Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

Purpose: Spontaneous coronary artery dissection (SCAD) disproportionately affects females who are often younger in age. Age-based comparisons of the post-SCAD experience are required to adequately inform rehabilitation programming that is sensitive to patient life circumstances and needs. This multi-site qualitative study investigated the experiences of SCAD in females analyzed according to their age (<50 and ≥50 years).

Methods: Females who had experienced a SCAD event were recruited from 5 large tertiary care hospitals. Participants completed sociodemographic and medical questionnaires and took part in a semi-structured interview. Transcribed data were subject to the framework method using deductive coding. Constructed codes and overarching themes were then compared in the <50 and ≥50-year patient groups. Themes that highlighted the central differences between demographic groups were then constructed inductively.

Results: Overall, females with SCAD (n = 77; mean age = 52.9 ± 10.8 years; range = 29-77) reported struggling with a lack of information from their health care team with regards to the diagnosis, management, and long-term prognosis of SCAD. Younger patient (n = 32; mean age = 40.2 ± 6.7 years) transcripts evidenced more prominent themes of uncertainty, dissatisfaction with cardiac rehabilitation programming, difficulty adjusting to lifestyle and vocational changes, and family-related distress in comparison to those over 50 (n = 45; mean age = 57.8 ± 6.9 years).

Conclusions: Females with SCAD who are <50 years old appear to experience their recovery from SCAD differently than those who are older in age. These differences suggest that tailored approaches may be required in cardiovascular rehabilitation programming for younger SCAD patients.

Purpose: This review explores the role and impact of digital technology in cardiac rehabilitation (CR), assessing its potential to enhance patient outcomes and address barriers to CR delivery.

Review methods: A comprehensive literature search was conducted using curated search terms to target CR studies using digital technologies as an adjunct to in-person CR or as part of remote (ie, asynchronous) or virtual (ie, synchronous audiovisual communication) formats. The literature search focused on studies that evaluated the implementation and efficacy of using digital technologies within CR.

Summary: Digital technology offers significant opportunities to improve CR by providing flexible and scalable solutions that can overcome traditional barriers to CR such as accessibility and capacity constraints. Remote or virtual CR delivery that incorporates digital technologies improves CR adherence and achieves similar improvements in exercise capacity when compared to in-person CR. While the majority of studies have focused on exercise, digital technologies are increasingly used to deliver comprehensive CR solutions as part of remote and virtual CR programs. However, challenges and gaps in the literature remain, such as the impact of digital literacy and promoting equitable CR access, particularly in high-risk and vulnerable populations. Further research needs to focus on longer term outcomes to evaluate the safety, efficacy, and cost-effectiveness of digital CR interventions. The potential of digital health to transform CR and reduce the burden of cardiovascular disease is substantial and warrants further investigation.

Purpose: The Exercise Sensitivity Questionnaire (ESQ) is a self-report measure used to assess the extent to which different physical sensations of exercise elicit anxiety (ie, exercise sensitivity). The ESQ was developed for individuals with cardiovascular conditions and initially validated in a non-clinical sample. This study evaluates the factor structure and measurement invariance in a clinical sample of adults with various cardiovascular conditions.

Methods: This was a cross-sectional study with retrospective chart review. Patients (N = 265; 73% male, mean age 67.8 ± 10.5 years) were attending an orientation for outpatient medically supervised exercise-based cardiac rehabilitation. The factor structure was examined using Confirmatory Factor Analysis, and tests of measurement invariance were evaluated by sex and advanced age (<65 years, >65 years). Internal consistency, descriptive characteristics, and correlates of ESQ scores and its factors were evaluated. Concurrent validity was evaluated in a subset of patients (N = 57) with elevated exercise sensitivity.

Results: The Confirmatory Factor Analysis supported a 2-factor model, which was invariant, but not a 1-factor model, and reflected anxiety about (1) cardiopulmonary and (2) pain/weakness exercise sensations. Internal consistency of ESQ items was high. ESQ scores were associated with higher body mass index and shorter 6-Minute Walk Test distance, particularly the pain/weakness factor. ESQ scores evidenced preliminary concurrent validity with anxiety sensitivity and general anxiety but discriminant validity with depressive symptoms.

Conclusions: There is support for the validity and reliability of ESQ scores as a 2-dimensional index of exercise sensitivity. The ESQ taps a psychological phenotype with relevance to exercise tolerance, and potentially cardiac rehabilitation participation, that warrants continued investigation.

Purpose: Cardiac rehabilitation (CR) is a valuable secondary preventive intervention for Veterans given their increased risk of cardiovascular disease. Adults cared for in the Veterans Affairs (VA) healthcare system are a unique population that receives healthcare from the largest integrated care network in the United States. Yet, this group faces distinct challenges in utilizing CR. In this review, we evaluated the existing data regarding CR utilization and outcomes among U.S. Veterans.

Review methods: A literature search was conducted using PubMed and Scopus for cardiac rehabilitation and U.S. Veterans.

Summary: Veterans have 3 potential options for attending CR: in-person at their local VA medical centers, home-based CR through their local VA medical centers, and in-person at community CR centers. However, participation remains low. A significant barrier to participation is transportation to in-person CR. Home-based CR shows promise in addressing this barrier and has demonstrated resilience in the face of pandemic restrictions. Cardiac rehabilitation outcomes among Veterans who participate include improved exercise capacity, fewer depressive symptoms, and decreased mortality. Despite its benefits for secondary prevention among Veterans, there remains a paucity of data about the current uptake of CR, the impact of mental health on uptake, possible sex-based or racial disparities, and long-term outcomes.

Purpose: Little research has focused on the potential impact that the environment plays in shaping cardiac rehabilitation (CR) patient sedentary time (ST) and physical activity (PA). To address this, the current study generated daily path areas (DPAs) based on the locations they visited during and after they completed CR.

Methods: Patients in CR (n = 66) completed a survey and wore an accelerometer and Global Positioning System receiver for 7 days early (first month), late (last 2 weeks of program), and 3 months after completing CR.

Results: Individual DPAs were approximately 24 km 2 at baseline and remained stable over time. Location-based analyses showed that most patients' ST and PA time was spent at home, followed by other residential, commercial, work, and CR locations. However, the time spent in certain locations (eg, parks and recreation locations) fluctuated during and after CR by intensity.

Conclusions: CR patient DPA was stable over time. Within this space, they primarily engaged in ST and PA at home. However, when not home, the distribution of location use varied across a number of locations that extended well beyond their neighborhoods. Therefore, proximity to home may not be a barrier for CR patients in relation to their ST and PA.