Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: Chronic obstructive pulmonary disease (COPD) is commonly associated with respiratory difficulties, but it also presents with musculoskeletal problems. The objective of this systematic review and meta-analysis was to evaluate the effects of pulmonary rehabilitation (PR) on balance and gait in patients with COPD.

Review methods: We conducted a comprehensive search of 4 databases, including PubMed, Google Scholar, Science Direct, and Web of Science, from inception to November 2023. The review included studies reporting the association between COPD status and balance and gait using PR. Two independent reviewers examined the titles and abstracts, extracted the data using a standardized form, and assessed the risk of bias of the included articles.

Summary: A total of 14 studies with 320 patients in the study groups and 188 controls were included in the analysis. The risk of bias in the included studies was medium to high. The results showed that PR non-statistically significantly improved balance, as demonstrated by moderate effect sizes in the Timed Up and Go (standardized mean difference [SMD] = 0.1: 95% CI, -1.41 to 1.69) and Berg Balance Scale (SMD = -0.39: 95% CI, -1.30 to 0.53). However, the impact of PR on gait function was less clear, with mixed results. The study findings highlight the positive but non-significant effects of PR on balance in individuals with COPD. The results suggest that PR programs could include exercises that target balance improvement to enhance the overall quality of patients. However, further research is needed to determine the optimal duration and intensity of these exercises to achieve maximum benefits for patients with COPD.

Purpose: To systematically review the literature regarding barriers and facilitators to remote exercise among individuals with cardiovascular diseases (CVD).

Review methods: Six databases were searched (inception-December 2023). Studies including barriers and facilitators for remote exercise reported by individuals living with CVD were considered. Quality was rated using the Mixed Methods Assessment Tool (MMAT). Results were synthesized following a thematic analysis approach. Characteristics of interventions were reported using the Template for Intervention Description and Replication (TIDieR).

Summary: From an initial pool of 8543 records, 18 studies met the inclusion criteria. Among these, 13 were qualitative studies, with individual interviews being the most frequent data extraction method. Nine studies received 5/5 MMAT scores (ie, high quality). Twelve studies reported remote exercise interventions, mostly delivered within cardiac rehabilitation, by physiotherapists, nurses, and dietitians, predominantly via telephone calls or videoconferences, with only one study incorporating text messages. Five key themes influencing remote exercise interventions were identified: technology (encompassing access and literacy, self-monitoring/motivation, and security concerns), individual health considerations (health/personal aspects and coronavirus disease-2019), social factors (support from health care team and family/social support), environment (facilities), and logistical factors (time and displacement). Several themes served as both facilitators and barriers. Key insights for remote exercise interventions included mobile accessibility, interactive chat sessions, minimal click interactions, short sessions, personalized feedback, and flexible timing. Results emphasize the importance of promoting social interaction and support between participants and health care teams to mitigate barriers and enhance facilitators in remote exercise interventions for individuals with CVD.

Purpose: Great travel distances and long travel times can be barriers to outpatient stroke rehabilitation services (OSR) receipt, but there is limited information on differences in proximity to specific OSR services between urban and potentially medically underserved rural areas. Accordingly, we compared travel distance and time to the nearest service for different OSR services between rural and urban counties in Tennessee.

Methods: We conducted data scraping on Google Maps to locate Tennessee facilities offering any of the 13 American Heart Association recognized OSR services. We conducted manual validation by calling located facilities and visiting facility websites. We used the Wilcoxon rank sum test to examine if mean travel distance and time to a specific OSR service differed significantly between rural and urban counties.

Results: All OSR services but audiology were available in Tennessee. In rural counties, social work had the highest median of mean travel distance (135.2 km), chaplaincy the highest median of mean travel time (113.5 min), and physical therapy the lowest distance (37.7 km) and time (36.3 min). Except for social work, rural counties had significantly higher travel distance and time than urban counties (P < .01) for all OSR services.

Conclusions: Rural Tennessee counties had significantly higher travel distance and time for almost all OSR services compared to urban areas. These findings from a largely rural state with high stroke risk factor prevalence suggest that additional focus on establishing maximum travel limits for OSR are warranted to overcome transportation barriers to enhance post-stroke services access in similar areas.

Purpose: We tested the hypothesis that an exaggerated exercise systolic blood pressure (ESBP) would be associated with the risk of stroke in men with and without a history of cardiovascular disease (CVD).

Methods: An ESBP was defined as a maximal systolic blood pressure (SBP) ≥ 210 mmHg during graded exercise testing on a stationary bike until volitional fatigue in 2410 men aged 42 to 61 yr at baseline.

Results: Over a median 27-yr follow-up, 419 incident stroke events occurred. In a multivariable adjusted model, men with an ESBP had a significantly increased risk of stroke in the entire cohort (HR = 1.41: 95% CI, 1.15-1.74). This association was still significant following further adjustment for resting SBP (HR = 1.25: 95% CI, 1.01-1.56). In subgroup analysis, ESBP was modestly associated with an increased risk of stroke in men with a history of CVD (HR = 1.37: 95% CI, 0.98-1.93), with no strong evidence of an association in men without a history of CVD (HR = 1.20: 95% CI, 0.90-1.60).

Conclusions: These findings suggest that the heightened risk of stroke related to ESBP response in a general population-based sample of men may be primarily driven by a history of CVD. The results underscore the importance of considering exercise blood pressure response when interpreting stress tests, particularly in individuals with pre-existing CVD.

Purpose: Improving cardiorespiratory fitness (CRF) through exercise training is associated with lower morbidity and mortality in patients with atrial fibrillation (AF). Smaller CRF improvements have been suggested in females than males with cardiovascular disease following exercise training. This systematic review compared changes in CRF (primary) and additional physical and mental health outcomes following exercise training between females and males with AF.

Review methods: Five bibliographic databases were searched to identify prospective studies implementing exercise training in patients with AF. The mean difference (MD) in the change following exercise training was compared between sexes using random-effects meta-analyses.

Summary: Sex-specific data were obtained from 19 of 63 eligible studies, with 886 participants enrolled in exercise training (n = 259 [29%] females; female: 68 ± 7 years, male: 66 ± 8 years). Exercise training was 6 weeks to 1 year in duration and mostly combined moderate- to vigorous-intensity aerobic and resistance training, 2 to 6 d/wk. Changes in CRF did not differ between sexes (MD = 0.15: 95% CI, -1.08 to 1.38 mL O2/kg/min; P = .81; I2 = 27%). Severity of AF (MD = 1.00: 95% CI, 0.13-1.87 points; I2 = 0%), general health perceptions (MD = -3.71: 95% CI, -6.88 to -0.55 points; I2 = 22%), and systolic blood pressure (MD = 3.11: 95% CI, 0.14-6.09 mmHg; I2 = 42%) improved less in females than in males. Females may benefit from more targeted exercise training programs given their smaller improvement in several health outcomes than males. However, our findings are largely hypothesis-generating, considering the limited sample size and underrepresentation of females (29% females in our review vs 47% females with AF globally).

Purpose: The aim of this study was to explore the role of cardiopulmonary exercise test parameters, especially peak oxygen uptake (VO 2peak ), in predicting the incidence of adverse cardiovascular events in older Chinese patients with coronary heart disease (CHD).

Methods: Older patients with CHD who underwent cycle ergometer cardiopulmonary exercise test at the Cardiac Rehabilitation Clinic of Chinese PLA General Hospital from July 1, 2015 to January 31, 2020 were enrolled. The follow-up intervals were 6 mo. Cox regression was used to analyze the relationship between VO 2peak and adverse cardiovascular events. Restricted cubic splines and subgroup analyses were used to observe the relationship between VO 2peak and the hazard ratio (HR) of the primary end point event (PEE), which included a composite of all-cause death, nonfatal recurrent myocardial infarction, unscheduled revascularization, and stroke. The composite end point event was the PEE combined with cardiac rehospitalization.

Results: A total of 1223 participants (mean age 68 ± 5 yr) were included. Median follow-up was 68 mo. Mean VO 2peak was 16.5 ± 4.0 mL/kg/min, and VO 2peak was an independent predictor of the PEE (HR = 0.929; 95% CI, 0.891-0.970; P = .001). This association was further validated by restricted cubic spline and subgroup analyses. Peak oxygen uptake was also an independent risk factor for the composite end point event (HR = 0.968; 95% CI, 0.941-0.996; P = .025).

Conclusion: In conclusion, VO 2peak is an independent risk factor for adverse cardiovascular events in older Chinese patients with CHD, and more optimal therapy should be recommended to patients with lower VO 2peak .

Purpose: The aim of this study was to analyze the effects of isometric handgrip training (IHT) on ambulatory blood pressure (BP) in individuals aged 18 yr and older.

Review methods: A systematic review and meta-analysis was performed in Medline and Web of Science, encompassing studies published until July 2023, as well as the gray literature. We calculated the mean difference (MD) and 95% CI using an inverse variance method with a random effects model.

Summary: Considering both published and unpublished studies, we observed an effect of IHT on awake diastolic BP (MD = -2.02; 95% CI, -3.89 to -0.15 mmHg; P = .03). There were no significant effects on 24-hr systolic BP (MD = -1.31; 95% CI, -3.84 to 1.22 mmHg; P = .31), asleep systolic BP (MD = -0.84; 95% CI, -3.31 to 1.63 mmHg; P = .50), awake systolic BP (MD = -0.93: 95% CI, -3.10 to 1.23 mmHg; P = .40), 24-hr diastolic BP (MD = -0.96; 95% CI, -2.65 to 0.74 mmHg; P = .27), or asleep diastolic BP (MD = -1.27; 95% CI, -3.22 to 0.67 mmHg; P = .20). In conclusion, the effects of IHT on ambulatory BP were observed primarily in awake diastolic BP among individuals over 18 yr of age.

Purpose: Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels.

Methods: Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period.

Results: In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period.

Conclusions: Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.