Science.gov

Sample records for outpatient cardiac rehabilitation

  1. Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation

    PubMed Central

    Heydarpour, Behzad; Saeidi, Mozhgan; Ezzati, Parvin; Soroush, Ali

    2015-01-01

    Objective To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). Methods This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. Results Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). Conclusion Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation. PMID:26798599

  2. [Development and importance of outpatient cardiac rehabilitation in German-speaking countries].

    PubMed

    Benzer, W

    2014-07-01

    Cardiac rehabilitation is a coordinated treatment approach. The interdisciplinary team aims to provide the best possible physical and psychological outcomes for patients with cardiac diseases. Patients should be enable to independently resume work and and social life. Furthermore cardiac rehabilitation wants to limit or reverse the progress of cardiac disease through sustained health-related life habits. Cardiac rehabilitation significantly contributes to long-term success based on comprehensive care of cardiac patients. Outpatient cardiac rehabilitation has shown to be effective after myocardial infarction, coronary artery bypass grafting and chronic heart failure. However randomized controlled trials were performed only in Anglo-American countries. In these trials effects were observed mainly for exercise-based cardiac rehabilitation programs. Because the results have been derived from different program settings they cannot simply be translated to German-speaking countries. However, several cohort studies predominantly performed in Germany also revealed effects of inpatient and outpatient cardiac rehabilitation programs for German-speaking countries. The most recent results demonstrated a significant reduction of recurrent events in patients after inpatient cardiac rehabilitation. Following the current evidence concerning the effect of inpatient and outpatient cardiac rehabilitation programs particularly after myocardial infarction international guidelines provide Class I (USA) and IIa (Europe) recommendation for this treatment intervention.In contrast to Anglo-American countries cardiac rehabilitation in Austria, Germany and Switzerland was established at its beginning exclusively for inpatient programs. In addition more and more outpatient programs were introduced in the last decades. Nevertheless inpatient cardiac rehabilitation is still the most common program in German-speaking countries.Future challenges of cardiac rehabilitation should not address the

  3. Cardiac Rehabilitation

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac Rehabilitation? Cardiac rehabilitation (rehab) is a medically supervised program ... be designed to meet your needs. The Cardiac Rehabilitation Team Cardiac rehab involves a long-term commitment ...

  4. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP)

    PubMed Central

    2010-01-01

    Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT). Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with number ACTRN12609000251224. PMID:20109196

  5. [Cardiac Rehabilitation 2015].

    PubMed

    Hoffmann, Andreas

    2015-11-25

    The goals of cardiac rehabilitation are (re-)conditioning and secondary prevention in patients with heart disease or an elevated cardiovascular risk profile. Rehabilitation is based on motivation through education, on adapted physical activity, instruction of relaxation techniques, psychological support and optimized medication. It is performed preferably in groups either in outpatient or inpatient settings. The Swiss working group on cardiac rehabilitation provides a network of institutions with regular quality auditing. Positive effects of rehabilitation programs on mortality and morbidity have been established by numerous studies. Although a majority of patients after cardiac surgery are being referred to rehabilitation, these services are notoriously underused after catheter procedures. PMID:26602848

  6. Cardiac rehabilitation

    MedlinePlus

    ... 123-210. Thomas PD. Exercise-Based, Comprehensive Cardiac Rehabilitation. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 9th ed. Philadelphia, PA: Saunders Elsevier; 2011: ...

  7. Cardiac rehabilitation in Germany.

    PubMed

    Karoff, Marthin; Held, Klaus; Bjarnason-Wehrens, Birna

    2007-02-01

    The purpose of this review is to give an overview of the rehabilitation measures provided for cardiac patients in Germany and to outline its legal basis and outcomes. In Germany the cardiac rehabilitation system is different from rehabilitation measures in other European countries. Cardiac rehabilitation in Germany since 1885 is based on specific laws and the regulations of insurance providers. Cardiac rehabilitation has predominantly been offered as an inpatient service, but has recently been complemented by outpatient services. A general agreement on the different indications for offering these two services has yet to be reached. Cardiac rehabilitation is mainly offered after an acute cardiac event and bypass surgery. It is also indicated in severe heart failure and special cases of percutaneous coronary intervention. Most patients are men (>65%) and the age at which events occur is increasing. The benefits obtained during the 3-4 weeks after an acute event, and confirmed in numerous studies, are often later lost under 'usual care' conditions. Many attempts have been made by rehabilitation institutions to improve this deficit by providing intensive aftercare. One instrument set up to achieve this is the nationwide institution currently comprising more than 6000 heart groups with approximately 120000 outpatients. After coronary artery bypass grafting or acute coronary syndrome cardiac rehabilitation can usually be started within 10 days. The multidisciplinary rehabilitation team consists of cardiologists, psychologists, exercise therapists, social workers, nutritionists and nurses. The positive effects of cardiac rehabilitation are also important economically, for example, for the improvement of secondary prevention and vocational integration. PMID:17301623

  8. Outpatients in Neurological Rehabilitation.

    ERIC Educational Resources Information Center

    Barnes, M. P.; Skeil, D. A.

    1996-01-01

    This paper describes the multidisciplinary approach used at a neurological rehabilitation clinic in England. Analysis of questionnaire responses from outpatients indicated general support for the multidisciplinary approach, though a significant minority felt intimidated by the large number of professionals seen simultaneously. Patients also…

  9. Cardiac rehabilitation.

    PubMed

    Ehsani, A A

    1984-02-01

    Exercise training is a major, and the most important, component of cardiac rehabilitation. Besides providing psychological benefits and promoting a "sense of well being," it elicits a number of adaptations in patients with ischemic heart disease. Among the clinically important adaptations are changes in the trained skeletal muscles and autonomic nervous system, resulting not only in increased maximum exercise capacity but also a slower heart rate and, at times, a lower systolic blood pressure during submaximal exercise. The reduction in the rate pressure product decreases myocardial O2 demand at any given submaximal exercise intensity and may thus alleviate myocardial ischemia and angina in patients with coronary artery disease. These adaptive responses occur even with a relatively modest exercise intensity. Although short-term exercise training of moderate intensity has not been reported to result in improvement in left ventricular performance, recent data suggest that exercise training of higher intensity and longer duration (12 months or longer) than has conventionally been used in cardiac rehabilitation programs may favorably affect the heart. This is characterized by improvements in left ventricular function, diminished electrocardiographic criteria of myocardial ischemia and increased stroke volume during exercise. Modest weight reduction accompanies regularly performed prolonged exercise training. It is important, however, to recognize that high-intensity exercise programs are suitable for only some patients with coronary artery disease who are stable and should be used only under strict medical supervision. PMID:6400004

  10. What Is Cardiac Rehabilitation?

    MedlinePlus

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  11. Safety of early enrollment into outpatient cardiac rehabilitation after open heart surgery.

    PubMed

    Pack, Quinn R; Dudycha, Kent J; Roschen, Kyle P; Thomas, Randal J; Squires, Ray W

    2015-02-15

    The safety of early enrollment (<2 weeks after hospital discharge) into cardiac rehabilitation (CR) after recent coronary artery bypass graft (CABG) surgery or heart valve surgery (HVS) has not previously been assessed and has important policy implications. Consequently, we performed a detailed review of all clinical adverse events within 6 months of hospital discharge. We compared early and late attendees for patients undergoing CABG surgery or HVS and included patients with myocardial infarction (MI) as an additional control group. We analyzed 112 patients undergoing CABG surgery, 69 patients undergoing HVS, and 59 patients with MI. Median time (interquartile range) from hospital discharge to CR enrollment was 10.5 (8 to 15), 12 (8.5 to 21), and 9 days (7 to 14), respectively. There was no difference in major event rates between early and late enrollees (17% vs 17%, respectively, log-rank p = 0.98) or by diagnosis (15%, 16%, and 22% for CABG surgery, HVS, and MI, respectively; log-rank p = 0.50). Sternal instability and wound infection rates were similar. CR-related adverse events trended toward increased event rates in surgical and early enrollees, but of 44 events, only 3 were exercise related, none resulted in permanent harm, and 41 (93%) were managed in CR without need for emergency services. In conclusion, it appears that a policy of encouraging early enrollment into CR in patients with a recent open heart surgery seems unlikely to harm patients when careful individualized assessment and exercise prescription take place within the bounds of an established CR program. PMID:25543236

  12. Cardiac rehabilitation

    MedlinePlus

    ... goal of cardiac rehab is to: Improve your cardiovascular function Improve your overall health and quality of ... E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  13. The Role of the Health Educator in Cardiac Rehabilitation.

    ERIC Educational Resources Information Center

    Papenfuss, Dick

    1985-01-01

    A four-phased model for cardiac rehabilitation consisting of inpatient, outpatient, supervised, and unsupervised stages is reviewed and the role of the health educator in facilitating this recovery and prevention process is discussed. (DF)

  14. Cardiac rehabilitation in Germany.

    PubMed

    Cantwell, J D

    1976-09-01

    The concept of cardiac reconditioning centers for the prevention and rehabilitation of coronary patients has been tremendously successful in Germany over the past 20 years. At least 40 such centers are located throughout the country. Physicians, nurses, and physical therapists work closely together in the various facets of the rehabilitation process. The financial backing for these facilities is primarily through governmental and regional insurance companies, whose officials are apparently convinced that in the long run supporting preventive measures is financially sound. Objective data supporting their convictions come from studies such as that of Brusis, who showed that such as that of 1,500 employees was diminished by nearly 70 percent during a two-year period after cardiac reconditioning, as compared to a similar time period before the rehabilitation experience. Subjective benefits, which are extremely difficult to quantitate in meaningful terms, were nonetheless expressed by nearly all the patients with whom I conversed. Perhaps they have experienced the same feelings that Mark Twain did when he observed that "all frets and worries and chafings sank to sleep in the presence of the benignant serenity of the Alps; the Great Spirit of the Mountains breathed his own peace upon their hurt minds and sore hearts and healed them." PMID:959329

  15. Interventional cardiology in perspective: impact on cardiac rehabilitation.

    PubMed

    Maier, W; Meier, B

    1998-11-01

    Exponential evolution of percutaneous, catheter-based revascularization has modified traditional premises of cardiac rehabilitation. With increasing numbers of percutaneous transluminal angioplasty (PTCA) procedures relative to coronary artery bypass grafting interventions, the need for in-patient rehabilitation is declining; on the other hand, the need for life-style counselling within the framework of out-patient rehabilitation is increasing. Risk factor interventions are important to minimize and to retard the progression of the disease. Rehabilitation programmes offer exercise training, stress modification and life style counselling to reduce cardiovascular risk factors and to increase exercise capability. Since costs of out-patient rehabilitation seem to be lower than those of in-patient rehabilitation, a case may be made in favour of directing limited funds to additional interventions and to saving money by replacing in-patient rehabilitation with outpatient programmes after PTCA. The budget-holder has to make the choice. PMID:9857946

  16. [Cardiac rehabilitation after myocardial infarction].

    PubMed

    Ghannem, M; Ghannem, L; Ghannem, L

    2015-12-01

    Although the proofs of the benefits of cardiac rehabilitation accumulate, many patients are not sent to rehabilitation units, especially younger and very elderly patients. As the length of stay in acute care units decreases, rehabilitation offers more time to fully assess the patients' conditions and needs. Meta-analyses of randomised trials suggest that mortality can be improved by as much as 20-30%. In addition, rehabilitation helps managing risk factors, including hyperlipidemia, diabetes, smoking and sedentary behaviours. Physical training also helps improving exercise capacity. Because of all of these effects, cardiac rehabilitation for post-myocardial infarction patients has been given a class IA recommendation in current guidelines. PMID:26548984

  17. Current trends in cardiac rehabilitation

    PubMed Central

    Dafoe, W; Huston, P

    1997-01-01

    Cardiac rehabilitation can reduce mortality and morbidity for patients with many types of cardiac disease cost-effectively, yet is generally underutilized. Rehabilitation is helpful not only for patients who have had a myocardial infarction but also for those with stable angina or congestive heart failure or those who have undergone myocardial revascularization procedures, a heart transplant or heart valve surgery. The beneficial effects of rehabilitation include a reduction in the rate of death from cardiovascular disease, improved exercise tolerance, fewer cardiac symptoms, improved lipid levels, decreased cigarette smoking, improvement in psychosocial well-being and increased likelihood of return to work. Rehabilitation involves a multidisciplinary team that focuses on education, individually tailored exercise, risk-factor modification and the optimization of functional status and mental health. Current research trends in this area include the evaluation of new secondary-prevention modalities and alternative program options, such as home-based rehabilitation. PMID:9054823

  18. Cardiac Rehabilitation: Then and Now.

    ERIC Educational Resources Information Center

    Wilson, Philip K.

    1988-01-01

    As more and more patients survive a coronary event, the need for cardiac rehabilitation will increase. The author reviews the history and current status of this field and predicts what lies ahead. (JD)

  19. MedlinePlus: Cardiac Rehabilitation

    MedlinePlus

    ... available Research Clinical Trials Journal Articles Resources Reference Desk Find an Expert For You Patient Handouts Summary Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or ...

  20. Women's compliance with cardiac rehabilitation programs.

    PubMed

    Ginzel, A R

    1996-01-01

    As the incidence of cardiovascular disease in women increases, the process of cardiac rehabilitation in women is becoming increasingly important to nurses. Specifically, the issue of women's compliance with cardiac rehabilitation needs to be addressed by nurses. Most past and current research on cardiac rehabilitation and compliance with rehabilitation programs has been conducted on male subjects and cannot be accurately generalized to the female population. This article reviews current literature which addresses the issues of heart disease in women, cardiac rehabilitation and compliance in the general population, gender differences in cardiac rehabilitation, and compliance of women in cardiac rehabilitation. PMID:8657707

  1. Global availability of cardiac rehabilitation.

    PubMed

    Turk-Adawi, Karam; Sarrafzadegan, Nizal; Grace, Sherry L

    2014-10-01

    Cardiovascular disease (CVD) is the most-prevalent noncommunicable disease and leading cause of death globally. Over 80% of deaths from CVD occur in low-income and middle-income countries (LMICs). To limit the socioeconomic impact of CVD, a comprehensive approach to health care is needed. Cardiac rehabilitation delivers a cost-effective and structured exercise, education, and risk reduction programme, which can reduce mortality by up to 25% in addition to improving a patient's functional capacity and lowering rehospitalization rates. Despite these benefits and recommendations in clinical practice guidelines, cardiac rehabilitation programmes are grossly under-used compared with revascularization or medical therapy for patients with CVD. Worldwide, only 38.8% of countries have cardiac rehabilitation programmes. Specifically, 68.0% of high-income and 23% of LMICs (8.3% for low-income and 28.2% for middle-income countries) offer cardiac rehabilitation programmes to patients with CVD. Cardiac rehabilitation density estimates range from one programme per 0.1 to 6.4 million inhabitants. Multilevel strategies to augment cardiac rehabilitation capacity and availability at national and international levels, such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed. PMID:25027487

  2. Outpatient pulmonary rehabilitationrehabilitation models and shortcomings in outpatient aftercare

    PubMed Central

    Korczak, Dieter; Huber, Beate; Steinhauser, Gerlinde; Dietl, Markus

    2010-01-01

    Background The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are

  3. Current state of cardiac rehabilitation in Japan.

    PubMed

    Goto, Yoichi

    2014-01-01

    In Japan, metabolic risk factors have been increasing due to the westernization and urbanization of lifestyle. This justifiably raises a concern that the incidence of coronary heart disease (CHD) in Japan will increase over time, and indeed, recent epidemiological studies in Japan suggest the incidence of acute myocardial infarction (AMI) is increasing. Cardiac rehabilitation (CR) in Japan has been traditionally performed in the inpatient setting. To obtain reimbursement, a CR facility must fulfill certain criteria including being a medical institution with a cardiology/cardiac surgery section which has at least a cardiologist/cardiac surgeon and an experienced CR physician as full-time employees. These criteria create challenges to the availability of outpatient CR after hospital discharge. A recent analysis found outpatient CR participation rate was estimated to be between 3.8 and 7.6% in Japan. This review describes recent trends in the incidence of AMI and the current status of the use of CR in Japan. PMID:24607022

  4. Cardiac Rehabilitation in Older Adults.

    PubMed

    Schopfer, David W; Forman, Daniel E

    2016-09-01

    The biology of aging and the pathophysiology of cardiovascular disease (CVD) overlap, with the effect that CVD is endemic in the growing population of older adults. Moreover, CVD in older adults is usually complicated by age-related complexities, including multimorbidity, polypharmacy, frailty, and other intricacies that add to the risks of ambiguous symptoms, deconditioning, iatrogenesis, falls, disability, and other challenges. Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with cardiovascular conditions. Although CR was originally designed primarily as an exercise training program for younger adults after a myocardial infarction or coronary artery bypass surgery, it has evolved as a comprehensive lifestyle program (promoting physical activity as well as education, diet, risk reduction, and adherence) for a broader range of CVD (coronary heart disease, heart failure, and valvular heart disease). It provides a valuable opportunity to address and moderate many of the challenges pertinent for the large and growing population of older adults with CVD. Cardiac rehabilitation promotes physical function (cardiorespiratory fitness as well as strength and balance) that helps overcome disease and deconditioning as well as related vulnerabilities such as disability, frailty, and falls. Similarly, CR facilitates education, monitoring, and guidance to reduce iatrogenesis and promote adherence. Furthermore, CR fosters cognition, socialization, and independence in older patients. Yet despite all its conceptual benefits, CR is significantly underused in older populations. This review discusses benefits and the paradoxical underuse of CR, as well as evolving models of care that may achieve greater application and efficacy. PMID:27297002

  5. Motivational factors of adherence to cardiac rehabilitation

    PubMed Central

    Shahsavari, Hooman; Shahriari, Mohsen; Alimohammadi, Nasrollah

    2012-01-01

    Background: Main suggested theories about patients’ adherence to treatment regimens recognize the importance of motivation in positive changes in behaviors. Since cardiac diseases are chronic and common, cardiac rehabilitation as an effective prevention program is crucial in management of these diseases. There is always concern about the patients’ adherence to cardiac rehabilitation. The aim of this study was to describe the motivational factors affecting the patients’ participation and compliance to cardiac rehabilitation by recognizing and understanding the nature of patients’ experiences. Materials and Methods: The participants were selected among the patients with cardiac diseases who were referred to cardiac rehabilitation in Isfahan Cardiovascular Research Center, Iran. The purposive sampling method was used and data saturation achieved after 8 semi-structured interviews. Findings: The three main concepts obtained from this study are “beliefs”, “supporters” and “group cohesion”. Conclusions: In cardiac rehabilitation programs, emphasis on motivational factors affects the patient’s adherence. It is suggested that in cardiac rehabilitation programs more attention should be paid to patients’ beliefs, the role of patients’ supporters and the role of group-based rehabilitation. PMID:23833634

  6. 42 CFR 414.1105 - Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for Comprehensive Outpatient Rehabilitation... AND OTHER HEALTH SERVICES Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) Services § 414.1105 Payment for Comprehensive Outpatient Rehabilitation Facility (CORF) services. (a)...

  7. Ethnocultural diversity in cardiac rehabilitation.

    PubMed

    Midence, Liz; Mola, Ana; Terzic, Carmen M; Thomas, Randal J; Grace, Sherry L

    2014-01-01

    Cardiovascular disease is the leading cause of death globally. Despite a greater burden of disease, ethnocultural minorities in both the United States and Canada are significantly less likely to access cardiac rehabilitation (CR). Without equitable access to CR, these patients may be more likely to experience recurrent cardiac events and unnecessarily premature death. In this article, the current state of ethnocultural diversity in CR patients and unique barriers that ethnocultural minority patients face are reviewed. Strategies for CR program delivery and diversity of CR program staff are considered. Guidance on ethnocultural considerations in American and Canadian associations of CR is also reviewed. Lower rates of access to CR are seen among ethnocultural minorities in both American and Canadian CR programs. Only 2 studies evaluating ethnoculturally tailored CR could be identified in the literature. American CR staff are predominantly white (∼96%), whereas ethnocultural data are not collected from Canadian CR professionals. American guidelines emphasize the importance of ethnocultural competency. Meanwhile, Canadian guidelines underscore the low use of CR services among ethnocultural minorities, and support ethnoculturally informed CR delivery. The American and Canadian populations are rapidly diversifying, yet the CR workforce is not, and ethnocultural minorities continue to be underrepresented in our programs. Although recent CR guidelines have made some preliminary recommendations to overcome these discrepancies, more focused efforts are needed. Thirteen points of action are proposed for the CR community with the goal of promoting the development and delivery of more ethnoculturally sensitive CR services. PMID:25357126

  8. Cardiac Rehabilitation: Improving Function and Reducing Risk.

    PubMed

    Servey, Jessica T; Stephens, Mark

    2016-07-01

    Cardiac rehabilitation is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. The overall goals focus on improving daily function and reducing cardiovascular risk factors. Cardiac rehabilitation includes interventions aimed at lowering blood pressure and improving lipid and diabetes mellitus control, with tobacco cessation, behavioral counseling, and graded physical activity. The physical activity component typically involves 36 sessions over 12 weeks, during which patients participate in supervised exercise under cardiac monitoring. There are also intensive programs that include up to 72 sessions lasting up to 18 weeks, although these programs are not widely available. Additional components of cardiac rehabilitation include counseling on nutrition, screening for and managing depression, and assuring up-to-date immunizations. Cardiac rehabilitation is covered by Medicare and recommended for patients following myocardial infarction, bypass surgery, and stent placement, and for patients with heart failure, stable angina, and several other conditions. Despite proven benefits in mortality rates, depression, functional capacity, and medication adherence, rates of referral for cardiac rehabilitation are suboptimal. Groups less likely to be referred are older adults, women, patients who do not speak English, and persons living in areas where cardiac rehabilitation is not locally available. Additionally, primary care physicians refer patients less often than cardiologists and cardiothoracic surgeons. PMID:27386722

  9. What Are the Benefits and Risks of Cardiac Rehabilitation?

    MedlinePlus

    ... NHLBI on Twitter. What Are the Benefits and Risks of Cardiac Rehabilitation? Benefits Cardiac rehabilitation (rehab) has ... health also can help some people quit smoking . Risks The lifestyle changes that you make during cardiac ...

  10. Cardiac Rehabilitation in the Mid-1980s.

    ERIC Educational Resources Information Center

    Cantwell, John D.

    1986-01-01

    The author describes a state-of-the-art cardiac rehabilitation program consisting of training and supervision in exercise, nutrition, and stress management. Inpatient, postdischarge, and late postdischarge regimens are presented. (MT)

  11. [Outpatient orthopaedic rehabilitation: treatment, outcomes and costs as compared to inpatient rehabilitation].

    PubMed

    Bührlen, B; Jäckel, W H

    2002-01-01

    In a parallel design the study examined an outpatient rehabilitation model project for patients of the pension insurance scheme of Rhineland-Palatinate (LVA Rheinland-Pfalz). In 6 centers for the rehabilitation of musculoskeletal diseases patients were assessed at the beginning and at the end of rehabilitation as well as six and twelve months after discharge. In this article the final results concerning therapeutic measures as well as health-related and economic outcomes are presented. Not included are aspects of differential utilization and the perception of the rehabilitation by the clients, which will be published in a separate article. No large differences were found concerning participation in the various therapeutic measures. As measured by the main score and the sub-dimensions of the IRES patient questionnaire, effects of the same magnitude were found for the parallelized samples. Equally, no differences in outcome quality were found concerning the great majority of medical parameters documented in a doctors' questionnaire, the rate of applications for pension, occupational status twelve months after rehabilitation, as well as the reduction of sick-leave. The economic evaluation was carried out only from the perspective of the pension insurance agency. Considerable differences were found in the net costs of rehabilitation: although there are no user charges for patients in outpatient rehabilitation, mean expenditure was about 970 EURO lower than in inpatient rehabilitation. The study findings demonstrate that the concept of interdisciplinary rehabilitation has been realized in the outpatient centers as well and that the centers have reached an effectiveness comparable to that of inpatient rehabilitation. At least those patients who actively choose the outpatient setting gain as much as patients in inpatient rehabilitation. PMID:12007039

  12. Cardiac Rehabilitation in Real Life

    PubMed Central

    Jankowski, Piotr; Pajak, Andrzej; Lysek, Radoslaw; Lukaszewska, Anna; Wolfshaut-Wolak, Renata; Bogacki, Piotr; Grodecki, Janusz; Mirek-Bryniarska, Ewa; Nessler, Jadwiga; Podolec, Piotr; Kawecka-Jaszcz, Kalina; Czarnecka, Danuta

    2015-01-01

    Abstract Participation in cardiac rehabilitation programs (CRPs) improves prognosis in patients with coronary artery disease (CAD). However, not much is known about the effectiveness of CRP in real life. The aim of this analysis was to identify factors related to the referral to CRP following hospitalization for CAD and estimate the effectiveness of the programs in real life. Medical records of 1061 consecutive patients aged ≤80 years, hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure in 5 hospitals serving the city and surrounding counties, were reviewed and 611 patients were interviewed 6–18 months posthospitalization. Of 611 patients participating in the interview, 212 (34.7%) were referred following the hospitalization to a center providing CRP. Age, hospitalization in a teaching hospital, and index diagnosis were independently related to being granted a referral. Among the referred patients, 86.3% participated in the CRP. Participation in CRP was related to the lower probability of having high total cholesterol (23% vs 32%, P < 0.05), fasting glucose (11% vs 18%, P = 0.05), HbA1c (8% vs 16%, P = 0.05), and body mass index (27% vs 37%, P < 0.05). Generally, the effect of the CRP was significant in participants with a higher education, but not in those with a low education level. Other factors were not significantly related to the effectiveness of CRP. This study shows that CRPs are effective, but underused in Poland. The participant's education level may influence the effectiveness of CRP. Therefore, in order to increase the impact of CRP, the content of such programs should vary depending on the education level of the participants. PMID:26266357

  13. Outpatient Rehabilitation for Medicaid-insured Children Hospitalized With Traumatic Brain Injury

    PubMed Central

    Jimenez, Nathalia; Symons, Rebecca G.; Wang, Jin; Ebel, Beth H.; Vavilala, Monica S.; Buchwald, Dedra; Temkin, Nancy; Jaffe, Kenneth M.; Rivara, Frederick P.

    2016-01-01

    OBJECTIVES To describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services. METHODS Retrospective cohort of children <21 years, hospitalized for a TBI between 2007 and 2012, from a national Medicaid claims database. Outcome measures were receipt of outpatient rehabilitation (physical, occupational, or speech therapies or physician visits to a rehabilitation provider) 1 and 3 years after discharge. Multivariable regression analyses determined the association of demographic variables, injury severity, and receipt of inpatient services with receipt of outpatient rehabilitation at 1 and 3 years. The mean number of services was compared between racial/ethnic groups. RESULTS Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy. CONCLUSIONS Hospitalized children who received inpatient assessment of rehabilitation needs were more likely to continue outpatient rehabilitation care. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy. Interventions to increase inpatient rehabilitation during acute care might increase outpatient rehabilitation and improve outcomes for all children. PMID:27244850

  14. Cardiac Rehabilitation. A Handbook for Vocational Rehabilitation Counselors.

    ERIC Educational Resources Information Center

    Brammell, H. L.; And Others

    Basic information about heart disease and functional capacity assessment and its application to activity/job counseling are presented in this handbook for vocational rehabilitation counselors. Sections include the following: impact of heart disease; basic anatomy and physiology (e.g., the heart, pulmonary circulation, causes of cardiac pain, and…

  15. 42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... percutaneous coronary interventions; (2) An intensive cardiac rehabilitation program must also demonstrate... coronary artery bypass surgery; (iii) Current stable angina pectoris; (iv) Heart valve repair or replacement; (v) Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; (vi) A heart...

  16. 42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... percutaneous coronary interventions; (2) An intensive cardiac rehabilitation program must also demonstrate... coronary artery bypass surgery; (iii) Current stable angina pectoris; (iv) Heart valve repair or replacement; (v) Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; (vi) A heart...

  17. 42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... percutaneous coronary interventions; (2) An intensive cardiac rehabilitation program must also demonstrate... coronary artery bypass surgery; (iii) Current stable angina pectoris; (iv) Heart valve repair or replacement; (v) Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; (vi) A heart...

  18. Legal Aspects of Cardiac Rehabilitation Exercise Programs.

    ERIC Educational Resources Information Center

    Herbert, William; Herbert, David L.

    1988-01-01

    A medical model is used to examine liability issues related to cardiac rehabilitation programs. Obtaining effective informed consent from patients, standardizing policies and procedures, and exercise prescription and monitoring are among the proposed elements of a risk management model for developing safe and legally defensible programs. (IAH)

  19. Health Literacy Predicts Cardiac Knowledge Gains in Cardiac Rehabilitation Participants

    ERIC Educational Resources Information Center

    Mattson, Colleen C.; Rawson, Katherine; Hughes, Joel W.; Waechter, Donna; Rosneck, James

    2015-01-01

    Objective: Health literacy is increasingly recognised as a potentially important patient characteristic related to patient education efforts. We evaluated whether health literacy would predict gains in knowledge after completion of patient education in cardiac rehabilitation. Method: This was a re-post observational analysis study design based on…

  20. 42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... coronary artery bypass surgery; (iii) Current stable angina pectoris; (iv) Heart valve repair or replacement; (v) Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; (vi) A heart or heart-lung transplant. (vii) For cardiac rehabilitation only, other cardiac conditions as...

  1. Cardiac rehabilitation in Latin America.

    PubMed

    Anchique Santos, Claudia Victoria; Lopez-Jimenez, Francisco; Benaim, Briseida; Burdiat, Gerard; Fernandez Coronado, Rosalia; Gonzalez, Graciela; Herdy, Arthur; Medina-Inojosa, Jose; Santibañez, Claudio; Uriona Villarroel, Juan E; Zeballos, Cecilia

    2014-01-01

    This article provides a description of the status of cardiovascular (CV) rehabilitation (CVR) in Latin America (LA) and the potential impact on CV disease in the region. We discuss the insufficient number of CVR programs in the region and describe the components of CVR that are more commonly available, like exercise interventions, medical assessment and patient education. Additionally, we discuss the heterogeneity in other components, like the evaluation of depression, sleep apnea, and smoking cessation programs. Lastly, we provide a brief review on the main characteristics of the health systems of each country regarding access to CVR programs and compare the average cost of CV procedures and treatments with CVR. PMID:25220257

  2. Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization: ICAROS study. A survey from the Italian cardiac rehabilitation network: rationale and design.

    PubMed

    Griffo, Raffaele; Fattirolli, Francesco; Temporelli, Pier Luigi; Tramarin, Roberto

    2008-09-01

    In this paper, the Italian Association for Cardiac Prevention and Rehabilitation (GICR) presents the rationale and design of the "Italian survey on CArdiac RehabilitatiOn and Secondary prevention after cardiac revascularization (ICAROS)". The survey is a prospective, longitudinal, multicentric survey, with a on-line web-based data collection. Its design corresponds to the survey's goal, i.e. to describe accurately in the Italian cardiological setting, through a representative number of cardiac rehabilitation centers belonging to the GICR national network, the characteristics, content and effects in the medium term of cardiac rehabilitation (CRP) inpatient or outpatient programs offered to patients after coronary artery bypass (CABG) or percutaneous revascularization (PTCA). The primary aims of the study are: a) to define the principal clinical characteristics of patients who have undergone PTCA or CABG and have been admitted to a CRP program; b) to identify the components of the CRP programs in terms of diagnostic procedures and assessment tests performed, treatments administered, educational programs and physical exercise interventions employed; c) to identify and analyze drug treatments prescribed at discharge from the acute facility and those prescribed at the end of the CRP program; d) to verify the clinical outcome during the course of the CRP program and at 6 months and 1 year after the end of the post-acute CRP program, as well as patients' adherence to the prescribed pharmacological therapy and to the recommended life styles, and the achievement and maintenance of the targets in relation to the modifiable risk factors; e) to define the consumption of major healthcare resources (major cardiac events, hospital re-admission, emergency care access, specialist visits) during the first year following a CRP program. The survey population will consist of all patients consecutively discharged in the period November 3-30, 2008 at the end of an inpatient, day

  3. Cardiac rehabilitation outcome following percutaneous coronary intervention compared to cardiac surgery.

    PubMed

    Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro; Hiraki, Koji; Morio, Yuji; Kasahara, Yusuke; Osada, Naohiko; Omiya, Kazuto; Makuuchi, Haruo

    2011-05-01

    To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip and knee extensor muscle strength, peak oxygen uptake VO₂, upper- and lower-body self-efficacy for physical activity (SEPA), and physical component summary (PCS) and mental component summary (MCS) scores as assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS. All outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the CS versus PCI group in handgrip strength (+12.3 % vs. +8.1%, P < 0.01), knee extensor muscle strength (+19.3% vs. +17.5%, P = 0.008), peak VO₂ (+20.9% vs. +16.9%, P < 0.01), upper-body SEPA (+27.7% vs. +9.2 vs. , P = 0.001), and PCS score (+6.5% vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR increased all outcomes for both groups, outcomes showed the recovery process was different between the PCI and CS groups, slightly favoring CS patients. Furthermore, patents in the field of CR are presented. PMID:21513490

  4. Benefits of cardiac rehabilitation in heart failure patients according to etiology: INCARD French study.

    PubMed

    Koukoui, François; Desmoulin, Franck; Lairy, Gérard; Bleinc, Dominique; Boursiquot, Ludovic; Galinier, Michel; Smih, Fatima; Rouet, Philippe

    2015-02-01

    We investigated the impact of heart failure (HF) etiology on the outcome of cardiac rehabilitation (CR) assessed by functional and clinical parameters. Treatment of chronic HF requires multidisciplinary approaches with a recognized role for CR. INCARD is a French study aimed at evaluating the benefits of sustainable CR in coronary (C) and noncoronary patients (NC) treated and educated during a 24-month period of follow-up. Prospective, monocentric patients with HF underwent inpatient physical training followed by a home-based program. Evaluations were performed at inclusion, discharge, 3 months after discharge, and subsequently every 6 months over the 24 months of outpatient rehabilitation.A total of 147 HF patients with left ventricular ejection fraction (LVEF) <40 were admitted to the CR center, 63 accepted to join INCARD (29 C and 34 NC). Although the C participants C having both an echocardiographic LVEF and an initially lower peak VO2, inpatient rehabilitation improved all functional parameters. Only NC showed an improved LVEF during the first 3 months of outpatient-follow-up. The main outcome of the outpatient rehabilitation was a trend toward stabilization of clinical and laboratory parameters with no significant difference between C and NC. This study confirms the benefits of initial HF inpatient rehabilitation and encourages prolonged outpatient monitoring. The results on functional parameters suggest exercise training should be conducted regardless of the HF etiology. PMID:25700319

  5. The Ontario Cardiac Rehabilitation Pilot Project.

    PubMed

    Swabey, Terri; Suskin, Neville; Arthur, Heather M; Ross, Jillian

    2004-08-01

    In February 2001, the Ontario Ministry of Health and Long-Term Care announced a $9.6 million, 15-month pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of cardiac rehabilitation (CR) service delivery at 17 sites across Ontario. This is the second paper in a three-part, policy-related series which provides a summary of the Ontario CR Pilot model and the Pilot implementation and evaluation methodology. The aim of the present paper was to outline the goals of the Pilot, the Pilot model of care, the organizational structure that facilitated implementation of the model, and the operational procedures that were put in place to evaluate patient outcomes and the generalizability of a regional model of CR service delivery. The model was based on the findings and recommendations of the Cardiac Care Network of Ontario's 1999 Consensus Panel on Cardiac Rehabilitation and Secondary Prevention, which was described in part one of this series. An upcoming final paper will describe the outcomes of the project and its recommendations for CR health policy decisions in Ontario. PMID:15332143

  6. An expanded delivery model for outpatient burn rehabilitation.

    PubMed

    Wiechman, Shelley A; Carrougher, Gretchen J; Esselman, Peter C; Klein, Matthew B; Martinez, Erin M; Engrav, Loren H; Gibran, Nicole S

    2015-01-01

    Despite the numerous multidisciplinary services burn centers provide, a number of challenges to obtaining optimal outcomes exist. The goal of this study was to overcome the barriers to effective burn rehabilitation by utilizing an expanded care coordinator (ECC) to supplement the existing outpatient services. In this between-group, single-blind, randomized, controlled trial, the control group (n = 41) received standard outpatient care and the experimental group (n = 40) received additional services provided by the ECC, including telephone calls at set intervals (24 hours postdischarge, 2, 4, 8, 12 weeks postdischarge and 5, 7, 9 months postdischarge). The ECC was trained in motivational interviewing, crisis intervention, and solution-focused counseling. He assisted patients before and after each clinic visit, coordinated outpatient services in their geographic area (physical and occupational therapy, counseling, primary care provider referrals, etc.), and helped develop problem-solving approaches to accomplish individualized goals. Outcome measures included patient identified goals utilizing the goal attainment scale, the urn-specific health scale-brief, the Short Form 12, a patient satisfaction survey, and a return to work survey. The average subject age was 43 years (SD = 16.9) with a mean TBSA of 19% (SD = 18.8). The average length of hospitalization was 36 days (SD = 42.9). The patient and injury characteristics were similar between the study groups. For the experimental group, 33% completed seven calls, with 23% completing all the eight calls. All were assessed using general linear models and were adjusted for sex, age, length of hospitalization, urban vs rural area of residence, %TBSA burn, and ethnicity. There was no difference between the control and experimental groups for any of the outcome measures at either 6 or 12 months postburn. No differences in outcomes between the groups were found. All participants appreciated the individualized goal setting

  7. [Optimization of the transition from phase II to III of cardiac rehabilitation].

    PubMed

    Keck, M

    2000-04-01

    A decisive element of reliable maintenance of the rehabilitation result achieved by patients undergoing inpatient cardiac rehabilitation has turned out to be comprehensive and successful management of the transition into the outpatient phase. This requires concrete planning and implementation of the concept, to be based on patient-related approaches and including the family physician, relatives, occupational institutions, and local and regional partners such as adult education centres, health insurances, sports clubs, psychological individual care, etc. Problem-orientated planning adapted to the individual requirements and expectations of the patient is of utmost importance. PMID:10832165

  8. Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

    PubMed Central

    Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2014-01-01

    Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and

  9. [Cardiac rehabilitation in patients with atrial fibrillation].

    PubMed

    Schlitt, Axel; Kamke, Wolfram; Guha, Manju; Haberecht, Olaf; Völler, Heinz

    2015-06-01

    The course of cardiac rehabilitation is often altered due to episodes of paroxysmal, predominantly postoperative atrial fibrillation. In symptomatic patients, a TEE-guided cardioversion - preferential DC shock - is indicated. In patients with persistent / permanent atrial fibrillation, a heart rate up to 110 / min and 170 / min at rest and during physical activity should, respectively, be tolerated. Therefore, training should not be quitted by heart rate but rather by load. The antithrombotic management is in addition a great task in treating patients with atrial fibrillation. With the exception of patients with a CHA2DS2-VASc-Score < 1, oral anticoagulation is indicated. Atrial fibrillation has little impact on social aspects, whereas the underlying heart disease and drug treatment (oral anticoagulation) has an important impact. PMID:26115137

  10. Cardiac rehabilitation past, present and future: an overview

    PubMed Central

    2012-01-01

    Cardiac Rehabilitation has evolved over the past decades from a simple monitoring for the safe return to physical activities to a multidisciplinary approach that focuses on patient education, individually tailored exercise training, modification of the risk factors and the overall well-being of the cardiac patients. It has been proven to be an effective tool for the care of the patients with heart disease. Recent research in cardiac rehabilitation has demonstrated that tremendous benefits can be derived from the optimal use of cardiac rehabilitation in patients with various cardiac pathologies including ischemic heart disease, heart failure and post heart surgery. The benefits of cardiac rehabilitation include mortality reduction, symptom relief, reduction in smoking and improved exercise tolerance, risk factors modification and the overall psychosocial wellbeing. Unfortunately, cardiac rehabilitation remains considerably underutilized mainly because of referral problems and poor enrollment. The development of alternate approaches and the use of transtelephonic and other means of monitoring and surveillance will help expand the utilization of cardiac rehabilitation. PMID:24282695

  11. Home-based versus centre-based cardiac rehabilitation

    PubMed Central

    Taylor, Rod S; Dalal, Hayes; Jolly, Kate; Moxham, Tiffany; Zawada, Anna

    2014-01-01

    Background The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Traditionally centre-based cardiac rehabilitation (CR) programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. Objectives To determine the effectiveness of home-based cardiac rehabilitation programmes compared with supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life and modifiable cardiac risk factors in patients with coronary heart disease. Search methods We updated the search of a previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January 2008. We checked reference lists and sought advice from experts. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes, in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Data collection and analysis Studies were selected independently by two reviewers, and data extracted by a single reviewer and checked by a second one. Authors were contacted where possible to obtain missing information. Main results Twelve studies (1,938 participants) met the inclusion criteria. The majority of studies recruited a lower risk patient following an acute myocardial infarction (MI) and revascularisation. There was no difference in outcomes of home- versus centre-based cardiac rehabilitation in mortality risk ratio (RR) was 1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events, exercise capacity standardised mean difference (SMD) −0.11 (95% CI −0.35 to 0.13), as well

  12. Are older patients’ cardiac rehabilitation needs being met?

    PubMed Central

    Tolmie, Elizabeth P; Lindsay, Grace M; Kelly, Tim; Tolson, Debbie; Baxter, Susan; Belcher, Philip R

    2009-01-01

    Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Design. Mixed methods. Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’. Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older

  13. Efficacy of cardiac rehabilitation. 1: A critique of the research.

    PubMed

    Brennan, A

    This article, the first of two parts, suggests that cardiac rehabilitation has two primary foci: the reduction of morbidity and mortality, and the amelioration of distress associated with cardiac pathology. While exercise programmes figure prominently in cardiac rehabilitation, empirical studies attest to their relatively modest impact on the recurrence of myocardial infarction. Other interventions such as stress management programmes reduce psychological distress and increase effective coping mechanisms, but only for a limited period. Traditional educational programmes compare unfavourably with cognitive-behavioural interventions. Empirical research appraising the efficacy of many cardiac rehabilitation interventions are tainted by numerous design problems. The second part of this article considers research into the efficacy of smoking cessation and type A behaviour modification programmes. PMID:9238918

  14. A personalised approach to cardiac rehabilitation.

    PubMed

    Normington, K; Goodwin, S

    2000-04-01

    Patients' beliefs about their myocardial infarction will affect their physical and emotional recovery. An individualised, behavioural approach to rehabilitation aims to treat the patient as an adult learner who participates fully in negotiating priorities for rehabilitation. Initiating rehabilitation advice in the very early stages post-AMI requires the use of specific nursing interventions. PMID:11129924

  15. 42 CFR 424.27 - Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for comprehensive outpatient rehabilitation facility (CORF) services. 424.27 Section 424.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Certification and Plan Requirements...

  16. 42 CFR 424.27 - Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Requirements for comprehensive outpatient rehabilitation facility (CORF) services. 424.27 Section 424.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Certification and Plan Requirements...

  17. 42 CFR 424.27 - Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Requirements for comprehensive outpatient rehabilitation facility (CORF) services. 424.27 Section 424.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) CONDITIONS FOR MEDICARE PAYMENT Certification and...

  18. 42 CFR 424.27 - Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Requirements for comprehensive outpatient rehabilitation facility (CORF) services. 424.27 Section 424.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) CONDITIONS FOR MEDICARE PAYMENT Certification and...

  19. The costs and benefits of technology-enabled, home-based cardiac rehabilitation measured in a randomised controlled trial.

    PubMed

    Whittaker, Frank; Wade, Victoria

    2014-10-01

    We conducted a cost benefit analysis of a home telehealth-based cardiac rehabilitation programme compared to the standard hospital-based programme. A total of 120 participants were enrolled in a trial, with 60 randomised to the telehealth group and 60 randomised to usual care. Participants in the telehealth group received a mobile phone, Wellness Diary and a Wellness web portal, with daily text messaging. Participants in the usual care group received the standard 6-week hospital-based outpatient cardiac rehabilitation programme, including gym sessions. The cost of delivery by telehealth was slightly lower than for patients attending a rehabilitation service in person. From the provider's perspective, the telehealth intervention could be delivered for $1633 per patient, compared to $1845 for the usual care group. From the participant's perspective, patient travel costs for home rehabilitation were substantially less than for hospital attendance ($80 vs $400). Cardiac rehabilitation by telehealth offers obvious advantages and the option should be available to all patients who are eligible for cardiac rehabilitation. PMID:25400004

  20. [Selection criteria for patient admission to cardiac rehabilitation centers].

    PubMed

    Greco, Cesare; Cacciatore, Giuseppe; Gulizia, Michele; Martinelli, Luigi; Oliva, Fabrizio; Olivari, Zoran; Seccareccia, Fulvia; Temporelli, Pier Luigi; Urbinati, Stefano

    2011-03-01

    Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the post-acute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase. PMID:21560480

  1. [Selection criteria for referral to cardiac rehabilitation centers].

    PubMed

    Greco, Cesare; Cacciatore, Giuseppe; Gulizia, Michele; Martinelli, Luigi; Oliva, Fabrizio; Olivari, Zoran; Seccareccia, Fulvia; Temporelli, Pier Luigi; Urbinati, Stefano

    2011-03-01

    Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the postacute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase. PMID:21751732

  2. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263

    PubMed Central

    Jolly, Kate; Lip, Gregory YH; Sandercock, Josie; Greenfield, Sheila M; Raftery, James P; Mant, Jonathan; Taylor, Rod; Lane, Deirdre; Lee, Kaeng Wai; Stevens, AJ

    2003-01-01

    Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation

  3. ECG Monitoring in Cardiac Rehabilitation: Is It Needed?

    ERIC Educational Resources Information Center

    Greenland, Philip; Pomilla, Paul V.

    1989-01-01

    Discusses the controversial use of continuous electrocardiogram (ECG) monitoring as a safety measure in cardiac rehabilitation exercise programs. Little evidence substantiates its value for all patients during exercise. In the absence of empirical evidence documenting the worth of this expensive procedure, it is recommended for use with high-risk…

  4. Multidisciplinary VA Cardiac Rehabilitation: Preliminary Results and Treatment Efficacy.

    ERIC Educational Resources Information Center

    Daly, Susan S.; And Others

    Initial studies have suggested that a cardiac rehabilitation program (CRP) may improve the physical and psychological functioning of participants. However, these studies have generally addressed a relatively young group of employed adult males. Three studies were designed to target an older, generally retired Veterans Administration population for…

  5. Best Practices for Counseling in Cardiac Rehabilitation Settings

    ERIC Educational Resources Information Center

    Sheikh, Alia I.; Marotta, Sylvia A.

    2008-01-01

    Heart disease is the leading cause of death in the United States and can affect individuals of all ages, gender, ethnicity, and socioeconomic status. This article reviews the research on psychosocial interventions in cardiac rehabilitation programs and discusses the evolving set of best practices for counselors working in a new setting with people…

  6. Responsiveness of Health-Related Quality of Life Outcome Measures in Cardiac Rehabilitation: Comparison of Cardiac Rehabilitation Outcome Measures

    ERIC Educational Resources Information Center

    Hevey, David; McGee, Hannah M.; Horgan, John

    2004-01-01

    Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each…

  7. Sex education and rehabilitation with schizophrenic male outpatients.

    PubMed

    Lukoff, D; Gioia-Hasick, D; Sullivan, G; Golden, J S; Nuechterlein, K H

    1986-01-01

    Research indicates that schizophrenic patients lack intimate relationships and show a high rate of sexual dysfunction. Despite increasing awareness of the rights of handicapped persons to sexual expression, the treatment of schizophrenic patients rarely addresses their sexuality. A sex education program for recent-onset male schizophrenic patients attending an outpatient clinic was developed in response to several incidents involving patients' inappropriate sexual behaviors. To enhance our understanding of the current sexual functioning and needs of these patients, sex histories were taken. Almost all of the 16 patients interviewed were sexually active, with autoerotic activity predominating. Sixty-three percent of the patients reported orgasmic and/or erectile dysfunctions. Other studies have linked sexual dysfunction to the side effects of antipsychotic medications. The objectives of the sex education program were: to provide information; to clarify values; to overcome sexual dysfunction; and to enhance intimacy skills. The authors used role playing, modeling, group exercises, and explicit sex therapy audiovisual material to improve patients' intimacy skills. Patients participated actively and used the group to explore sexual issues. No exacerbations of symptoms were observed among patients participating in the program. PMID:3027886

  8. [A multidisciplinary approach to cardiac rehabilitation].

    PubMed

    Barbet, Régis; Caux, Christelle; Brysse, Lydie; Foy, Mireille; Cardon, Cindy

    2015-03-01

    The rehabilitation of a coronary patient involves numerous professionals in a global care approach. The objective is to reintroduce physical activity and put in place lifestyle changes, in order to reduce the risk factors. Therapeutic education is an essential part of this support. PMID:26040143

  9. Review of High-intensity Interval Training in Cardiac Rehabilitation.

    PubMed

    Ito, Shigenori; Mizoguchi, Tatsuya; Saeki, Tomoaki

    2016-01-01

    For the secondary prevention of cardiovascular disease, comprehensive cardiac rehabilitation is required. This involves optimal medical therapy, education on nutrition and exercise therapy, and smoking cessation. Of these, efficient exercise therapy is a key factor. A highly effective training protocol is therefore warranted, which requires a high rate of compliance. Although moderate-intensity continuous training has been the main training regimen recommended in cardiac rehabilitation guidelines, high-intensity interval training has been reported to be more effective in the clinical and experimental setting from the standpoint of peak oxygen uptake and central and peripheral adaptations. In this review, we illustrate the scientific evidence for high-intensity interval training. We then verify this evidence and discuss its significance and the remaining issues. PMID:27580530

  10. Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty.

    PubMed

    Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J

    2015-05-01

    Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. PMID:25765128

  11. Exercise-based cardiac rehabilitation for coronary heart disease

    PubMed Central

    Heran, Balraj S; Chen, Jenny MH; Ebrahim, Shah; Moxham, Tiffany; Oldridge, Neil; Rees, Karen; Thompson, David R; Taylor, Rod S

    2014-01-01

    Background The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health. Objectives To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD. Search methods RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009). Selection criteria Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography. Data collection and analysis Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information. Main results This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health

  12. Return to flight status after cardiac rehabilitation: three case histories.

    PubMed

    Dwyer, J

    2001-01-01

    A pilot's license to operate aircraft is not valid unless it is accompanied by a medical certificate. This certificate is revoked if a pilot is diagnosed with a cardiovascular illness. After a lengthy waiting period, the medical certificate may be reinstated if the pilot meets rigid standards. For many pilots, participation in a cardiac rehabilitation program is essential to achieve the minimal functional capacity in exercise testing (10.0 metabolic equivalents), document tolerance of medications, and achieve successful rehabilitation. Our staff has assisted 11 pilots in their quest to resume commercial or recreational flying after heart surgery, pacemaker implantation, or angioplasty. This article summarizes the case histories of three pilots who returned to fight status, in three Federal Aviation Administration categories (FAA), after a cardiac illness. The principle goals of our rehabilitation program for pilots are: (1) to achieve the highest possible outcome of the rehabilitation process; (2) to establish a safe and effective independent exercise program; (3) to obtain measures of compliance and success with the independent exercise program; (4) to document tolerance of medications and ensure that medications are acceptable to the FAA; (5) to document stability of the serum glucose in diabetic patients engaged in rigorous, prolonged exercise; and (6) prepare the patient for performance of a treadmill test in which 100% predicted maximum heart rate is achieved without symptoms of cardiovascular distress. An inherent effect of pursuing these goals is dramatic risk factor modification including improved blood pressure and lipid status and reduced body mass index. After resumption of flying, none of our pilot-patients have experienced cardiac symptoms during flight, nor have they required emergency department visits or hospitalization for any reason. PMID:11591042

  13. Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach

    PubMed Central

    Castelnuovo, Gianluca; Manzoni, Gian Mauro; Pietrabissa, Giada; Corti, Stefania; Giusti, Emanuele Maria; Molinari, Enrico; Simpson, Susan

    2014-01-01

    Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area. PMID:24959157

  14. Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation: Can we learn from cardiac rehabilitation?

    PubMed

    Triest, Filip Jj; Singh, Sally J; Vanfleteren, Lowie Egw

    2016-08-01

    Patients with chronic obstructive pulmonary disease (COPD) who participate in pulmonary rehabilitation (PR) often have concomitant cardiovascular disease (CVD), which is a frequently undiagnosed and undertreated comorbidity. CVD contributes to the burden of the disease and is associated with an increased risk for hospitalizations and mortality. Optimizing the diagnosis and management of cardiovascular risk and disease should be considered as part of the holistic approach of PR. In addition, we need to consider similarities and differences in cardiac and PR programs, in order to improve personalized care in patients with both diseases. The current review addresses the burden of CVD in COPD patients who participate in PR, how CVD and its risk factors affect PR and should be managed during PR, and extends on what we can learn of the organization of cardiac rehabilitation programs. PMID:27081189

  15. Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

    PubMed Central

    Lee, Jea-Geun; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

    2016-01-01

    Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Results Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). Conclusion No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group. PMID:27014347

  16. Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

    PubMed Central

    Ringbaek, Thomas J.; Lavesen, Marie; Lange, Peter

    2016-01-01

    Background A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). Objective To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. Methods A total of 115 patients participated in a 7- to 10-week outpatient PR programme in groups of 10–12 individuals. Half of the groups were assigned to PR plus a tablet (tablet group) and the other groups were assigned to PR only (controls). Primary effect parameters were endurance shuttle walk time (ESWT) and disease-specific health status (COPD Assessment Test=CAT). Results The change in ESWT was significantly better in the control group (mean 167 sec) compared with the tablet group (mean 51 sec) (p<0.01), whereas the change in CAT score did not differ significantly between the two groups (−0.6 vs. −2.3) (p=0.17). Conclusions Compared with usual PR, no significant improvements were seen in the group equipped with the tablet after 7–10 weeks of rehabilitation. Future studies should focus on long-term effects. PMID:27225598

  17. Resistive exercise training in cardiac rehabilitation. An update.

    PubMed

    Verrill, D E; Ribisl, P M

    1996-05-01

    Resistive exercise training has become very popular for patients of cardiopulmonary rehabilitation programmes (CRPs). For decades, CRPs focused almost exclusively on improving cardiorespiratory endurance and most programmes ignored muscular fitness development. Moreover, resistance training was thought to be potentially hazardous for the cardiac patient due to the risk of cardiovascular complications from adverse haemodynamic responses. We now know that resistive exercise testing and training is very safe for properly screened patients, even at relatively high workloads. Improvement in muscular strength facilitates return to daily vocational and avocational activities and is important for the CRP participant to regain lost strength and resume work soon after a cardiac event. Circuit weight training (CWT) is helpful in this respect and has been shown to increase muscular strength, cardiovascular endurance, body composition, bone density and mineral content, self-confidence, and self-efficacy in various populations. This article presents an update on current research in cardiac patients and also presents guidelines for implementing a properly supervised cardiac resistive exercise programme. PMID:8724203

  18. Cardiovascular prevention and rehabilitation in the elderly: evidence for cardiac rehabilitation after myocardial infarction or chronic heart failure.

    PubMed

    Fattirolli, Francesco; Pratesi, Alessandra

    2016-01-01

    Cardiac rehabilitation in the elderly today often represents a utopia. The international scientific literature takes little into account this type of prescription for old people, although they represent a large and growing proportion of cardiac patients, with acute coronary syndrome or heart failure, which we have to manage in everyday life. Furthermore, interventions of health education, clinical follow up, rehospitalisation prevention and prescription of tailored exercise, are sometimes more necessary in this kind of patients, given the presence of multimorbidity, functional dependence, frailty, sarcopenia, social neglect. Most of the data on the feasibility, safety and efficacy of cardiac rehabilitation are favourable, but they are few and apparently not strong enough to convince the medical community. Therefore is necessary to join efforts to identify the geriatric patient's peculiarities and plan a suitable program of cardiac rehabilitation, which takes into account the multi-dimensionality and complexity of typical problems of the elderly, for which the classical cardiac outcomes can be limited. PMID:27374045

  19. Bandura's self-efficacy theory: a guide for cardiac rehabilitation nursing practice.

    PubMed

    Jeng, C; Braun, L T

    1994-12-01

    To help patients achieve the greatest benefit from cardiac rehabilitation programs, nurses must assist them to modify unhealthy behaviors. Many cardiac rehabilitation programs, however, lack a theoretical foundation; therefore, interventions are usually executed without accounting for the complexities of human behavior, and little consideration is given to the difficulties encountered in altering unhealthy behavior patterns. Bandura's self-efficacy theory is considered a suitable model for cardiac rehabilitation because it provides a systematic direction which allows one to interpret, modify, and predict patients' behaviors. This article describes the development of and conceptual framework for Bandura's theory, how it provides a basis for measurement of self-efficacy, and how it may be applied to the study of cardiac rehabilitation. Finally, some research issues, which are related to applications of self-efficacy theory in cardiac rehabilitation are discussed. PMID:7722281

  20. Effects of a brief intervention on retention of patients in a cardiac rehabilitation program.

    PubMed

    McGrady, Angele; Burkes, Robert; Badenhop, Dalynn; McGinnis, Ron

    2014-12-01

    This intervention assessed the effects of a brief intervention on dropout rate in a cardiac rehabilitation program. One hundred thirty five patients were recruited from a cardiac rehabilitation program and randomized to either a control or intervention group. The intervention group participated in four sessions of motivational interviewing and stress management-relaxation in addition to standard cardiac rehabilitation. The control group underwent cardiac rehabilitation alone. Patients who completed the intervention completed an average of 30 sessions while those who dropped out of the intervention completed about six (p < 0.001). Anxiety and depression measured at baseline were the primary predictors of dropout. Patients in both the intervention and controls groups who completed cardiac rehabilitation improved the distance walked, quality of life and decreased anxiety. PMID:25150038

  1. ISYDE-2008. Study presentation. The Italian survey on cardiac rehabilitation: a snapshot of current cardiac rehabilitation programmes and providers in Italy.

    PubMed

    Tramarin, Roberto; De Feo, Stefania; Ambrosetti, Marco; Griffo, Raffaele; Maslowsky, Franco; Vaghi, Paola

    2007-12-01

    The Italian Society of Cardiac Rehabilitation and Prevention (GICR) has developed the ISYDE-2008 survey with the purpose to take a detailed snapshot in terms of number, distribution, facilities, staffing levels, organization, and programme details of CR units in Italy and to compare actual provision with the recommendation of National GL for CR and secondary prevention. The study will be carried out with a web-based questionnaire running on the GICR website in 2 weeks from Jan. 28 to Feb. 10, 2008. The first part of the questionnaire is designed to collect information on the institutional organization of the CR unit, on its location and functional relationships within the hospital, on the number of beds for inpatient CR units and hours of activity for outpatient and home-based services, on the composition of the core and multidisciplinary teams, and finally on the components of CR programmes. In the second part of the survey, CR directors will be requested to report for each patient discharged during the 2 weeks of the study, indications for admission to CR, time of enrolment, comorbidity, complications, risk profile, diagnostic procedures, exercise and educational programme, discharge modalities, treatment at discharge and follow-up schedule. More than 2300 pts are expected to enter in the survey, whose results depicting the status of CR in Italy will be available within April 2008. PMID:18361217

  2. [The ISYDE project. A survey on Cardiac Rehabilitation in Italy].

    PubMed

    Urbinati, Stefano; Fattirolli, Francesco; Tramarin, Roberto; Chieffo, Carmine; Temporelli, Pierluigi; Griffo, Raffaele; Belardinelli, Romualdo; Vaghi, Paola; Briolotti, Luisa

    2003-03-01

    In 2001-2002 the Italian Working Group on Cardiac Rehabilitation (CR) developed the ISYDE project, a survey on CR in Italy. In 2001, the CR units were 144 (57% in the North of the country), 58% in general hospitals, 23% in private hospitals, 8% in rehabilitative hospital, and only 2% in university clinics. Patients admitted to CR were 60,819 (vs 37.049 in 1996, +64%); 86% of CR units treated > 100 pts/year (vs 66% in 1996; +32%). Patients were admitted to CR units after cardiosurgery in 55% of cases, after myocardial infarction in 22%, and for chronic heart failure in 9.6%, without significant differences respect to 1996. A special survey investigated the work-up performed in patients with recent myocardial infarction. The admission ranges from 11th to 20th day, the mean duration of the CR programs ranges from 21 to 34 days. Most of italian CR units have a definite program for risk stratification and secondary prevention. In particular, the programs of exercise training, educational interventions concerning diet, lifestyle, and smoking cessation, and psychological intervention are well designed, developed, and evaluated before discharge in most cases. In conclusion, although in recent years the number of CR units are increasing, and the quality of care may be well-established by serial evaluations scheduled before discharge and during the long-term follow-up, a further development is mandatory to face the needs of cardiac patients in the post-acute and chronic phase of a cardiac disease. PMID:12827829

  3. How do hospital administrators perceive cardiac rehabilitation in a publicly-funded health care system?

    PubMed Central

    2013-01-01

    Background Patient and provider-related factors affecting access to cardiac rehabilitation (CR) have been extensively studied, but health-system administration factors have not. The objectives of this study were to investigate hospital administrators’ (HA) awareness and knowledge of cardiac rehabilitation (CR), perceptions regarding resources for and benefit of CR, and attitudes toward and implementation of inpatient transition planning for outpatient CR. Methods A cross-sectional and observational design was used. A survey was administered to 679 HAs through Canadian and Ontario databases. A descriptive examination was performed, and differences in HAs’ perceptions by role, institution type and presence of within-institution CR were compared using t-tests. Results 195 (28.7%) Canadian HAs completed the survey. Respondents reported good knowledge of what CR entails (mean=3.42±1.15/5). Awareness of the closest site was lower among HAs working in community versus academic institutions (3.88±1.24 vs. 4.34±0.90/5 respectively; p=.01). HAs in non-executive roles (4.77±0.46/5) perceived greater CR importance for patients’ care than executives (4.52±0.57; p=.001). HAs perceived CR programs should be situated in both hospitals and community settings (n=134, 71.7%). Conclusions HAs value CR as part of patients’ care, and are supportive of greater CR provision. Those working in community settings and executives may not be as aware of, or less-likely to value, CR services. CR leaders from academic institutions might consider liaising with community hospitals to raise awareness of CR benefits, and advocate for it with the executives in their home institutions. PMID:23537384

  4. Smartphone-Based Cardiac Rehabilitation Program: Feasibility Study

    PubMed Central

    Chung, Heewon; Yoon, Kwon-Ha; Lee, Jinseok

    2016-01-01

    We introduce a cardiac rehabilitation program (CRP) that utilizes only a smartphone, with no external devices. As an efficient guide for cardiac rehabilitation exercise, we developed an application to automatically indicate the exercise intensity by comparing the estimated heart rate (HR) with the target heart rate zone (THZ). The HR is estimated using video images of a fingertip taken by the smartphone’s built-in camera. The introduced CRP app includes pre-exercise, exercise with intensity guidance, and post-exercise. In the pre-exercise period, information such as THZ, exercise type, exercise stage order, and duration of each stage are set up. In the exercise with intensity guidance, the app estimates HR from the pulse obtained using the smartphone’s built-in camera and compares the estimated HR with the THZ. Based on this comparison, the app adjusts the exercise intensity to shift the patient’s HR to the THZ during exercise. In the post-exercise period, the app manages the ratio of the estimated HR to the THZ and provides a questionnaire on factors such as chest pain, shortness of breath, and leg pain during exercise, as objective and subjective evaluation indicators. As a key issue, HR estimation upon signal corruption due to motion artifacts is also considered. Through the smartphone-based CRP, we estimated the HR accuracy as mean absolute error and root mean squared error of 6.16 and 4.30bpm, respectively, with signal corruption due to motion artifacts being detected by combining the turning point ratio and kurtosis. PMID:27551969

  5. Smartphone-Based Cardiac Rehabilitation Program: Feasibility Study.

    PubMed

    Chung, Heewon; Ko, Hoon; Thap, Tharoeun; Jeong, Changwon; Noh, Se-Eung; Yoon, Kwon-Ha; Lee, Jinseok

    2016-01-01

    We introduce a cardiac rehabilitation program (CRP) that utilizes only a smartphone, with no external devices. As an efficient guide for cardiac rehabilitation exercise, we developed an application to automatically indicate the exercise intensity by comparing the estimated heart rate (HR) with the target heart rate zone (THZ). The HR is estimated using video images of a fingertip taken by the smartphone's built-in camera. The introduced CRP app includes pre-exercise, exercise with intensity guidance, and post-exercise. In the pre-exercise period, information such as THZ, exercise type, exercise stage order, and duration of each stage are set up. In the exercise with intensity guidance, the app estimates HR from the pulse obtained using the smartphone's built-in camera and compares the estimated HR with the THZ. Based on this comparison, the app adjusts the exercise intensity to shift the patient's HR to the THZ during exercise. In the post-exercise period, the app manages the ratio of the estimated HR to the THZ and provides a questionnaire on factors such as chest pain, shortness of breath, and leg pain during exercise, as objective and subjective evaluation indicators. As a key issue, HR estimation upon signal corruption due to motion artifacts is also considered. Through the smartphone-based CRP, we estimated the HR accuracy as mean absolute error and root mean squared error of 6.16 and 4.30bpm, respectively, with signal corruption due to motion artifacts being detected by combining the turning point ratio and kurtosis. PMID:27551969

  6. What Does It Take? Comparing Intensive Rehabilitation to Outpatient Treatment for Children With Significant Pain-Related Disability

    PubMed Central

    Sieberg, Christine B.; Pielech, Melissa; Conroy, Caitlin; Logan, Deirdre E.

    2013-01-01

    Objectives This study compared outcomes between day hospital pain rehabilitation patients and patients engaged in outpatient multidisciplinary pain treatment. Methods This study included 100 children who presented for an initial tertiary care pain clinic evaluation. 50 patients enrolled in intensive day hospital pain rehabilitation and 50 patients pursued outpatient multidisciplinary treatment. Across 2 time points, children completed measures of functional disability, pain-related fear, and readiness to change and parents completed measures of pain-related fear and readiness to change. Results Across both treatment modalities, patients and parents reported improvements. Patients enrolled in intensive pain rehabilitation had significantly larger improvements in functional disability, pain-related fear, and readiness to change. Parents of day hospital patients reported larger declines in child pain-related fear and increased readiness to change compared with their outpatient counterparts. Discussion For patients with high levels of pain-related disability and distress, intensive pain rehabilitation provides rapid, dramatic improvements in functioning. PMID:23104827

  7. Update in cardiology: vascular risk and cardiac rehabilitation.

    PubMed

    Galve, Enrique; Cordero, Alberto; Bertomeu-Martínez, Vicente; Fácila, Lorenzo; Mazón, Pilar; Alegría, Eduardo; Fernández de Bobadilla, Jaime; García-Porrero, Esteban; Martínez-Sellés, Manuel; González-Juanatey, José Ramón

    2015-02-01

    As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case. PMID:25583549

  8. Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols

    PubMed Central

    da Silva, Anne Kastelianne França; Barbosa, Marianne Penachini da Costa de Rezende; Bernardo, Aline Fernanda Barbosa; Vanderlei, Franciele Marques; Pacagnelli, Francis Lopes; Vanderlei, Luiz Carlos Marques

    2014-01-01

    Objective Gather and describe general characteristics of different protocols of risk stratification for cardiac patients undergoing exercise. Methods We conducted searches in LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO electronic databases, using the following descriptors: Cardiovascular Disease, Rehabilitation Centers, Practice Guideline, Exercise and Risk Stratification in the past 20 years. Results Were selected eight studies addressing methods of risk stratification in patients undergoing exercise. Conclusion None of the methods described could cover every situation the patient can be subjected to; however, they are essential to exercise prescription. PMID:25140477

  9. [Participation in cardiac rehabilitation after coronary bypass surgery: good news, bad news].

    PubMed

    Henkin, Yaakov

    2012-09-01

    Cardiac rehabilitation programs have the potential to decrease morbidity and mortality and increase quality of life after acute coronary events and coronary bypass surgery (CABG). Unfortunately, the proportion of eligible patients that participate in cardiac rehabilitation remains low, despite coverage of such programs by the Israeli National Health Insurance. A low participation rate is especially prominent in women, elderly, minorities and low socioeconomic classes. In this edition of Harefuah, Gendler et at conducted an interventional study aimed at increasing the participation of patients in cardiac rehabilitation programs after CABG in 5 cardiothoracic wards across Israel. They interviewed 489 patients in the intervention arm and 472 patients in the control arm before surgery and a year later. The intervention included dissemination of information on cardiac rehabilitation to the medical staff and patients. Following the intervention, cardiac rehabilitation increased almost twofold in veteran-Israeli males and females. Although it increased significantly in USSR-born male immigrants, their absolute rate of participation remained low (13.6%). No USSR-born female participated in rehabilitation, either before or after the intervention. The good news is that a simple, inexpensive intervention can increase participation in cardiac rehabilitation after CABG surgery. The bad news is that this potentially lifesaving activity remains unattended by most USSR-born immigrants, and particularly by females. Additional research is required to explore the cultural, social and economic barriers of this phenomenon. PMID:23367745

  10. Correlates of the timed 25 foot walk in a multiple sclerosis outpatient rehabilitation clinic.

    PubMed

    Bethoux, Francois A; Palfy, Dylan M; Plow, Matthew A

    2016-06-01

    The Timed 25 Foot Walk (T25FW), a test of maximum walking speed on a short distance, is commonly used to monitor ambulation status and to assess treatment outcomes in multiple sclerosis (MS). The main aim of this study was to determine how walking speed on the T25FW correlates with other clinician-reported and patient-reported measures in an outpatient MS rehabilitation clinic. We analyzed cross-sectional data systematically collected during a physiatry evaluation for the management of spasticity and walking limitations. In addition to demographic variables and the Expanded Disability Status Scale (EDSS), measures of body functions [lower extremity manual muscle testing (LE MMT), lower extremity Modified Ashworth Scale, Fatigue Severity Scale, leg pain], and measures of activity and quality of life (reported frequency of falls, Incapacity Status Scale, Rivermead Mobility Index, EQ5D health questionnaire, and Patient Health Questionnaire-9 items) were administered. A multivariate regression analysis was carried out. 199 patients were included in the analysis [age 49.41 (9.89) years, disease duration 15.40 (10.22) years, EDSS score 5.6 (1.2), and T25FW speed 70.93 (44.13) cm/s]. Both EDSS and LE MMT were correlated significantly with T25FW speed (R=0.692, P<0.001). After adjusting for EDSS and LE MMT, lower T25FW speed was associated with higher Incapacity Status Scale scores (R=0.316, P<0.001), lower Rivermead Mobility Index scores (R=0.540, P<0.001), and higher frequency of falls. EQ5D and Patient Health Questionnaire-9 items were not significantly associated with T25FW speed. Our findings support the clinical relevance of the T25FW in the rehabilitation of patients with MS. PMID:26926380

  11. Experience of Spiritual Care in Cardiac Rehabilitation: An Interpretative Phenomenological Analysis.

    PubMed

    Hosseini, Mohammadali; Davidson, Patricia M; Khoshknab, Masoud Fallahi; Nasrabadi, Alireza Nikbakht

    2015-06-01

    The aim of the study was to explore the experience of spiritual care among a cardiac rehabilitation team. Spiritual care is an important dimension of providing comprehensive care, and understanding the views of health professionals is pivotal to making recommendations for caring. This study used an interpretive phenomenological approach. Semi-structured interviews were undertaken with 13 cardiac rehabilitation professionals. Seven persons participated in individual interviews and six in focus group discussions. Data were analyzed using Smith and Osborn's interpretative phenomenological analysis method. Study data were categorized into more than 150 initial themes, 12 clustered and four superordinate themes, included: 'Helping patients to obtain a meaningful sense of being', 'Providing religious/spiritual focused care', 'holistic approach to rehabilitation is needed' and 'spirituality as a neglected aspect of rehabilitation'. Participants described that they did not have sufficient training in providing spiritual care. Nurses' awareness of spiritual care meaning among a cardiac rehabilitation team is helping to respond to rehabilitation care in a holistic approach. Helping patients to get a meaningful sense of being is an important part of assisting in recovery and adjustment following an acute cardiac event. Providing clear guidelines and support for providing spiritual care in cardiac rehabilitation is required. PMID:26227935

  12. Evolving Role of Exercise Testing in Contemporary Cardiac Rehabilitation.

    PubMed

    Reeves, Gordon R; Gupta, Shuchita; Forman, Daniel E

    2016-01-01

    Symptom-limited (maximal) exercise testing before cardiac rehabilitation (CR) was once an unambiguous standard of care. In particular, it served as an important screen for residual ischemia and instability before initiating a progressive exercise training regimen. However, improved revascularization and therapy for coronary heart disease has led many clinicians to downplay this application of exercise testing, especially because such testing is also a potential encumbrance to CR enrollment (delaying ease and efficiency of enrollment after procedures and hospitalizations) and patient burden (eg, added costs, logistic hassle, and anxiety). Nonetheless, exercise testing has enduring value for CR, especially because it reveals dynamic physiological responses as well as ischemia, arrhythmias, and symptoms pertinent to exercise prescription and training and to overall stability and prognosis. Moreover, as indications for CR have expanded, the value of exercise testing and functional assessment is more relevant than ever in the growing population of eligible patients, including those with heart failure, valvular heart disease, and posttransplantation, especially as current patients also tend to be more clinically complex, with advanced ages, multimorbidity, frailty, and obesity. This review focuses on the appropriate use of exercise testing in the CR setting. Graded exercise tests, cardiopulmonary exercise tests, submaximal walking tests, and other functional assessments (strength, frailty) for CR are discussed. PMID:27120040

  13. Usefulness of Cardiac Rehabilitation After Spontaneous Coronary Artery Dissection.

    PubMed

    Krittanawong, Chayakrit; Tweet, Marysia S; Hayes, Sarah E; Bowman, Melissa J; Gulati, Rajiv; Squires, Ray W; Hayes, Sharonne N

    2016-05-15

    Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction; however, the role of cardiac rehabilitation (CR) for patients with SCAD has not been well defined. To further understand CR in patients with SCAD, we studied a large cohort of patients with confirmed SCAD enrolled in the Mayo Clinic SCAD Registry from January 2010 to December 2014 (n = 354). Demographics, clinical characteristics, mental health status, and details about CR participation and experience were collected through medical record review and questionnaires. Participants at time of SCAD were 46 ± 10 years old; 96% were women. Most (76%) attended ≥1 CR sessions, averaging 18 ± 12 sessions. Most reported CR-related physical and emotional benefits (82% and 75%, respectively). Of the CR nonparticipants, 57 of 85 reported not participating because CR was not recommended by their health care provider. Other reasons included inadequate transportation (10 of 85), no insurance coverage (7 of 85), cost (2 of 85), no energy (2 of 85), being too ill (2 of 85), and miscellaneous comments (5 of 85). In conclusion, 3 of 4 of patients with SCAD participated in CR, most of whom reported benefit. Lack of recommendation for CR by a health care provider was the primary reason patients did not participate. PMID:27055757

  14. Availability and characteristics of cardiac rehabilitation programmes in China

    PubMed Central

    Zhang, Zixin; Pack, Quinn; Squires, Ray W; Lopez-Jimenez, Francisco; Yu, Lujiao; Thomas, Randal J

    2016-01-01

    Objective Cardiac rehabilitation (CR) improves patient outcomes in cardiovascular disease (CVD), but little is known about its current practice in China. Since China has a high CVD burden, the potential impact of CR is large. We surveyed large hospitals in China to assess the prevalence and characteristics of CR. Methods We carried out a cross-sectional survey of 454 large medical centres in China to ascertain the prevalence of CR, perceived barriers to CR and various other characteristics of centres with and without CR programmes. Results Responses were received from 124 (27%) of the 454 centres surveyed. Of these, only 30 (24%) reported having an operating CR programme. This was true, despite the near universal availability of advanced imaging, coronary stenting and other technologies. Overall, the estimated availability of CR programmes was about 2 programmes per 100 million inhabitants. Centres with CR were more likely than centres without CR to be university or government hospitals, have more inpatient cardiovascular beds and provide secondary CVD prevention services. Perceived barriers to CR included a lack of awareness, training and experience in CR, as well as limited resources for a CR programme. Respondents suggested that educational and training activities could help promote greater implementation of CR in China. Conclusions The availability of CR is low (24%) in the large medical centres in China we surveyed, highlighting the importance of efforts to raise awareness of the benefits of CR, to provide CR training to healthcare professionals and to improve CR availability throughout China. PMID:27326243

  15. Tai Chi as an adjunct physical activity for adults aged 45 years and older enrolled in phase III cardiac rehabilitation

    PubMed Central

    Taylor-Piliae, Ruth E; Silva, Edna; Sheremeta, Sharon Peachey

    2015-01-01

    Background Cardiac rehabilitation improves physical, cognitive and psychosocial functioning, yet services are greatly underutilized with increasing patterns of attrition over time. Tai Chi has been suggested as a possible adjunct to cardiac rehabilitation exercise training. Aim To describe differences in physical, cognitive and psychosocial functioning among adults ≥ 45 years old attending phase III cardiac rehabilitation, who have or have not self-selected Tai Chi exercise as an adjunct physical activity. Methods A cross-sectional design compared subjects attending group-based Wu style Tai Chi classes plus cardiac rehabilitation, with cardiac rehabilitation only. Subjects had a battery of physical and cognitive functioning tests administered to examine aerobic endurance, balance, strength, and flexibility, verbal retrieval/recall, attention, concentration and tracking. Subjects completed a health survey to ascertain cardiac event information, medical history, and psychosocial functioning (i.e. health-related quality of life, stress, depressive symptoms, social support, and Tai Chi self-efficacy). Results A total of 51 subjects (75% married, 84% college-educated, 96% White/European-American) participated. Subjects were on average 70 (± 8) years old and had attended cardiac rehabilitation for 45 (± 37) months. Approximately 45% (n = 23) attended Tai Chi classes plus cardiac rehabilitation, while 55% (n = 28) attended cardiac rehabilitation only. Subjects attending Tai Chi plus cardiac rehabilitation had better balance, perceived physical health, and Tai Chi self-efficacy compared to those attending cardiac rehabilitation only (p ≤ 0.03). Conclusion Tai Chi can be easily implemented in any community/cardiac rehabilitation facility, and may offer adults additional options after a cardiac event. PMID:21095159

  16. Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation.

    PubMed

    Pulignano, Giovanni; Tinti, Maria Denitza; Del Sindaco, Donatella; Tolone, Stefano; Minardi, Giovanni; Lax, Antonio; Uguccioni, Massimo

    2016-01-01

    In heart failure (HF), cardiac rehabilitation (CR) may reduce decompensations, hospitalization, and ultimately mortality in long term. Many studies over the past decade have demonstrated that aerobic exercise training is effective and safe in stable patients with HF. Exercise CR resulted in a clinically important improvement in the QOL. Several clinical and psychosocial factors are associated with decreased participation in CR programs of elderly HF patients, such as perception of exercise as tiring or painful, comorbidities, lack of physician encouragement, and opinion that CR will not improve their health status. Besides low functional capacity, and chronic deconditioning may also deter patients from participating in CR programs.  Recent data suggest that current smoking, a BMI ≥30 kg/m2, diabetes mellitus, and cognitive dysfunction are associated with failure to enroll in outpatient CR in older age group. Moreover the lack of availability of CR facilities or the absence of financial refunds for enrolment of CHF patients in cardiac rehabilitation programs can play a crucial role. Many of this factors are modifiable through patient education and self care strategy instruction, health providers sensibilization, and implementing economic measures in order to make CR affordable. RiassuntoNumerosi studi hanno dimostrato come la riabilitazione cardiovascolare (RC) con esercizio aerobico sia risultato efficace e sicuro nei pazienti con scompenso cardiaco (SC), nel ridurre ospedalizzazioni, mortalità ed indurre un miglioramento della qualità di vita. Tuttavia numerosi fattori clinici e psicosociali, come la bassa capacità funzionale, le comorbidità, la percezione dell'esercizio fisico come noioso o doloroso, sono associati a ridotta partecipazione a RC da parte di pazienti anziani con SC.  Inoltre dati recenti mostrano come l'abitudine tabagica, un BMI ≥30 kg/m2, il diabete mellito ed il deterioramento cognitivo siano associati con il mancato arruolamento di

  17. Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study

    PubMed Central

    Lee, K W; Blann, A D; Jolly, K; Lip, G Y H

    2006-01-01

    Background Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D‐dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P‐selectin (an index of platelet activation)), vasomotor function (using flow‐mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown. Methods 81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital‐based (n = 40) or home‐based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D‐dimer, fibrinogen, soluble P‐selectin and plasma viscosity, as well as FMD and 24‐h ABP, were measured at baseline and after 3 months of cardiac rehabilitation. Results In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D‐dimer were significantly lower and FMD improved (all p⩽0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24‐h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital‐based and home‐based cardiac rehabilitation programmes on these indices. Conclusions Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home‐based and hospital‐based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes. PMID:16807272

  18. Cardiac rehabilitation delivery model for low-resource settings

    PubMed Central

    Grace, Sherry L; Turk-Adawi, Karam I; Contractor, Aashish; Atrey, Alison; Campbell, Norm; Derman, Wayne; Melo Ghisi, Gabriela L; Oldridge, Neil; Sarkar, Bidyut K; Yeo, Tee Joo; Lopez-Jimenez, Francisco; Mendis, Shanthi; Oh, Paul; Hu, Dayi; Sarrafzadegan, Nizal

    2016-01-01

    Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Results Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings. Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed. PMID:27181874

  19. Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment?

    PubMed Central

    Intzandt, Brittany; Black, Sandra E.; Lanctôt, Krista L.; Herrmann, Nathan; Oh, Paul; Middleton, Laura E.

    2015-01-01

    Background Exercise is a promising strategy to prevent dementia, but no clinically supervised exercise program is widely available to people with mild cognitive impairment (MCI). The objective was to survey health professionals to assess the feasibility of using cardiac rehabilitation exercise programs for MCI populations. Methods We distributed surveys to: 1) health professionals working in cardiac rehabilitation exercise programs (36/72 responded); and 2) physicians who treat MCI (22/32 responded). Questions addressed clinician and clinic characteristics and feasibility of referring and accommodating people with MCI. Results Most cardiac rehabilitation exercise programs currently treat people with MCI (61.1%). Nearly all were willing and able to accept people with MCI and comorbid vascular risk (91.7%), though only a minority could accept MCI without vascular risk (16.7%). Although most physicians recommend exercise to people with MCI (63.6%), few referred patients with MCI to programs or people to guide exercise (27.3%). However, all physicians (100%) would refer patients with MCI to a cardiac rehabilitation exercise program. Conclusions Our study supports cardiac rehabilitation exercise programs as a feasible model of exercise for patients with MCI with vascular risk. Patients with and without vascular risk could likely be accommodated if program mandates were expanded. PMID:26180562

  20. Cardiac rehabilitation in Austria: long term health-related quality of life outcomes

    PubMed Central

    2009-01-01

    Background The goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria. Methods Patients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]. Results All MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients. Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time. Conclusion These findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed. PMID:19995445

  1. 42 CFR 424.27 - Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... rehabilitation facility (CORF) services. 424.27 Section 424.27 Public Health CENTERS FOR MEDICARE & MEDICAID... rehabilitation facility (CORF) services. Medicare Part B pays for CORF services only if a physician certifies... needed skilled rehabilitation services; (2) The services were furnished while the individual was...

  2. Assessing Physical Activity as a Core Component in Cardiac Rehabilitation: A POSITION STATEMENT OF THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION.

    PubMed

    Kaminsky, Leonard A; Brubaker, Peter H; Guazzi, Marco; Lavie, Carl J; Montoye, Alexander H K; Sanderson, Bonnie K; Savage, Patrick D

    2016-01-01

    Physical inactivity is a well-established major risk factor for cardiovascular disease. As such, physical activity counseling is 1 of the 10 core components of cardiac rehabilitation/secondary prevention programs recommended by the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition, the ability to perform a physical activity assessment and report outcomes is 1 of the 10 core competencies of cardiac rehabilitation/secondary prevention professionals published by the AACVPR. Unfortunately, standardized procedures for physical activity assessment of cardiac rehabilitation patients have not been developed and published. Thus, the objective of this AACVPR statement is to provide an overview of physical activity assessment concepts and procedures and to provide a recommended approach for performing a standardized assessment of physical activity in all comprehensive cardiac rehabilitation programs following the core components recommendations. PMID:27307067

  3. Interest of Ultrasonographic Assessment of Diaphragmatic Function in Cardiac Rehabilitation Center: A Case Report

    PubMed Central

    Boussuges, Alain; Chaumet, Guillaume; Poirette, Laurent

    2015-01-01

    Abstract Diaphragmatic paresis is a rare but recognized complication of atrial fibrillation ablation. A 59-year-old woman experiencing dyspnea in supine position and for minimal effort was admitted in a cardiac rehabilitation center. One month before, she was referred to a cardiac center to ablation of paroxysmal atrial fibrillation. After the procedure, the patient developed respiratory failure attributed to aspiration pneumonia and requiring mechanical ventilation. At admission in the rehabilitation center, M-mode ultrasonography reported an absence of movement of the right hemidiaphragm during quiet breathing and a paradoxical movement during voluntary sniffing. Chest ultrasonography can be useful to detect diaphragmatic dysfunction in patients suffering from dyspnea, at admission in a cardiac rehabilitation center. Its use should be envisaged more frequently. PMID:25984664

  4. Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

    PubMed Central

    Fukui, Shigefumi; Ogo, Takeshi; Takaki, Hiroshi; Ueda, Jin; Tsuji, Akihiro; Morita, Yoshiaki; Kumasaka, Reon; Arakawa, Tetsuo; Nakanishi, Michio; Fukuda, Tetsuya; Yasuda, Satoshi; Ogawa, Hisao; Nakanishi, Norifumi; Goto, Yoichi

    2016-01-01

    Objective To determine safety and efficacy of cardiac rehabilitation (CR) initiated immediately following balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) who presented with continuing exercise intolerance and symptoms on effort even after a course of BPA; 2–8 sessions/patient. Methods Forty-one consecutive patients with inoperable CTEPH who underwent their final BPA with improved resting mean pulmonary arterial pressure of 24.7±5.5 mm Hg and who suffered remaining exercise intolerance were prospectively studied. Participants were divided into two groups just after the final BPA (6.8±2.3 days): patients with (CR group, n=17) or without (non-CR group, n=24) participation in a 12-week CR of 1-week inhospital training followed by an 11-week outpatient programme. Cardiopulmonary exercise testing, haemodynamics, and quality of life (QOL) were assessed before and after CR. Results No significant between-group differences were found for any baseline characteristics. At week 12, peak oxygen uptake (VO2), per cent predicted peak VO2 (70.7±9.4% to 78.2±12.8%, p<0.01), peak workload, and oxygen pulse significantly improved in the CR group compared with the non-CR group, with a tendency towards improvement in mental health-related QOL. Quadriceps strength and heart failure (HF) symptoms (WHO functional class, 2.2–1.8, p=0.01) significantly improved within the CR group. During the CR, no patient experienced adverse events or deterioration of right-sided HF or haemodynamics as confirmed via catheterisation. Conclusions The combination of BPA and subsequent CR is a new treatment strategy for inoperable CTEPH to improve exercise capacity to near-normal levels and HF symptoms, with a good safety profile. PMID:27220694

  5. Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice

    PubMed Central

    Abell, Bridget; Glasziou, Paul; Briffa, Tom; Hoffmann, Tammy

    2016-01-01

    Introduction Exercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia. Design Cross-sectional survey. Methods Australian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics. Results 297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1–2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (<6%) made use of technology, such as mobile phones or the internet, to deliver or support exercise training. Conclusions While advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients. PMID

  6. Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase

    PubMed Central

    Winkelmann, Eliane Roseli; Dallazen, Fernanda; Bronzatti, Angela Beerbaum Steinke; Lorenzoni, Juliara Cristina Werner; Windmöller, Pollyana

    2015-01-01

    Objective To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. PMID:25859866

  7. Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave

    PubMed Central

    Hansen, T B; Zwisler, A D; Berg, S K; Sibilitz, K L; Thygesen, L C; Doherty, P; Søgaard, R

    2015-01-01

    Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery. Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs. Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups. Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis. PMID:26301099

  8. Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants

    PubMed Central

    Haennel, Robert G.

    2012-01-01

    In the past decade a significant development in the management and rehabilitation of people with chronic heart failure (CHF) has been the utilization of cardiac devices. The use of biventricular pacemakers, referred to as Cardiac Resynchronization Therapy (CRT) can yield improvements in functional abilities for a select group of CHF patients and the inclusion of implantable cardiac defibrillators (ICDs) may reduce the risk of sudden death. This review provides physical therapists with a basic understanding of how to prescribe exercise for people with CHF who have these device implants. PMID:22993499

  9. Collaboration: a solution to the challenge of conducting nursing research in cardiac rehabilitation.

    PubMed

    Gallagher, Robyn; Sadler, Leonie; Kirkness, Ann; Belshaw, Julie; Roach, Kellie; Warrington, Darrell

    2013-01-01

    Clinical nurse leaders such as clinical nurse consultants are required to conduct research and incorporate outcomes of this research into their every day practice. However, undertaking research presents issues for cardiac rehabilitation clinical nurse consultants because they may have competing demands, difficulty with finding replacements and may be relatively isolated from other researchers. The solution to this situation is the formation of a collaborative research team with other cardiac rehabilitation clinical nurse consultants, with the inclusion of an experienced university academic as a mentor for the cardiac rehabilitation clinical nurse consultants working in an Area Health Service encompassing both rural and metropolitan hospitals in New South Wales, Australia. The related research project aimed to evaluate and improve the clients' knowledge and practices related to the use of sublingual glyceryl trinitrate. The team's experiences and suggestions for clinical nurse Leaders are presented in this paper. Essential team characteristics include having shared motivation, good communication practices, flexibility and tolerance, an effective team size, achieving success, willingness to accept challenges and an experienced mentor. The benefits of developing a collaborative team for research led by clinical nurse consultants in cardiac rehabilitation by far outweigh the time and effort involved in the process. PMID:24596995

  10. ECG telemonitoring during home-based cardiac rehabilitation in heart failure patients.

    PubMed

    Piotrowicz, Ewa; Jasionowska, Anna; Banaszak-Bednarczyk, Maria; Gwilkowska, Joanna; Piotrowicz, Ryszard

    2012-06-01

    We assessed ECGs recorded during home-based telemonitored cardiac rehabilitation (HTCR) in stable patients with heart-failure. The study included 75 patients with heart failure (NYHA II, III), with a mean age of 56 years. They participated in an eight-week programme of home cardiac rehabilitation which was telemonitored with a device which recorded 16-s fragments of their ECG. These fragments were transmitted via mobile phone to a monitoring centre. The times of the automatic ECG recordings were pre-set and coordinated with the cardiac rehabilitation. Patients were able to make additional recordings when they felt unwell using a tele-event-Holter ECG facility. During the study, 5757 HTCR sessions were recorded and 11,534 transmitted ECG fragments were evaluated. Most ECGs originated from the automatic recordings. Singular supraventricular and ventricular premature beats and ventricular couplets were detected in 16%, 69% and 16% of patients, respectively. Twenty ECGs were recorded when patients felt unwell: non sustained ventricular tachycardia occurred in three patients and paroxysmal atrial fibrillation episode in two patients. Heart failure patients undergoing HTCR did not develop any arrhythmia which required a change of the procedure, confirming it was safe. Cardiac rehabilitation at home was improved by utilizing the tele-event-Holter ECG facility. PMID:22604276

  11. Older Adults in Cardiac Rehabilitation: A New Strategy for Enhancing Physical Function.

    ERIC Educational Resources Information Center

    Rejeski, W. Jack; Foy, Capri Gabrielle; Brawley, Lawrence R.; Brubaker, Peter H.; Focht, Brian C.; Norris, James L., III; Smith, Marci L.

    2002-01-01

    Contrasted the effect of a group-mediated cognitive- behavioral intervention (GMCB) versus traditional cardiac rehabilitation (CRP) upon changes in objective and self-reported physical function of older adults after 3 months of exercise therapy. Both groups improved significantly. Adults with lower function at the outset of the intervention…

  12. Process and Outcome in Cardiac Rehabilitation: An Examination of Cross-Lagged Effects.

    ERIC Educational Resources Information Center

    Evon, Donna M.; Burns, John W.

    2004-01-01

    Cardiac rehabilitation patients improve cardiorespiratory fitness and quality of life, yet therapeutic processes that produce these changes remain unknown. A cross-lagged panel design was used to determine whether early-treatment enhancement of self-efficacy regarding abilities to change diet and exercise habits and the quality of the…

  13. Does the Effect of Supervised Cardiac Rehabilitation Programs on Body Fat Distribution Remained Long Time?

    PubMed Central

    Nalini, Mehdi; Moradi, Bahieh; Esmaeilzadeh, Maryam; Maleki, Majid

    2013-01-01

    Introduction: An increased accumulation of fat in the intra-abdominal cavity is highly correlated with adverse coronary risk profiles. Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. Further research is needed to define better program for weight loss and risk improvement in coronary patients. The aim of this study was to determine the effect of supervised and unsupervised cardiac rehabilitation program on body composition and body fat distribution in a population with coronary artery disease. Methods: The study investigated 167 patients with coronary artery disease (73% males; mean age = 52.67±9.11 years) before and after a supervised protocol cardiac rehabilitation program, and 12-months later. Target variables included body fat distribution indices (waist and hip circumference and waist to hip ratio), weight and body mass index. Results: Weight, waist circumference, waist to hip ratio and body mass index significantly decreased with 2 month supervised program (P<0.001), but hip circumference was not significantly changed. Males improved to a greater extent than the female patients. All of measurements relatively returned to baseline at the end of program (after 12 months). Conclusion: Supervised cardiac rehabilitation program results in improvements in body composition and body fat distribution. The effects of non-supervised program were minimal and the program needed to be reviewed. PMID:24404342

  14. Effect of Long-Term Physical Activity Practice after Cardiac Rehabilitation on Some Risk Factors

    ERIC Educational Resources Information Center

    Freyssin, Celine, Jr.; Blanc, Philippe; Verkindt, Chantal; Maunier, Sebastien; Prieur, Fabrice

    2011-01-01

    The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity…

  15. Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation.

    PubMed

    Hardcastle, Sarah J; McNamara, Keira; Tritton, Larette

    2015-01-01

    Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence. PMID:26381147

  16. [Predictors of return to work after inpatient cardiac rehabilitation under workers' compensation plan].

    PubMed

    Budde, H G; Keck, M

    2001-08-01

    Vocational reintegration is one of the major goals of cardiac rehabilitation. 70 % of blue-collar workers under 50 years of age resume their job after in-patient cardiac rehabilitation. 10 % are hindered to do so by cardiac problems. Specific measures exist that may facilitate work resumption. As these measures should be started as soon as possible there is a need for predictors of return to work which can be obtained easily and at an early stage. Subjects of this prospective study were 650 patients (10 % female) under 50 years of age who participated in an in-patient cardiac rehabilitation programme under the workers' pension insurance scheme. At the beginning of programme participation, problems in work resumption as expected by the patient and by his physician were obtained, as well as depression and anxiety scores (HADS-D). Physicians' and patients' expectations concerning problems in resuming work turn out to be significant predictors of the vocational situation of the male patients six months following medical rehabilitation. The depression score obtained at the outset of the programme is the only predictor of return to work in female patients. PMID:11505298

  17. Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation

    PubMed Central

    Hardcastle, Sarah J.

    2015-01-01

    Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence. PMID:26381147

  18. Standard and alternative adjunctive treatments in cardiac rehabilitation.

    PubMed Central

    Levy, J K

    1993-01-01

    Cardiovascular rehabilitation is the process of restoring functional abilities degraded by a serious cardiovascular event or by a surgical procedure to preempt such an event. Cardiovascular rehabilitation also includes attempts to reverse risk factors that have contributed initially to the disease process. Rehabilitation programs generally comprise disease-related educational components, supervised prescriptive physical exercise, diet counseling and modification, cessation of tobacco use, psychoeducational interventions aimed at adjustment and coping, and relaxation and stress management to lower nonexertion-related sympathetic drive. The presence of so-called coronary-prone behavior patterns can be detected, and special behavioral modifications may be indicated to mitigate these putative risk factors. This paper reviews the roles of these behavioral adjuncts in treating cardiovascular disease and its aftermath, and notes new and unusual approaches to these components of treatment, such as alternative exercises, biofeedback, yoga, and other relaxation methods. Barriers to compliance are acknowledged, and enhancement of compliance is discussed briefly. PMID:8219823

  19. The Walk to Save: Benefits of Inpatient Cardiac Rehabilitation.

    PubMed

    Rion, Joann H; Kautz, Donald D

    2016-01-01

    Hospital immobilization after a cardiac event can cause complications. The pathophysiology of complications, research concerning benefits of early ambulation, and recommendations from the American College of Sports Medicine are discussed. PMID:27522842

  20. Comparison of cardiac rehabilitation outcomes in individuals with respiratory, cardiac or no comorbidities: A retrospective review

    PubMed Central

    Nonoyama, Mika L; Kin, Susan Marzolini R; Brooks, Dina; Oh, Paul

    2016-01-01

    OBJECTIVE: To describe the prevalence and impact of respiratory comorbidities on patients undergoing cardiac rehabilitation (CR). METHODS: A retrospective review of a CR database (1999 to 2004) of patients with ischemic heart disease with ≥10 pack per year (ppy) smoking history and respiratory comorbidities (RC), non-respiratory comorbidities (NRC) and no comorbidities (NC) was performed. Primary outcomes at zero, six and 12 months included peak oxygen uptake (VO2peak), maximum workload, resting heart rate, ventilatory anaerobic threshold and anthropometrics. Analyses were performed on individuals who completed the program, adjusting for age, sex and baseline VO2peak. RESULTS: Of 5922 patients, 1247 had ≥10 ppy smoking history: 77 (6.2%) had RC; 957 (76.7%) had NRC; and 213 (17.1%) had NC. The program completion rate for each group was similar for the RC (46.8%), NRC (55.8%) and NC groups (57.3%) (P=0.26). The RC group had the lowest baseline fitness levels (P<0.002). For VO2peak, there were significant differences among groups (P=0.02) and improvements over program duration (P<0.0001). There were no significant differences in other outcomes. CONCLUSIONS: There was a low prevalence of patients with comorbid chronic obstructive pulmonary disease in CR when based on physician referral documentation. This is likely underestimated and/or reflects a referral bias. Diagnostic testing at CR entry would provide a more accurate measure of the prevalence and severity of disease. CR participation resulted in significant and similar improvements in most key CR outcomes in all groups including similar completion rate. A CR model was effective for patients with coexisting RCs. Strategies to improve access and diagnosis should be explored. PMID:27471422

  1. Physical activity in patients with grown-up congenital heart defects after comprehensive cardiac rehabilitation

    PubMed Central

    Haponiuk, Ireneusz; Jaworski, Radosław; Chojnicki, Maciej; Szalewska, Dominika; Leszczyńska, Katarzyna; Bakuła, Stanisław

    2014-01-01

    Introduction The group of grown-up patients with congenital heart defects (grown-up congenital heart – GUCH) complains of a number of specific medical and non-medical problems. The presented program of comprehensive cardiac rehabilitation (CCR-GUCH), dedicated to the above mentioned group, can potentially improve the physical activity of GUCH patients. Aim The aim of the study was to assess the effect of the comprehensive cardiac rehabilitation program on the physical activity of GUCH patients. Material and methods The invitation to take part in the CCR-GUCH program was addressed to a group of 57 patients (mean age: 23.7 ± 4.1 years) who had undergone the surgical correction of ventricular septal defects (VSD) or atrial septal defects (ASD) at least 12 months earlier. The patients were divided into two groups: A – patients undergoing rehabilitation, and B – patients who did not participate in the program. The patients were initially examined using functional and stress tests, and the program of comprehensive cardiac rehabilitation was started in group A. After 30 days, the patients from both groups underwent further testing using the same methods as during the initial evaluation. Results After one month of rehabilitation, the physical activity parameters of patients participating in the CCR-GUCH program (group A) were significantly better than those observed among non-participants (group B). Conclusions The introduction of the comprehensive rehabilitation program improves the physical activity and, consequently, the quality of life of GUCH patients. The CCR-GUCH program appears to be a justified supplement to holistic care in the late rehabilitation of patients after the surgical correction of congenital heart defects. PMID:26336469

  2. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson’s disease outpatients under rehabilitation

    PubMed Central

    Gison, Annalisa; Rizza, Federica; Bonassi, Stefano; Donati, Valentina; Giaquinto, Salvatore

    2015-01-01

    Summary This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson’s disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson’s Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO did not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances. PMID:26415782

  3. Does Cardiac Rehabilitation After Myocardial Infarction Favorably Affect Prognosis?

    ERIC Educational Resources Information Center

    Shephard, Roy J.

    1988-01-01

    This article discusses the limitations of 14 randomized controlled trials of exercise rehabilitation for patients who sustained myocardial infarction. The difficulty of sampling patients and controlling the sample size is discussed and the benefits of pooled statistical evidence are considered. (JL)

  4. Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial

    PubMed Central

    Jacobson, Eric E.; Meleger, Alec L.; Bonato, Paolo; Wayne, Peter M.; Langevin, Helene M.; Kaptchuk, Ted J.; Davis, Roger B.

    2015-01-01

    Structural Integration (SI) is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE), 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP) were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR) versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n = 23 per group. Median reductions in VAS Pain, the primary outcome, of −26 mm in SI + OR versus 0 in OR alone were not significantly different (P = 0.075). Median reductions in RMDQ, the secondary outcome, of −2 points in SI + OR versus 0 in OR alone were significantly different (P = 0.007). Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399). PMID:25945112

  5. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation.

    PubMed

    Bjarnason-Wehrens, B; Mayer-Berger, W; Meister, E R; Baum, K; Hambrecht, R; Gielen, S

    2004-08-01

    Aerobic endurance training has been an integral component of the international recommendations for cardiac rehabilitation for more than 30 years. Notwithstanding, only in recent years have recommendations for a dynamic resistance-training program been cautiously put forward. The perceived increased risk of cardiovascular complications related to blood pressure elevations are the primary concern with resistance training in cardiac patients; recent studies however have demonstrated that this need not be a contraindication in all cardiac patients. While blood pressure certainly may rise excessively during resistance training, the actual rise depends on a variety of controllable factors including magnitude of the isometric component, the load intensity, the amount of muscle mass involved as well as the number of repetitions and/or the load duration. Intra-arterial blood pressure measurements in cardiac patients have demonstrated that that during low-intensity resistance training [40-60% maximum voluntary contraction (MVC)] with 15-20 repetitions, only modest elevations in blood pressure are revealed, similar to those seen during moderate endurance training. When properly implemented by an experienced exercise therapist, in specific patient groups an individually tailored, medically supervised dynamic resistance training program carries no inherent higher risk for the patient than aerobic endurance training. As an adjunct to endurance training, in selected patients, resistance training can increase muscle strength and endurance, as well as positively influence cardiovascular risk factors, metabolism, cardiovascular function, psychosocial well-being and quality of life. According to present data, resistance training is however not recommended for all patient groups. The appropriate training method and correct performance are highly dependent on each patient's clinical status, cardiac stress tolerance and possible comorbidities. Most studies have used middle-aged men of

  6. Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST-elevation myocardial infarction in Australia.

    PubMed

    Soo Hoo, Soon Yeng; Gallagher, Robyn; Elliott, Doug

    2016-06-01

    Cardiac rehabilitation is an important component of recovery and secondary prevention following urgent primary percutaneous coronary intervention. However, attendance and factors that predict participation by patients admitted with ST-elevation myocardial infarction remain unclear. This Australian study was conducted using a descriptive, comparative design. Consecutive patients (n = 246) at two hospitals were interviewed by telephone at four weeks and six months. Open-ended questions were used to assess cardiac rehabilitation attendance, sociodemographics, modifiable risk factors, clinical outcomes, and post-discharge health support. Post-discharge home visits at four weeks (odds ratio: 2.64, 95% confidence interval: 1.48-4.71) and at six months were associated with better cardiac rehabilitation attendance; more males participated at four weeks and at six months. The results suggest the need to integrate post-discharge health support with cardiac rehabilitation to facilitate recovery after primary percutaneous coronary intervention, particularly for females with ST-elevation myocardial infarction. PMID:26858136

  7. Long-Term Outcomes of Cardiac Rehabilitation in Diabetic and Non-diabetic Patients With Myocardial Infarction

    PubMed Central

    Kim, Hyun Jun; Joo, Min Cheol; Noh, Se Eung

    2015-01-01

    Objective To investigate the long-term outcomes of cardiac rehabilitation (CR) on exercise capacity in diabetic (DM) and non-diabetic (non-DM) patients with myocardial infarction (MI). Methods Of the MI patients who received hospital-based CR from February 2012 to January 2014, we retrospectively reviewed the medical records of the patients who continued follow-up through the outpatient clinic and community-based self-exercise after CR. A total of 37 patients (12 with DM and 25 without DM) were included in this study. Exercise capacity was measured by symptom-limited exercise tests before and after hospital-based CR and 1 year after the onset of MI. Results Before the CR, the DM group had significantly lower exercise capacity in exercise times, peak oxygen consumption (VO2peak), and metabolic equivalent tasks (METs) than did the non-DM group. After the CR, both groups showed significantly improved exercise capacity, but the DM group had significantly lower exercise capacity in exercise times, submaximal rate pressure products (RPPsubmax), VO2peak, and METs. One year after the onset of the MI, the DM group had significantly lower exercise capacity in exercise times, RPPsubmax, and VO2peak than did the non-DM group, and neither group showed a significant difference in exercise capacity between before and after the CR. Conclusion As a result of continued follow-up through an outpatient clinic and community-based self-exercise after hospital-based CR in patients with MI, the DM group still had lower exercise capacity than did the non-DM group 1 year after the onset of MI, but both groups maintained their improved exercise capacity following hospital-based CR. PMID:26798598

  8. Support groups and cardiac rehabilitation: effects of partner participation on anxiety and depression.

    PubMed

    de Roda, Ana Barrón López; Moreno, Esteban Sánchez; Montero, Isabel Varela; Churnin, Steve

    2014-01-01

    This study analyzes the effect on levels of patient anxiety and depression of a partner joining a cardiac rehabilitation program support group, also taking into account the sex of the patient. The study was undertaken using a two-group comparison design with pre-and post-test measures in non-equivalent groups. The sample comprised patients in the cardiac rehabilitation program (CRP) at the Ramón y Cajal Hospital, Madrid (Spain). Analysis of covariance (ANCOVA) showed direct effects of sex and partner participation in support groups on the anxiety trait. Similarly, interaction effects were observed between the sex variable and partner participation. These results indicate the pertinence of designing separate groups for patients and partners. PMID:25011462

  9. Influence of cardiac rehabilitation in Primigravida with spontaneous coronary artery dissection during postpartum

    PubMed Central

    2014-01-01

    Background The physical exercise consists of trainable physical abilities such as strength and endurance. It can be inferred that the individual cardiac patient is dependent on it as an associated therapy to the drug treatment for a rapid and lasting improvement of their overall clinical status Case presentation The patient – with Spontaneous Coronary Artery Dissection Postpartum period – was subjected to 21 sessions of cardiac rehabilitation. A physical evaluation was performed, before and after the treatment period, for data collection: anthropometric values, flexibility, aerobic capacity and strength of grip. Conclusion The patient had a positive response in aerobic capacity, flexibility and grip strength and the anthropometric values were kept in short term rehabilitation. PMID:24829614

  10. Cardiac rehabilitation programs and health-related quality of life. State of the art.

    PubMed

    Cano de la Cuerda, Roberto; Alguacil Diego, Isabel María; Alonso Martín, Joaquín Jesús; Molero Sánchez, Alberto; Miangolarra Page, Juan Carlos

    2012-01-01

    Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature. PMID:22015019

  11. The Affordable Care Act: new opportunities for cardiac rehabilitation in the workplace?

    PubMed

    Pinkstaff, Sherry O; Arena, Ross; Myers, Jonathan; Kaminsky, Leonard; Briggs, Paige; Forman, Daniel E; Patel, Mahesh J; Cahalin, Lawrence P

    2014-08-01

    Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team. PMID:25099406

  12. Environmental Resources in Maintenance of Physical Activity 6 Months Following Cardiac Rehabilitation.

    PubMed

    Perez, Adriana; Fleury, Julie; Belyea, Michael

    2016-08-01

    This study examined differences in weekly time spent in physical activity by level of perceived environmental resources, 6 months following graduation from cardiac rehabilitation. A descriptive, longitudinal design used standardized measures to evaluate perceived environmental resources and physical activity levels. Repeated measures analysis of variance was used to examine mean differences in weekly time spent in physical activity by level of perceived environmental resources. Adults 51 to 86 years old (N = 150) diagnosed with coronary heart disease were included. There was a significant change over time in physical activity as measured by minutes per week, F(2, 148) = 7.915, p = .001, where activity increased between baseline and 3 months, and then dropped slightly at 6 months. This change over time differed by the level of perceived neighborhood resources, F(2, 148) = 3.545, p = .032. Home and neighborhood resources may positively influence physical activity maintenance following cardiac rehabilitation. PMID:26826141

  13. Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease.

    PubMed

    Arena, Ross; Lavie, Carl J; Cahalin, Lawrence P; Briggs, Paige D; Guizilini, Solange; Daugherty, John; Chan, Wai-Man; Borghi-Silva, Audrey

    2016-01-01

    The current incidence and prevalence of noncommunicable diseases (NCDs) is currently a cause for great concern on a global scale; future projections are no less disconcerting. Unhealthy lifestyle patterns are at the core of the NCD crisis; physical inactivity, excess body mass, poor nutrition and tobacco use are the primary lifestyle factors that substantially increase the risk of developing one or more NCDs. We have now come to recognize that healthy lifestyle interventions are a medical necessity that should be prescribed to all individuals. Perhaps the most well-established model for healthy lifestyle interventions in the current healthcare model is cardiac rehabilitation. To have any hope of improving the outlook for NCDs on a global scale, what is currently known as cardiac rehabilitation must transform into broad-based healthy lifestyle programing, with a shifted focus on primordial and primary prevention. PMID:26511659

  14. Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions.

    PubMed

    Silver, Julie K; Gilchrist, Laura S

    2011-05-01

    Cancer rehabilitation is an important part of survivorship as a distinct phase of treatment. Although cancer rehabilitation may involve many disciplines, this article specifically covers evidence-based treatment in physical and occupational therapy. Patients may need physical and occupational therapy services for a variety of cancer-related or cancer-treatment-related problems, including pain, fatigue, deconditioning, and difficulty with gait. They may also have problems resuming their previous level of function, which can impact on activities of daily living, instrumental activities of daily living, return to previous home and community activity levels, and return to work. This review discusses the role of physical and occupational therapy in helping cancer patients improve pain and musculoskeletal issues, deconditioning and endurance effects, fatigue, balance and falls, and lymphedema and psychosocial problems. PMID:21765263

  15. Observational study of the relationship between volume and outcomes using data from the National Audit of Cardiac Rehabilitation

    PubMed Central

    Doherty, Patrick; Harrison, Alexander S; Knapton, Mike; Dale, Veronica

    2015-01-01

    Objective Cardiac rehabilitation (CR) is an evidence-based intervention delivered by a wide range of high-volume and low-volume centres; however, the extent of volume–outcome relationship is yet to be studied. There is a lack of consensus about the effect of volume on outcomes, with evidence of mixed effects in acute and chronic care. The aim of this study is, to investigate the extent of association of outcomes in CR with patient volume. Methods Data was validated and extracted from the national audit from 2012 to 2013 for each CR centre. Volume was calculated as the total number of patients entering outpatient CR. Hierarchical multiple regression models were used to test for relationships between volume and outcomes. The outcomes included body mass index, blood pressure, psychosocial well-being, cholesterol, smoking cessation and physical activity. The analyses were adjusted for centre and patient characteristics and confounders. Results The number of patients included in the volume analysis was 48 476, derived from 178 CR centres. The average age per centre was 66 years with a 70% male distribution of patients enrolled. Regression analysis revealed no volume–outcome relationship, additionally no statistical significance existed. Conclusions Unlike cardiac surgery this study, after accounting for staffing, age, gender and comorbidity, shows no effect of volume on outcome following CR delivered by high-volume and low-volume programmes. Based on our data there is no support for centralisation of services. Our findings and methodology can be used as a benchmark for future volume–outcome relationship studies in CR. PMID:26629349

  16. [Experiences with ambulatory cardiologic phase II rehabilitation].

    PubMed

    Schönstedt, S; Beckmann, S; Disselhoff, W; Rüssmann, B

    1999-04-01

    The phase II cardiac rehabilitation in Germany differs markedly from other European countries and the USA. Most of the patients enter a 3-week full residential program. In contrast we developed an outpatient phase II cardiac rehabilitation program. Since 1979 we treated more than 8,500 patients with different indications (i.e. after myocardial infarction, coronary bypass surgery, valve replacement and reconstruction). Patients with a daily commuting time over 60 minutes are not suitable for outpatient rehabilitation. Our model corresponds to the German intrahospital rehabilitation. The rehabilitation is carried out in 3 weeks offering approximately 66 hours of therapy. Groups of 8 patients with a similar level of physical capacity stay together during the rehabilitation. A comprehensive program with exercise training, physical therapy, psychological support, education in life style changes and risk factor modification has been developed. The compliance of the patients as well as the acceptance by the family are excellent. Long-lasting reduction in LDL cholesterol levels and increments in work-load capacities have been demonstrated. A high percentage of patients returned to work. Cost analysis demonstrates a reduction up to 40% in comparison to the full residential program. Therefore the outpatient phase II cardiac rehabilitation is a good alternative especially in urban areas. PMID:10372303

  17. [The Italian SurveY on carDiac rEhabilitation 2008 (ISYDE 2008): study presentation].

    PubMed

    Tramarin, Roberto; Ambrosetti, Marco; De Feo, Stefania; Griffo, Raffaele; Maslowsky, Franco; Diaco, Tommaso; Piepoli, M; Riccio, C

    2008-07-01

    In this paper, the Italian Society of Cardiac Rehabilitation and Prevention (GICR) presents the third survey on the status of cardiac rehabilitation (CR) in Italy. The Italian SurveY on carDiac rEhabilitation 2008 (ISYDE 2008) is a multicenter, observational study aimed at identifying the number and characteristics of Italian CR facilities, both in terms of health operators and interventions. Clinical records of all patients consecutively discharged within the whole network--composed of up to 200 CR units--from January 28 to February 10, 2008 will also be reviewed for diagnosis of admission, comorbidities, rehabilitation programs, and drug therapy, in order to obtain a snapshot of current implementation strategies in daily clinical practice. The survey will adopt a web-based methodology for data provision and transmission. Preliminary results of the survey are expected in the late summer 2008. PMID:18678216

  18. Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis

    PubMed Central

    Kennedy, Michael D; Haykowsky, Mark; Daub, Bill; van Lohuizen, Karen; Knapik, Grant; Black, Bill

    2003-01-01

    Background Currently, there are a lack of investigations that have examined the effect of participating in a comprehensive cardiac rehabilitation program on quality of life and physiological measures in women of different ages. The purpose of this investigation was to examine the effect of participating in a comprehensive cardiac rehabilitation program on quality of life, exercise tolerance, blood pressure and lipids in women between 33 and 82 years of age. Methods The 126 women participated in a 14-week cardiac rehabilitation program that consisted of 7 weeks of formal supervised exercise training and 7 weeks of unsupervised exercise and lifestyle modification. Physiologic and quality of life outcome measures obtained at the outset and after 14 weeks included: 1) exercise treadmill time; 2) resting and peak systolic and diastolic blood pressure; 3) total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and Triglycerides; 4) Cardiac Quality of Life Index questionnaire. Results Significant improvements were found in the following quality of life measures after participating in the cardiac rehabilitation program: physical well being, psychosocial, worry, nutrition and symptoms. No significant differences were seen for any QOL variable between the different age groups. Significant improvements were seen in exercise tolerance (+21%) and high density lipoprotein (+5%). Conclusion Cardiac rehabilitation may play an important role in improving quality of life, exercise tolerance and high density lipoprotein cholesterol levels in younger and older women with underlying cardiovascular disease. PMID:12735789

  19. Development and evaluation of a treadmill-based exercise tolerance test in cardiac rehabilitation

    PubMed Central

    Adams, Jenny; Cheng, Dunlei; Barton, Stephanie; Bigej-Cerqua, Janet; Mims, Lisa; Molden, Jennifer; Anderson, Valerie

    2013-01-01

    Cardiac rehabilitation exercise prescriptions should be based on exercise stress tests; however, limitations in performing stress tests in this setting typically force reliance on subjective measures like the Duke Activity Status Index (DASI). We developed and evaluated a treadmill-based exercise tolerance test (ETT) to provide objective physiologic measures without requiring additional equipment or insurance charges. The ETT is stopped when the patient's Borg scale rating of perceived exertion (RPE) reaches 15 or when any sign/symptom indicates risk of an adverse event. Outcomes of the study included reasons for stopping; maximum heart rate, systolic blood pressure, and rate pressure product; and adverse events. We tested equivalence to the DASI as requiring the 95% confidence interval for the mean difference between DASI and ETT metabolic equivalents (METs) to fall within the range (–1, 1). Among 502 consecutive cardiac rehabilitation patients, one suffered a panic attack; no other adverse events occurred. Most (80%) stopped because they reached an RPE of 15; the remaining 20% were stopped on indications that continuing risked an adverse event. Mean maximum systolic blood pressure, heart rate, and rate pressure product were significantly (P < 0.001) below thresholds of the American Association of Cardiovascular and Pulmonary Rehabilitation. Two patients’ heart rates exceeded 150 beats per minute, but their rate pressure products remained below 36,000. The mean difference between DASI and ETT METs was −0.8 (−0.98, −0.65), indicating equivalence at our threshold. In conclusion, the ETT can be performed within cardiac rehabilitation, providing a functional capacity assessment equivalent to the DASI and objective physiologic measures for developing exercise prescriptions and measuring progress. PMID:23814381

  20. Development and evaluation of a treadmill-based exercise tolerance test in cardiac rehabilitation.

    PubMed

    Dunagan, Julie; Adams, Jenny; Cheng, Dunlei; Barton, Stephanie; Bigej-Cerqua, Janet; Mims, Lisa; Molden, Jennifer; Anderson, Valerie

    2013-07-01

    Cardiac rehabilitation exercise prescriptions should be based on exercise stress tests; however, limitations in performing stress tests in this setting typically force reliance on subjective measures like the Duke Activity Status Index (DASI). We developed and evaluated a treadmill-based exercise tolerance test (ETT) to provide objective physiologic measures without requiring additional equipment or insurance charges. The ETT is stopped when the patient's Borg scale rating of perceived exertion (RPE) reaches 15 or when any sign/symptom indicates risk of an adverse event. Outcomes of the study included reasons for stopping; maximum heart rate, systolic blood pressure, and rate pressure product; and adverse events. We tested equivalence to the DASI as requiring the 95% confidence interval for the mean difference between DASI and ETT metabolic equivalents (METs) to fall within the range (-1, 1). Among 502 consecutive cardiac rehabilitation patients, one suffered a panic attack; no other adverse events occurred. Most (80%) stopped because they reached an RPE of 15; the remaining 20% were stopped on indications that continuing risked an adverse event. Mean maximum systolic blood pressure, heart rate, and rate pressure product were significantly (P < 0.001) below thresholds of the American Association of Cardiovascular and Pulmonary Rehabilitation. Two patients' heart rates exceeded 150 beats per minute, but their rate pressure products remained below 36,000. The mean difference between DASI and ETT METs was -0.8 (-0.98, -0.65), indicating equivalence at our threshold. In conclusion, the ETT can be performed within cardiac rehabilitation, providing a functional capacity assessment equivalent to the DASI and objective physiologic measures for developing exercise prescriptions and measuring progress. PMID:23814381

  1. Assessment of use of music by patients participating in cardiac rehabilitation.

    PubMed

    Metzger, L Kay

    2004-01-01

    The primary cause of morbidity and mortality in the United States is heart disease. It is a costly and pervasive group of disorders that effect all ages, races, and genders. Behavioral medicine and health psychology have focused on prevention and psychosocial influences of cardiovascular diseases for the past 30 years. Music therapy is a viable collaborative method in the psychosocial arena for alleviating risks and motivating rehabilitation from cardiac events. There is research to support the use of music to modulate heart health measurements such as heart rate and blood pressure, to enhance exercise programs, and to relieve stress symptoms. However, inconsistencies in the results of this research warrant continued collaboration of social scientists to find scientific means of establishing interventions with measurable outcomes. This project involved administering a music therapy survey in order to determine current use and preference for music in a cardiac rehabilitation program. Patients who were attending rehabilitation sessions in a large city hospital completed a survey on which they rated their level of use of music for exercise, relaxation, and enjoyment. The researcher also gathered information about musical preferences, musical experiences, and pertinent demographics. Patients, mostly white males over the age of 60, showed positive responses to the aesthetically pleasurable aspects of music. The use of music as a stimulus cue for exercise was decidedly absent. Nursing staff members were receptive to the project, and both staff and patients showed some interest for learning about music for therapeutic purposes. The results suggest that education about and development of music therapy in a cardiac rehabilitation program is warranted. PMID:15157124

  2. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis

    PubMed Central

    Zawada, Anna; Jolly, Kate; Moxham, Tiffany; Taylor, Rod S

    2010-01-01

    Objective To compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease. Design Systematic review. Data sources Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, CINAHL, and PsycINFO, without language restriction, searched from 2001 to January 2008. Review methods Reference lists checked and advice sought from authors. Included randomised controlled trials that compared centre based cardiac rehabilitation with home based programmes in adults with acute myocardial infarction, angina, or heart failure or who had undergone coronary revascularisation. Two reviewers independently assessed the eligibility of the identified trials and extracted data independently. Authors were contacted when possible to obtain missing information. Results 12 studies (1938 participants) were included. Most studies recruited patients with a low risk of further events after myocardial infarction or revascularisation. No difference was seen between home based and centre based cardiac rehabilitation in terms of mortality (relative risk 1.31, 95% confidence interval 0.65 to 2.66), cardiac events, exercise capacity (standardised mean difference −0.11, −0.35 to 0.13), modifiable risk factors (weighted mean difference systolic blood pressure (0.58 mm Hg, −3.29 mm Hg to 4.44 mm Hg), total cholesterol (−0.13 mmol/l, −0.31 mmol/l to 0.05 mmol/l), low density lipoprotein cholesterol (−0.15 mmol/l, −0.31 mmol/l to 0.01 mmol/l), or relative risk for proportion of smokers at follow-up (0.98, 0.73 to 1.31)), or health related quality of life, with the exception of high density lipoprotein cholesterol (−0.06, −0.11 to −0.02) mmol/l). In the home based participants, there was evidence of superior adherence. No consistent difference was seen in the healthcare costs of the two forms

  3. Changes in Risk Factors and Exercise Capacity After Cardiac Rehabilitation and Its Effect on Hospital Readmission

    PubMed Central

    Najafi, Farid; Nalini, Mehdi; Nikbakht, Mohammad Reza

    2014-01-01

    Background: Despite the positive outcomes reported with cardiac rehabilitation (CR), its impacts have been reported to be different from a region or country to another, which may be due to the different contents of rehabilitation programs. Objectives: To investigate the effect of CR on cardiovascular risk factors. Patients and Methods: This is a retrospective cohort study on the data from Imam Ali Cardiac Rehabilitation Center in Kermanshah province, Iran from 2001 to 2008. We used paired t-test to evaluate the effect of CR on cardiovascular risk factors. Logistic regression or t-test (unequal variance) were used to assess the factors influencing re-admission (due to cardiac problems). The relationship between different variables and death was studied using univariate cox proportional hazard. P values < 0.05 were considered significant for all analyses. Results: Out of 504 patients who completed rehabilitation, a total of 499 were analyzed. These 499 patients consisted of 383 men and 116 women. All anthropometric measurements, blood lipids (except HDL cholesterol), systolic and diastolic blood pressure, depression, anxiety and exercise capacity improved after rehabilitation (P < 0.05 for all cases). The improvement was observed in both sexes. A total of 39 patients were re-admitted to hospital after rehabilitation. Being female (OR = 2.40; 95%CI: 1.22-4.68) and history of diabetes (OR = 2.04; 95%CI: 1.04-4.02) increased the risk of re-admission significantly. Patients who were readmitted had higher anthropometric measurements at the beginning and the end of the program. Moreover, the initial exercise capacity of readmitted patients was lower than those who were not readmitted. After a maximal follow-up period of 6.3 years (median = 2.99 years), only eight patients expired (survival rate: 97.5%; 95%CI: 94.7-98.8). None of the variables in our study was significantly related to the survival rate. Conclusions: The comprehensive CR program in Imam Ali Center

  4. Cardiac rehabilitation using the Family-Centered Empowerment Model versus home-based cardiac rehabilitation in patients with myocardial infarction: a randomised controlled trial

    PubMed Central

    Vahedian-Azimi, Amir; Hajiesmaieli, Mohammadreza; Kangasniemi, Mari; Alhani, Fatemah; Jelvehmoghaddam, Hosseinali; Fathi, Mohammad; Farzanegan, Behrooz; Ardehali, Seyed H; Hatamian, Sevak; Gahremani, Mehdi; Mosavinasab, Seyed M M; Rostami, Zohreh; Madani, Seyed J; Izadi, Morteza

    2016-01-01

    Objective To determine if a hybrid cardiac rehabilitation (CR) programme using the Family-Centered Empowerment Model (FCEM) as compared with standard CR will improve patient quality of life, perceived stress and state anxiety of patients with myocardial infarction (MI). Methods We conducted a randomised controlled trial in which patients received either standard home CR or CR using the FCEM strategy. Patient empowerment was measured with FCEM questionnaires preintervention and postintervention for a total of 9 assessments. Quality of life, perceived stress, and state and trait anxiety were assessed using the 36-Item Short Form Health Survey (SF-36), the 14-item Perceived Stress, and the 20-item State and 20-item Trait Anxiety questionnaires, respectively. Results 70 patients were randomised. Baseline characteristics were similar. Ejection fraction was significantly higher in the intervention group at measurements 2 (p=0.01) and 3 (p=0.001). Exercise tolerance measured as walking distance was significantly improved in the intervention group throughout the study. The quality of life results in the FCEM group showed significant improvement both within the group over time (p<0.0001) and when compared with control (p<0.0001). Similarly, the perceived stress and state anxiety results showed significant improvement both within the FCEM group over time (p<0.0001) and when compared with control (p<0.0001). No significant difference was found either within or between groups for trait anxiety. Conclusions The family-centred empowerment model may be an effective hybrid cardiac rehabilitation method for improving the physical and mental health of patients post-MI; however, further study is needed to validate these findings. Clinical Trials.gov identifier NCT02402582. Trial registration number NCT02402582. PMID:27110376

  5. Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

    PubMed Central

    Nery, Rosane Maria; Zanini, Maurice; Ferrari, Juliana Nery; Silva, César Augusto; Farias, Leonardo Fontanive; Comel, João Carlos; Belli, Karlyse Claudino; da Silveira, Anderson Donelli; Santos, Antonio Cardoso; Stein, Ricardo

    2014-01-01

    Background Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard. PMID:24759952

  6. Rehabilitation

    MedlinePlus

    ... doing things you did before. This process is rehabilitation. Rehabilitation often focuses on Physical therapy to help your ... who has had a stroke may simply want rehabilitation to be able to dress or bathe without ...

  7. Rehabilitation

    MedlinePlus

    ... This process is rehabilitation. Rehabilitation often focuses on Physical therapy to help your strength, mobility and fitness Occupational ... who has had a stroke may simply want rehabilitation to be able to dress or bathe without ...

  8. Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy

    PubMed Central

    de Macedo, Rafael Michel; Faria-Neto, José Rocha; Costantini, Costantino Ortiz; Casali, Dayane; Muller, Andrea Pires; Costantini, Costantino Roberto; de Carvalho, Katherine Athayde Teixeira; Guarita-Souza, Luiz César

    2011-01-01

    Cardiac rehabilitation protocols applied during the in-hospital phase (phase I) are subjective and their results are contested when evaluated considering what should be the three basic principles of exercise prescription: specificity, overload and reversibility. In this review, we focus on the problems associated with the models of exercise prescription applied at this early stage in-hospital and adopted today, especially the lack of clinical studies demonstrating its effectiveness. Moreover, we present the concept of “periodization” as a useful tool in the search for better results. PMID:21860705

  9. Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation.

    PubMed

    Dafoe, William; Arthur, Heather; Stokes, Helen; Morrin, Louise; Beaton, Louise

    2006-09-01

    The Canadian Cardiovascular Society formed an Access to Care Working Group ('Working Group') in the spring of 2004. The mandate of the group was to use the best science and information to establish reasonable triage categories and safe wait times for access to common cardiovascular services and procedures. The present commentary presents the rationale for benchmarks for cardiac rehabilitation (CR) services. The Working Group's search for evidence included: a full literature review of the efficacy of CR, and the factors affecting access and referral to CR; a review of existing guidelines for access to CR; and a national survey of 14 CR programs across Canada undertaken in May 2005 to solicit information on referral to, and wait times for, CR. The Working Group also reviewed the results of The Ontario Cardiac Rehabilitation Pilot Project (2002) undertaken by the Cardiac Care Network of Ontario, which reported the average and median wait times for CR. Some international agencies have formulated their own guidelines relating to the optimal wait time for the onset of CR. However, due to the limited amount of supporting literature, these guidelines have generally been formed as consensus statements. The Canadian national survey showed that few programs had guidelines for individual programs. The Cardiac Care Network of Ontario pilot project reported that the average and median times from a cardiac event to the intake into CR were 99 and 70 days, respectively. The national survey of sampled CR programs also revealed quite remarkable differences across programs in terms of the length of time between first contact to first attendance and to commencement of exercise. Programs that required a stress test before program initiation had the longest wait for exercise initiation. Some patients need to be seen within a very short time frame to prevent a marked deterioration in their medical or psychological state. In some cases, early intervention and advocacy may reduce the risk

  10. Effect of phase III cardiac rehabilitation and relaxation on the quality of life in patients with cardiac syndrome X

    PubMed Central

    Feizi, Aram; Ghaderi, Chiman; Dehghani, Mohammad R.; Khalkhali, Hamid R.; Sheikhi, Siamak

    2012-01-01

    Background: Cardiac syndrome X is a relatively common disorder, and still not much is known about the causative factors or its pathophysiology, which makes it difficult to cure. Due to its chronic nature and debilitating symptoms, many patients have significantly reduced quality of life (QOL).The purpose of this study was to assess the impact of phase III cardiac rehabilitation (CR) and relaxation on the QOL of patients. Materials and Methods: This research is a randomized clinical trial study. Forty eligible and consenting women (age 30-65 years) were randomly assigned to four groups. In the first group (n = 11), progressive muscle relaxation (PMR); in the second group (n = 11), phase III CR; and in the third group (n = 11), PMR along with phase III CR were performed for 8 weeks at home. The fourth group (n = 7) was used as the control group. Short form of QOL questionnaire (SF-36) was used for data gathering. Data analysis was performed using χ2, Kruskal-Wallis, and rank sum difference tests. Results: After phase III CR, relaxation, and combination of CR and relaxation, patients demonstrated improved QOL (P < 0.001). The results of post-test multiple comparisons showed that there were statistically significant differences between control and all intervention groups (P < 0.05). There was also statistically significant difference between relaxation and combination of phase III CR and relaxation groups (P < 0.5). Conclusions: An 8-week phase III CR program together with relaxation improved QOL of patients with cardiac syndrome X. We suggest phase III CR program together with relaxation as an effective treatment in these patients. PMID:23922604

  11. Insomnia symptoms and heart rate recovery among patients in cardiac rehabilitation.

    PubMed

    Horsley, Kristin J; Rouleau, Codie R; Garland, Sheila N; Samuels, Charles; Aggarwal, Sandeep G; Stone, James A; Arena, Ross; Campbell, Tavis S

    2016-08-01

    Insomnia symptoms (i.e., difficulty falling asleep, difficulty staying asleep, and early morning awakenings) are common among people with cardiovascular disease, and have been linked to adverse cardiovascular health outcomes. Reduced parasympathetic tone is one pathway through which risk may be conferred. The purpose of this study was to evaluate whether insomnia symptoms are associated with lower parasympathetic tone in cardiac rehabilitation patients with suspected insomnia. Participants (N = 121) completed a self-report measure of insomnia severity. 1-min heart rate recovery (HRR), an index of parasympathetic tone, was obtained during a maximal exercise test. Difficulty falling asleep, but not difficulty staying asleep or early awakenings, was associated with attenuated 1-min HRR. When analyses were restricted to participants with moderate and severe insomnia severity (n = 51), the strength of this association increased. In a sample of cardiac rehabilitation patients with insomnia, only the symptom of difficulty falling asleep was associated with lower parasympathetic tone, suggesting that individual insomnia symptoms may show specificity in their associations with physiological mechanisms. PMID:26944765

  12. Cardiac Rehabilitation

    MedlinePlus

    ... such as high blood pressure, high blood cholesterol, depression, and diabetes. Being overweight or obese, smoking, and not exercising are other risk factors. NIH: National Heart, Lung, and Blood Institute

  13. The Use of Virtual World-Based Cardiac Rehabilitation to Encourage Healthy Lifestyle Choices Among Cardiac Patients: Intervention Development and Pilot Study Protocol

    PubMed Central

    Squires, Ray W

    2015-01-01

    Background Despite proven benefits through the secondary prevention of cardiovascular disease (CVD) and reduction of mortality, cardiac rehabilitation (CR) remains underutilized in cardiac patients. Underserved populations most affected by CVD including rural residents, low socioeconomic status patients, and racial/ethnic minorities have the lowest participation rates due to access barriers. Internet-and mobile-based lifestyle interventions have emerged as potential modalities to complement and increase accessibility to CR. An outpatient CR program using virtual world technology may provide an effective alternative to conventional CR by overcoming patient access limitations such as geographics, work schedule constraints, and transportation. Objective The objective of this paper is to describe the research protocol of a two-phased, pilot study that will assess the feasibility (Phase 1) and comparative effectiveness (Phase 2) of a virtual world-based (Second Life) CR program as an extension of a conventional CR program in achieving healthy behavioral change among post-acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI) patients. We hypothesize that virtual world CR users will improve behaviors (physical activity, diet, and smoking) to a greater degree than conventional CR participants. Methods In Phase 1, we will recruit at least 10 patients enrolled in outpatient CR who were recently hospitalized for an ACS (unstable angina, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction) or who recently underwent elective PCI at Mayo Clinic Hospital, Rochester Campus in Rochester, MN with at least one modifiable, lifestyle risk factor target (sedentary lifestyle, unhealthy diet, and current smoking). Recruited patients will participate in a 12-week, virtual world health education program which will provide feedback on the feasibility, usability, and design of the intervention. During Phase 2, we will conduct a

  14. Heart Wellness Programme: a pilot community-based cardiac rehabilitation programme in a multiethnic society

    PubMed Central

    Kwan, Yu Heng; Ong, Kheng Yong; Tay, Hung Yong; Chang, Joanne Yeh

    2016-01-01

    INTRODUCTION Community-based exercise programmes have been shown to be effective in the Western world. However, there is a dearth of literature on their effectiveness in Asia. This pilot study aims to assess the effectiveness of the Asian community-based Health Wellness Programme (HWP) in Singapore. The HWP provides community cardiac rehabilitation services. METHODS A retrospective database analysis was conducted on cardiac rehabilitation patients who had completed the one-year wellness programme from 2010 to 2011. Patients were included in the programme if they had an underlying cardiac disease such as ischaemic heart disease and were deemed as stable by their cardiologist. Patients with New York Heart Association Class III or IV heart failure were excluded from this programme. Sociodemographic, anthropometric, clinical and laboratory data was recorded. Changes between the baseline and final measurements were analysed. RESULTS Complete data from a total of 136 patients was analysed. Improvements were noted in body fat percentage (change [Δ] –1.3%, p < 0.01), distance walked (Δ 9.7 m, p = 0.01), total cholesterol (Δ –7.8 mg/dL, p = 0.03), low-density lipoprotein (Δ –7.8 mg/dL, p = 0.03) and triglyceride (Δ –17.8 mg/dL, p < 0.01). CONCLUSION The low-to-moderate intensity HWP seems to be effective in a multiethnic community setting. To confirm the quality and effectiveness of such a programme in secondary cardiovascular prevention, more evidence from prospective controlled trials with suitable controls is needed. PMID:27075576

  15. The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome

    PubMed Central

    Xu, Lin; Zhao, Hui; Qiu, Jian; Zhu, Wei; Lei, Hongqiang; Cai, Zekun; Lin, Wan-Hua; Huang, Wenhua; Zhang, Heye; Zhang, Yuan-Ting

    2015-01-01

    One of the purposes of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) is to monitor and control weight of the patient. Our study is to compare the different obesity indexes, body mass index (BMI), and waist circumference (WC), through one well-designed CR program (CRP) with ACS in Guangzhou city of Guangdong Province, China, in order to identify different effects of BMI and WC on organ damage. In our work, sixty-one patients between October 2013 and January 2014 fulfilled our study. We collected the vital signs by medical records, the clinical variables of body-metabolic status by fasting blood test, and the organ damage variables by submaximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) both on our inpatient and four-to-five weeks of outpatient part of CRP after ACS. We mainly used two-tailed Pearson's test and liner regression to evaluate the relationship of BMI/WC and organ damage. Our results confirmed that WC could be more accurate than BMI to evaluate the cardiac function through the changes of left ventricular structure on the CRP after ACS cases. It makes sense of early diagnosis, valid evaluation, and proper adjustment to ACS in CRP of the obesity individuals in the future. PMID:26247035

  16. Evaluation of bluetooth low power for physiological monitoring in a home based cardiac rehabilitation program.

    PubMed

    Martin, Timothy; Ding, Hang; D'Souza, Matthew; Karunanithi, Mohan

    2012-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality in Australia, and places large burdens on the healthcare system. To assist patients with CVDs in recovering from cardiac events and mediating cardiac risk factors, a home based cardiac rehabilitation program, known as the Care Assessment Platform (CAP), was developed. In the CAP program, patients are required to manually enter health information into their mobile phones on a daily basis. The manual operation is often subject to human errors and is inconvenient for some elderly patients. To improve this, an automated wireless solution has been desired. The objectives of this paper are to investigate the feasibility of implementing the newly released Bluetooth 4.0 (BT4.0) for the CAP program, and practically evaluate BT4.0 communications between a developed mobile application and some emulated healthcare devices. The study demonstrated that BT4.0 addresses usability, interoperability and security for healthcare applications, reduces the power consumption in wireless communication, and improves the flexibility of interface for software development. This evaluation study provides an essential mobile BT4.0 framework to incorporate a large range of healthcare devices for clinical assessment and intervention in the CAP program, and hence it is useful for similar development and research work of other mobile healthcare solutions. PMID:22797030

  17. Expanding the Limits of Evidence-Based Medicine: A Discourse Analysis of Cardiac Rehabilitation Clinical Practice Guidelines.

    ERIC Educational Resources Information Center

    Wise, Meg

    Heart attacks are the leading cause of death in the United States, and cardiac rehabilitation, a form of post-MI (myocardial infarction) education, accounts for at most 20% of improved lifestyle behavior that can effectively manage symptoms, delay or prevent subsequent attacks, and lower mortality and morbidity rates. In an attempt to improve…

  18. Multidimensional Health Locus of Control and Causal Attributions as Predictors of Health and Risk Factor Status after Cardiac Rehabilitation.

    ERIC Educational Resources Information Center

    Birkimer, John C.; And Others

    Compliance with many health-promoting regimens is often poor, even among individuals with known chronic disease. Lifestyle changes recommended by cardiac rehabilitation educators are often not adopted or not maintained by clients having suffered myocardial infarction and/or coronary graft bypass surgery. Subjects were graduates (N=117) of a Phase…

  19. Developing a Cardiac Rehabilitation Education Resource for Rural Health Workers in Queensland: Reviewing the Process and Outcomes.

    ERIC Educational Resources Information Center

    Parker, Elizabeth; O'Connor-Fleming, M.; Tooth, L.; Humphries, R. J.

    2002-01-01

    A resource manual on cardiac rehabilitation education was developed for health workers providing patient education in rural and remote Queensland (Australia). A process evaluation of the manual received feedback from 5 key informants and 31 rural health care workers following a 3-month trial. Overall, feedback was positive. Recommended content…

  20. Effect of Intense Lifestyle Modification and Cardiac Rehabilitation on Psychosocial Cardiovascular Disease Risk Factors and Quality of Life

    ERIC Educational Resources Information Center

    Aldana, Steven G.; Whitmer, William R.; Greenlaw, Roger; Avins, Andrew L.; Thomas, Dean; Salberg, Audrey; Greenwell, Andrea; Lipsenthal, Lee; Fellingham, Gill W.

    2006-01-01

    This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR) on psychosocial risk factors and quality of life in patients with confirmed coronary artery disease. Participants had previously undergone a revascularization procedure. The 84 patients self-selected to participate in the Ornish Program…

  1. The Role of Clinical and Geographic Factors in the Use of Hospital versus Home-Based Cardiac Rehabilitation

    ERIC Educational Resources Information Center

    Brual, Janette; Gravely, Shannon; Suskin, Neville; Stewart, Donna E.; Grace, Sherry L.

    2012-01-01

    Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis…

  2. Heart Failure Update: Outpatient Management.

    PubMed

    Wojnowich, Katherine; Korabathina, Ravi

    2016-03-01

    Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage. Despite a great interest in and theoretical benefit of naturoceutical products in the mitigation of oxidative stress and HF progression, none has been proven to be beneficial, and concerns exist regarding their interactions with standard HF drugs. Other nonpharmacologic interventions, including sodium restriction, regular exercise, and/or cardiac rehabilitation, should be initiated at diagnosis. HF often is progressive, and clinicians should be aware of late stage management options, including implantable devices, cardiac transplantation, and hospice care. PMID:26974001

  3. Predictors of Clinical Anxiety Aggravation at the End of a Cardiac Rehabilitation Program

    PubMed Central

    Saeidi, Mozhgan; Komasi, Saeid; Heydarpour, Behzad; Karim, Hossein; Nalini, Mehdi; Ezzati, Parvin

    2015-01-01

    Background: Anxiety is one of the most primary and common reactions to a cardiac event can lead to hypertension, tachycardia, and high cardiac output. Objectives: To investigate the predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation (CR) program. Patients and Methods: This retrospective study used a database of a CR ward of a hospital in Iran. The demographic and clinical information of 574 patients participating in the CR program from April 2005 through April 2010 were analyzed. In order to determine the predictors of anxiety, binary logistic regression was performed. Results: After adjustment for gender, age and education, the results showed that 16.7% of the patients completed their CR program with increased levels of clinical anxiety. The following study variables were independently predictive of increased anxiety at the end of the CR program: male gender (OR = 2.04, 95% CI = 1.11 to 3.33, P = 0.048), no history of diabetes (OR = 4.24, 95% CI = 172 to 10.44, P = 0.002), family history of cardiac disease (OR = 2.63, 95% CI = 1.03 to 6.74, P = 0.043), and not quitting smoking (OR = 3.29, 95% CI = 1.38 to 7.85, P = 0.007). These variables could explain 9% - 15% of the variance in the dependent variable. Conclusions: It is possible to predict higher anxiety levels at the end of the CR program and implement preventive measures to control anxiety by considering certain demographic and clinical variables. Future studies should assess the predictive power of other variables. PMID:26937419

  4. Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use: Patient and Provider Perspectives.

    PubMed

    Mead, Holly; Ramos, Christal; Grantham, Sarah C

    2016-06-01

    Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use. PMID:26400868

  5. Cardiac rehabilitation: a comprehensive program for the management of heart failure.

    PubMed

    Boudreau, Mary; Genovese, Janet

    2007-01-01

    Heart failure is one of the major health problems found in the United States today. Medical and interventional therapies play an important role in the treatment of this chronic condition, but they create a huge economic burden on the health care system. Nonpharmacologic interventions need further exploration. This article reviews research that examined the relationship between exercise and heart failure. A variety of exercise modalities measured outcomes of functional capacity and quality of life in both supervised and nonsupervised settings. Many investigators found exercise training to be safe and to confer benefits, especially on functional capacity, quality of life, and survival. The most favorable outcomes were observed in supervised settings. Cardiac rehabilitation provides an ideal environment for safe exercise and management of the health care needs of patients with heart failure. The multidisciplinary staff is adept at providing a paced approach to activity based on individualized exercise prescriptions, education, and management of this population's many comorbidities. PMID:17541318

  6. Exercise Training and Cardiac Rehabilitation in Primary and Secondary Prevention of Coronary Heart Disease

    PubMed Central

    Lavie, Carl J.; Thomas, Randal J.; Squires, Ray W.; Allison, Thomas G.; Milani, Richard V.

    2009-01-01

    Substantial data have established a sedentary lifestyle as a major modifiable risk factor for coronary heart disease (CHD). Increased levels of physical activity, exercise training, and overall cardiorespiratory fitness have provided protection in the primary and secondary prevention of CHD. This review surveys data from observational studies supporting the benefits of physical activity, exercise training, and overall cardiorespiratory fitness in primary prevention. Clearly, cardiac rehabilitation/secondary prevention (CRSP) programs have been greatly underused by patients with CHD. We review the benefits of CRSP programs on CHD risk factors, psychological factors, and overall CHD morbidity and mortality. These data support the routine referral of patients with CHD to CRSP programs. Patients should be vigorously encouraged to attend these programs. PMID:19339657

  7. Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis

    PubMed Central

    Fell, Jennifer; Dale, Veronica; Doherty, Patrick

    2016-01-01

    Objectives To ascertain the characteristics associated with delayed cardiac rehabilitation (CR) and determine if an association between CR timing and fitness outcomes exists in patients receiving routine care. Methods The study used data from the UK National Audit of Cardiac Rehabilitation, a data set which captures information on routine CR practice and patient outcomes. Data from 1 January 2012 to 8 September 2015 were included. Logistic regression models were used to explore the relationship between timing of CR and fitness-related outcomes as measured by patient-reported exercise level (150 min/week: yes/no), Dartmouth quality of life physical fitness scale and the incremental shuttle-walk test. Results Based on UK data current CR practice shows that programmes do not always adhere to recommendations on the start of prompt CR, that is, start CR within 28 days of referral (42 days for coronary artery bypass graft (CABG)). Wait time exceeded recommendations in postmyocardial infarction (post-MI), elective percutaneous coronary intervention (PCI), MI-PCI and post-CABG surgery patients. This was particularly pronounced in the medically managed post-MI group, median wait time 40 days. Furthermore, statistical analysis revealed that delayed CR significantly impacts fitness outcomes. For every 1-day increase in CR wait time, patients were 1% less likely to improve across all fitness-related measures (p<0.05). Conclusions With the potential for suboptimal patient outcome if starting CR is delayed, efforts should be made to identify and overcome barriers to timely CR provision. PMID:26870390

  8. Design and methods of the Gentle Cardiac Rehabilitation Study – A behavioral study of tai chi exercise for patients not attending cardiac rehabilitation

    PubMed Central

    Salmoirago-Blotcher, Elena; Wayne, Peter; Bock, Beth C; Dunsiger, Shira; Wu, Wen-Chih; Stabile, Loren; Yeh, Gloria

    2015-01-01

    Introduction Cardiac rehabilitation (CR) programs reduce overall and cardiovascular mortality in patients with a history of acute coronary events or revascularization procedures, but only 30 % of patients enroll in CR and attrition rates reach up to 60 %. Tai chi, a mind-body practice based on light/moderate aerobic exercise accompanied by meditative components could be a possible exercise option for patients who do not attend CR. Methods/Design Sixty patients will be randomized to a “LITE ” condition (one tai chi session twice weekly for 12 weeks) or to a “PLUS” condition (one tai chi session 3 times weekly for 12 weeks, followed by maintenance classes 1–2 times weekly for an additional 12 weeks). Measurements will be conducted at baseline, 3-, 6-, and 9 months after enrollment. The primary outcome is to determine the feasibility, acceptability and safety of each dose. Secondary outcomes include estimates of effect size of each dose on accelerometry-assessed physical activity; the proportion of patients meeting current recommendations for physical activity; and measures of fitness, quality of life, body weight, and sleep. In addition, we will collect exploratory information on possible mediators (exercise self-efficacy, perceived social support, resilience, mindfulness, and depression). Conclusions Findings from this pilot study will provide preliminary indications about the usefulness of tai chi as an exercise option for patients not attending traditional CR programs. Results will also shed light on the possible mechanisms by which tai chi practice may improve overall physical activity among patients with atherosclerotic coronary heart disease. PMID:26115880

  9. Motivational processes and well-being in cardiac rehabilitation: a self-determination theory perspective.

    PubMed

    Rahman, Rachel Jane; Hudson, Joanne; Thøgersen-Ntoumani, Cecilie; Doust, Jonathan H

    2015-01-01

    This research examined the processes underpinning changes in psychological well-being and behavioural regulation in cardiac rehabilitation (CR) patients using self-determination theory (SDT). A repeated measures design was used to identify the longitudinal relationships between SDT variables, psychological well-being and exercise behaviour during and following a structured CR programme. Participants were 389 cardiac patients (aged 36-84 years; M(age) = 64 ± 9 years; 34.3% female) referred to a 12-week-supervised CR programme. Psychological need satisfaction, behavioural regulation, health-related quality of life, physical self-worth, anxiety and depression were measured at programme entry, exit and six month post-programme. During the programme, increases in autonomy satisfaction predicted positive changes in behavioural regulation, and improvements in competence and relatedness satisfaction predicted improvements in behavioural regulation and well-being. Competence satisfaction also positively predicted habitual physical activity. Decreases in external regulation and increases in intrinsic motivation predicted improvements in physical self-worth and physical well-being, respectively. Significant longitudinal relationships were identified whereby changes during the programme predicted changes in habitual physical activity and the mental quality of life from exit to six month follow-up. Findings provide insight into the factors explaining psychological changes seen during CR. They highlight the importance of increasing patients' perceptions of psychological need satisfaction and self-determined motivation to improve well-being during the structured component of a CR programme and longer term physical activity. PMID:25753948

  10. Perceptions of risk factors of cardiovascular disease and cardiac rehabilitation: a cross-sectional study targeting the Chinese population in the Midlands, UK

    PubMed Central

    Za, Tay; Lau, Jeff C F; Wong, Arthur C K; Wong, Alice W S; Lui, Sally; Fong, James W D; Chow, Patrick Y C; Jolly, Kate B

    2012-01-01

    Objectives To find out and explore the knowledge and opinion of Chinese people on cardiovascular disease and awareness of cardiac rehabilitation. Design A cross-sectional study using 14-item bilingual (Chinese and English) questionnaires that include information on demographics, health status, cardiovascular disease related knowledge and perception, and awareness and understanding of the cardiac rehabilitation programme. Setting Chinese community groups in the Midlands, UK from January to April 2008. Participants 436 questionnaires from Chinese adults over 18 were obtained. Main outcome measures Current knowledge and attitude towards cardiovascular disease and awareness of cardiac rehabilitation. Results Obesity was the most common risk factor identified by 80.7% of participants. Those originated from China had significantly less knowledge compared with subjects from other countries (p<0.001). People who have had exposure or experience of cardiac disease rated a higher risk of cardiac disease for Chinese living in the UK than people without experience. A majority (81.7%) used orthodox medicine and perceived it to be most effective against cardiac disease. Only 30% of participants were aware of cardiac rehabilitation. Conclusion The coronary artery disease (CAD) risk factors of Chinese population have increased significantly in the last decade. Cardiac rehabilitation awareness was poor among the sample population of this study and language barrier is still a problem. More large studies on Chinese population assessing CAD risk should be done to provide more evidence on CAD prevention for this growing population in the Western world. PMID:27326032

  11. Degree and Direction of Change of Body Weight in Cardiac Rehabilitation and Impact on Exercise Capacity and Cardiac Risk Factors.

    PubMed

    Gomadam, Pallavi S; Douglas, Christopher J; Sacrinty, Matthew T; Brady, Molly M; Paladenech, Connie C; Robinson, Killian C

    2016-02-15

    Cardiac rehabilitation (CR) improves functional capacity and reduces mortality in patients with cardiovascular disease. It also improves cardiovascular risk factors and aids in weight reduction. Because of the increase in morbidly obese patients with cardiovascular disease, the prevalence of obesity and patterns of weight change in those undergoing CR merit fresh study. We studied 1,320 participants in a 12-week CR program at our academic medical center. We compared 5 categories: 69 class III obese (body mass index [BMI] ≥40) patients, 128 class II obese patients (BMI 35.0 to 39.9), 318 class I obese patients (BMI 30.0 to 34.9), 487 overweight patients (BMI 25.0 to 29.9), and 318 normal weight patients (BMI 18.5 to 24.9). Exercise capacity in METs, weight, blood pressure, and fasting lipid profile were measured before and after CR. Overall, 131 patients gained weight, 827 had no significant weight change, and 363 lost weight (176 lost 3% to 5% of their baseline weight, 161 lost 5% to 10%, and 26 lost >10%). Exercise capacity, blood pressure, and low-density lipoprotein cholesterol improved in all patients. Class III obese patients had the smallest improvement in peak METs (p <0.001), but the greatest weight loss. Patients who lost >10% of their baseline weight had the greatest improvements in exercise capacity, low-density lipoprotein, and triglycerides. In conclusion, after CR, a minority of patients lost weight. Most patients had no significant weight change and some even gained weight. The greatest loss was seen in class III obese patients. All patient groups showed improvements in exercise capacity and risk factors, regardless of the direction or degree of weight change. PMID:26768674

  12. [ICAROS (Italian survey on CardiAc RehabilitatiOn and Secondary prevention after cardiac revascularization): temporary report of the first prospective, longitudinal registry of the cardiac rehabilitation network GICR/IACPR].

    PubMed

    Griffo, Raffaele; Temporelli, Pier Luigi; Fattirolli, Francesco; Ambrosetti, Marco; Tramarin, Roberto; Vestri, Anna Rita; De Feo, Stefania; Tavazzi, Luigi

    2012-06-01

    The Italian survey on CardiAc RehabilitatiOn and Secondary prevention after cardiac revascularization (ICAROS) was a multicenter, prospective, longitudinal survey carried out by the Italian Association on Cardiovascular Prevention and Rehabilitation (GICR/IACPR) in patients on completion of a CR program after coronary artery by pass grafting (CABG) and percutaneous coronary intervention (PCI). The aim was to evaluate in the short and medium-term: i) the cardioprotective drug prescription, modification and adherence; ii) the achievement and maintenance of recommended lifestyle targets and risk factor control and their association with cardiovascular events; iii) the predictors of non-adherence to therapy and lifestyle recommendations. The ICAROS results offers a portrait of the "real world" of clinical practice concerning patients after CABG and PCI, and stresses the need to improve secondary prevention care after the index event: many patients after revascularization leave the acute wards without an optimal prescription of preventive medication but the prescription of cardiopreventive drugs and risk factors control is excellent after completion of a CR program. Following CR, the maintenance of evidence-based drugs and lifestyle adherence at one year is fairly good as far as the target goals of secondary prevention are concerned, but to investigate the influence of CR on long-term outcome longer-term studies are required. Last, but not least, ICAROS shows that some characteristics (PCI as index event, living alone, poor eating habits or smoking in young age, and old age, in particular with comorbidities) may identify patients with poor behavioral modification in the medium-term follow-up and in these patients further support may be warranted. In conclusion, participation in CR results in excellent treatment after revascularization, as well as a good lifestyle and medication adherence at 1 year and provides further confirmation of the the benefit of secondary

  13. Prediction of oxygen consumption in cardiac rehabilitation patients performing leg ergometry

    NASA Astrophysics Data System (ADS)

    Alvarez, John Gershwin

    The purpose of this study was two-fold. First, to determine the validity of the ACSM leg ergometry equation in the prediction of steady-state oxygen consumption (VO2) in a heterogeneous population of cardiac patients. Second, to determine whether a more accurate prediction equation could be developed for use in the cardiac population. Thirty-one cardiac rehabilitation patients participated in the study of which 24 were men and 7 were women. Biometric variables (mean +/- sd) of the participants were as follows: age = 61.9 +/- 9.5 years; height = 172.6 +/- 1.6 cm; and body mass = 82.3 +/- 10.6 kg. Subjects exercised on a MonarchTM cycle ergometer at 0, 180, 360, 540 and 720 kgm ˙ min-1. The length of each stage was five minutes. Heart rate, ECG, and VO2 were continuously monitored. Blood pressure and heart rate were collected at the end of each stage. Steady state VO 2 was calculated for each stage using the average of the last two minutes. Correlation coefficients, standard error of estimate, coefficient of determination, total error, and mean bias were used to determine the accuracy of the ACSM equation (1995). The analysis found the ACSM equation to be a valid means of estimating VO2 in cardiac patients. Simple linear regression was used to develop a new equation. Regression analysis found workload to be a significant predictor of VO2. The following equation is the result: VO2 = (1.6 x kgm ˙ min-1) + 444 ml ˙ min-1. The r of the equation was .78 (p < .05) and the standard error of estimate was 211 ml ˙ min-1. Analysis of variance was used to determine significant differences between means for actual and predicted VO2 values for each equation. The analysis found the ACSM and new equation to significantly (p < .05) under predict VO2 during unloaded pedaling. Furthermore, the ACSM equation was found to significantly (p < .05) under predict VO 2 during the first loaded stage of exercise. When the accuracy of the ACSM and new equations were compared based on

  14. Exercise-based cardiac rehabilitation improves endothelial function assessed by flow-mediated dilation but not by pulse amplitude tonometry.

    PubMed

    Cornelissen, Véronique A; Onkelinx, Steven; Goetschalckx, Kaatje; Thomaes, Tom; Janssens, Stefan; Fagard, Robert; Verhamme, Peter; Vanhees, Luc

    2014-01-01

    We aimed to investigate the effect of exercise on endothelium-dependent vasodilator function assessed simultaneously in the brachial artery and in the distal arterial bed by flow-mediated dilation and the pulse amplitude tonometry method, respectively, in coronary artery disease patients. The study included 146 patients with stable coronary artery disease (123 men, mean age 62 ± 9 years) who participated in the Cardiac Rehabilitation and Genetics of Exercise performance study. All patients completed a 12-week supervised cardiac rehabilitation programme (three sessions per week at an intensity of 80% of the heart rate reserve). At baseline and upon completion of the training, we measured brachial artery diameters by means of ultrasound scanning (linear array transducer of 12 MHz) and simultaneously assessed pulse amplitudes in the fingertip using a pulse amplitude tonometry device both at rest and after reactive hyperaemia induced by a 5-min forearm cuff occlusion. Peak oxygen uptake significantly increased (+22%; p < 0.0001) and flow-mediated dilation improved from 10.0% to 13.1% (+37%; p < 0.0001), whereas the reactive hyperaemia index of the pulse amplitude tonometry method remained unchanged (p = 0.47) following exercise-based cardiac rehabilitation. However, the basal digital pulse amplitude (+58%; p < 0.001) increased as a result of training, as did the digital pulse amplitude after reactive hyperaemia (+22%; p < 0.05). Exercise-based cardiac rehabilitation is associated with an improvement in endothelial function, as can be measured by flow-mediated dilation but not by the reactive hyperaemia index of the pulse amplitude tonometry method. PMID:22962311

  15. Patient Perspectives on the Hula Empowering Lifestyle Adaptation Study: Benefits of Dancing Hula for Cardiac Rehabilitation

    PubMed Central

    Maskarinec, Gregory G.; Look, Mele; Tolentino, Kalehua; Trask-Batti, Mililani; Seto, Todd; de Silva, Mapuana; Kaholokula, Joseph Keawe‘aimoku

    2014-01-01

    Background The Hula Empowering Lifestyle Adaption Study, funded by the National Institute on Minority Health and Health Disparities, was a 5-year research trial evaluating the impact of the traditional Native Hawaiian dance form, hula, as an exercise modality for cardiac rehabilitation, compared with usual care, on individuals recently hospitalized for a cardiac event or who had recently undergone coronary artery bypass surgery. Method and results Seeking to learn what physical, mental, spiritual, and social effects the intervention may have had for participants, we interviewed 20 of a total of 35 patients who were enrolled in the dance arm of the study. Classical thematic triangulation analysis was used. Participants recognized that hula’s coordination of body, mind, and spirit as a group activity deepened their appreciation of and connections to Hawaiian culture. This was true for those who were Native Hawaiian, connecting to their own cultural heritage, as well as for non–Native Hawaiians, who found that it improved their appreciation of the surrounding cultural traditions of the host culture where they now live. Conclusions Not only was hula a safe activity that improved functional capacity, participants also regarded its significant sociocultural aspects—even for participants who are not Native Hawaiian —as enhancing its value and meaningfulness. Learning the words of well-known Hawaiian songs provided additional long-term cues that encouraged “ownership” of the therapy and acted as practical reminders of the importance of exercise and lifestyle moderation while also offering new spiritual connections to the surrounding social environment. PMID:24677383

  16. Testing a Longitudinal Integrated Self-Efficacy and Self-Determination Theory Model for Physical Activity Post-Cardiac Rehabilitation

    PubMed Central

    Sweet, Shane N.; Fortier, Michelle S.; Strachan, Shaelyn M.; Blanchard, Chris M.; Boulay, Pierre

    2014-01-01

    Self-determination theory and self-efficacy theory are prominent theories in the physical activity literature, and studies have begun integrating their concepts. Sweet, Fortier, Strachan and Blanchard (2012) have integrated these two theories in a cross-sectional study. Therefore, this study sought to test a longitudinal integrated model to predict physical activity at the end of a 4-month cardiac rehabilitation program based on theory, research and Sweet et al.’s cross-sectional model. Participants from two cardiac rehabilitation programs (N=109) answered validated self-report questionnaires at baseline, two and four months. Data were analyzed using Amos to assess the path analysis and model fit. Prior to integration, perceived competence and self-efficacy were combined, and labeled as confidence. After controlling for 2-month physical activity and cardiac rehabilitation site, no motivational variables significantly predicted residual change in 4-month physical activity. Although confidence at two months did not predict residual change in 4-month physical activity, it had a strong positive relationship with 2-month physical activity (β=0.30, P<0.001). The overall model retained good fit indices. In conclusion, results diverged from theoretical predictions of physical activity, but self-determination and self-efficacy theory were still partially supported. Because the model had good fit, this study demonstrated that theoretical integration is feasible. PMID:26973926

  17. Occult peripheral artery disease is common and limits the benefit achieved in cardiac rehabilitation.

    PubMed

    Tam, Marty C; Longenecker, Chris T; Chow, Chen; Vest, Marianne; Sukeena, Richard; Madan Mohan, Sri K; Carman, Teresa; Parikh, Sahil A; Josephson, Richard A

    2016-04-01

    Cardiac rehabilitation (CR) has proven morbidity and mortality benefits in cardiovascular disease, which directly correlates with exercise performance achieved. Many patients in CR exercise at sub-optimal levels, without obvious limitations. Occult lower-extremity peripheral artery disease (PAD) may be a determinant of diminished exercise capacity and reduced benefit obtained from traditional CR. In this prospective study of 150 consecutive patients enrolled in Phase II CR, we describe the prevalence of PAD, the utility of externally validated screening questionnaires, and the observed impact on CR outcomes. Abnormal ankle-brachial indices (ABI) (< 0.9 and >1.4) were observed in 19% of those studied. The Edinburgh Claudication Questionnaire was insensitive for detecting PAD by low ABI in this population, and the Walking Impairment Questionnaire and a modified Gardner protocol demonstrated a lack of typical symptoms with low levels of activity. Importantly, at completion of traditional CR, exercise improvement measured in metabolic equivalents (METs) was worse in those with a low ABI compared to those with a normal ABI (+1.39 vs +2.41 METs, p = 0.002). In conclusion, PAD is common in patients in Phase II CR and often clinically occult. Screening based on standard questionnaires appears insensitive in this population, suggesting a need for a broad-based screening strategy with ABI measurements. In this study, undiagnosed PAD significantly attenuated improvements in exercise performance, which potentially has bearings on future clinical events. PMID:26850114

  18. Determinants of eligibility and use of ehealth for cardiac rehabilitation patients: preliminary results.

    PubMed

    Wiggers, Anne-Marieke; Peek, Niels; Kraaijenhagen, Roderik; Jaspers, Monique

    2014-01-01

    To foster implementation of eHealth in care practice, it is important to gain insight into the factors that influence acceptance. The aim of this study was to identify determinants of eligibility and use for completing an electronic needs assessment for cardiac rehabilitation. We analysed the influence of age, gender, diagnosis, health literacy, quality of life scores, and depression and anxiety scores. Among 240 patients entering CR in two clinics, 101 patients were deemed eligible to use the system by their CR professional, of which 75 (74.2%) actually used it. Only 50% of the patients who had an acute coronary syndrome and 20% of the patients with chronic heart failure were deemed eligible. Furthermore, there was a decreasing trend towards usage in female patients, patients with symptoms of anxiety, and patients with a better quality of life. In the future we will continue to explore barriers and success factors as experienced by the patients and the participating clinics to optimize the system. PMID:25160301

  19. Cardiac Rehabilitation Enrollment and the Impact of Systematic Nursing Interventions for Postmyocardial Infarction and Stent Patients.

    PubMed

    Grossman, Joan A Cebrick

    2016-08-01

    A randomized experimental design was used to determine the most effective intervention for enhancing cardiac rehabilitation (CR) enrollment for postmyocardial infarction and stent patients. The 104 subjects (70 males and 34 females; 23-87 years old) were patients with a discharge diagnosis of a myocardial infarction followed by a percutaneous coronary intervention, which included a percutaneous transluminal coronary angioplasty and the placement of one or more coronary stents. Regardless of the intervention, patients who received face-to-face nursing interventions were more likely to enroll in CR than were patients who had indirect interventions, χ(2)(3) = 32.84, p < .001. Patients who experienced an entrance interview were most likely to enroll, χ(2)(1) = 86.80, p < .001. Direct logistic regression determined that the full model was statistically significant for all predictors, χ(2)(5), 105.56, p < .001, with the strongest predictor, the entrance interview, having an odds ratio of 1.73. PMID:26655562

  20. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology.

    PubMed

    Pogosova, Nana; Saner, Hugo; Pedersen, Susanne S; Cupples, Margaret E; McGee, Hannah; Höfer, Stefan; Doyle, Frank; Schmid, Jean-Paul; von Känel, Roland

    2015-10-01

    A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team. PMID:25059929

  1. Peak Oxygen Uptake after Cardiac Rehabilitation: A Randomized Controlled Trial of a 12-Month Maintenance Program versus Usual Care

    PubMed Central

    Madssen, Erik; Arbo, Ingerid; Granøien, Ingrid; Walderhaug, Liv; Moholdt, Trine

    2014-01-01

    Background Exercise capacity is a strong predictor of survival in patients with coronary artery disease (CAD). Exercise capacity improves after cardiac rehabilitation exercise training, but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program. There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients. We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care. Materials and Methods Two-centre, open, parallel randomized controlled trial with 12 months follow-up comparing usual care to a maintenance program. The maintenance program consisted of one monthly supervised high intensity interval training session, a written exercise program and exercise diary, and a maximum exercise test every third month during follow-up. Forty-nine patients (15 women) on optimal medical treatment were included following discharge from cardiac rehabilitation. The primary endpoint was change in peak oxygen uptake at follow-up; secondary endpoints were physical activity level, quality of life and blood markers of cardiovascular risk. Results There was no change in peak oxygen uptake from baseline to follow-up in either group (intervention group 27.9 (±4.7) to 28.8 (±5.6) mL·kg (-1) min (−1), control group 32.0 (±6.2) to 32.8 (±5.8) mL·kg (−1) min (−1), with no between-group difference, p = 0.22). Quality of life and blood biomarkers remained essentially unchanged, and both self-reported and measured physical activity levels were similar between groups after 12 months. Conclusions A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake in CAD patients after discharge from cardiac rehabilitation compared to usual care. This suggests that infrequent supervised high intensity interval training sessions are

  2. [Primary results and long-term outcome of an ambulatory, cardiac rehabilitation model (phase II) after myocardial infarct, dilatation treatment and heart operation].

    PubMed

    Gysan, D B; Heinzler, R; Schmidt, K

    1997-09-01

    From October 1994 to July 1996, 128 patients (30 women, 98 men) participated in an outpatient cardiac rehabilitation program (phase II). Our objectives were to demonstrate risk-factor modification and increased work-load capacity resulting directly from the rehabilitation in terms of primary results and long-term effects, 6 months (n = 59) and 12 months (n = 30) after termination of the program. We observed how many of the patients were able to be occupationally re-integrated after completion of phase II rehabilitation. During the 4-week program, the work-load capacity increased significantly from 1.2 W/kg to 1.5 W/kg (p < or = 0.05). After 6 months (1.4 W/kg) and 1 year (1.5 W/kg), consistently high workload capacities were noted. Total cholesterol decreased significantly from 247 mg/dl to 201 mg/dl (p < or = 0.05) during the 4-week program. After 6 months (219 mg/dl) and 1 year (210 mg/dl) significant reductions persisted (p < or = 0.05). Similar results with LDL-cholesterol were seen: 185 mg/dl before entering the program, 146 mg/dl after 4 weeks, 158 mg/dl after 6 months and 151 mg/dl after 1 year. Triglyceride levels showed a significant reduction (p < or = 0.05), 189 mg/dl before entering in the program, 148 mg/dl after 4 weeks, 143 mg/dl after 6 months, and 135 mg/dl after 1 year. The HDL-levels increased slightly as a long-term effect, i.e., from 51 mg/dl to 49 mg/dl during the 4 week program, and 57 mg/dl after 6 and 12 months. Of the patients questioned (n = 73), 73% found the program very good, 27% said it was good, and no patient was dissatisfied. Of the 63 patients who were actively employed before becoming ill and later entered our program, 51 (81%) were able to be immediately re-integrated into their previous occupation. In several cases this re-integration took 7 weeks. Seven (11%) patients applied for pension, and 5 (8%) patients remained unemployed on sick-leave. PMID:9441530

  3. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    PubMed Central

    KAFFASH-CHARANDABI, Neda; SADEGHI-NIARAKI, Abolghasem; PARK, Dong-Kyun

    2015-01-01

    Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identified and cardiac rehabilitation defibrillators installed there. Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and to determine appropriate places for installing defibrillators with 5-year period data, swarm intelligence algorithms were used. Moreover, the location of the defibrillators was determined based on the following five evaluation criteria: land use, altitude of the area, economic conditions, distance from hospitals and approximate areas of reported cases of cardiac arrest for public places that were created in geospatial information system (GIS). Results: The A-P HADEL algorithm results were more precise about 27.36%. The validation results indicated a wider coverage of real values and the verification results confirmed the faster and more exact optimization of the cost function in the PSO method. Conclusion: The study findings emphasize the necessity of applying optimal optimization methods along with GIS and precise selection of criteria in the selection of optimal locations for installing medical facilities because the selected algorithm and criteria dramatically affect the final responses. Meanwhile, providing land suitability maps for installing facilities across hot and risky spots has the potential to save many lives. PMID:26587471

  4. Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial

    PubMed Central

    Fitchet, A; Doherty, P J; Bundy, C; Bell, W; Fitzpatrick, A P; Garratt, C J

    2003-01-01

    Objective: To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD). Design: Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34–74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage. Results: Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR. Conclusions: CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings. PMID:12527665

  5. Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation

    PubMed Central

    Anazodo, Udunna C.; Shoemaker, J. K.; Suskin, Neville; Ssali, Tracy; Wang, Danny J. J.; St. Lawrence, Keith S.

    2016-01-01

    Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control. PMID:26779011

  6. Cardiac Rehabilitation is Associated with Lasting Improvements in Cognitive Function in Older Adults with Heart Failure

    PubMed Central

    Alosco, Michael L.; Spitznagel, Mary Beth; Cohen, Ronald; Sweet, Lawrence H.; Josephson, Richard; Hughes, Joel; Rosneck, Jim; Gunstad, John

    2016-01-01

    Objective Heart failure (HF) is a known risk factor for cognitive impairment. Cardiac rehabilitation (CR) may attenuate poor neurocognitive outcomes in HF via improved physical fitness—a significant promoter of cognitive function. However, no study has examined the possible acute and lasting benefits of CR on cognitive function in persons with HF. Methods and Results 52 patients with HF completed a 12-week Phase II CR program. All participants were administered neuropsychological testing and completed a brief physical fitness assessment at baseline, completion of CR (i.e. 12-weeks), and 12-month follow-up. Repeated measures analyses showed a significant time effect for both attention/executive function and memory (p < 0.05). Attention/executive function performance increased from baseline to 12-weeks and these gains remained up to 12-months; memory was unchanged from baseline to 12-weeks, but then improved between the 12-week and 12-month time points. Physical fitness improved from baseline to 12-weeks and these benefits were maintained 12-months later. Changes in physical fitness and cognitive function over time did not reach a statistically significant association, though poorer physical fitness was associated with decreased cognitive performance at the baseline and 12-month time points. Conclusions CR is associated with both acute and lasting cognitive benefits in patients with HF. Prospective studies with extended follow-ups are needed to clarify the mechanisms that underpin cognitive improvements following CR (e.g., improved cerebral perfusion) and whether CR can ultimately reduce risk for cognitive decline and conditions like Alzheimer’s disease in HF. PMID:25181916

  7. Survey Reported Participation in Cardiac Rehabilitation and Survival After Mitral or Aortic Valve Surgery.

    PubMed

    Pack, Quinn R; Lahr, Brian D; Squires, Ray W; Lopez-Jimenez, Francisco; Greason, Kevin L; Michelena, Hector I; Goel, Kashish; Thomas, Randal J

    2016-06-15

    We sought to measure the impact of cardiac rehabilitation (CR) on mortality in patients with mitral or aortic heart valve surgery (HVS) and nonobstructive coronary artery disease. We surveyed all patients (or a close family member if the patient was deceased) who had HVS without coronary artery bypass in 2006 through 2010 at the Mayo Clinic to assess if they attended CR after their HVS. We performed a propensity-adjusted landmark analysis to test the association between CR attendance and long-term all-cause mortality conditional on surviving the first year after HVS. Survey response rate was 40% (573/1,420), with responders more likely to be older, have longer hospitalizations, and have more aortic valve disease. A total of 547 patients (59% aortic surgery, ejection fraction 64%) with valid survey responses and 1-year follow-up were included in the propensity analysis, of whom 296 (54%) attended CR. There were 100 deaths during a median follow-up of 5.8 years. For all patients, the propensity-adjusted model suggested no impact of CR on mortality (hazard ratio [HR] 1.03, 95% CI 0.66 to 1.62). When stratified by procedure, results suggested a potentially favorable, but nonsignificant, effect in patients with mitral valve surgery (HR 0.49, 95% CI 0.15 to 1.56), but not in patients with aortic valve surgery (HR 1.00, 95% CI 0.61 to 1.64.) In conclusion, we found no survival advantage for patients with normal preoperative ejection fraction who attended CR after surgical "correction" of their severe aortic or mitral valve disease. PMID:27138188

  8. Impact of supervised cardiac rehabilitation on urinary albumin excretion in patients with cardiovascular disease.

    PubMed

    Kimura, Sahika; Ueda, Yuka; Ise, Takayuki; Yagi, Shusuke; Iwase, Takashi; Nishikawa, Koji; Yamaguchi, Koji; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Katoh, Shinsuke; Akaike, Masashi; Yasui, Natsuo; Sata, Masataka

    2015-01-01

    Urinary albumin excretion is a predictor of cardiovascular death. Cardiac rehabilitation (CR) with exercise training (ET) has been shown to improve exercise capacity and prognosis in patients with cardiovascular disease (CVD). However, it remains unclear whether CR reduces urinary albumin excretion in CVD patients. We performed a retrospective, observational study using data obtained from 98 male CVD patients without macroalbuminuria and estimated glomerular filtration rate (eGFR) < 30 mL/minute/1.73 m(2) who participated in CR with ET during hospitalization. Twenty-three patients continued supervised ET for 6 months (supervised group) and 75 patients quit supervised ET (non-supervised group). The supervised ET program consisted of 60 minutes of supervised sessions 1-3 times a week and 30-60 minutes of home exercise at least twice a week. Urinary albumin/creatinine ratio (ACR) was significantly decreased in the supervised group at 6 months after enrollment (43 ± 71 mg/g to 17 ± 20 mg/g creatinine, P < 0.05) but not in the non-supervised group. eGFR was unchanged in the supervised group but was significantly decreased in the non-supervised group (72 ± 18 mL/minute/1.73 m(2) to 67 ± 17 mL/minute/1.73 m(2), P < 0.001). The results of multiple regression analysis showed that only supervised ET was an independent contributor to ΔACR. CR with supervised ET decreased urinary albumin excretion without deterioration of renal function. These findings suggest that continuation of a supervised ET program is associated with reduction in the development of CVD and reduction in cardiovascular morbidity and mortality in CVD patients. PMID:25742947

  9. Relationship Between Exercise Workload During Cardiac Rehabilitation and Outcomes in Patients With Coronary Heart Disease.

    PubMed

    Brawner, Clinton A; Abdul-Nour, Khaled; Lewis, Barry; Schairer, John R; Modi, Shalini S; Kerrigan, Dennis J; Ehrman, Jonathan K; Keteyian, Steven J

    2016-04-15

    The purpose of this retrospective, observational study was to describe the relation between exercise workload during cardiac rehabilitation (CR), expressed as metabolic equivalents of task (METs), and prognosis among patients with coronary heart disease. We included patients with coronary heart disease who participated in CR between January 1998 and June 2007. METs were calculated from treadmill workload. Cox regression analysis was used to describe the relationship between METs and time to a composite outcome of all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization. Among 1,726 patients (36% women; median age 59 years [interquartile range, 52 to 66]), there were 467 events (27%) during a median follow-up of 5.8 years (interquartile range, 2.6 to 8.7). In analyses adjusted for age, sex, Charlson co-morbidity index, hypertension, diabetes, and CR referral diagnosis, METs were independently related to the composite outcome at CR start (Wald chi-square 43, hazard ratio 0.59 [95% confidence interval 0.51 to 0.70]) and CR end (Wald chi-square 47, hazard ratio 0.68 [95% confidence interval 0.61 to 0.76]). Patients exercising below 3.5 METs on exit from CR represent a high-risk group with 1- and 3-year event rates ≥7% and ≥18%, respectively. In conclusion, METs during CR is available at no additional cost and can be used to identify patients at increased risk for an event who may benefit from closer follow-up, extended length of stay in CR, and/or participation in other strategies aimed at maximizing adherence to secondary preventive behaviors and improving exercise capacity. PMID:26897640

  10. Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

    PubMed Central

    2010-01-01

    Background Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation. Methods N = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation). In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted. Results The baseline values explain most of the variance (42%-60%). After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9%) for all six scales. In particular, the

  11. Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation

    PubMed Central

    Gitt, Anselm; Jannowitz, Christina; Karoff, Marthin; Karmann, Barbara; Horack, Martin; Völler, Heinz

    2012-01-01

    Aim Metabolic syndrome (MetS) is a clustering of factors that are associated with increased cardiovascular risk. We aimed to investigate the proportion of patients with MetS in patients undergoing cardiac rehabilitation (CR), and to describe differences between patients with MetS compared to those without MetS with regard to (1) patient characteristics including demographics, risk factors, and comorbidities, (2) risk factor management including drug treatment, and (3) control status of risk factors at entry to CR and discharge from CR. Methods Post-hoc analysis of data from 27,904 inpatients (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry) that underwent a CR period of about 3 weeks were analyzed descriptively in total and compared by their MetS status. Results In the total cohort, mean age was 64.3 years, (71.7% male), with no major differences between groups. Patients had been referred after a ST elevation of myocardial infarction event in 41.1% of cases, non-ST elevation of myocardial infarction in 21.8%, or angina pectoris in 16.7%. They had received a percutaneous coronary intervention in 55.1% and bypass surgery (coronary artery bypass graft) in 39.5%. Patients with MetS (n = 15,819) compared to those without MetS (n = 12,085) were less frequently males, and in terms of cardiac interventions, more often received coronary artery bypass surgery. Overall, statin use increased from 79.9% at entry to 95.0% at discharge (MetS: 79.7% to 95.2%). Patients with MetS compared to those without MetS received angiotensin converting enzyme inhibitors, angiotensin receptor blockers, oral antidiabetics, and insulin at entry and discharge more frequently, and less frequently clopidogrel and aspirin/clopidogrel combinations. Mean blood pressure was within the normal range at discharge, and did not differ substantially between groups (124/73 versus 120/72 mmHg). Overall, between entry and discharge, levels of total cholesterol, low density

  12. Long-term secondary prevention programs after cardiac rehabilitation for the reduction of future cardiovascular events: focus on regular physical activity.

    PubMed

    Scrutinio, Domenico; Temporelli, Pier Luigi; Passantino, Andrea; Giannuzzi, Pantaleo

    2009-05-01

    Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease, and as such are recommended in most contemporary clinical practice guidelines. The interventions are aimed at reducing disability, optimizing cardiovascular risk reduction by drug therapy and promoting healthy behavior. Healthy lifestyle habits must be recognized as capable of substantially reducing the risk for cardiovascular events in patients with coronary heart disease. This review highlights the recommended components of cardiac rehabilitation/secondary prevention programs, with special emphasis on regular physical activity. PMID:19450055

  13. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study

    PubMed Central

    2013-01-01

    Background Physical training has beneficial effects on exercise capacity, quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation. However, cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period. Home-based training has the potential to increase cardiac rehabilitation uptake, and was shown to be safe and effective in improving short-term exercise capacity. Long-term effects on physical fitness and activity, however, are disappointing. Therefore, we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home. In this way, we aim to improve self-management skills like self-efficacy and action planning for independent exercise and, consequently, improve long-term effectiveness with respect to physical fitness and physical activity. In addition, we aim to compare costs of this strategy with centre-based cardiac rehabilitation. Methods/design This randomized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular, 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention. The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment. Participants are instructed to train at 70-85% of their maximal heart rate for 45–60 minutes, twice a week. Patients receive individual coaching by telephone once a week, based on measured heart rate data that are shared through the internet. Primary endpoints are physical fitness and physical activity, assessed at baseline, after 12 weeks and after one year. Physical fitness is expressed as peak oxygen uptake, assessed by symptom limited exercise testing with gas exchange

  14. Cardiac acceleration at the onset of exercise: a potential parameter for monitoring progress during physical training in sports and rehabilitation.

    PubMed

    Hettinga, Florentina J; Monden, Paul G; van Meeteren, Nico L U; Daanen, Hein A M

    2014-05-01

    There is a need for easy-to-use methods to assess training progress in sports and rehabilitation research. The present review investigated whether cardiac acceleration at the onset of physical exercise (HRonset) can be used as a monitoring variable. The digital databases of Scopus and PubMed were searched to retrieve studies investigating HRonset. In total 652 studies were retrieved. These articles were then classified as having emphasis on HRonset in a sports or rehabilitation setting, which resulted in 8 of 112 studies with a sports application and 6 of 68 studies with a rehabilitation application that met inclusion criteria. Two co-existing mechanisms underlie HRonset: feedforward (central command) and feedback (mechanoreflex, metaboreflex, baroreflex) control. A number of studies investigated HRonset during the first few seconds of exercise (HRonsetshort), in which central command and the mechanoreflex determine vagal withdrawal, the major mechanism by which heart rate (HR) increases. In subsequent sports and rehabilitation studies, interest focused on HRonset during dynamic exercise over a longer period of time (HRonsetlong). Central command, mechanoreflexes, baroreflexes, and possibly metaboreflexes contribute to HRonset during the first seconds and minutes of exercise, which in turn leads to further vagal withdrawal and an increase in sympathetic activity. HRonset has been described as the increase in HR compared with resting state (delta HR) or by exponential modeling, with measurement intervals ranging from 0-4 s up to 2 min. Delta HR was used to evaluate HRonsetshort over the first 4 s of exercise, as well as for analyzing HRonsetlong. In exponential modeling, the HR response to dynamic exercise is biphasic, consisting of fast (parasympathetic, 0-10 s) and slow (sympathetic, 1-4 min) components. Although available studies differed largely in measurement protocols, cross-sectional and longitudinal training studies showed that studies analyzing HRonset

  15. Psychiatric disorders and associated factors in cancer: results of an interview study with patients in inpatient, rehabilitation and outpatient treatment.

    PubMed

    Härter, M; Reuter, K; Aschenbrenner, A; Schretzmann, B; Marschner, N; Hasenburg, A; Weis, J

    2001-07-01

    An association between mental disorders, especially affective and anxiety disorders, and cancer has been reported in many studies. The present study investigated current (4-weeks-, 12-months-, and lifetime-prevalence rates of comorbid mental disorders in cancer patients. Through a cross-sectional design, 517 patients (75% female patients) from two acute inpatient care clinics, two rehabilitation clinics and nine specialised practices for oncology were examined with standardised scales for psychological burden and quality of life. Somatic parameters were assessed through standardised medical records. In the second-stage-examination, a sample of 200 patients was interviewed with standardised clinical interview (CIDI) in order to obtain DSM-IV diagnoses of mental disorders. Differences in the type of mental disorders were examined for gender, treatment setting, severity of cancer and physical impairment. Prevalence rates of mental disorders were 23.5% for the 4-weeks, 40% for the 12-months, and 56.5% for the lifetime periods. The current and 12-months rates of affective and anxiety disorders were approximately 25-33% higher than prevalence rates found in recent epidemiological studies of the general population. These higher rates were, however, mainly due to the preponderance of female patients with a higher risk for mental disorders compared with males. The most prevalent current disorders were affective (9.5%), and anxiety disorders (13%). Female gender was associated with an approximately 2-fold risk of mental disorders during the patient's lifespan. Current diagnosis of affective disorders in women was highly related to the cancer. Physical impairment was also associated with the frequency of current psychiatric disorders, especially affective and anxiety disorders. The frequency of mental disorders in cancer patients does not differ from results of recent international epidemiological studies of the normal population. The slightly higher rates of anxiety

  16. Evaluation of a Standardized Patient Education Program for Inpatient Cardiac Rehabilitation: Impact on Illness Knowledge and Self-Management Behaviors up to 1 Year

    ERIC Educational Resources Information Center

    Meng, Karin; Seekatz, Bettina; Haug, Günter; Mosler, Gabriele; Schwaab, Bernhard; Worringen, Ulrike; Faller, Hermann

    2014-01-01

    Patient education is an essential part of the treatment of coronary heart disease in cardiac rehabilitation. In Germany, no standardized and evaluated patient education programs for coronary heart disease have been available so far. In this article, we report the evaluation of a patient-oriented program. A multicenter quasi-experimental,…

  17. Flexibility and Strength Measures in Children Participating in a Cardiac Rehabilitation Exercise Program.

    ERIC Educational Resources Information Center

    Koch, Barbara M.; And Others

    1988-01-01

    A 12-week structured rehabilitation program featuring warm-up exercises, increased aerobic exercise, cool down, and home-based continuation of exercise helped 12 children with surgically corrected congenital heart disease improve lower extremity strength and flexibility. (Author/CB)

  18. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial

    PubMed Central

    2013-01-01

    Background Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. Methods/Design The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients’ self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. Discussion This

  19. Measurement of functional capacity requirements to aid in development of an occupation-specific rehabilitation training program to help firefighters with cardiac disease safely return to work.

    PubMed

    Adams, Jenny; Roberts, Joanne; Simms, Kay; Cheng, Dunlei; Hartman, Julie; Bartlett, Charles

    2009-03-15

    We designed a study to measure the functional capacity requirements of firefighters to aid in the development of an occupation-specific training program in cardiac rehabilitation; 23 healthy male firefighters with no history of heart disease completed a fire and rescue obstacle course that simulated 7 common firefighting tasks. They wore complete personal protective equipment and portable metabolic instruments that included a data collection mask. We monitored each subject's oxygen consumption (VO(2)) and working heart rate, then calculated age-predicted maximum heart rates (220 - age) and training target heart rates (85% of age-predicted maximum heart rate). During performance of the obstacle course, the subjects' mean working heart rates and peak heart rates were higher than the calculated training target heart rates (t(22) = 5.69 [working vs target, p <0.001] and t(22) = 15.14 [peak vs target, p <0.001]). These findings, with mean results for peak VO(2) (3,447 ml/min) and metabolic equivalents (11.9 METs), show that our subjects' functional capacity greatly exceeded that typically attained by patients in traditional cardiac rehabilitation programs (5 to 8 METs). In conclusion, our results indicate the need for intense, occupation-specific cardiac rehabilitation training that will help firefighters safely return to work after a cardiac event. PMID:19268728

  20. Effect of Respiratory Rehabilitation Before Open Cardiac Surgery on Respiratory Function: A Randomized Clinical Trial

    PubMed Central

    Shakouri, Seyed Kazem; Salekzamani, Yaghoub; Taghizadieh, Ali; Sabbagh-Jadid, Hamed; Soleymani, Jamal; Sahebi, Leyla; Sahebi, Roya

    2015-01-01

    Introduction: Prevention of pulmonary complications after coronary artery bypass graft is attended as a very important issue. The aim of this study was to evaluate the role of pulmonary rehabilitation before surgery for reducing the risk of pulmonary complications after surgery. Methods: In a randomized clinical trial, 60 patients undergoing heart surgery were randomly divided into two groups A and B. Chest physiotherapy was performed before and after surgery on group A patients however it was done on group B’s, only after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and arterial blood gas (ABG). Results: Thirty nine males (65%) and 21 females (35%) with mean age of 8.10 ± 9.56 were analyzed. The mean differences were statistically significant for predicted forced vital capacity (FVC) (CI 95%:1.3 to 8.7) and Predicted Peak Flow indices (PEF) (CI 95%: 1.9 to 9.4) of spirometry indicator, PCO2 index (of ABG parameter) (CI 95%: 1.4 to 8.9) and mean oxygen saturation (mean Spo2) (CI 95%: 0.6 to 1.7) of ABG index in two groups. Conclusion: The performance of pulmonary rehabilitation program before surgery is recommended, as it may result in the reduction of complications of heart surgery PMID:25859310

  1. Evaluating the Effectiveness of an Interactive Multimedia Computer-based Patient Education Program in Cardiac Rehabilitation.

    ERIC Educational Resources Information Center

    Jenny, Ng Yuen Yee; Fai, Tam Sing

    2001-01-01

    A study compared 48 cardiac patients who used an interactive multimedia computer-assisted patient education program and 48 taught by tutorial. The computer-assisted instructional method resulted in significantly better knowledge about exercise and self-management of chronic diseases. (Contains 29 references.) (JOW)

  2. CRIB—the use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial (RCT) with embedded feasibility study

    PubMed Central

    Munro, Julie; Adams, Richard; Campbell, Anna; Campbell, Sandra; Donaldson, Cam; Godwin, Jon; Haw, Sally; Kidd, Lisa; Lane, Chrissie; Leslie, Stephen J; Mason, Helen; Mutrie, Nanette; O'Carroll, Ronan; Taylor, Cara; Treweek, Shaun; Watson, Angus; Hubbard, Gill

    2014-01-01

    Introduction Patients with colorectal cancer report ongoing physical and psychological impairments and a high proportion of these patients are overweight, insufficiently active and high-risk drinkers, putting them at risk of poor recovery and risk of recurrence and comorbidities. A challenge is implementing sustainable and effective rehabilitation as part of routine care for this group. Methods and analysis A two-arm pilot randomised controlled trial (RCT) with embedded feasibility study undertaken as a phased programme of work. The intervention involves an existing cardiac rehabilitation programme for cardiac patients accepting colorectal cancer patient referrals. The intervention consists of supervised exercise sessions run by a cardiac physiotherapist and information sessions. Phase 1 will involve one research site enrolling 12 patients to assess intervention and study design processes. Semistructured interviews with patients with colorectal cancer and cardiac patients and clinicians will be used to gather data on acceptability of the intervention and study procedures. Phase 2 will involve three sites enrolling 66 patients with colorectal cancer randomised to control or intervention groups. Outcome measures will be taken preintervention and postintervention, for phases 1 and 2. The primary outcome is accelerometer measured physical activity; secondary outcomes are self-report physical activity, quality of life, anxiety, depression, symptoms including fatigue. The following variables will also be examined to determine if these factors influence adherence and outcomes: self-efficacy, risk perception and treatments. Ethics and dissemination Full ethical approval was granted by NRES Committees—North of Scotland (13/NS/0004; IRAS project ID: 121757) on 22 February 2013. The proposed work is novel in that it aims to test the feasibility and acceptability of using an evidence-based and theory driven existing cardiac rehabilitation service with patients with

  3. Acute Physiological Responses to Short- and Long-Stage High-Intensity Interval Exercise in Cardiac Rehabilitation: A Pilot Study

    PubMed Central

    Tschakert, Gerhard; Kroepfl, Julia M.; Mueller, Alexander; Harpf, Hanns; Harpf, Leonhard; Traninger, Heimo; Wallner-Liebmann, Sandra; Stojakovic, Tatjana; Scharnagl, Hubert; Meinitzer, Andreas; Pichlhoefer, Patriz; Hofmann, Peter

    2016-01-01

    Despite described benefits of aerobic high-intensity interval exercise (HIIE), the acute responses during different HIIE modes and associated health risks have only been sparsely discovered in heart disease patients. Therefore, the aim of this study was to investigate the acute responses for physiological parameters, cardiovascular and inflammatory biomarkers, and catecholamines yielded by two different aerobic HIIE protocols compared to continuous exercise (CE) in phase III cardiac rehabilitation. Eight cardiac patients (7 with coronary heart disease, 1 with myocarditis; 7 males, 1 female; age: 63.0 ± 9.4 years; height: 1.74 ± 0.05 m; weight: 83.6 ± 8.7 kg), all but one treated with ß-blocking agents, performed a maximal symptom-limited incremental exercise test (IET) and three different exercise tests matched for mean load (Pmean) and total duration: 1) short HIIE with a peak workload duration (tpeak) of 20 s and a peak workload (Ppeak) equal to the maximum power output (Pmax) from IET; 2) long HIIE with a tpeak of 4 min, Ppeak was corresponding to the power output at 85 % of maximal heart rate (HRmax) from IET; 3) CE with a target workload equal to Pmean of both HIIE modes. Acute metabolic and peak cardiorespiratory responses were significantly higher during long HIIE compared to short HIIE and CE (p < 0.05) except HRpeak which tended to be higher in long HIIE than in short HIIE (p = 0.08). Between short HIIE and CE, no significant difference was found for any parameter. Acute responses of cardiovascular and inflammatory biomarkers and catecholamines didn’t show any significant difference between tests (p > 0.05). All health-related variables remained in a normal range in any test except NT-proBNP, which was already elevated at baseline. Despite a high Ppeak particularly in short HIIE, both HIIE modes were as safe and as well tolerated as moderate CE in cardiac patients by using our methodological approach. Key points High-intensity interval exercise (HIIE

  4. Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome

    PubMed Central

    2013-01-01

    Background Despite well-established medical recommendations, many cardiac patients do not exercise regularly either independently or through formal cardiac prevention and rehabilitation programs (CPRP). This non-adherence is even more pronounced among minority ethnic groups. Illness cognition (IC), i.e. the way people perceive the situation they encounter, has been recognized as a crucial determinant of health-promoting behavior. Few studies have applied a cognitive perspective to explain the disparity in exercising and CPRP attendance between cardiac patients from different ethnic backgrounds. Based on the Health Belief Model (HBM) and the Common Sense Model (CSM), the objective was to assess the association of IC with exercising and with participation in CPRP among Jewish/majority and Arab/minority patients hospitalized with acute coronary syndrome. Methods Patients (N = 420) were interviewed during hospitalization (January-2009 until August- 2010) about IC, with 6-month follow-up interviews about exercise habits and participation in CPRP. Determinants that predict active lifestyle and participation in CPRP were assessed using backward stepwise logistic regression. Results Perceived susceptibility to heart disease and sense and personal control were independently associated with exercising 6 months after the acute event (OR = 0.58, 95% CI: 0.42-0.80 and OR = 1.09, 95% CI: 1.02-1.17, per unit on a 5-point scale). Perceived benefits of regular exercise and a sense of personal control were independently associated with participation in CPRP (OR = 1.56, 95% CI: 1.12-2.16 and OR = 1.08, 95% CI: 1.01-1.15, per unit on a 5-point scale). None of the IC variables assessed could explain the large differences in health promoting behaviors between the majority and minority ethnic groups. Conclusions IC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed

  5. Women's experiences of how their recovery process is promoted after a first myocardial infarction: Implications for cardiac rehabilitation care

    PubMed Central

    Wieslander, Inger; Mårtensson, Jan; Fridlund, Bengt; Svedberg, Petra

    2016-01-01

    Background A rapid improvement in the care of myocardial infarction (MI) in the emergency services has been witnessed in recent years. There is, however, a lack of understanding of the factors involved in a successful recovery process, after the initial stages of emergency care among patients, and in particular those who are women. Both preventive and promotive perspectives should be taken into consideration for facilitating the recovery process of women after a MI. Aim To explore how women's recovery processes are promoted after a first MI. Methods A qualitative content analysis was used. Findings The women's recovery process is a multidirectional process with a desire to develop and approach a new perspective on life. The women's possibility to approach new perspectives on life incorporates how they handle the three dimensions: behaviour, that is, women's acting and engaging in various activities; social, that is, how women receive and give support in their social environment; and psychological, that is, their way of thinking, reflecting, and appreciating life. Conclusions The personal recovery of women is a multidirectional process with a desire to develop and approach a new perspective on life. It is important for cardiac rehabilitation nurses to not only focus on lifestyle changes and social support but also on working actively with the women's inner strength in order to promote the recovery of the women. PMID:27172514

  6. Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program?

    PubMed Central

    Komasi, Saeid; Montazeri, Nafiseh; Masoumi, Masoumali; Soroush, Ali; Ezzati, Parvin

    2015-01-01

    Objective To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. Methods The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. Results The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. Conclusion The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables. PMID:26798600

  7. Randomized controlled trial of a self-efficacy enhancement program for the cardiac rehabilitation of Thai patients with myocardial infarction.

    PubMed

    Vibulchai, Nisakorn; Thanasilp, Sureeporn; Preechawong, Sunida

    2016-06-01

    This study examined the effects of a self-efficacy enhancement program for the cardiac rehabilitation of Thai patients who had a myocardial infarction. Sixty-six hospitalized patients of various ages and both genders were randomly assigned to either an experimental or a control group. Participants in the experimental group took part in three individualized in-hospital education sessions and three weekly sessions of telephone counseling. The control group primarily engaged in a supervised exercise and activities of a daily living performance regimen, and received education in this regard. Self-efficacy and functional status were measured via questionnaire. Four weeks after discharge, the experimental group was found to have significantly higher total self-efficacy and functional status scores than the control group. In addition, the experimental group exhibited significantly higher subscale scores on social activity, household tasks, occupation, and exercise self-efficacy than the control group. These results indicate that the program is effective in improving the self-efficacy and functional status of Thai patients who have had a myocardial infarction. PMID:26415520

  8. [Psychiatric rehabilitation].

    PubMed

    Dusek, K

    1990-04-01

    The author presents a brief account of the development of psychiatric rehabilitation during the past two centuries. He draws attention to new trends in rehabilitation of the mentally sick during the post-war period and at present. He describes the system of rehabilitation in the Soviet Union which began to develop as a results of efforts in the Bekhterev Institute in Leningrad. In our country the law on social security in 1964 created conditions for protected workshop and protected work places. In 1973 methodical instructions of the Ministry of Labour and Social Affairs issued instructions which specified the principles of planning, establishment and operation of these facilities. At the end of 1986 the Ministry of Health CSR issued an amendment to the concept of psychiatry which contains the organization of psychiatric rehabilitation not only in in-patient but in particular in out-patient psychiatric facilities. PMID:2194684

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

    PubMed Central

    Wangberg, Silje C

    2014-01-01

    Background An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual. Objective Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version. Methods The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program. Results Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but

  10. A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis—the CopenHeartIE trial protocol

    PubMed Central

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe; Sibilitz, Kirstine Lærum; Risom, Signe Stelling; Bundgaard, Henning; Gluud, Christian; Moons, Philip; Winkel, Per; Thygesen, Lau Caspar; Hansen, Jane Lindschou; Norekvål, Tone Merete; Berg, Selina Kikkenborg

    2012-01-01

    Introduction Infective endocarditis (IE) is among the most serious infectious diseases in the western world. Treatment requires lengthy hospitalisation, high-dosage antibiotic therapy and possible valve replacement surgery. Despite advances in treatment, the 1-year mortality remains at 20–40%. Studies indicate that patients experience persisting physical symptoms, diminished quality of life and difficulties returning to work up to a year postdischarge. No studies investigating the effects of rehabilitation have been published. We present the rationale and design of the CopenHeartIE trial, which investigates the effect of comprehensive cardiac rehabilitation versus usual care for patients treated for IE. Methods and analysis We will conduct a randomised clinical trial to investigate the effects of comprehensive cardiac rehabilitation versus usual care on the physical and psychosocial functioning of patients treated for IE. The trial is a multicentre, parallel design trial with 1 : 1 individual randomisation to either the intervention or control group. The intervention consists of five psychoeducational consultations provided by specialised nurses and a 12-week exercise training programme. The primary outcome is mental health (MH) measured by the standardised Short Form 36 (SF-36). The secondary outcome is peak oxygen uptake measured by the bicycle ergospirometry test. Furthermore, a number of exploratory analyses will be performed. Based on sample size calculation, 150 patients treated for left-sided (native or prosthetic valve) or cardiac device endocarditis will be included in the trial. A qualitative and a survey-based complementary study will be undertaken, to investigate postdischarge experiences of the patients. A qualitative postintervention study will explore rehabilitation participation experiences. Ethics and dissemination The study complies with the Declaration of Helsinki and was approved by the regional research ethics committee (no H-1

  11. Association between heart rate at rest and myocardial perfusion in patients with acute myocardial infarction undergoing cardiac rehabilitation – a pilot study

    PubMed Central

    Uematsu, Mariko; Ashikaga, Kohei; Yoneyama, Kihei; Kida, Keisuke; Suzuki, Kengo; Omiya, Kazuto; Harada, Tomoo; Banach, Maciej; Miyake, Fumihiko

    2012-01-01

    Introduction This study was conducted to determine if there was a link among heart rate at rest (rHR), muscle volume changes, and single photon emission computed tomography (SPECT) parameters after 6-month cardiac rehabilitation in patients with acute myocardial infarction (AMI). Material and methods Twenty-nine consecutive AMI patients (mean age: 63.0 ±9.1 years) who received appropriate percutaneous coronary intervention on admission were enrolled. 99mTc-Sestamibi myocardial SPECT images were obtained at the early (30 min) and delayed (4 h) phases after tracer injection at 2 weeks (0M) and 6 months (6M) after the onset of AMI. Within a few days of SPECT, all patients underwent cardiopulmonary exercise test for evaluation of cardiac rehabilitation effects. Before the initiation of exercise test, leg muscle volume was measured. All patients were stratified into the ≥ 70 beats per minute (bpm) (n = 15) or < 70 bpm (n = 14) group based on rHR at 6M. Results There were no significant differences in the recanalization time, peak cardiac enzyme, or initial left ventricular ejection fraction between the two groups. After the 6-month training, the muscle volume changes in the lower limbs (< 70 bpm, 0.23 ±0.22; ≥ 70 bpm, –0.07 ±0.26, p < 0.05) were significantly greater in the < 70 bpm group than the ≥ 70 bpm group. The decreased rate of rHR had a significant correlation with the improved global severity (r = 0.62, p = 0.001) and extent (r = 0.48, p = 0.017) of left ventricle evaluated by 99mTc-Sestamibi myocardial SPECT delayed phase. Conclusions The result of this preliminary study demonstrated that improved myocardial perfusion was closely related to decreased rHR after cardiac rehabilitation. PMID:23056072

  12. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol

    PubMed Central

    Risom, Signe Stelling; Zwisler, Ann-Dorth Olsen; Rasmussen, Trine Bernholdt; Sibilitz, Kirstine Lærum; Svendsen, Jesper Hastrup; Gluud, Christian; Hansen, Jane Lindschou; Winkel, Per; Thygesen, Lau Caspar; Perhonen, Merja; Hansen, Jim; Dunbar, Sandra B; Berg, Selina Kikkenborg

    2013-01-01

    Introduction Atrial fibrillation affects almost 2% of the population in the Western world. To preserve sinus rhythm, ablation is undertaken in symptomatic patients. Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physically active due to fear of triggering fibrillation. Small trials indicate that exercise training has a positive effect on exercise capacity and mental health, and both patients with recurrent atrial fibrillation and in sinus rhythm may benefit from rehabilitation in managing life after ablation. No randomised trials have been published on cardiac rehabilitation for atrial fibrillation patients treated with ablation that includes exercise and psychoeducational components. Aim To test the effects of an integrated cardiac rehabilitation programme versus treatment as usual for patients with atrial fibrillation treated with ablation. Methods and analysis design The trial is a multicentre parallel arm design with 1:1 randomisation to the intervention and control group with blinded outcome assessment. 210 patients treated for atrial fibrillation with radiofrequency ablation will be included. The intervention consists of a rehabilitation programme including four psychoeducative consultations with a specially trained nurse and 12 weeks of individualised exercise training, plus the standard medical follow-up. Patients in the control group will receive the standard medical follow-up. The primary outcome measure is exercise capacity measured by the VO2 peak. The secondary outcome measure is self-rated mental health measured by the Short Form 36 questionnaire. Postintervention, qualitative interviews will be conducted in 10% of the intervention group. Ethics and dissemination The protocol is approved by the regional research ethics committee (number H-1-2011-135), the Danish Data Protection Agency (reg. nr. 2007-58-0015) and follows the latest version of the Declaration of Helsinki

  13. [Ambulatory heart groups after inpatient cardiologic rehabilitation].

    PubMed

    Keck, M; Budde, H G

    1999-05-01

    In n = 1504 consecutive patients after inpatient cardiac rehabilitation, we investigate how many patients can be motivated to join a so-called outpatient heart group, which sociographical and medical variables influence participation, and whether participation in a heart group prompts a more health-orientated nutrition. Applying a special team-based motivation programme, almost 30% of patients undergoing cardiac rehabilitation under the pension insurance scheme for workers can be motivated to join a heart group, who otherwise can hardly be prompted to do so. About 75% of them still participate in the heart group 7 months later. Initial and continuing participation are more probable in patients of middle age, male gender, with previous PTCA, moderately or severely restricted left ventricular function, and--for patients up to the age of 55 years--in case of reintegration or expected reintegration into work life. Patients after heart valve surgery are significantly less liable to join a heart group than CHD patients. Seven months after cardiac rehabilitation, medium cholesterol values have less increased among participants of heart groups than among non-participants. This may indicate a more stabilized health-orientated lifestyle among members of heart groups. PMID:10413799

  14. [Atherosclerosis of the lower extremities as a linked comorbidity in Patients Admitted for cardiac rehabilitation (THINKPAD): rationale, design, and study group].

    PubMed

    Ambrosetti, Marco; Diaco, Tommaso; Febo, Oreste; Calisi, Pasqualina; Favretto, Giuseppe; Carlon, Roberto; Temporelli, Pier Luigi

    2012-03-01

    Peripheral arterial disease (PAD) is a frequent comorbidity among patients entering cardiac rehabilitation (CR) programmes and an important source of disability and impaired prognosis. The prevalence of PAD across the wide range of conditions for CR is poorly understood, as far as its impact on drug optimization and intervention delivered. The "ATHerosclerosis of the lower extremities as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation" (THINKPAD) study was carried out by the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) in order to explore PAD both as a comorbidity and a primary indication at the entry of CR. The study was a retrospective case series. In the study period (from May 1, 2012 to June 30, 2012), data on consecutive patients discharged from 17 CR units in Northern Italy were collected. Web-based electronic case report forms (e-CRF), accessible in a dedicated section of the IACPR website (www.iacpr.it), were used for data entry, and data were transferred via web to a central database. The data collection instrument was designed with a multiple choice format, with jump menus or select boxes and obligatory items. A sample size of 1,300 subjects is expected, with first data available by the end of 2012. PMID:22928398

  15. Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform

    PubMed Central

    Gant, Nicholas; Meads, Andrew; Warren, Ian; Maddison, Ralph

    2016-01-01

    Background Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. Objective We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. Methods An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. Results The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients’ exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. Conclusions The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial. PMID:27342791

  16. Evaluating the Interactive Web-Based Program, Activate Your Heart, for Cardiac Rehabilitation Patients: A Pilot Study

    PubMed Central

    Boyce, Sally; Houchen-Wolloff, Linzy; Sewell, Louise; Singh, Sally

    2014-01-01

    Background Conventional cardiac rehabilitation (CR) programs are traditionally based on time-constrained, structured, group-based programs, usually set in hospitals or leisure centers. Uptake for CR remains poor, despite the ongoing evidence demonstrating its benefits. Additional alternative forms of CR are needed. An Internet-based approach may offer an alternative mode of delivering CR that may improve overall uptake. Activate Your Heart (AYH) is a Web-based CR program that has been designed to support individuals with coronary heart disease (CHD). Objective The aim of this pilot study was to observe the outcome for participants following the AYH program. Methods We conducted a prospective observational trial, recruiting low-risk patients with CHD. Measures of exercise, exercise capacity, using the Incremental Shuttle Walk Test (ISWT), dietary habits, and psychosocial well-being were conducted by a CR specialist at baseline and at 8 weeks following the Web-based intervention. Results We recruited 41 participants; 33 completed the program. We documented significant improvements in the ISWT distance (mean change 49.69 meters, SD 68.8, P<.001), and Quality of Life (QOL) (mean change 0.28, SD 0.4, P<.001). Dietary habits improved with an increased proportion of patients consuming at least 5 portions of fruit and vegetables per day, (22 [71%] to 29 [94%] P=.01) and an increased proportion of patients consuming at least 2 portions of oily fish per week (14 [45%] to 21 [68%], P=.01). We did not detect changes in anxiety and depression scores or exercise behavior. Conclusions We observed important improvements in exercise capacity, QOL, and dietary habits in a group of participants following a Web-based CR program. The program may offer an alternative approach to CR. A mobile version has been developed and we need to conduct further trials to establish its value compared to supervised CR. PMID:25359204

  17. Impact of Exercise-Based Cardiac Rehabilitation on De Novo Coronary Lesion in Patients With Drug Eluting Stent

    PubMed Central

    Choi, Hee Eun; Kim, Chul

    2014-01-01

    Objective To compare the rate of progression of de novo lesion between the cardiac rehabilitation (CR) and control groups. Methods This is a retrospective observational study. Patients who received drug-eluting stent (DES) due to acute coronary syndrome were included as subjects. The CR group received eight weeks of early CR program, and sustained a self-exercise program in the homes. The control group was instructed to exercise independently. Nine months after the first insertion of DES, we implemented follow-up coronary angiography, and compared the rate of progression of de novo lesion by quantitative angiographic measurement between the two groups. Results A total of 81 patients were recruited as subjects to CR group (n=32) or control group (n=49). At nine months, late luminal loss was 0.04±0.23 mm in the CR group and 0.00±0.31 mm in the control group (p=0.54, observed power=0.10). Late loss was -0.90%±9.53% in the CR group and 0.80%±11.15% in the control group (p=0.58, observed power=0.05). No target lesion revascularization procedures were needed in the CR group, while two in the control group (p=0.25). In the CR group, mean VO2max was significantly improved from 24.36±5.00 to 27.68±5.24 mL/kg/min (p<0.001). Conclusion We could not observe a statistically significant difference in the progression rate of de novo lesion between the CR and control groups. Thus the current amount of nine months exercise-based CR program does not seem to have a distinct impact on the retardation of de novo coronary lesion in patients who received percutaneous coronary intervention with DES. PMID:24855621

  18. Comparison Between Effects of Home Based Cardiac Rehabilitation Programs Versus Usual Care on the Patients’ Health Related Quality of Life After Coronary Artery Bypass Graft

    PubMed Central

    Salavati, Mohsen; Falahinia, Gholamhossein; Vardanjani, Ali Esmaeili; Rafiei, Hossein; Moosavi, Saeid; Torkamani, Mehdi

    2016-01-01

    Background & Aim: To compare home-based cardiac rehabilitation with usual care on the patients’ Health Related Quality of Life (HRQoL) after coronary artery bypass graft in patients with coronary artery bypass graft (CABG) surgery. Methods: In a randomized controlled clinical conducted from March 2013 to June 2013, 110 patients with CABG surgery were randomly assigned into two groups. While patients in group I, were received usual care and patients in group II, in addition to the usual care were received home-based cardiac rehabilitation programs. The 27-item MacNew Heart Disease HRQoL questionnaire was used to evaluate the patient’s HRQoL under and over 2 months after intervention. Results: At the time of 0, mean score of HRQoL was 67.86±7.5 and 64.76±8.4 in patients in group I and group II, respectively (P> 0.05). Although mean score of HRQoL in all patients in both groups increased two month after intervention, but this increase in patients in group II were higher than patients in group I (154.93±4.6 vs 134.20±8.2). This difference were statistically significant (P< 0.05). Conclusion: Quality of Life (QoL) can be considered as a quality indicator of health care systems. Results of present study showed that home-based cardiac rehabilitation program improved patients HRQoL after CABG surgery. PMID:26573042

  19. Combining Users’ Needs With Health Behavior Models in Designing an Internet- and Mobile-Based Intervention for Physical Activity in Cardiac Rehabilitation

    PubMed Central

    2014-01-01

    Background Internet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions. Objective The aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention. Methods We explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data. Results We chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail. Conclusions We applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input. Trial Registration Clinicaltrials.gov NCT01223170; http

  20. Outpatient Surgery

    MedlinePlus

    Policymakers | Members | Patients | News Media Anesthesia 101 Patient Safety Stories Resources About Home » Patients » Preparing For Surgery » Types of Surgery » Outpatient Surgery Share this Page Preparing For ...

  1. The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction

    PubMed Central

    2016-01-01

    Objective To observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF. Methods Patients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%–49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%–85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program. Results After completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO2max. In the pLVEF group, LVEF and VO2max increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO2max increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely. Conclusion In both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group. PMID:27606271

  2. High-intensity cardiac rehabilitation training of a commercial pilot who, after percutaneous coronary intervention, wanted to continue participating in a rigorous strength and conditioning program.

    PubMed

    Shrestha, Sanjay; Adams, Jenny; Lawrence, Anne; Schussler, Jeffrey M

    2016-01-01

    After undergoing elective percutaneous coronary intervention, a 64-year-old commercial pilot was referred to cardiac rehabilitation. His stated goals were to continue participating in a rigorous strength and conditioning program at a community workout facility and to resume working as a pilot. To help him meet those goals, we designed and implemented a regimen of high-intensity exercises, with quick transitions between a variety of tasks that are not typically included in cardiac rehabilitation programs (e.g., medicine ball throws, push-ups, dead lifts, squats, military presses, sprints, and lunges). The training was symptom limited, enabling the patient to reach extreme levels of physical exertion in a controlled, monitored setting. By studying his training data (heart rate, blood pressure, and rating of perceived exertion), we were able to give him specific recommendations for controlling his exercise intensity after graduating from our program. More than 18 months later, he continues to exercise vigorously 3 days per week and is working as a commercial pilot. PMID:26722183

  3. High-intensity cardiac rehabilitation training of a commercial pilot who, after percutaneous coronary intervention, wanted to continue participating in a rigorous strength and conditioning program

    PubMed Central

    Shrestha, Sanjay; Lawrence, Anne; Schussler, Jeffrey M.

    2016-01-01

    After undergoing elective percutaneous coronary intervention, a 64-year-old commercial pilot was referred to cardiac rehabilitation. His stated goals were to continue participating in a rigorous strength and conditioning program at a community workout facility and to resume working as a pilot. To help him meet those goals, we designed and implemented a regimen of high-intensity exercises, with quick transitions between a variety of tasks that are not typically included in cardiac rehabilitation programs (e.g., medicine ball throws, push-ups, dead lifts, squats, military presses, sprints, and lunges). The training was symptom limited, enabling the patient to reach extreme levels of physical exertion in a controlled, monitored setting. By studying his training data (heart rate, blood pressure, and rating of perceived exertion), we were able to give him specific recommendations for controlling his exercise intensity after graduating from our program. More than 18 months later, he continues to exercise vigorously 3 days per week and is working as a commercial pilot. PMID:26722183

  4. Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

    PubMed Central

    Ali-Faisal, Sobia F; Benz Scott, Lisa; Johnston, Lauren; Grace, Sherry L

    2016-01-01

    Objectives To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment. Setting 3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre. Participants CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants. Intervention The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers. Outcome measures The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction. Results Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24). Conclusions There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest

  5. Yoga based cardiac rehabilitation after coronary artery bypass surgery: One-year results on LVEF, lipid profile and psychological states – A randomized controlled study

    PubMed Central

    Raghuram, Nagarathna; Parachuri, Venkateshwara Rao; Swarnagowri, M.V.; Babu, Suresh; Chaku, Ritu; Kulkarni, Ravi; Bhuyan, Bhagavan; Bhargav, Hemant; Nagendra, Hongasandra Ramarao

    2014-01-01

    Objective To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors. Methods In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35–65 years) who satisfied the selection criteria and consented were randomized into two groups. Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively. Results Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (≥23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ≥110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety. Conclusion Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence. PMID:25443601

  6. [Community-based rehabilitation and outpatient care for patients with acquired brain injury and chronic neurological disability in Germany: continuing support for social participation and re-integration in the neurological care system?].

    PubMed

    Reuther, P; Hendrich, A; Kringler, W; Vespo, E

    2012-12-01

    Persons with Disabilities of the United Nations: Goals of rehabilitation have to be more than functional treatment. Activation of the patient and supporting their coping and adaptive processes are necessary to achieve social participation and (re)integration into the community and in occupational life as implied by the standards of our society. Important elements of these are (1) identification of the individual patient and his/her burden during acute phase treatment or early rehabilitation (defined red-flag), (2) an individual clinical reasoning and planning of interventions and help, (3) general acceptance of the defined demands by all "players" in medical and social networks, (4) coordination and supervision of the medical and social interventions and of the assistive processes necessary in the individual environment. What seems to be needed is (5) systematic orientation to the goal of individual social participation at all levels of support, (6) cross linking, cooperation and development of the existing medical and social structures on site, (7) expansion of the legal framework and (7a) especially control of the implementation of the existing rights of social benefits and (7b) surveillance (transparency and quality management not only in the area of caregivers but also for the administration of social insurances!). The recommendations of the authors integrate systematically into the phase model of neurorehabilitation (VDR/BAR) in Germany. The focus of this work is the needs-appropriate programming of phase E, i. e., the transition between inpatient and outpatient care, between the clinical facility-oriented and the community-based (domicile-oriented, occupational-oriented) sectors, between welfare and independency. PMID:23235935

  7. Rehabilitation Management of Hemicorporectomy.

    PubMed

    Cavalheiro, Daniela Potas; Marten Teixeira, João Eduardo; Braga, Douglas Martins; Pessoa, Claudia Vöhringer; Ceregatti, Marina; McNeill Ingham, Sheila Jean

    2015-07-01

    This is a case report of a 55-year-old woman who was treated with a hemicorporectomy consequent to an invasive undifferentiated sacral chordoma. We describe the clinical course and rehabilitation process in an amputee outpatient clinic and report outcome measures such as the modified Functional Reach Test, the Amputee Mobility Predictor, the Functional Independence Measure, and the Short-Form Health Survey after 9 months of rehabilitation. PMID:25794625

  8. Effects of treatment with a combination of cardiac rehabilitation and bosentan in patients with pulmonary Langerhans cell histiocytosis associated with pulmonary hypertension.

    PubMed

    Fukuda, Yusuke; Miura, Shin-ichiro; Fujimi, Kanta; Yano, Masaya; Nishikawa, Hiroaki; Yanagisawa, Jun; Hiratsuka, Masafumi; Shiraishi, Takeshi; Iwasaki, Akinori; Saku, Keijiro

    2014-12-01

    Pulmonary hypertension (PH), which is classified as group 5 in the clinical classification of PH, is sometimes a complication of Pulmonary langerhans cell histiocytosis (PLCH), and is associated with high mortality. A 36-year-old woman had suffered from severe dyspnea 9 years previously and was diagnosed with PLCH and was on a waiting list for a lung transplant. Right heart failure had been observed and the mean pulmonary artery pressure was over 40 mmHg. The patient was diagnosed as PLCH with PH. After combined treatment with exercise rehabilitation and bosentan for 6 months, the cardiothoracic ratio, brain natriuretic peptide, and bodyweight were significantly decreased (cardiothoracic ratio from 43 to 38%, brain natriuretic peptide from 284 to10 pg/ml and bodyweight from 63 to 58 kg). Six-minute walk test also improved from 214 to 275 meters and the SF36 score for screening of depressive and anxiety disorders was improved. This is the report demonstrating the efficacy and safety of cardiac rehabilitation in combination with bosentan in a single patient with PLCH associated with PH. PMID:23897898

  9. Specificity of testing in a cardiac rehabilitation setting resulting in a patient's return to high-intensity outdoor activity following aortic dissection repair

    PubMed Central

    Bartee, Sparky; Shrestha, Sanjay; Ramos, Beatriz; Bilbrey, Tim; Carbone, Pasquale; Schussler, Jeffrey M.; Deutsch, Rick

    2016-01-01

    A 66-year-old man who had undergone aortic dissection repair a year earlier sought to assess the feasibility of returning to the high-intensity outdoor activities he had long enjoyed. In response to his inquiry, the cardiac rehabilitation staff at Baylor Hamilton Heart and Vascular Hospital designed a comprehensive testing plan that simulated the specific movements and anticipated cardiac requirements associated with his goal activities. The activities included 1) lifting and manipulating a 50-pound suitcase, 2) hiking to the top of Half Dome in California's Yosemite National Park, and 3) scuba diving. To illustrate our approach, we describe some of the tests that were performed and report the results. After analyzing the detailed physiological data collected during testing, we provided the patient with an exercise prescription and specific guidelines that he could use to gauge his level of physical exertion during his outdoor adventures. Within approximately 6 months of testing, he successfully performed the goal activities without adverse symptoms. PMID:27034550

  10. Specificity of testing in a cardiac rehabilitation setting resulting in a patient's return to high-intensity outdoor activity following aortic dissection repair.

    PubMed

    Bartee, Sparky; Shrestha, Sanjay; Ramos, Beatriz; Bilbrey, Tim; Carbone, Pasquale; Schussler, Jeffrey M; Deutsch, Rick; Adams, Jenny

    2016-04-01

    A 66-year-old man who had undergone aortic dissection repair a year earlier sought to assess the feasibility of returning to the high-intensity outdoor activities he had long enjoyed. In response to his inquiry, the cardiac rehabilitation staff at Baylor Hamilton Heart and Vascular Hospital designed a comprehensive testing plan that simulated the specific movements and anticipated cardiac requirements associated with his goal activities. The activities included 1) lifting and manipulating a 50-pound suitcase, 2) hiking to the top of Half Dome in California's Yosemite National Park, and 3) scuba diving. To illustrate our approach, we describe some of the tests that were performed and report the results. After analyzing the detailed physiological data collected during testing, we provided the patient with an exercise prescription and specific guidelines that he could use to gauge his level of physical exertion during his outdoor adventures. Within approximately 6 months of testing, he successfully performed the goal activities without adverse symptoms. PMID:27034550

  11. Is referral of postsurgical colorectal cancer survivors to cardiac rehabilitation feasible and acceptable? A pragmatic pilot randomised controlled trial with embedded qualitative study

    PubMed Central

    Hubbard, Gill; Adams, Richard; Campbell, Anna; Kidd, Lisa; Leslie, Stephen J; Munro, Julie; Watson, Angus

    2016-01-01

    Objectives (1) Assess whether cardiac rehabilitation (CR) is a feasible and acceptable model of rehabilitation for postsurgical colorectal cancer (CRC) survivors, (2) evaluate trial procedures. This article reports the results of the first objective. Design and setting A pragmatic pilot randomised controlled trial with embedded qualitative study was conducted in 3 UK hospitals with CR facilities. Descriptive statistics were used to summarise trial parameters indicative of intervention feasibility and acceptability. Interviews and focus groups were conducted and data analysed thematically. Participants People with CRC were considered for inclusion in the trial if they were ≥18 years old, diagnosed with primary CRC and in the recovery period postsurgery (they could still be receiving adjuvant therapy). 31% (n=41) of all eligible CRC survivors consented to participate in the trial. 22 of these CRC survivors, and 8 people with cardiovascular disease (CVD), 5 CRC nurses and 6 CR clinicians participated in the qualitative study. Intervention Referral of postsurgical CRC survivors to weekly CR exercise classes and information sessions. Classes included CRC survivors and people with CVD. CR nurses and physiotherapists were given training about cancer and exercise. Results Barriers to CR were protracted recoveries from surgery, ongoing treatments and poor mobility. No adverse events were reported during the trial, suggesting that CR is safe. 62% of participants completed the intervention as per protocol and had high levels of attendance. 20 health professionals attended the cancer and exercise training course, rating it as excellent. Participants perceived that CR increased CRC survivors’ confidence and motivation to exercise, and offered peer support. CR professionals were concerned about CR capacity to accommodate cancer survivors and their ability to provide psychosocial support to this group of patients. Conclusions CR is feasible and acceptable for postsurgical

  12. “I Just Can’t Do It Anymore” Patterns of Physical Activity and Cardiac Rehabilitation in African Americans with Heart Failure: A Mixed Method Study

    PubMed Central

    McCarthy, Margaret; Katz, Stuart D.; Schipper, Judith; Dickson, Victoria Vaughan

    2015-01-01

    Physical activity and cardiac rehabilitation (CR) are components of heart failure (HF) self-care. The aims of this study were to describe patterns of physical activity in African Americans (n = 30) with HF and to explore experience in CR. This was a mixed method, concurrent nested, predominantly qualitative study. Qualitative data were collected via interviews exploring typical physical activity, and CR experience. It was augmented by quantitative data measuring HF severity, self-care, functional capacity and depressive symptoms. Mean age was 60 ± 15 years; 65% were New York Heart Association (NYHA) class III HF. Forty-three percent reported that they did less than 30 min of exercise in the past week; 23% were told “nothing” about exercise by their provider, and 53% were told to do “minimal exercise”. A measure of functional capacity indicated the ability to do moderate activity. Two related themes stemmed from the narratives describing current physical activity: “given up” and “still trying”. Six participants recalled referral to CR with one person participating. There was high concordance between qualitative and quantitative data, and evidence that depression may play a role in low levels of physical activity. Findings highlight the need for strategies to increase adherence to current physical activity guidelines in this older minority population with HF. PMID:27417807

  13. Cardiac rehabilitation is safe and effective also in the elderly, but don't forget about drugs!

    PubMed

    Del Sindaco, Donatella; Tinti, Maria Denitza; Pulignano, Giovanni; Tolone, Stefano; Minardi, Giovanni; Uguccioni, Massimo; Lax, Antonio

    2016-01-01

    In the setting of heart failure (HF) pharmacotherapy demonstrates a quantifiable improvement in exercise tolerance also in HF with preserved ejection fraction (HFpEF). For patients with HFpEF, often older, with higher prevalence of hypertension, diabetes mellitus, atrial fibrillation and other comorbidities, endpoints such as quality of life and functional capacity may be more clinically relevant. However several study show as the use of ACE-I and B-blocker were lesser than expected. Beta-blocker therapy is the keystone of pharmacotherapy of HF patients and exercise training is the essential core of rehabilitation programs, it is important to elucidate the relationship between these therapies. Exercise training improves the clinical status of HF, improving left ventricular ejection fraction and improving quality of life, but it is possible that b-blocker may attenuate exercise training adaptations. Despite this, possible adverse b-blocker effects are just presumed and not confirmed by published randomized clinical trials. Metanalysis suggests that b-blocker compared with placebo enhances improvements in cardiorespiratory performance in exercise training intervention. Despite these evidences, prescription of gold standard therapy and adherence are still suboptimal and should be a priority goal for all CR program. PMID:27374048

  14. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    PubMed Central

    Layton, Aimee M.; Whitworth, James; Peacock, James; Bartels, Matthew N.; Jellen, Patricia A.; Thomashow, Byron M.

    2014-01-01

    The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients' medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group) and 53% (>31-day group) of the time, education material was read 44% (1–30) and 53% (>31) of the time, and physical activity was reported 25% (1–30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients. PMID:25574165

  15. Weather-induced ischemia and arrhythmia in patients undergoing cardiac rehabilitation: another difference between men and women

    NASA Astrophysics Data System (ADS)

    Schneider, Alexandra; Schuh, Angela; Maetzel, Friedrich-Karl; Rückerl, Regina; Breitner, Susanne; Peters, Annette

    2008-07-01

    Given the accumulating evidence that people with underlying heart disease are a particularly vulnerable group for triggers like changing meteorological parameters, the objective of this longitudinal study was to analyze the influence of weather parameters on blood pressure, arrhythmia and ischemia in cardiovascular patients. A panel study with repeated measurements was conducted in a rehabilitation clinic in Timmendorfer Strand (Baltic Sea, Germany) with 872 cardiovascular patients. Heart rate, blood pressure and electrocardiography changes were measured during repeated bicycle ergometries. Generalized Estimating Equations were used for regression analyses of immediate, delayed and cumulative influences of the daily measured meteorological data. For men, a decrease in air temperature and in water vapor pressure doubled the risk of ST-segment depression during ergometry [odds ratio (OR) for 1 day delay: 1.88 (1.24; 2.83) for air temperature] with a delay of 1-2 days. For women, an increase of their heart rate before the start of the ergometry [same day: 4.36 beats/min (0.99; 7.74) for air temperature] and a 2- to 3-fold higher risk for ventricular ectopic beats [1 day delay: OR 2.43 (1.17; 5.05) for air temperature] was observed with an increase in temperature and water vapor pressure in almost all analyzed time-windows. The study indicates that meteorological parameters can induce changes in heart function which may lead to adverse cardiovascular events especially in susceptible, diseased individuals. The observed effect on ST-segment depression could be a link between the association of weather changes and cardiovascular morbidity and mortality.

  16. Effect of exercise-based cardiac rehabilitation on non-culprit mild coronary plaques in the culprit coronary artery of patients with acute coronary syndrome.

    PubMed

    Kurose, Satoshi; Iwasaka, Junji; Tsutsumi, Hiromi; Yamanaka, Yutaka; Shinno, Hiromi; Fukushima, Yaeko; Higurashi, Kyoko; Imai, Masaru; Masuda, Izuru; Takeda, Shinichi; Kawai, Chuichi; Kimura, Yutaka

    2016-06-01

    Approximately, 70 % of acute myocardial infarctions are known to develop from mild atherosclerotic lesions. Therefore, it is important to evaluate mild coronary plaques to prevent acute coronary syndrome (ACS). The aim of the present study was to investigate the effects of exercise-based cardiac rehabilitation (CR) on mild coronary atherosclerosis in non-culprit lesions in patients with ACS. Forty-one men with ACS who underwent emergency percutaneous coronary interventions and completed a 6-month follow-up were divided into CR and non-CR groups. Quantitative coronary angiography (QCA) was performed using the automatic edge detection program. The target lesion was a mild stenotic segment (10-50 % stenosis) at the distal site of the culprit lesion, and the segment to be analyzed was determined at a segment length ranging from 10 to 15 mm. The plaque area was significantly decreased in the CR group after 6 months, but was significantly increased in the non-CR group (P < 0.05). The low-density lipoprotein (LDL) cholesterol, LDL/high-density lipoprotein (HDL) ratio and high-sensitivity C-reactive protein (Hs-CRP) levels were significantly reduced in both groups (P < 0.01). Peak VO2 in the CR group was significantly increased (P < 0.01). Changes in the plaque area correlated with those in Hs-CRP in both groups, while that association with those in HDL-C was observed in only CR group. Stepwise regression analysis revealed the decrease in Hs-CRP as an independent predictor of plaque area regression in the CR group. CR prevented the progression of mild coronary atherosclerosis in patients with ACS. PMID:25896129

  17. Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack.

    PubMed

    Simonÿ, Charlotte P; Dreyer, Pia; Pedersen, Birthe D; Birkelund, Regner

    2015-01-01

    This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and

  18. Empowered to gain a new foothold in life—A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

    PubMed Central

    Simonÿ, Charlotte P.; Dreyer, Pia; Pedersen, Birthe D.; Birkelund, Regner

    2015-01-01

    This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients’ particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients’ total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and

  19. Outpatient burn management.

    PubMed

    Warner, Petra M; Coffee, Tammy L; Yowler, Charles J

    2014-08-01

    Most burn patients have injuries that may be treated on an outpatient basis. Newer silver-based dressings and improved medications for the treatment of pain and pruritus have led to further growth of outpatient care. The final barrier of distance from the burn center will decrease with the growth of telemedicine. It is incumbent for burn centers to develop outpatient guidelines to facilitate this growth of outpatient care. PMID:25085094

  20. Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: an assessment of CR Services across Western Australia

    PubMed Central

    2009-01-01

    Background Cardiovascular disease is the major cause of premature death of Indigenous Australians, and despite evidence that cardiac rehabilitation (CR) and secondary prevention can reduce recurrent disease and deaths, CR uptake is suboptimal. The National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples, published in 2005, provide checklists for services to assist them to reduce the service gap for Indigenous people. This study describes health professionals' awareness, implementation, and perspectives of barriers to implementation of these guidelines based on semi-structured interviews conducted between November 2007 and June 2008 with health professionals involved in CR within mainstream health services in Western Australia (WA). Twenty-four health professionals from 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services were interviewed. Results The majority of respondents reported that they were unfamiliar with the NHMRC guidelines and as a consequence implementation of the recommendations was minimal and inconsistently applied. Respondents reported that they provided few in-patient CR-related services to Indigenous patients, services upon discharge were erratic, and they had few Indigenous-specific resources for patients. Issues relating to workforce, cultural competence, and service linkages emerged as having most impact on design and delivery of CR services for Indigenous people in WA. Conclusions This study has demonstrated limited awareness and poor implementation in WA of the recommendations of the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples: A Guide for Health Professionals. The disproportionate burden of CVD morbidity and mortality among Indigenous Australians mandates urgent attention to this problem and alternative approaches to CR

  1. [Standards and outcome measures in cardiovascular rehabilitation. Position paper GICR/IACPR].

    PubMed

    Griffo, Raffaele; Ambrosetti, Marco; Furgi, Giuseppe; Carlon, Roberto; Chieffo, Carmine; Favretto, Giuseppe; Febo, Oreste; Corrà, Ugo; Fattirolli, Francesco; Giannuzzi, Pantaleo; Greco, Cesare; Piepoli, Massimo F; Temporelli, Pier Luigi; Tramarin, Roberto; Urbinati, Stefano

    2012-12-01

    Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic problem in Italy. Costs and resources required are increasing in close correlation to both the improved quality of care and to the population ageing. There is an overwhelming evidence of the efficacy of cardiac rehabilitation (CR) in terms of reduction in morbidity and mortality after acute cardiac events. CR services are by definition multi-factorial and comprehensive. Furthermore, systematic analysis and monitoring of the process of delivery and outcomes is of paramount importance. The aim of this position paper promoted by the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is to provide specific recommendations to assist CR staff in the design, evaluation and development of their care delivery organization. The position paper should also assist health care providers, insurers, policy makers and consumers in the recognition of the quality of care requirements, standards and outcome measure, quality and performance indicators, and professional competence involved in such organization and programs. The position paper i) include comprehensive CR definition and indications, ii) describes priority criteria based on the clinical risk for admission to both inpatient or outpatient CR, and iii) defines components and technological, structural and organizing requirements for inpatient or outpatient CR services, with specific indicators and standards, performance measures and required professional skills. A specific chapter is dedicated to the requirements for highly specialized CR services for patients with more advanced cardiovascular diseases. PMID:23659104

  2. A Future Model of Musculoskeletal Rehabilitation at the University of Iowa Hospitals and Clinics

    PubMed Central

    Chen, Joseph J

    2005-01-01

    Models of rehabilitation care vary widely within academic medical centers, with most housing their own inpatient rehabilitation units. The University of Iowa Hospitals and Clinics focuses both on acute hospital inpatient and outpatient rehabilitation care instead of leaving rehabilitation to local community-based hospitals. This article discusses a method to provide adult inpatient rehabilitation care, and simultaneously provide specialized rehabilitation teams capable of spanning the entire continuum of rehabilitative care from admission at a Level I Trauma Center to the conclusion of successful outpatient rehabilitation needs. The costs of implementation of this plan can be justified by avoiding increased expenses already being incurred in addition to successful capture of outpatient rehabilitation revenues. PMID:16089094

  3. Outpatient preanaesthesia evaluation clinics.

    PubMed

    Lew, E; Pavlin, D J; Amundsen, L

    2004-11-01

    In recent years, there has been a paradigm shift from an inpatient to outpatient preanaesthesia evaluation. This has been driven by rising healthcare costs and the increasing popularity of ambulatory and same-day admission surgery. These outpatient preanaesthesia clinics play an important role in enhancing the cost-effectiveness of the perioperative process. This review describes the structure of modern outpatient preanaesthesia evaluation clinics, and the associated benefits, limitations and controversies. PMID:15510321

  4. Withdrawal strategies for outpatients

    PubMed Central

    Mezciems, Edgar

    1996-01-01

    This article discusses outpatient withdrawal strategies for patients addicted to alcohol, benzodiazepines, barbiturates, and opiates and describes some practical ways to support recovery. PMID:8828877

  5. Making pulmonary rehabilitation a success in COPD.

    PubMed

    Bourbeau, J

    2010-01-01

    A truly successful pulmonary rehabilitation entails implementing physical activity maintenance. This article reviews the current knowledge on pulmonary rehabilitation and the expected benefits, the setting, the relationship between self-management and pulmonary rehabilitation, in order to develop and implement clinically-effective physical activity maintenance interventions. The effectiveness of pulmonary rehabilitation is well-established. However, access to pulmonary rehabilitation is limited. Home-based pulmonary rehabilitation has been shown to be an effective, equivalent alternative to outpatient pulmonary rehabilitation in COPD patients. The opportunity to offer different pulmonary rehabilitation settings tailored to individual needs should improve accessibility to this intervention. Sustained long-term physical activity remains the most important challenge for COPD patients. We need a dependable system of coordinated health care interventions and communication, and components that include self-management support. Self-management should be an integrated part of pulmonary rehabilitation and remain long after the pulmonary rehabilitation is completed. By early identification of patients who may have difficulty maintaining exercise and implementing appropriate self-management interventions during and after the rehabilitation program, it may be possible to promote better long-term involvement in physical activity. Pulmonary rehabilitation should not stand alone; the best program is that which can be maintained to translate into a continuous increase in the activities of daily living. Future research should evaluate the effect of self-management interventions combined with pulmonary rehabilitation to improve long-term activity and exercise maintenance. PMID:20809435

  6. Stroke Rehabilitation

    MedlinePlus

    ... relearn skills they lose because of the damage. Rehabilitation can help them relearn those skills. Stroke can ... Problems with thinking and memory Emotional disturbances Stroke rehabilitation involves many kinds of health professionals. The goal ...

  7. Pulmonary Rehabilitation

    MedlinePlus

    Pulmonary Rehabilitation If you have shortness of breath because of lung problems, you may have asked yourself: • Can I ... medications do I really need to take? Pulmonary rehabilitation can help answer these and other questions. Enrolling ...

  8. Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

    PubMed

    Solberg, E E; Borjesson, M; Sharma, S; Papadakis, M; Wilhelm, M; Drezner, J A; Harmon, K G; Alonso, J M; Heidbuchel, H; Dugmore, D; Panhuyzen-Goedkoop, N M; Mellwig, K-P; Carre, F; Rasmusen, H; Niebauer, J; Behr, E R; Thiene, G; Sheppard, M N; Basso, C; Corrado, D

    2016-04-01

    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal. PMID:26285770

  9. Stress Management Training May Help Cardiac Rehab Patients

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_157876.html Stress Management Training May Help Cardiac Rehab Patients When added ... March 21, 2016 (HealthDay News) -- The addition of stress management training can make cardiac rehabilitation programs more effective, ...

  10. [Psychosocial rehabilitation at the dawn of the 21st century: II: Therapeutic or rehabilitative modalities and institutional disposition].

    PubMed

    Gasset, François; Orita, Alina; Spagnoli, Dany; Pomini, Valentino; Rabia, Sophie; Ducret, Michel; Veillon, Henri; Cucchia, Anne-Therèse

    2004-04-01

    The main goal of psychosocial rehabilitation is to compensate the vulnerability underlying psychiatric disorders through intermediate institutions when the persistence and recurrence of these disorders have led to social and professional exclusion. Intermediate institutions refer to services which allow transition between the state of dependence on the hospital to the state of relative autonomy in social community. Psychosocial rehabilitation is a comprehensive approach which link the type of interventions: treatment, rehabilitation and support integrated in multimodal and individualized programs. A study of the out-patients followed by the rehabilitation unit of the psychiatric department in Lausanne has shown that provision of services is divided into 60% for rehabilitation, 20% for treatment and 20% for support independently of the psychiatric disorders. The implementation of these programs necessitates institutional support from psychiatric hospital to outpatient clinics through different types of facilities in order to offer a medical and psychosocial device of rehabilitation into the community. PMID:15209049