Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: To investigate (1) the relationship between socioeconomic status of patients with acute coronary syndrome and participation in cardiac rehabilitation and (2) the relationship between patient participation stratified by socioeconomic status and their outcomes at 12 months.

Methods: Analyzed data were from the CONCORDANCE registry. Patients were stratified (quintiles) according to the National Index of Relative Socio-Economic Disadvantage. The odds of a major adverse cardiovascular event (MACE; defined as heart failure, myocardial infarction, stroke, or cardiac-cause death) and separately all-cause death between hospital discharge and 12 months were analyzed using multilevel logistic regression models, adjusting for clinical history and hospital clustering.

Results: Of 3787 patients referred to cardiac rehabilitation, followed up at 6 and 12 months, 1834 (48%) participated in cardiac rehabilitation. Participation rate was higher among patients in least socioeconomically disadvantaged quintiles (Q5 [least disadvantaged]: 61%, Q4: 53%, Q3: 42%, Q2: 47%, Q1 [most disadvantaged]: 42%). The odds of MACE were not different between participants and non-participants (6% vs 8%, OR = 0.87: 95% CI, 0.66-1.15). However, the odds of death were lower among participants than non-participants (0.4% vs 2%, OR = 0.35: 95% CI, 0.16-0.78). The association between participation and MACE and death did not differ by socioeconomic status ( Pinteraction = .6943 and Pinteraction = .6339, respectively).

Conclusions: Although patient socioeconomic status may influence their participation rates in cardiac rehabilitation, no significant differences were observed in the relationships between participation and MACE or mortality at 12 months across socioeconomic groups. Targeted strategies are needed to improve participation rates across all socioeconomic groups.

Purpose: Unlike center-based cardiac rehabilitation (CBCR), hybrid cardiac rehabilitation (HCR) combines both center-based and home-based training sessions. However, there are various types of HCR, and it remains unclear which type is most effective. This study aimed to classify HCR models and compare their effectiveness relative to CBCR.

Review methods: We extracted original studies on HCR effectiveness from 3 databases: Medline, CINAHL, and SPORTDiscus. Inclusion criteria required that the HCR model incorporate a mix of exercise sessions in both a center setting and at home and at least 1 additional core component of cardiac rehabilitation (i.e., education, multidisciplinary care, psychosocial support, or medical risk management). Data on functional capacity, health-related quality of life (HRQoL), level of physical activity (PA), anxiety, depression, adherence, satisfaction, and long-term effects were extracted.

Summary: Twenty-six studies were identified, and HCR were classified into 3 types: (1) sequential programs (initial CBCR followed by home-based cardiac rehabilitation only); (2) progressive programs (gradual shift from center-based to home-based); (3) simultaneous programs (CBCR with concurrent home-based sessions). All 3 HCR models achieved results comparable to those of CBCR in terms of functional capacity, HRQoL, anxiety, and depression. Participants reported high levels of adherence and satisfaction with HCR programs. However, the effectiveness of HCR programs on PA levels and long-term effects remains inconclusive. The three HCR models provide similar outcomes to CBCR and thus appear to be promising alternatives to CBCR.

Purpose: A low breathing reserve (peak ventilation [Epeak]/estimated maximum ventilation [Emax] ≤ 15%) is recommended as the decision node to indicate abnormal ventilatory limitation during incremental cycle ergometry. Given higher Epeak during weight-bearing exercise, we aim to establish which coefficients should multiply the forced expiratory volume in 1 second (FEV1) to reduce the prevalence of a low breathing reserve in healthy subjects undergoing treadmill exercise.

Methods: We determined the coefficients for FEV1 multiplication associated with <5% prevalence of a low breathing reserve in 3544 healthy individuals aged 20 to 80 years. We then contrasted their performance in differentiating healthy subjects (N = 148) from patients with chronic obstructive pulmonary disease (COPD) (N = 133) in an external validation sample.

Results: A low breathing reserve was found in 22% and 6% of women versus 48% and 17% of men when FEV1 was multiplied by 35 and 40, respectively. Sex-adjusted coefficients required to decrease the prevalence of a low breathing reserve ranged from 33 and 48 in women versus 36.5 and 50 in men in those showing peak oxygen uptake <80% and >120% predicted, respectively. Breathing reserve using the new sex- and fitness-adjusted coefficients were superior to previous values in differentiating health from disease, regardless of COPD severity.

Conclusion: Higher coefficients for FEV1 multiplication are required to estimate Emax at peak treadmill exercise in men than in women, increasing as a function of cardiorespiratory fitness in both sexes. These data are poised to improve the yield of cardiopulmonary exercise tests in accurately indicating pathological ventilatory limitation in patients with respiratory diseases.

Purpose: Patients with chronic obstructive pulmonary disease (COPD) and symptoms of depression have increased health care utilization and lower quality of life. There is a knowledge gap regarding feasible and effective approaches for the management of depressive symptoms in patients with COPD. The objective of this randomized clinical trial sub-study is to determine whether 12-weeks of home-based pulmonary rehabilitation (PR) with health coaching is feasible and effective for improving depressive symptoms in patients with COPD.

Methods: Patients with severe COPD and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] ≥5 points) randomized to the intervention (N = 90) or control (N = 78) groups in the parent study were included. The primary outcome of this sub-study was the 12-week change in the PHQ-9 score. Secondary outcomes included dyspnea, fatigue, emotions, and mastery (self-management) as measured by the Chronic Respiratory Questionnaire (CRQ) and daily physical activity and sleep measured by ActiGraph.

Results: Home-based PR with health coaching was associated with improved measures of depression ( P = .07), dyspnea, fatigue, emotion, and mastery (self-management) ( P < .001). Being in the intervention group was associated with a higher odds of improving by the minimal clinically important difference on the PHQ-9 (OR = 2.10: 95% CI, 1.06-4.27), CRQ-Dyspnea (OR = 2.37: 95% CI, 1.11-5.26), CRQ-Fatigue (OR = 3.35: 95% CI, 1.59-7.35), CRQ-Emotions (OR = 4.59: 95% CI, 2.13-10.40), and CRQ-Mastery (OR = 3.36: 95% CI 1.60-7.28) after multivariable adjustment. The improvement in depression symptoms was maintained for 3 and 6 months after finishing the intervention.

Conclusion: Home-based PR with health coaching is feasible and possibly effective in improving depressive symptoms and quality of life in patients with COPD and symptoms of depression.

Purpose: To examine the effects of postoperative pulmonary telerehabilitation (PTR) in older adults with lung cancer using a popular mobile instant messenger.

Methods: We conducted a randomized controlled trial in ambulatory patients (n = 64; aged ≥ 65 years) with lung cancer scheduled for video-assisted thoracoscopic surgery. Participants were randomly assigned to intervention (IG) or control (CG) groups. Four weeks after surgery, both groups received a one-time education session on standard home-based pulmonary rehabilitation at the rehabilitation center. The IG underwent a PTR program thrice weekly for 4 weeks using a mobile instant messenger or telephone. Both groups were instructed to maintain their exercise routine (at least 3 times a week) during the 4-week follow-up.

Results: Compared with the CG, the IG showed significant improvements in peak oxygen uptake (VO2peak) and percent predicted VO2peak of 3.3 mL/kg/min (95% CI, 1.9-4.8; P < .001) and 14% (95% CI, 7-21; P < .001), respectively, after PTR. These improvements persisted at the 4-week follow-up (VO2peak = 3.8 mL/kg/min: 95% CI, 2.1-5.5; P < .001 and percent predicted VO2peak = 13%: 95% CI, 6-20; P < .001). Compared with preoperative values, postoperative VO2peak and percent predicted VO2peak decreased significantly by 3.5 mL/kg/min (95% CI, 2.6-4.3; P < .001) and 15% (95% CI, 11-19; P < .001), respectively.

Conclusions: A 4-week postoperative PTR program improved VO2peak in older adults with lung cancer. Our findings suggest that PTR may be a feasible therapeutic strategy for lung cancer, even in older adults.

Purpose: To describe 2-year post-myocardial infarction (MI) longitudinal patterns of guideline- directed medical therapy (GDMT) and cardiac rehabilitation (CR) participation with Sankey diagrams.

Methods: Eligible Medicare beneficiaries were aged 66 to 95 years with an acute MI (International Classification of Diseases-9-CM discharge codes of 410.xx excluding 410.x2) hospital admission between January 1, 2014 and September 30, 2015 and ≥1 follow-up CR sessions. We defined GDMT (angiotensin converting enzyme-inhibitor or angiotensin receptor blocker, statin, and β-blocker) use as having at least a 21-day supply available during a 30-day window. We stratified CR participation by days with claims (1-11, 12-23, ≥ 24). Population level trends of 6 GDMT combinations, CR participation, and death were depicted with Sankey diagrams.

Results: Study population consisted of 5793 beneficiaries, 72% of whom had ≥1 GDMT pre-MI, 93% had ≥1 GDMT at baseline, and 45% initiated CR by 30 days post-MI. A median 23% of CR participants did not flow from low to moderate CR participation each month. At 1-year post-MI, 37% of beneficiaries without pre-MI GDMT and 33% of beneficiaries with pre-MI GDMT concluded CR early. Between 9% and 16% of beneficiaries without pre-MI GDMT and 2% to 6% beneficiaries with pre-MI GDMT did not have a GDMT fill post-MI. On average, 4% to 5% of beneficiaries switched from β-blocker + statin to another GDMT group post-MI each month.

Conclusions: Describing patterns of secondary prevention method utilization with Sankey diagrams can identify intervention populations, such as groups with inconsistent CR participation, primary nonadherence to new medications, and volatile medication persistence.

Objective: To explore the incremental dose-response effect of aerobic exercise-based cardiac rehabilitation programs (ExCRP) on cardiorespiratory fitness in comparison to non-exercise controls among people with coronary heart disease (CHD).

Review methods: Medline, CINAHL, Cochrane, SCOPUS, and SPORTDiscus were searched from January 1, 2000 until December 4, 2023. Articles were eligible for selection if they satisfied the following criteria: randomized controlled studies assessing change in cardiorespiratory fitness among people with CHD in non-exercise and aerobic intervention groups, established peak oxygen uptake via cardiopulmonary exercise test, minimum of 4-week program duration, and reported frequency, intensity, and duration of prescribed exercise. The study was prospectively registered (PROSPERO ID: CRD42021274924).

Summary: Thirty-three studies, including 1901 participants were included in the continuous dose-analysis. A significant difference in cardiorespiratory fitness was identified between ExCRP and non-exercise control that favored exercise by 3.4 (3.0-3.9) mL·kg -1 ·min -1 . No difference existed between interval and continuous training when matched for exercise dose. Dose-response analyses identified a significant increase in cardiorespiratory fitness (3.4 [2.9-5.5] mL·kg -1 ·min -1 ) associated with program completion, with no additional benefit related to increased exercise dose. When compared to non-exercise control, participating in ExCRP with a minimum total program intervention dose of 2194 metabolic equivalent minutes significantly improves cardiorespiratory fitness. However, no additional benefit was discernible from higher exercise doses. Although the recommended dose for ExCRP augments medical treatment and is sufficient to improve cardiorespiratory fitness, it is likely that the narrow range in prescribed exercise dose and variations in the fidelity of exercise interventions limit interpretation.

Purpose: To investigate the relationship of upper extremity exercise capacity (UEEC) with activities of daily living (ADL), handgrip strength, handgrip endurance, and anthropometric and clinical characteristics in patients with heart failure (HF).

Methods: In 48 patients with HF and 50 age- and sex-matched healthy controls, we evaluated UEEC, handgrip strength and endurance, and AD using the 6-minute pegboard ring test (6PBRT), a hydraulic hand dynamometer, and the London Chest Activity of Daily Living (LCADL) scale, respectively.

Results: Clinical characteristics were similar between patients with HF (mean age 63.21 ± 8.55 years, 42% female) and healthy controls (mean age 60.16 ± 8.64 years, 54 % female, P > .05). Patients with HF had significantly reduced 6PBRT scores (Cohen's d = - 1.906), handgrip strength (Cohen's d = - 0.595), and handgrip endurance (Cohen's d = - 1.791), as well as higher LCADL scores (Cohen's d = 1.628) compared to healthy controls ( P < .05). The 6PBRT score showed strong positive correlation with handgrip endurance (r = 0.595, P < .001) and moderate positive correlation with total work capacity (r = 0.497, P < .001). The LCADL %total revealed a moderate negative correlation with handgrip strength (r = - 0.495, P < .001) and total work capacity (r = - 0.493, P < .001) and a moderate positive correlation with body mass index (r = 0.477, P  = .001) in patients with HF. Performance of ADL was not correlated to 6PBRT score in patients with HF. Also, the diagnosis of HF and handgrip endurance were the strongest predictors for 6PBRT score ( P < .05).

Conclusions: Patients with HF exhibited a clinically significant decrease in their UEEC. Based on our findings, this decline is likely associated with handgrip endurance.