Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: The link between arterial stiffness and physical activity remains unknown in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to assess the association between arterial stiffness and physical activity in patients with HFrEF.

Methods: Seventy-six patients with HFrEF (mean age: 61.40 ± 8.56 years) were recruited in this cross-sectional study. Arterial stiffness was evaluated with carotid-femoral pulse wave velocity (cfPWV). Physical activity was objectively assessed with an accelerometer over 7 days. Physical activity intensity was classified based on the metabolic equivalents of task (MET) as light-intensity physical activity (LPA; 1.5-2.9 MET), moderate-intensity physical activity (MPA; 3.0-6.0 MET), and vigorous-intensity physical activity (VPA; >6.0 MET).

Results: There was a significant correlation between cfPWV and the time spent per week in LPA ( r = -0.478, P < .001), MPA ( r = -0.547, P < .001), total physical activity ( r = -0.579, P < .001), and step count ( r = -0.489, P < .001). After adjusting for age, sex, body mass index, mean arterial pressure, and New York Heart Association functional class, the correlations remained significant. When patients were categorized into inactive, active, and highly active groups according to weekly moderate-to-vigorous intensity physical activity (sum of MPA and VPA), there was a significant difference in cfPWV between the groups ( P < .001).

Conclusions: This study indicates that LPA, MPA, total physical activity, and step count are independently associated with arterial stiffness in patients with HFrEF. Arterial stiffness is lower in patients who are active or highly active compared to those who are inactive.

Purpose: Both cardiorespiratory fitness (CRF) and obesity have been well-established as predictors of cardiometabolic risk and mortality. This study sought to investigate the joint association of CRF and adiposity measures with all-cause and cardiovascular (CVD) mortality in a cohort of patients with stable CVD.

Methods: Data were extracted from the ITER registry. The sample was composed of 2860 cardiac patients involved in an exercise-based secondary prevention program between 1997 and 2023. Patient CRF was estimated using the 1-km treadmill walking test, and measures of body mass index (BMI) and predicted body fat percentage (pBF%) were determined. Cox proportional hazard models were used to determine associations with mortality. All results were adjusted for demographic and clinical confounders.

Results: A total of 1034 deaths (463 of CVD) occurred over a median of 11 years. Each of the fitness-fatness combinations was associated with an increased risk of mortality as compared with normal weight-fit or low pBF%-fit groups. As regards BMI, compared to the reference group, higher mortality risks were observed for overweight-unfit (HR = 1.93: 95% CI, 1.55-2.41; P < .0001), and obese-unfit patients (HR = 1.63: 95% CI, 1.28-2.08; P < .0001). Similar magnitudes were detected in the moderate pBF%-unfit (HR = 2.47: 95% CI, 1.99-3.06) and high pBF%-unfit (HR = 2.07: 95% CI, 1.69-2.54; P < .0001) groups. A similar pattern was observed for CVD mortality.

Conclusion: While overweight and obesity have been associated with an increased risk of death, maintaining CRF can mitigate this risk. These findings support the fundamental role of CRF in exercise assessment and prescription in secondary prevention programs.

Purpose: To analyze the effect of physical exercise on functional parameters in individuals with long coronavirus disease-2019 (COVID-19).

Review methods: A search in MEDLINE, EMBASE, Web of Science, Scielo, and EBSCO was carried out in October 2022, and it was updated in June 2024. For inclusion, studies should have involved physical training without pulmonary rehabilitation, have involved individuals who had long COVID-19, and were prospective trials, clinical trials, or controlled trials. Two reviewers independently performed data extraction and assessed the risk of bias. Seven studies were reviewed, three of high methodological quality. Participants with long COVID-19 were hospitalized in two studies. Interventions lasted 2 to 16 weeks, with frequencies of 2 to 7 days per week, often involving resistance exercise. Strength improved in 67% of studies, cardiorespiratory fitness in 50%, and agility/mobility in 60%. Anxiety improved in 25% of studies, while depression improved in 75%. Quality of life improved across all studies, with dyspnea and fatigue improving in 40% and 80%, respectively.

Summary: Results suggest potential benefits of exercise training for subjects with long COVID-19 in several outcomes, mainly in functional capacity, depression symptoms, quality of life, and fatigue.

Purpose: National guidelines have focused on increasing early referrals to cardiac rehabilitation (CR) before hospital discharge. However, patients often have not seen their cardiologists for a CR discussion, which may affect their willingness to enroll. This study compared the odds of enrollment between inpatient, outpatient, and dual (inpatient and outpatient) referrals.

Methods: A retrospective study was conducted on 1614 patients referred to CR within a university hospital system in Rhode Island from October 1, 2021 to September 30, 2022. Rates of CR enrollment were compared across inpatient (n = 807), outpatient (n = 670), and dual (n = 137) referral settings. Multivariable regression models, including demographics and comorbidities, were used to identify predictors of enrollment.

Results: A total of 874 (54%) patients enrolled with 40% of patients with inpatient referrals enrolling compared to 70% and 60% of those with outpatient and dual referrals, respectively ( P < .005). The average time between referral to initial visit was 24.2 ± 20.0 days. Regression modeling showed that patients with outpatient (OR = 3.74: 95% CI, 2.97-4.72) and those with dual referrals (OR = 2.09: 95% CI, 1.44-3.05) had higher odds of enrolling than those with inpatient referrals. Additionally, patients >80 years had lower odds of enrolling (OR = 0.50: 95% CI, 0.36-0.71) compared to younger patients.

Conclusions: Patients with outpatient referrals and dual referrals had greater odds of CR enrollment compared to those with inpatient referrals. Older patients (age >80 years) had lower odds of enrollment compared to those aged 50 to 65 years. Studies should focus on how to strengthen the inpatient CR referral process and tailor the CR discussion to meet older patient needs.