Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: Pulmonary restriction is common in patients with a Fontan circulation and is associated with impaired quality of life. Studies often fail to accurately define pulmonary restriction, and few have investigated its predictors, longitudinal course, and clinical implication. We investigate the prevalence and determinants of pulmonary restriction in patients with a Fontan circulation, the evolution of pulmonary function over time, and the relationship between pulmonary function and exercise capacity.

Methods: This longitudinal study included 85 patients with a Fontan circulation who underwent serial pulmonary function measurements and exercise testing over an 11-year period. According to established criteria, pulmonary restriction was defined as a total lung capacity (TLC) z score < -1.645.

Results: Mean age ± SD was 20 ± 10 years. Median (IQR) TLC, forced vital capacity (FVC), and diffusing capacity of the lungs for carbon monoxide z scores were -0.98 (-1.98, -0.25), -0.82 (-1.52, -0.19), and -2.30 (-3.04, -1.44). Twenty-eight patients (33%) had pulmonary restriction. A longer time since Fontan completion and undergoing 2 or more thoracotomies increased the odds of developing pulmonary restriction. The FVC z score was associated with log 2 percentage of predicted peak oxygen uptake ( β = .08, P = .025), and FVC z scores declined by 0.06 per year ( P = .009).

Conclusion: Pulmonary restriction is prevalent in patients with a Fontan circulation. Multiple thoracotomies and a longer time since Fontan completion predict the development of pulmonary restriction. The FVC, not TLC, is associated with lower exercise tolerance. This emphasizes the importance of muscle-dependent pulmonary ventilation. Finally, FVC z scores are decreased in adolescence and deteriorate faster than in the general population.

Purpose: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome predominantly affecting women. Although the knowledge of SCAD has expanded over the past 2 decades, limited evidence exists to guide post-event management and prevention of future adverse events. This review aims to synthesize the current understanding of SCAD and outline considerations for exercise prescription and cardiac rehabilitation (CR) in this unique population.

Review methods: A comprehensive literature review was conducted, incorporating original research articles, systematic reviews, meta-analyses, and current clinical guidelines related to SCAD and CR.

Summary: Current literature demonstrates that CR is safe in this population and is associated with improvement in measures of physical and mental health. Expert consensus supports reintroduction of exercise and an individualized multidisciplinary CR framework.

Conclusions: This review highlights current evidence and expert recommendations for the multidisciplinary outpatient management of patients with SCAD.

Purpose: An internship experience is vital in the training of clinical exercise physiologists (CEP), yet the availability and scope of clinical exercise internships throughout the United States have not been described. We evaluate the availability and scope of clinical exercise internship programs throughout the United States.

Methods: Using a survey-based study design, we recruited clinicians (eg, CEP, nurses, respiratory therapists) via email to complete a 31-question survey covering facility characteristics, internship availability and scope, and knowledge/skills needed to work as a CEP.

Results: Of the 295 completed surveys, 74% of the respondents, representing 42 US states, reported offering a clinical exercise internship. Among sites offering an internship, 88% included a pre-internship interview, while a few (7%) included a quiz (eg, electrocardiogram, cardiac medications) for evaluating potential student interns. Internship sites reported supervising 4 ± 3 interns annually, 41% included stress testing (96 ± 124 hours), 49% included Phase I experience (55 ± 81 hours), and 95% included Phase II experience (245 ± 134 hours). Additionally, 91% of the sites included other learning opportunities, including developing individualized treatment plans (83%) and working in pulmonary rehabilitation (71%), weight management programs (59%), human performance testing (16%), and exercise oncology (13%). Overall, 88% of all 295 respondents strongly agreed that a clinical internship experience is vital for training future CEP.

Conclusion: Our survey data suggest that clinical internships for future CEP are felt to be an important part of student training, and most (95%) internship program settings surveyed include direct patient care experience in cardiac rehabilitation.

Purpose: To examine socioeconomic differences in the nonpharmacological cardiac rehabilitation (CR) pathway from hospital discharge to CR completion in hospital and primary care settings.

Methods: This nationwide cohort study included patients hospitalized with ischemic heart disease between April 1, 2019, and March 31, 2022. Follow-up continued through December 31, 2022, focusing on nonutilization of 11 CR components, including: delayed CR needs assessment (>14 days) and physical exercise training (>29 days); lack of patient education, physical exercise training, test of cardiorespiratory fitness (CRF), depression screening, improvement in CRF (<10% increase), smoking cessation, and finalizing CR meeting; and completion of <75% of planned exercise sessions and dropout. Socioeconomic differences were analyzed by educational attainment, income, occupation, and cohabitant status.

Results: Among 45 497 hospitalized patients with ischemic heart disease, 43% (n = 19 573) participated in CR. Only 25% received a CR needs assessment within 14 days of discharge. Socioeconomic differences were demonstrated throughout the CR pathway, except for the finalizing meeting, improvement in CRF, and smoking cessation. The odds of nonutilization among patients with lower educational attainment ranged between 8% higher odds of delayed CR needs assessment (adjusted OR = 1.08: 95% CI, 1.01-1.15) and 31% higher odds of no CRF test (adjusted OR = 1.31: 95% CI, 1.18-1.45).

Conclusions: The observed socioeconomic differences throughout the CR pathway underscore the need for targeted interventions to ensure early assessment of CR needs and participation in specific CR activities among patients with lower socioeconomic positions. This study identifies specific patient characteristics and CR activities as key markers for reducing these inequalities.

Purpose: The aim of this study was to determine which stage of the Talk Test (TT) represents the most appropriate workload for prescribing aerobic exercise in cardiovascular rehabilitation.

Methods: Individuals with cardiovascular disease underwent a 3-day evaluation. Day 1: cardiopulmonary exercise test; day 2: 2 incremental TT (conventional and with gas analysis); day 3: 2 constant workload TT (CWTT) based on the intensities of the stages last positive (LPTT) and first equivocal (EQTT). Friedman's test was used to compare the heart rate (HR) and oxygen uptake ( ) from the CWTT with the first and second ventilatory thresholds (VT1 and VT2). The association between HR and of VT and CWTT was analyzed using Spearman's correlation coefficient. Chi-square test was used to analyze the proportion of individuals who reached the moderate intensity zone during the CWTTs, considering HR, HR reserve (HRR), and .

Results: Thirty-two individuals (23 male, 61 ± 10 years) were included. Heart rate in LPTT was similar to VT1 and lower than VT2 ( P < .001). The HR in EQTT was higher than the VT1 ( P = .002) and lower than VT2 ( P < .001). The during CWTT was similar to VT1 and lower than VT2 ( P < .001). The EQTT showed a higher proportion of individuals with HR and between the VT (HR: 70% vs 53%, P = .026; : 48% vs 31%, P = .023), as well as with HRR in the moderate intensity zone ( P = .025).

Conclusions: Exercise intensity similar to the EQTT promotes HR and responses more consistent with the recommended exercise intensity (moderate). This stage represents the most appropriate workload for aerobic exercise prescription in cardiovascular rehabilitation.

Purpose: Prior research indicates that verbal reports of illness perceptions are associated with quality of life among individuals with interstitial lung disease (ILD). However, individuals with diverse language and verbal abilities may have difficulty providing verbal ratings of illness status. This study evaluated both verbal and visuo-graphic measures of perceived illness as predictors of illness-related quality of life and self-reported pulmonary symptoms among individuals with ILD.

Methods: This was a cross-sectional study in a convenience sample of patients with ILD recruited from a clinic setting. Forty adults (63% female; mean age: 62.8; range: 32-85 years) with ILD completed standard medical evaluations of pulmonary function and exercise capacity. Study participants also completed self-report questionnaires (pulmonary symptoms, illness-related quality of life, and illness perceptions) and the lung coloring task (LCT), a standardized visuo-graphic measure of illness perceptions developed for this study. The primary approach to data analysis was multiple regression analysis predicting illness-related quality of life and self-rated symptoms from pulmonary function, illness perceptions, and LCT.

Results: Both forced vital capacity and illness perceptions were significant predictors of illness-related quality of life, accounting for approximately 55% of the variance. The symptom dimension of illness-related quality of life was predicted by forced vital capacity, illness perceptions, and LCT, accounting for approximately 40% of the variance.

Conclusions: Illness perceptions are important for understanding illness-related quality of life among individuals with chronic lung disease. Visuo-graphic measures of illness perceptions may be especially useful for evaluating symptom experiences in chronic lung disease.

Purpose: Patients undergoing cardiac surgery via sternotomy are typically advised to follow sternal precautions for 8 to 12 weeks post-operatively. These precautions vary across surgical centers, and current recommendations are primarily based on heterogeneous studies and expert opinion. This scoping review aimed to map the impact of upper body movement and sternal precaution strategies on clinical and patient-reported outcomes within 1 year post-operatively in adult patients undergoing cardiac surgery via sternotomy.

Review methods: The review was reported based on the PRISMA-ScR (Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies included randomized controlled trials; nonrandomized controlled trials; quasi-experimental, prospective, and retrospective cohort studies; mixed methods studies; case studies; case-control studies; and cross-sectional studies. Studies were considered eligible if they included patients ≥18 years undergoing cardiac surgery via sternotomy and examined the relationship between sternal precautions or upper body movement strategies within 12 weeks post-operatively and any clinical or patient-reported outcomes within 1 year post-operatively. The systematic literature search was conducted in March 2025 in 6 databases.

Summary: Of 16 464 unique records screened, 12 studies involving 2853 patients were included. These studies found that neither weighted upper body movement strategies nor less restrictive sternal precautions negatively affect sternal wound infections, sternal stability, pain, length of hospital stay, readmissions, or health-related quality of life. Positive improvements were found in functional status and discharge disposition in patients following a less restrictive sternal regimen. The body of evidence indicates that weighted upper body movement strategies and less restrictive sternal precautions do not negatively affect the investigated clinical or patient-reported outcomes post-sternotomy.

Purpose: Pediatric cardiac fitness and rehabilitation for patients with congenital heart disease is an emerging yet underdeveloped field. Adult cardiac rehabilitation programs prescribe 36 sessions, but there are no data regarding the ideal number for a pediatric cardiac fitness program (CFP). This study explored whether there was an optimal range of fitness sessions associated with significant gains following a CFP.

Methods: Pediatric CFP data from January 2017 to December 2022 were analyzed. Number of supervised fitness sessions were categorized into 4 groups (6-11, 12-18, 19-24, and 25-40 sessions) and also analyzed as a continuous variable. Cardiorespiratory fitness, strength, flexibility, and mindset outcome metrics were compared using 1-way analysis of covariance and linear regression, adjusting for baseline values.

Results: A total of 62 patients, with median age of 15.5 years (range: 8-21, 50% female), participated in a median of 19 fitness sessions (range: 6-40). Baseline characteristics, congenital heart disease classification, hemodynamic level, and number of sessions/weeks across the 4 groups were similar. Patients improved from pre- to post-CFP in cardiorespiratory fitness, strength, flexibility, and mindset metrics, but no significant differences were found between any of the ranges of sessions or numbers of sessions as a continuous variable. Power was limited due to small sample sizes per group.

Conclusions: Fitness improvements were seen with fewer than 36 sessions, but an optimal dose for a complete program remains unclear. Rethinking program completion as achieving goals rather than a specified number of sessions should be considered. Individualized, personal dosing may yield the most efficient use of patient time and health care resources.

Purpose: Our purpose was to assess the efficacy of a phase III cardiac rehabilitation (CR) program, based on counseling in the maintenance of physical exercise, on the time spent on physical exercise per week in patients with ischemic heart disease who had completed a phase II CR program.

Methods: Open, controlled, cluster randomized clinical trial. The intervention group (IG) participated in a phase III CR program based on counseling in the maintenance of physical exercise. The control group (CG) received standard care at their primary health care center. The main outcome was the time spent engaging in physical exercise per week at 6 and 12 months measured by the 7-day Physical Activity Recall questionnaire.

Results: Fourteen primary health care centers were randomly assigned, 7 to the CG and 7 to the IG. Ninety-nine patients (54 CG, 45 IG, mean age 59.8 ± 9.3, 86% men) were analyzed. The mean time per week of moderate and vigorous activity at 12 months was 270.7 ± 292.6 min/week in the CG and 321.0 ± 216.9 min/week in the IG (P = .124). Decreases in the percentages of patients who performed the recommended levels of physical exercise were observed in both groups (14% vs 9% in the CG and IG, respectively; P = .869).

Conclusions: The intervention did not result in significant differences in the stated objectives of the CR program, although the IG performed a greater amount of moderate and/or vigorous exercise.