COMPARING THE EFFECT OF CARDIAC REHABILITATION PROGRAMS ON BODY COMPOSITION AND CARDIAC BIOMARKERS IN PATIENTS WITH CORONARY ARTERY DISEASE

Abstract Background Obesity is associated with significant cardiovascular morbidity and mortality effects. Cardiac rehabilitation programs cause a significant reduction in cardiovascular mortality and a reduction in all cardiovascular risk factors. Up to 80% of patients referred to cardiac rehabilitation programs are either overweight or obese. This study aimed to compare the effects of a phase 2 cardiac rehabilitation program on obese and non-obese patients with stable coronary artery disease following total revascularization by coronary angioplasty. Results This was a prospective study including 120 patients with stable coronary artery disease. Patients were enrolled in a 12-week phase 2 cardiac rehabilitation program. Patients were classified into two groups based on their body mass index (BMI): those with a BMI < 30 kg/m2 were considered non-obese (n = 58) while those with a BMI ≥ 30 kg/m2 were considered obese (n = 62). At baseline, BMI and blood pressure (BP) were recorded; fasting blood sugar, triglyceride levels, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were assessed; and echocardiography was used to measure left ventricular ejection fraction (LVEF). These were re-assessed after completion of the program. At baseline, there were more females in the obese group 20 (32.25%) vs 6 (10.13%) (p = 0.04), more hypertensives (p = 0.023), and less smokers 32 (51%) vs 46 (79%) (p = 0.025). Obese patients achieved fewer metabolic equivalent of tasks (METs) 7.97 ± 2.4 vs 9.74 ± 2.47 (p = 0.007) and had higher LDL-C levels 121.63 ± 36.52 mg/dl vs 95.73 ± 31.51 mg/dl (p = 0.005). At the end of the program, obese patients showed more reduction in BMI − 1.78 ± 1.46 kg/m2 vs − 0. 60 ± 0.70 kg/m2 (p < 0.001) and systolic and diastolic BP (p = 0.016 and 0.038, respectively). LDL-C level was more reduced in the obese group − 25.76 ± 14.19 mg/dl vs − 17.37 ± 13.28 mg/dl (p = 0.022). Non-obese patients had more increase in LVEF (p = 0.024). There was no difference between obese and non-obese patients in the magnitude of increase in METs achieved (p = 0.21). Conclusion Cardiac rehabilitation programs lead to an improvement in cardiovascular disease risk factors with more reduction in BMI, BP, and LDL-C levels in obese patients compared to non-obese ones. LVEF was more increased in non-obese individuals. Exercise capacity in the form of METs achieved was equally improved in both groups.

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Efficacy of Smartphone-Based Secondary Preventive Strategies in Coronary Artery Disease

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820927402 ◽

2020 ◽

Vol 14 ◽

pp. 117954682092740

Author(s):

Alexandra C Murphy ◽

Georgina Meehan ◽

Anoop N Koshy ◽

Phelia Kunniardy ◽

Omar Farouque ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Systolic Blood Pressure ◽

Ldl Cholesterol ◽

Meta Analysis ◽

Established Coronary Artery Disease ◽

Rehabilitation Programs ◽

Artery Disease

Background: Cardiac rehabilitation programs provide a comprehensive framework for the institution of secondary preventive measures. Smartphone technology can provide a platform for the delivery of such programs and is a promising alternative to hospital-based services. However, there is limited evidence to date supporting this approach. Accordingly, we performed a systematic review and meta-analysis examining smartphone-based secondary prevention programs to traditional cardiac rehabilitation in patients with established coronary artery disease to ascertain the feasibility and effectiveness of these interventions. Methods: A systematic search of PubMed, MEDLINE, EMBASE, and the Cochrane Library was conducted. A meta-analysis was performed using a random-effects model with the outcomes of interest being 6-minute walk test (6MWT) distance, systolic blood pressure, low-density lipoprotein (LDL) cholesterol, and body mass index (BMI). Results: A total of 8 studies with 1120 patients across 5 countries were included in the quantitative analysis. Follow-up ranged from 6 weeks to 12 months. Five studies examined all patients post acute coronary syndrome, 2 studies examined only patients undergoing percutaneous coronary intervention, and 1 study examined all patients with a diagnosis of coronary artery disease, independent of intervention. Exercise capacity, as measured by the 6MWT, was significantly greater in the smartphone group (20.10 meters, 95% confidence interval [CI] 7.44-33.97; P < .001; I2 = 45.58). There was no significant difference in BMI reduction, systolic blood pressure, or LDL cholesterol levels between groups ( P value for all > .05). Conclusion: Publicly available smartphone-based cardiac rehabilitation programs are a convenient and easily disseminated intervention which show merit in exercise promotion in patients with established coronary artery disease. Further research is required to establish the clinical significance of recent findings favoring their use.

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Factors Influencing the Outcomes of Patients With Both Coronary Artery Disease and Diabetes Enrolled in Standard Cardiac Rehabilitation Programs

The Journal of Cardiovascular Nursing ◽

10.1097/jcn.0b013e31820017dc ◽

2011 ◽

Vol 26 (3) ◽

pp. 210-217 ◽

Cited By ~ 4

Author(s):

Joyce K. Miketic ◽

Marilyn Hravnak ◽

Carol S. Stilley ◽

Robert J. Robertson ◽

Susan M. Sereika

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Rehabilitation Programs ◽

Factors Influencing ◽

Artery Disease

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Effects of Community-Based Cardiac Rehabilitation on Body Composition and Physical Function in Individuals with Stable Coronary Artery Disease: 1.6-Year Followup

BioMed Research International ◽

10.1155/2013/903604 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Sandra Mandic ◽

Claire Hodge ◽

Emily Stevens ◽

Robert Walker ◽

Edwin R. Nye ◽

...

Keyword(s):

Coronary Artery Disease ◽

Body Composition ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Physical Function ◽

Handgrip Strength ◽

Stable Coronary Artery Disease ◽

Community Based ◽

Artery Disease

Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR).Design. Thirty-four individuals (69.7±8.2years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance.Results. Participants attended38.5±30.3%sessions during1.6±0.2year followup. A significant increase in 30-second chair stands (17.0±4.7to19.6±6.4,P<0.001), body weight (75.8±11.1to77.2±12.1 kg,P=0.001), and body fat (27.0±9.5to29.1±9.6%,P<0.001) and a decline in handgrip strength (36.4±9.4to33.0±10.6kg·f,P<0.001) and muscle mass (40.8±5.6to39.3±5.8%,P<0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes.Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.

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The role of psychological rehabilitation in complex cardiac rehabilitation of patients with coronary heart disease

National Psychological Journal ◽

10.11621/npj.2020.0407 ◽

2020 ◽

Vol 40 (4) ◽

pp. 85-97

Author(s):

Arseniy A. Velikanov ◽

Anna A. Stoljarova ◽

Nadezda E. Kruglova

Keyword(s):

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Integrative Approach ◽

Common Disease ◽

Rehabilitation Programs ◽

Artery Disease ◽

Anxious Behavior

Background. Coronary artery disease (CHD) remains the most common disease and a common cause of death worldwide. In this regard, much attention is paid to preventive measures in relation to coronary heart disease. Providing high-quality and timely psychological rehabilitation as part of secondary prevention programs has the potential to improve the prognosis of patients with coronary disease. Therefore, it is urgent to improve the measures of psychological rehabilitation. Objective: review and analysis of data from modern foreign and domestic studies on the psychological rehabilitation of patients with coronary heart disease (within the framework of complex cardiac rehabilitation). Results. Despite the obvious, recognized by experts, benefits of rehabilitation programs, there is a problem of insufficient active participation of patients with coronary heart disease in such programs. Research is needed to identify factors and develop methods that improve patient motivation to participate in and complete rehabilitation activities. The main targets of psychological rehabilitation of patients with coronary heart disease include the correction of such psychological characteristics as: hostility, emotional tension, manifestations of depressive and anxious behavior, maladaptive personality traits. The importance of dealing with anxiety and depression is emphasized. According to scientific literature, the most effective and appropriate methods of psycho-correction in the system of psychological rehabilitation of patients with coronary heart disease are cognitive-behavioral methods, as well as the use of an integrative approach. It is important to develop and implement general organizational standards for psychological rehabilitation of patients with coronary artery disease, as well as the inclusion of positions of medical psychologists in the staffing of cardiological medical institutions. Conclusions. Despite the use of modern methods of treatment and rehabilitation, the mortality rate from CHD remains high. Therefore, it is necessary to continue research aimed at optimizing treatment and rehabilitation measures with the expansion of the set of psychological rehabilitation.

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CARDIORESPIRATORY RESPONSES TO ISOKINETIC EXERCISE IN PATIENTS WITH CORONARY ARTERY DISEASE

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220202603185905 ◽

2020 ◽

Vol 26 (3) ◽

pp. 201-205

Author(s):

Aline Ertel Ribeiro ◽

Suelen Bordin ◽

Talinara Cristine Marini ◽

Vivian Carla Florianovicz ◽

Gilnei Lopes Pimentel ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Peak Torque ◽

Moderate Intensity ◽

Isokinetic Dynamometer ◽

Isokinetic Exercise ◽

Cardiorespiratory Responses ◽

Rehabilitation Programs ◽

Artery Disease

ABSTRACT Introduction Exercise training using an isokinetic dynamometer is an alternative for improving muscle strength in patients with coronary artery disease (CAD). Few studies have shown metabolic and cardiorespiratory responses to submaximal isokinetic exercises in patients in cardiac rehabilitation programs. Objective To describe cardiorespiratory responses at two intensities of isokinetic exercise. Additionally, we compared the cardiorespiratory responses of isokinetic exercise with data from the incremental cardiopulmonary exercise test (CPET). Methods Eight individuals with CAD (61.7 ± 6.6 years) performed the following tests: 1) CPET on a treadmill; 2) Peak torque test (five repetitions) and fatigue resistance test (20 repetitions) of knee flexion-extension at angular speeds of 120°/s and 180°/s; 3) Two sets of 20 repetitions were performed at 30–40% (low-intensity, LI) and 50–60% (moderate-intensity, MI) of peak torque at angular speeds of 120°/s and 180°/s, using an isokinetic dynamometer. During the exercises, the individuals were connected to an expired gases analyzer with simultaneous monitoring of the electrocardiogram trace, heart rate (HR), oxygen consumption (VO2), carbon dioxide production, and minute ventilation (VE). The differences (∆) between the peak measurements during exercises and the baseline values were calculated. Results Both LI and MI produced cardiorespiratory responses below the anaerobic threshold (82.8 ± 8.1% of HRmax and 74.4 ± 9.6% of VO2peak) compared to the CPET data ( P < 0.01). MI showed higher ∆ HR (9.8 ± 5.5 vs. 6.3 ± 4.6 bpm; P = 0.01), ∆ rate pressure product (3015 ± 2286 vs. 1957 ± 1932 mmHg·bpm; P = 0.01), and ∆VE (10.2 ± 6.2 vs. 6.9 ± 7 L·min-1; P = 0.03) than LI at the angular velocity of 180°/s. Conclusion These results suggest that this isokinetic exercise protocol may be used as a strategy for cardiac rehabilitation programs in patients with CAD. Level of evidence IV; Case series.

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