Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: We investigated the presence of impaired endothelial function in individuals with post-acute sequelae of coronavirus disease-2019 (PASC) compared to healthy individuals and explored the efficacy of combined exercise training in restoring or improving endothelial function in those with PASC.

Methods: Study I was a cross-sectional study which compared endothelial function between individuals with PASC (n = 29, mean age 22.9 ± 3.9 year) and healthy individuals (n = 42, mean age 21.7 ± 2.0 year). Study II, an intervention design, explored if combined exercise training (n = 14) could reverse the decline in endothelial function associated with PASC compared to controls (n = 14). The combined exercise program included aerobic, resistance, and inspiratory muscle training administered for 8 weeks. We measured endothelial function using flow-mediated dilation of the brachial artery and assessed peak oxygen uptake (VO2peak), dyspnea, and fatigue before and after the intervention.

Results: Individuals with PASC exhibited significantly lower endothelial function compared to healthy controls (4.95 ± 2.0% vs 8.00 ± 2.4%, P < .001). The exercise group showed a significant increase in endothelial function (4.73 ± 1.5% to 7.98 ± 2.4%) as opposed to the control group (5.31 ± 2.5% to 6.30 ± 2.5%) (interaction effect: P = .008), reaching levels similar to those in healthy individuals. Additionally, the exercise group demonstrated improvement in VO2peak (38.3 ± 6.4 ml/min/kg to 42.8 ± 7.3 ml/min/kg, P < .001) and a reduction in dyspnea and fatigue compared to the control group (P < .001).

Conclusions: Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.

Purpose: To evaluate the feasibility and acceptability of Capnography-Assisted Learned Monitored (CALM) Breathing, a carbon dioxide (CO 2 ) biofeedback, and motivational interviewing intervention, to treat dyspnea and anxiety together.

Methods: We randomized adults (n = 42) with chronic obstructive pulmonary disease (COPD) to a 4-week, 8-session intervention (CALM Breathing, n = 20) or usual care (n = 22). The CALM Breathing intervention consisted of tailored, slow nasal breathing exercises, capnography biofeedback, motivational interviewing, and a home breathing exercise program. The intervention targeted unlearning dysfunctional breathing behaviors. All participants were offered outpatient pulmonary rehabilitation (PR) in the second phase of the study. The primary outcomes were feasibility and acceptability of CALM Breathing. Exploratory secondary outcomes included respiratory and mood symptoms, physiological and exercise tolerance measures, quality of life, and PR uptake.

Results: Attendance at CALM Breathing sessions was 84%, dropout was 5%, and home exercise completion was 90% and 73% based on paper and device logs, respectively. Satisfaction with CALM Breathing therapy was rated as "good" to "excellent" by 92% of participants. Significantly greater between-group improvements in secondary outcomes-respiratory symptoms, activity avoidance, oxygen saturation (SpO 2 ), end-tidal CO 2 , and breathing self-regulation (interoception)-were found post-intervention at 6 weeks in support of CALM Breathing compared with usual care. At 3 months (after PR initiation), statistically significant between-group differences in Borg dyspnea and SpO 2 post-6-minute walk test were identified also supporting CALM Breathing.

Conclusions: Patient-centered CALM Breathing was feasible and acceptable in adults with COPD and dyspnea anxiety. A CALM Breathing intervention may optimize dyspnea treatment and complement PR.

Purpose: Myocardial ischemia is prevalent in chronic heart diseases. Cardiac rehabilitation (CR) offers non-pharmacological benefits to reduce hospitalization and mortality, yet its impact on coronary vascular changes remains unclear. We assessed the effects of CR on myocardial perfusion and exercise capacity in patients with stable coronary artery disease and exercise-induced ischemia.

Methods: We conducted a retrospective observational study in individuals with stable coronary artery disease and myocardial ischemia enrolled in a CR program. Inclusion criteria required a minimum of 3 months of supervised CR and cardiac single-photon emission computed tomography (SPECT) imaging before and after the program. Blinded analysis and interpretation of the SPECT studies was carried out by nuclear cardiologists. The primary outcome was a change in myocardial perfusion via SPECT analysis. Secondary outcomes included changes in exercise capacity, electrocardiographic changes during treadmill stress tests, and evaluation of adverse effects during training. Cinecoronariographies reports were collected for further cardiac status assessment.

Results: Of 394 patients, 22 with myocardial ischemia were analyzed (96% males, 61.5 ± 9.5 yr). Number of CR sessions ranged from 42 to 73. Stress-induced ischemia significantly decreased (P = .019), with improvements in exercise capacity, including absolute peak oxygen uptake (mL/min, P = .027), relative oxygen uptake (mL/kg/min, P = .044), maximum metabolic equivalent of task (P = .019), and exercise duration (P < .001). No adverse events occurred.

Conclusion: After a structured CR program of at least 3 months in patients with stable coronary artery disease and exercise-induced ischemia, there was a notable reduction in stress-induced ischemia and enhancements in exercise capacity, highlighting the safety and efficacy of CR in improving myocardial perfusion and exercise tolerance.

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.

Purpose: Uncovering the racial/ethnic health disparities that exist within cardiovascular medicine offers potential to mitigate treatment gaps that might affect outcomes. Socioeconomic status (SES) may be a more appropriate underlying factor to assess these disparities. We aimed to evaluate whether adherence, attendance, and outcomes in cardiac rehabilitation are associated with SES in a safety net hospital.

Methods: We analyzed 542 patients in a retrospective cohort study of the Cardiac Rehabilitation Program at Boston Medical Center from 2016 to 2019. Enrollees had a mean age of 59.4 years, 34% were female, 42% Black, and 12% Hispanic. The zip codes of each enrollee were used to obtain their area deprivation index (ADI). The ADI reflects income, education, employment, and housing quality within a given zip code. Associations between ADI and adherence and attendance rate were evaluated while controlling for covariates. Secondary outcomes included associations of ADI with change in exercise capacity, low density lipoprotein cholesterol, weight, quality of life, nutrition, and depression scores.

Results: We applied logistic regression to examine the association between adherence and ADI with adjustment on the covariates. The attendance rate was analyzed with negative binomial regression with percent of sessions attended as prescribed as a dependent variable and adjusted on the same covariates. The primary outcome revealed no association for ADI with adherence to cardiac rehabilitation (OR = 0.91: 95% CI, 0.74-1.12) or attendance rate (RR = 0.91: 95% CI, 0.80-1.04). Utilizing multiple linear regression, secondary outcomes improved among patients regardless of ADI.

Conclusions: We found equity in our cardiac rehabilitation program outcomes despite SES.

Purpose: Heart rate (HR)-derived variables (HR reserve [HR peak  - HR rest ], chronotropic indices [attenuated HR response to exercise], HR recovery [attenuated HR response to exercise recovery], and peak HR index [HR peak /HR rest ]) together with peak oxygen uptake (VO 2peak ) are potential prognostic variables for cardiovascular and all-cause mortality. However, heart rate index (HRI) has not been established as a surrogate for VO 2peak , whether measured (Meas) or estimated (Est), during cycle ergometry (CE) and/or treadmill testing (TT).

Methods: HR-derived prognostic variables to assess cardiovascular outcomes were identified from 150 studies obtained from MEDLINE and Google Scholar searches. The Meas CE/TT-VO 2peak was reported in 81 studies (21 773 participants) and Est CE/TT-VO 2peak in 69 studies (331 435 participants). Using the HRI equation with metabolic equivalent (METs) = 6 × HRI - 5 (where HRI = peak HR/resting HR), HRI-VO 2peak was calculated from HR data reported in the 150 studies. The HRI-VO 2peak was then compared against group mean data for both Meas CE/TT-VO 2peak and Est CE/TT-VO 2peak .

Results: The difference between Meas CE/TT-VO 2peak and HRI-VO 2peak was 1% (7.15 ± 3.25 METs vs 7.08 ± 3.02 METs [ P = .833], respectively). By comparison, the difference between Est CE/TT-VO 2peak and HRI-VO 2peak was 25.6% (8.94 ± 2.36 METs vs 7.12 ± 2.27 METs [ P < .001], respectively). Moreover, HRI equation estimation of VO 2peak showed greater overprediction for TT, 26.6%, than for CE, 11.9%.

Conclusions: The Meas-VO 2peak and HRI-VO 2peak agreed closely. When compared with HRI-VO 2peak , Est-VO 2peak from currently used exercise-based equations shows significant overprediction. Use of HRI and/or Fitness Registry and the Importance of Exercise National Database (FRIEND) registry equations warrant consideration for more accurately estimating VO 2peak .

Purpose: To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.

Review methods: We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.

Summary: Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.