Journal of Cardiopulmonary Rehabilitation最新文献

Purpose: Cardiopulmonary exercise testing is a common prognostic tool in heart failure, yet it is not standardized. The purpose of this study was to evaluate a means of standardizing oxygen consumption (VO(2)) measurement and to evaluate the ability to predict peak VO(2) from submaximal exercise.

Methods: Fifty consecutive exercise tests with a respiratory exchange ratio > or =1.10 were evaluated. VO(2) was graphed against respiratory exchange ratio and the peak VO(2) was determined with logarithmic, linear, power, and exponential regression lines. To predict a peak VO(2), each patient's submaximal exercise data (respiratory exchange ratio < or =0.98) were fitted to each regression line. The mean of the last 30 seconds of un-averaged breath-by-breath data was used as the reference value. Peak VO(2) assessments are also provided from the metabolic cart, a rolling time average, and the graphical method.

Results: Logarithmic regression best standardized peak VO(2). Mean absolute bias (mL x kg x min) was 0.60 +/- 0.44 for logarithmic, 0.61 +/- 0.47 for linear, 0.85 +/- 0.67 for power, and 1.44 +/- 2.22 for exponential. The mean absolute bias between the peak logarithmic predicted VO(2) and the reference peak VO(2) was 1.62 +/- 1.20 mL x kg x min (9.5% of the peak VO(2)).

Conclusion: Among the methods studied, logarithmic regression analysis was the best method to standardize and predict peak VO(2) in this cohort of patients with heart failure.

Purpose: To determine the effectiveness of an intervention, directed toward the primary care physician (PCP), to improve the number of patients treated to low-density lipoprotein cholesterol (LDL-C) goal in a cardiac rehabilitation (CR) population.

Methods: A pre-post intervention cohort comparison using data collected from participants in a CR program with LDL-C > or =100 mg/dL at entry. The control cohort participated in CR between 1/00 and 10/02, 41.5% (n = 178) had an entry LDL-C > or =100 mg/dL. The intervention cohort participated in CR between 10/03 and 1/05, 26.4% (n = 67) had an entry LDL-C > or =100 mg/dL. The intervention group had identical treatment as the control group as well as the following: each participant with an LDL-C > or =100 mg/dL in the intervention cohort had an entry letter sent to his or her cardiologist and PCP from the programs Cardiology Medical Director, detailing the lipid goals and therapeutic options. In addition, monthly faxes on progress toward lipid goals were sent to the PCP.

Results: The control cohort was less likely to achieve LDL-C goal compared with the intervention cohort (43% vs 67%, respectively; P = .001). A patient was also less likely to have a lipid medication change during CR in the control group compared with the intervention group (29% vs 42%, respectively; P = .05).

Conclusion: Use of systematic reminders directed at the PCP during CR can substantially increase the percentage of patients achieving nationally recognized LDL-C goals.

Purpose: The purpose of this study was to investigate changes that occur in pulmonary function when postural changes in the sagittal plane are made in a seated position in patients diagnosed with chronic obstructive pulmonary disease (COPD).

Methods: Fourteen patients diagnosed with COPD participated in this study. Standard spirometric measurements (minute ventilation, forced vital capacity, and forced expiratory volume in 1 second) were taken for each patient in each of 2 sitting postures: slumped and upright. Breathing frequency, heart rate, and blood oxygen saturation were also recorded for each of the 2 postures. Patients assumed each posture for 5 minutes before any measurements were taken, after which measurements were recorded each minute for an additional 5 minutes.

Results: A 2-factor (posture and time) analysis of variance with repeated measures on both factors was used to analyze the data. There were no significant differences between the means for heart rate, blood oxygen saturation, and breathing frequency. Paired t tests likewise did not reveal any significant differences between the slumped and upright positions for forced expiratory volume in 1 second, forced vital capacity, and minute ventilation.

Conclusions: These results suggest that there are no differences in measures of pulmonary function (minute ventilation, forced vital capacity, and forced expiratory volume in 1 second) and breathing frequency, heart rate, and blood oxygen saturation between slumped and upright sitting in patients with COPD. Based on this evidence alone, it may be inappropriate to instruct a patient with COPD to sit upright to improve respiratory function. However, further study is warranted before any definite recommendations can be made regarding sitting posture and respiratory performance in individuals with COPD.

Purpose: To develop and psychometrically test the Dyspnea Management Questionnaire (DMQ), a new multidimensional measure of dyspnea in adults with chronic obstructive lung disease.

Participants: Eighty-five participants were recruited with diagnoses of chronic obstructive pulmonary disease (COPD, n = 73) and asthma (n = 12). The total sample was predominately female (65%) and married (34%), with 64.9% white and a mean age of 75 years (SD = 9.6, n = 76), diagnosed with pulmonary disease 4.8 years ago (SD = 4.4), 32% requiring the use of supplemental oxygen. Participants were also African American (29.9%), Asian (2.6%), and Hispanic (2.6%); n = 77.

Methods: An initial item pool of 74 items was drawn for the DMQ aided by qualitative interview data, literature review, and pilot testing with 3 adults with COPD. Several analyses were used to reduce the item pool. An interdisciplinary panel of 12 experts evaluated the content validity of the DMQ items. To evaluate test-retest reliability, respondents with stable COPD (n = 26) completed the questionnaire twice within a mean interval of 18 days (SD = 7.17). The DMQ was compared with the Medical Outcomes Study 12-Item Short-Form (SF-12) Health Survey, the Seattle Obstructive Lung Disease Questionnaire, and the Hospital Anxiety and Depression Scale.

Results: The resulting DMQ is a 30-item scale that measures 5 conceptually derived dimensions: dyspnea intensity, dyspnea-related anxiety, fearful activity avoidance, self-efficacy for activity, and satisfaction with strategy use. It has a 7-point Likert-type scale and third Flesch-Kincaid reading grade level. A panel of 12 experts supported the content validity of the DMQ. It showed high internal consistency (alpha = .87 to .96) and test-retest reliability over 2.5 weeks (intraclass correlation coefficient = 0.71 to 0.95). Dyspnea intensity, dyspnea-related anxiety, and fearful activity avoidance subscales of DMQ-30 and composite score were moderately to highly correlated with 3 Seattle Obstructive Lung Disease Questionnaire dimensions (r = 0.44-0.83), Medical Outcomes Study 12-Item Short-Form scales (r = 0.41-0.57), and Hospital Anxiety and Depression Scale-Anxiety (r = -0.59 to -0.65). Two of DMQ's subscales, self-efficacy for activity and satisfaction with strategy use, correlated mildly with Seattle Obstructive Lung Disease Questionnaire (r = 0.28 and 0.27, respectively). Some very low correlations for DMQ-30's satisfaction with strategy use compared with the Medical Outcomes Study 12-Item Short-Form provided preliminary support for its divergent construct validity. The DMQ-30 discriminated adults with COPD requiring supplemental oxygen from those not requiring it.

Conclusions: The DMQ addresses the need for a more comprehensive, multidimensional assessment of dyspnea, especially for anxious patients with COPD, in order to better guide the appropr

Objective: Limited research has identified theoretical correlates of physical activity (PA) change in patients not receiving cardiac rehabilitation. The purpose of the present study was to determine whether changes in self-efficacy, PA intention, perceived severity and susceptibility, and PA benefits/barriers were associated with changes in PA over a 12-month period in these patients.

Methods: Patients (N = 555) not attending cardiac rehabilitation completed a psychosocial questionnaire in hospital and 6 and 12 months after hospitalization for a cardiac event.

Results: Hierarchical regression analyses showed that the increase in PA from baseline to 6 months was significantly related to an increase in self-efficacy and PA intentions and a decrease in the impact of health-related barriers. Furthermore, the decrease in PA from 6 to 12 months was significantly related to a decrease in health-related benefits and PA intentions and an increase in time and health-related barriers. Finally, the increase in PA from baseline to 12 months was significantly related to an increase in health-related benefits and intentions and a decrease in health-related barriers.

Conclusions: Changes in PA levels over a 12-month period were associated with changes in various theoretical variables. Interestingly, the associations among these variables with PA varied as a function of time after hospitalization.

Purpose: The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier.

Methods: In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004.

Results: More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004.

Conclusions: Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.

Rationale: Heart rate (HR) and oxygen consumption (VO(2)) are indicators of the intensity of exercise. Handrail support has been shown, during maximal treadmill testing, to blunt HR and VO(2) responses at a particular speed and grade, resulting in an increased treadmill time and overprediction in aerobic capacity.

Objectives: This study was designed to determine if handrail support would similarly blunt HR and VO(2) responses during steady-state treadmill exercise at intensities typical of exercise training.

Methods: Healthy volunteers (age, 38-60 years; N = 10) performed maximal treadmill exercise to define VO2max (35.4 +/- 6.5 mL kg(-1) min(-1)) and ventilatory threshold (26.4 +/- 5.8 mL kg(-1) min(-1)). They also performed 3 random steady-state exercise bouts including free arm swing, handrail support-resting, and handrail support-gripping (HRS-G). Each test consisted of three 5-minute stages with intensity levels corresponding to 75%, 85%, and 95% of the speed and grade at ventilatory threshold.

Results: There were significant (P < .05) differences in HR and VO2 at the 75%, 85%, and 95% ventilatory thresholds in HRS-G (108, 114, and 121 beats min and 17.2, 18.0, and 20.6 mL kg min, respectively) versus handrail support-resting (114, 126, and 137 beats min and 19.5, 21.8, and 23.9 mL kg min, respectively) and HRS-G versus free arm swing (120, 130, and 142 beats min and 20.3, 22.8, and 26.1 mL kg min, respectively). Rating of perceived exertion was significantly (P < .05) different between HRS-G (1.8, 2.4, and 3.1) and free arm swing (2.2, 2.9, and 3.6) at all intensities and between HRS-G (2.4 and 3.1, respectively) and handrail support-resting (3 and 3.7, respectively) at the 85% and 95% ventilatory thresholds.

Conclusion: Gripping and, to a lesser degree, resting the hands on the handrails during steady-state treadmill walking will blunt responses during exercise training and may result in less predictable exercise program.