Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: Aortic disease presents a significant risk of mortality and morbidity, with hypertension considered the primary driver of disease progression. Blood pressure naturally increases during physical activity, and patients need guidance on the optimal level of exercise. The purpose of this study was to evaluate change in cardiopulmonary fitness after attending a rehabilitation program using blood pressure-guided exercise intensity.

Methods: The cohort included patients with thoracic aortic dissection (type A and B) and surgically operated thoracic aortic aneurysm. All participated in a rehabilitation program with maximum workload recommendations based on cardiopulmonary exercise tests which were performed before and after the rehabilitation program.

Results: 63 patients were included. At ventilatory threshold, workload increased by 17-32 watt and oxygen uptake by 1.8-2.9 ml/kg/min. 22 patients were able to perform both tests to exhaustion without exceeding blood pressure restrictions of 160-180 mmHg. These patients improved maximum workload by 20.6 watt (95% CI, 13.0-28.3) and peak oxygen uptake by 2.3 ml/kg/min (95% CI, 1.2-3.5). Only two cases of light dizziness at the end of test were reported.

Conclusions: Generally, patients with aortic disease improved oxygen uptake and workload during the rehabilitation program. One-third of the patients were able to perform both cardiopulmonary exercise tests to exhaustion without exceeding blood pressure restrictions. No serious adverse events occurred during test or exercise.

Purpose: Exercises with a self-selected intensity (SSI) have emerged as an alternative to guideline-recommended sessions to improve adherence to exercise programs. We compared the cardiovascular and perceptual responses during a walking exercise performed at SSI and in a session with intensity recommended by clinical guidelines.

Methods: Twenty patients (mean 69.2 ± 7.7 years, 55% male, and mean ankle brachial index 0.59 ± 0.15) participated in two experimental sessions: guidelines (3-5 minutes of walking sets, 2-3 minutes of recovery, and moderate intensity by pain perception) and SSI (preferred walking speed and set duration) sessions. Blood pressure, heart rate, heart rate variability threshold, rating of perceived exertion, perception of pain, and affective response were assessed during the exercise.

Results: Independent of time, perceived exertion (∆0.8: 95% CI, 0.1-1.5, P session  = .035) and pain (∆0.6: 95% CI, 0.3-0.9, P session < .001) were lower, while affective responses (∆-0.8: 95% CI, - 1.5 to -0.1, P session  = .029) were higher in SSI session compared to the guideline session. Independent of time, the heart rate (∆5.5: 95% CI, 1.2-9.8 beats/min, P session  = .013) was lower in the SSI session, while blood pressure responses were similar between sessions ( P session > .05). The time spent above the heart rate variability threshold was significantly lower in the SSI session (∆4.2: 95% CI, 1.6-7.0 minutes, P interaction  = .005).

Conclusion: The SSI sessions promoted lower cardiovascular overload and better perceptual responses than guideline sessions in patients with symptomatic PAD.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) convened a writing group to define virtual and remote delivery of cardiac and pulmonary rehabilitation (CR-PR) services and their components. Virtual CR-PR is delivered using synchronous real-time audiovisual communication, while remotely delivered CR-PR is delivered asynchronously. In many cases, a hybrid of these approaches may be optimal, including a mix of in-person, virtually, and remotely delivered sessions. Regardless of the delivery method, CR-PR must include all core components listed in the most recent scientific statements and relevant guidelines from AACVPR. The metrics to assess the performance and quality of CR-PR remain the same, irrespective of the delivery methods. CR-PR programs should consistently track patient outcomes and care quality, which can be standardized by the use of the AACVPR registries (https://www.aacvpr.org/Registries) to monitor program and patient outcomes. Patient selection is critical to optimizing and utilizing appropriate CR-PR resources to ensure the CR-PR model fits the patient's medical status and preferences. A comprehensive assessment, preferably in-person, if possible, should precede program initiation. The exercise prescription used for virtual/remote CR-PR models should not differ from in-person CR-PR but should be adapted to the patient's environment, needs, and existing resources. Emergency and safety protocols, and education of the patient and caregivers regarding such protocols, should be established for virtual/remote CR-PR programs. In-person delivery of CR-PR is the most evidence-based model for delivering the service and remains the consensus recommendation for all eligible patients willing to attend; however, alternative models of CR-PR (virtual, remote, and hybrid) can be implemented to increase the number of patients benefiting from CR-PR programs.

Purpose: The coronavirus disease-2019 (COVID-19) pandemic negatively impacted mental health outcomes. This study aimed to 1) quantify the relationship between perceived impact of COVID-19 and hopelessness in patients with ischemic heart disease (IHD) and 2) identify potential mediators of the relationship.

Methods: Participants (n = 110) were recruited from 1 hospital in the Midwestern United States. Data on the perceived impact of COVID-19, state and trait hopelessness, depression, perceived social support (PSS), health-related quality of life (HRQoL), and well-being were collected 2 weeks post-hospitalization from 2020 to 2023. Linear models were used to evaluate associations between variables in adjusted and unadjusted models.

Results: Most participants were male (69%), non-Hispanic White (95%), married (64%), and with some college education (66%). Hopelessness showed a modest association with perceived COVID-19 impact (state = 0.23; trait = 0.30), as did anxiety (0.40), HRQoL (0.20), PSS (-0.24), fatigue (0.25), and pain interference (0.25), in adjusted and unadjusted models. Food access, family income/employment, social support access, and stress were associated with hopelessness and perceived COVID-19 impact. The strongest evidence for mediation between hopelessness and perceived COVID-19 impact was anxiety (66% mediation state; 50% mediation trait).

Conclusions: In this first study to report hopelessness levels in patients with IHD during the COVID-19 pandemic, the relationship between hopelessness and perceived COVID-19 impact was supported and mediated by anxiety. During a pandemic, food access, social support, family income/employment, and stress in patients with IHD may increase feelings of hopelessness. Further research is required to examine the hopelessness and anxiety relationship.

Purpose: Although skeletal muscle abnormalities caused by diabetes mellitus (DM) suggest that peripheral muscle impairment may have a greater effect on exercise tolerance in patients with DM, the magnitude of this effect on reduced exercise capacity remains unclear. As such, this study aimed to compare the strength of the association between lower-extremity muscle strength and exercise capacity in patients diagnosed with cardiovascular disease (CVD) with and without DM.

Methods: This retrospective cross-sectional study included data from 262 patients divided into two groups: patients with DM (DM group; n = 106); and without DM (non-DM group; n = 156). Peak oxygen uptake (VO 2peak ) and isometric knee extensor strength (IKES) were measured. Correlations between VO 2peak and IKES were analyzed using Pearson's correlation test in the DM and non-DM groups. Linear regression analyses were performed with VO 2peak as the dependent variable, and IKES, confounders, and the interaction term DM × IKES as the independent variables. Separate linear regression analyses were performed for the DM and non-DM groups.

Results: The correlation coefficient between VO 2peak and IKES was 0.58 in the DM group and 0.26 in the non-DM group. The interaction term DM × IKES had a significant effect on VO 2peak. The IKES was significantly associated with VO 2peak in the DM group ( β = 0.83, P < .001), but not in the non-DM group ( β  = 0.01, P = .96).

Conclusion: A specific association between lower-extremity muscle strength and VO 2peak was observed in patients with both CVD and DM.

Purpose: Smoking cessation is challenging, and many patients entering cardiac rehabilitation (CR) continue to smoke. Those who smoke may experience less improvement during CR. This study examined improvements during CR based on smoking status.

Methods: Data were collected from patients enrolled between 2012-2021 at CR programs participating in a national registry. Patients were categorized by self-reported cigarette smoking status (current vs. former/never). Variables examined included patient characteristics (age, sex, race, educational attainment, insurance coverage, qualifying diagnosis, and body mass index), number of CR sessions attended, and baseline and change in psychological (depression/anxiety symptoms) and cardiorespiratory fitness (6-minute walk test distance [6MWT], max metabolic equivalent of task [MET]) measures. Baseline values were compared using Chi-square tests or unpaired t -tests as appropriate, and changes in outcome variables were examined using multivariable linear regression.

Results: Of the 447 921 patients, 34 656 (8%) reported current smoking at the time of entry. Current smoking was associated with younger age (58.8 vs. 66.9 years), lower socioeconomic status (Medicaid-enrolled, 11% vs. 3%), qualifying for CR due to myocardial infarction (42% vs. 26%), higher anxiety (50.0 vs. 45.3) and depression (6.5 vs. 4.6) scores, lower cardiorespiratory fitness at entry (max MET 3.4 vs. 3.6), and completing fewer CR sessions (17.7 vs. 23.3). Current smoking was independently associated with significantly less improvement in cardiorespiratory fitness (-17.6 meters in 6MWT distance and -0.26 in max MET) and worse depression scores at exit (0.53 higher).

Conclusions: Those who enter CR and are smoking are at high risk and may not benefit as much from CR as those who do not smoke. Continued effort must be placed on improving smoking cessation efforts within CR.

Purpose: To describe the design of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) national pulmonary rehabilitation (PR) registry and the demographic and clinical characteristics of enrolled participants.

Methods: We defined enrollment as attending at least 1 rehabilitation session. Participant characteristics are expressed as median (IQR) or number (%). We used participant zip codes to determine county of residence and created a heat map of participants per county in the continental US. In those aged 65 years and older, we compared participant characteristics with published data on Medicare beneficiaries.

Results: From 2013 to 2021, 70 085 individuals from 319 programs have enrolled. Median age is 70 years (63, 76), 52% are female, 78% are White, and 99% have health insurance. Comorbidities and a history of smoking are common. Chronic obstructive pulmonary disease, including emphysema and chronic bronchitis, is the primary admission diagnosis for 71% of enrollees. At least 1 participant resides in 42% of continental US counties, with more representation in counties from the upper Midwest and East Coast of the US. Demographic characteristics of those aged 65 years and older are similar to samples of Medicare beneficiaries.

Conclusions: The AACVPR PR registry provides a wealth of data to examine patient outcomes and quality of care in PR. Not surprisingly, non-White individuals, those with lower education levels, and those who are uninsured are underrepresented in the AACVPR PR registry, reflecting national trends.

Purpose: To describe the design of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) National Cardiac Rehabilitation (CR) registry and the demographic and clinical characteristics of enrolled participants.

Methods: We defined enrollment as attending at least 1 CR session. Participant characteristics are expressed as median (IQR) or number (%). We used participant zip codes to determine the county of residence and created a heat map of participants per county in the continental US. In those aged 65 years and older, we compared participant characteristics with published data on Medicare beneficiaries in CR.

Results: From 2012 to 2021, 489 507 individuals from 702 programs have enrolled. Median age is 67 years (59, 74), 70% are male, 77% are White, and 99% have health insurance. Cardiovascular risk factors, comorbidities, and use of secondary prevention medications are highly prevalent. A coronary artery disease-related diagnosis is the primary admission diagnosis for 78% of enrollees, while only 6% have a primary admission diagnosis of heart failure. At least 1 participant resides in 78% of continental US counties, with more representation in counties from the upper Midwest, East Coast, and southwestern US. Demographic characteristics of those aged 65 years and older are similar to the CR samples of Medicare beneficiaries.

Conclusions: The AACVPR CR registry provides a wealth of data to examine patient outcomes and quality of care in CR. Females, non-White individuals, those with heart failure, and those who are uninsured are underrepresented in the AACVPR CR registry, reflecting national trends.