 6 months, with 1 supervised exercise session each week in the hospital outpatient gym. Each session comprised stretching and mobility, aerobic (treadmill, cycle ergometer or walking to 50–60% of heart rate reserve and 15–30 minutes duration) and resistance training (theraband, ankle, hand weights and body-weight) in order to improve flexibility, cardiorespiratory fitness and muscle strength. QoL and physiological outcomes were assessed at baseline, 4-weekly for 3 months, then 6 weekly for 3 months during the 6-month study period. A preliminary analysis of 17 patients who completed 3 months on the programme has been performed. Average attendance at the weekly exercise class was 84%. Adherence to the exercise programme, as assessed by inspection of a log-book was >50% in all patients; 35% achieved >90% adherence. Significant improvements were found in the FACT G (baseline: median 85; range 62 – 104, 3 months: 90; range 70 – 108, p<0.01), FACIT-Fatigue (baseline: 40; range 14 – 50, 3 months: 43; range 19 – 52, p<0.05) and HAD anxiety scores (baseline: 5; range 0 – 19, 3 months: 2; range 0 – 11, p<0.01). Upper limb strength, assessed by handgrip dynamometry also improved significantly (baseline: 28.80kg; range 8.75 – 51.30, 3 months: 30.65kg; range 18.15 – 50.00, p<0.05), as did VO2max, assessed by a submaximal stress test (baseline: 24.8 ml/kg/min; range 19.2 – 34.7, 3 months: 26.7 ml/kg/min; range 21.1 – 35.0, p<0.01). Several patients reduced their analgesia usage, and many are now able to undertake new activities such as lifting a grandchild, climbing ladders to decorate, and walking along a pebbled beach. Such reports of personal benefits are being captured using qualitative methods. In summary, an exercise training programme is feasible in patients with myeloma, resulting in significant benefits as assessed by QoL, physiological and cardio-respiratory measures. Our results provide the evidence base for the regular use of exercise prescription in the rehabilitation of myeloma patients.