Pub Date : 2023-11-01Epub Date: 2023-08-29DOI: 10.1097/HCR.0000000000000824
Crystal Grimshaw, Steven J Keteyian, Roberto Benzo, Joseph Finkelstein, Daniel E Forman, Diann E Gaalema, Pamela N Peterson, Paula T Einhorn, Antonello Punturieri, Susan Shero, Jerome L Fleg
{"title":"Baseline Characteristics and Barriers to Recruitment in Cardiac and Pulmonary Rehabilitation NIH-Funded Trials.","authors":"Crystal Grimshaw, Steven J Keteyian, Roberto Benzo, Joseph Finkelstein, Daniel E Forman, Diann E Gaalema, Pamela N Peterson, Paula T Einhorn, Antonello Punturieri, Susan Shero, Jerome L Fleg","doi":"10.1097/HCR.0000000000000824","DOIUrl":"10.1097/HCR.0000000000000824","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1097/HCR.0000000000000831
Leonard A Kaminsky
{"title":"Year in Review: THE JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION.","authors":"Leonard A Kaminsky","doi":"10.1097/HCR.0000000000000831","DOIUrl":"10.1097/HCR.0000000000000831","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61562802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Novel Digital Platform for Cardiac Rehabilitation: Implementation and Performance During Extreme Health Crisis.","authors":"Boaz Elad, Marina Promyslovsky, Iris Eisen, Ludmila Helmer, Shani Ben Gal, Oren Caspi","doi":"10.1097/HCR.0000000000000811","DOIUrl":"10.1097/HCR.0000000000000811","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-13DOI: 10.1097/HCR.0000000000000825
Adam M Shultz, Ray W Squires
{"title":"Cardio-Oncology Rehabilitation (CORE) for Cancer Patients and Survivors.","authors":"Adam M Shultz, Ray W Squires","doi":"10.1097/HCR.0000000000000825","DOIUrl":"10.1097/HCR.0000000000000825","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-03-02DOI: 10.1097/HCR.0000000000000785
Brian R Katz, Sherrie Khadanga, William A Middleton, Katharine Mahoney, Patrick D Savage, Michael DeSarno, Philip A Ades, Diann E Gaalema
Purpose: Executive function (ExF), the ability to do complex cognitive tasks like planning and refraining from impulsive behavior, is associated with compliance with medical recommendations. The present study identified associations between self-reported ExF and demographics of patients with cardiac disease as well as with cardiac rehabilitation (CR) attendance.
Methods: Self-reported ExF impairment was measured using the Behavior Rating Inventory of Executive Function (BRIEF) on 316 individuals hospitalized for CR-qualifying cardiac events. Scores were calculated for a global measure (Global Executive Composite [GEC]) and the two BRIEF indices: Behavioral Regulation Index and Metacognition Index (MCI). Participants were followed up post-discharge to determine CR attendance. Univariate logistic regressions between ExF measures and demographic variables were conducted, as were multiple logistic regressions to identify significant, independent predictors. Analyses were conducted using clinical (T scores ≥ 65) and subclinical (T scores ≥ 60) criteria for significant ExF impairment as outcomes. One-way analyses of variance were performed between ExF impairment and CR attendance.
Results: Self-reported ExF deficits were relatively rare; 8.9% had at least subclinical scores on the GEC. Using the subclinical criterion for the MCI, having diabetes mellitus (DM) and being male were significant, independent predictors of MCI impairment. No significant relationship was found between ExF and CR attendance.
Conclusion: Using the subclinical criterion only, individuals with DM and males were significantly more likely to have MCI impairment. No significant effect of ExF impairment on CR attendance was found, suggesting that self-reported ExF measured in the hospital may not be an appropriate measure for predicting behavioral outcomes.
{"title":"Self-Reported Executive Function in Hospitalized Cardiac Patients and Associations With Patient Characteristics and Cardiac Rehabilitation Attendance.","authors":"Brian R Katz, Sherrie Khadanga, William A Middleton, Katharine Mahoney, Patrick D Savage, Michael DeSarno, Philip A Ades, Diann E Gaalema","doi":"10.1097/HCR.0000000000000785","DOIUrl":"10.1097/HCR.0000000000000785","url":null,"abstract":"<p><strong>Purpose: </strong>Executive function (ExF), the ability to do complex cognitive tasks like planning and refraining from impulsive behavior, is associated with compliance with medical recommendations. The present study identified associations between self-reported ExF and demographics of patients with cardiac disease as well as with cardiac rehabilitation (CR) attendance.</p><p><strong>Methods: </strong>Self-reported ExF impairment was measured using the Behavior Rating Inventory of Executive Function (BRIEF) on 316 individuals hospitalized for CR-qualifying cardiac events. Scores were calculated for a global measure (Global Executive Composite [GEC]) and the two BRIEF indices: Behavioral Regulation Index and Metacognition Index (MCI). Participants were followed up post-discharge to determine CR attendance. Univariate logistic regressions between ExF measures and demographic variables were conducted, as were multiple logistic regressions to identify significant, independent predictors. Analyses were conducted using clinical (T scores ≥ 65) and subclinical (T scores ≥ 60) criteria for significant ExF impairment as outcomes. One-way analyses of variance were performed between ExF impairment and CR attendance.</p><p><strong>Results: </strong>Self-reported ExF deficits were relatively rare; 8.9% had at least subclinical scores on the GEC. Using the subclinical criterion for the MCI, having diabetes mellitus (DM) and being male were significant, independent predictors of MCI impairment. No significant relationship was found between ExF and CR attendance.</p><p><strong>Conclusion: </strong>Using the subclinical criterion only, individuals with DM and males were significantly more likely to have MCI impairment. No significant effect of ExF impairment on CR attendance was found, suggesting that self-reported ExF measured in the hospital may not be an appropriate measure for predicting behavioral outcomes.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10474250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-06-14DOI: 10.1097/HCR.0000000000000806
Steven J Keteyian, Katherina Steenson, Crystal Grimshaw, Noah Mandel, Wanda Koester-Qualters, Robert Berry, Dennis J Kerrigan, Jonathon K Ehrman, Edward L Peterson, Clinton A Brawner
Purpose: Among patients in cardiac rehabilitation (CR) on beta-adrenergic blockade (βB) therapy, this study describes the frequency for which target heart rate (THR) values computed using a predicted maximal heart rate (HR max ), correspond to a THR computed using a measured HR max in the guideline-based heart rate reserve (HR reserve ) method.
Methods: Before CR, patients completed a cardiopulmonary exercise test to measure HR max , with the data used to determine THR via the HR reserve method. Additionally, predicted HR max was computed for all patients using the 220 - age equation and two disease-specific equations, with the predicted values used to calculate THR via the straight percent and HR reserve methods. The THR was also computed using resting heart rate (HR) +20 and +30 bpm.
Results: Mean predicted HR max using the 220 - age equation (161 ± 11 bpm) and the disease-specific equations (123 ± 9 bpm) differed ( P < .001) from measured HR max (133 ± 21 bpm). Also, THR computed using predicted HR max resulted in values that were infrequently within the guideline-based HR reserve range calculated using measured HR max . Specifically, 0 to ≤61% of patients would have had an exercise training HR that fell within the guideline-based range of 50-80% of measured HR reserve . Use of standing resting HR +20 or +30 bpm would have resulted in 100% and 48%, respectively, of patients exercising below 50% of HR reserve .
Conclusions: A THR computed using either predicted HR max or resting HR +20 or +30 bpm seldom results in a prescribed exercise intensity that is consistent with guideline recommendations for patients in CR.
{"title":"Among Patients Taking Beta-Adrenergic Blockade Therapy, Use Measured (Not Predicted) Maximal Heart Rate to Calculate a Target Heart Rate for Cardiac Rehabilitation.","authors":"Steven J Keteyian, Katherina Steenson, Crystal Grimshaw, Noah Mandel, Wanda Koester-Qualters, Robert Berry, Dennis J Kerrigan, Jonathon K Ehrman, Edward L Peterson, Clinton A Brawner","doi":"10.1097/HCR.0000000000000806","DOIUrl":"10.1097/HCR.0000000000000806","url":null,"abstract":"<p><strong>Purpose: </strong>Among patients in cardiac rehabilitation (CR) on beta-adrenergic blockade (βB) therapy, this study describes the frequency for which target heart rate (THR) values computed using a predicted maximal heart rate (HR max ), correspond to a THR computed using a measured HR max in the guideline-based heart rate reserve (HR reserve ) method.</p><p><strong>Methods: </strong>Before CR, patients completed a cardiopulmonary exercise test to measure HR max , with the data used to determine THR via the HR reserve method. Additionally, predicted HR max was computed for all patients using the 220 - age equation and two disease-specific equations, with the predicted values used to calculate THR via the straight percent and HR reserve methods. The THR was also computed using resting heart rate (HR) +20 and +30 bpm.</p><p><strong>Results: </strong>Mean predicted HR max using the 220 - age equation (161 ± 11 bpm) and the disease-specific equations (123 ± 9 bpm) differed ( P < .001) from measured HR max (133 ± 21 bpm). Also, THR computed using predicted HR max resulted in values that were infrequently within the guideline-based HR reserve range calculated using measured HR max . Specifically, 0 to ≤61% of patients would have had an exercise training HR that fell within the guideline-based range of 50-80% of measured HR reserve . Use of standing resting HR +20 or +30 bpm would have resulted in 100% and 48%, respectively, of patients exercising below 50% of HR reserve .</p><p><strong>Conclusions: </strong>A THR computed using either predicted HR max or resting HR +20 or +30 bpm seldom results in a prescribed exercise intensity that is consistent with guideline recommendations for patients in CR.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9618535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-08-30DOI: 10.1097/HCR.0000000000000821
Justin A Edward, Adithya Peruri, Eric Rudofker, Nikhil Shamapant, Hugh Parker, Ryan Cotter, Katherine Sabin, Justin Lawley, William K Cornwell
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
{"title":"Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID.","authors":"Justin A Edward, Adithya Peruri, Eric Rudofker, Nikhil Shamapant, Hugh Parker, Ryan Cotter, Katherine Sabin, Justin Lawley, William K Cornwell","doi":"10.1097/HCR.0000000000000821","DOIUrl":"10.1097/HCR.0000000000000821","url":null,"abstract":"<p><p>The post-acute sequalae of SARS-CoV-2, also known as \"Long COVID,\" is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10468776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-07DOI: 10.1097/HCR.0000000000000816
Brittany Duong, Mohammed Zaidan, Daniel Puebla Neira, Efstathia Polychronopoulou, Gulshan Sharma, Alexander G Duarte
{"title":"Utilization of Pulmonary Rehabilitation Following Hospitalization for COVID-19.","authors":"Brittany Duong, Mohammed Zaidan, Daniel Puebla Neira, Efstathia Polychronopoulou, Gulshan Sharma, Alexander G Duarte","doi":"10.1097/HCR.0000000000000816","DOIUrl":"10.1097/HCR.0000000000000816","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41202062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-20DOI: 10.1097/HCR.0000000000000828
Allison E Gaffey, Carly M Goldstein, Megan M Hays, Sharon Y Lee, Diann E Gaalema
{"title":"Psychological Risk Factors in Cardiac Rehabilitation: ANXIETY, DEPRESSION, SOCIAL ISOLATION, AND ANGER/HOSTILITY.","authors":"Allison E Gaffey, Carly M Goldstein, Megan M Hays, Sharon Y Lee, Diann E Gaalema","doi":"10.1097/HCR.0000000000000828","DOIUrl":"10.1097/HCR.0000000000000828","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41145414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCR.0000000000000789
Thomas Schlöglhofer, Christoph Gross, Francesco Moscato, Alexander Neumayer, Elisabeth Kandioler, Daniela Leithner, Martin Skoumal, Günther Laufer, Dominik Wiedemann, Heinrich Schima, Daniel Zimpfer, Christiane Marko
Purpose: Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.
Methods: This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m 2 ). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.
Results: The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙ o2peak : 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙ o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙ o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03).
Conclusions: Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙ o2peak and 6MWT have prognostic value for readmission.
目的:早期心脏康复(CR)后,左室辅助装置(LVAD)患者的运动表现和生活质量(QoL)得到改善。本研究的目的是检验多专业长期3期门诊CR的疗效,以及lvad植入后心肺运动试验(CPX)和6分钟步行试验(6MWT)是否能预测再入院。方法:回顾性观察队列研究纳入29例LVAD患者(58.6±7.7岁,女性:13.8%,体重指数:29.4±3.3 kg/ m2)。功能表现测试(CPX、6MWT、坐立测试)、生活质量和心理调查(堪萨斯城心肌病问卷、医院焦虑和抑郁量表,以及疾病和健康控制信念[KKG])在CR基线和CR结束时进行。结果:CR开始于LVAD植入后的中位(IQR)为159 (130-260)d,持续时间为340 (180-363)d,训练时间为46.8±23.2。6MWT(408.4±113.3 vs 455.4±115.5 m, P = 0.003)和坐立试验(16.7±6.9 vs 19.0±5.3,P = 0.033)得到改善,但相对峰值摄氧量(V˙o2峰:9.4 [8.2-14.4]vs 9.3 [7.8-13.4] mL/min/kg, P = 0.57)没有变化。通过受试者工作特征曲线分析,基线V˙o2峰值与CR发病后1年再入院相关(c -统计量= 0.88),截断值V˙o2峰值< 9.15 mL/min/kg(100%敏感性,78%特异性,P < 0.001)。堪萨斯城心肌病问卷的自我效能和知识(+6.3分)、生活质量(+5.0分)和社会限制(+7.1分)表现出临床重要的变化。此外,医院焦虑和抑郁量表显示焦虑显著降低(4.6±3.2 vs 2.6±2.4,P = 0.03)。结论:长期CR是安全的,LVAD门诊患者的生活质量、焦虑和亚极限运动表现均有改善。此外,V˙o2峰值和6MWT对再入院有预测价值。
{"title":"Exercise Performance and Quality of Life of Left Ventricular Assist Device Patients After Long-Term Outpatient Cardiac Rehabilitation.","authors":"Thomas Schlöglhofer, Christoph Gross, Francesco Moscato, Alexander Neumayer, Elisabeth Kandioler, Daniela Leithner, Martin Skoumal, Günther Laufer, Dominik Wiedemann, Heinrich Schima, Daniel Zimpfer, Christiane Marko","doi":"10.1097/HCR.0000000000000789","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000789","url":null,"abstract":"<p><strong>Purpose: </strong>Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m 2 ). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.</p><p><strong>Results: </strong>The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙ o2peak : 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙ o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙ o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03).</p><p><strong>Conclusions: </strong>Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙ o2peak and 6MWT have prognostic value for readmission.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}