scholarly journals Home-based Cardiac Rehabilitation - the real barriers of programs at distance

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Brito ◽  
I Aguiar-Ricardo ◽  
P Alves Da Silva ◽  
B Valente Da Silva ◽  
N Cunha ◽  
...  
Keyword(s):  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Real Time ◽  
Training Session ◽  
Real Life ◽  
Participation Rate ◽  
Exercise Session ◽  
Exterior Space ◽  
Supervised Exercise ◽  
Home Based

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. Home-based CR (CR-HB) programs should offer the same core CR components as Centre-based programs (CR-CB) but several aspects need to be adapted, communication and supervision must be improved. Although CR-HB has been successfully deployed and is a valuable alternative to CR-CB, there is less structured experience with these non-uniform programs and further studies are needed to understand which patients (pts) are indicated to this type of program. Purpose To investigate pt-perceived facilitators and barriers to home-based rehabilitation exercise. Methods Prospective cohort study which included pts who were participating in a CR-CB program and accepted to participate in a CR-HB program after CR-CB closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including pt risk evaluation and regular assessment, exercise, educational and psychological sessions. The online exercise training sessions consisted of recorded videos and real time online supervised exercise training group sessions. It was recommended to do each session 3 times per week, during 60 min. A pictorial exercise training guidebook was available to all participants including instructions regarding safety, clothing and warm-up, and a detailed illustrated description of each  exercise sessions. Also, for questions or difficulties regarding the exercises, an e-mail and telephone was provided. Once a month, real time CR exercise sessions was provided with a duration of 60min. Results 116 cardiovascular disease pts (62.6 ± 8.9years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. The majority of the pts had coronary artery disease (89%) and 5% valvular disease. Regarding risk factors, obesity was the most common (75%) followed by hypertension (60%), family history (42%), dyslipidaemia (38%), diabetes (18%), and smoking (13%). Almost half (47%) of the participants did at least one online exercise training session per week: 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week. Participants who did less than one exercise session per week reported as cause: lack of motivation (38%), preference of a different mode of exercise training such as exercise in the exterior space (26%), technology barrier such as impossibility to stream online videos (11%), fear of performing exercise without supervision (4%), and limited space at home (4%). Conclusions Our study based on real-life results of a CR-HB program shows a sub-optimal rate of participation in exercise sessions due to different causes, but mainly for the lack of motivation to exercise alone or preference for walking in exterior space. The knowledge of the CR-HB program barriers will facilitate to find out strategies to increase the participation rate and to select the best candidates for this type of programs.

scholarly journals Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Alves Da Silva ◽  
I Aguiar-Ricardo ◽  
N Cunha ◽  
T Rodrigues ◽  
B Valente-Silva ◽  
...  
Keyword(s):  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Health ◽  
Training Session ◽  
Educational Status ◽  
Drop Out ◽  
Therapeutic Adherence ◽  
Validated Questionnaire ◽  
Home Based ◽  
Degree Of Participation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors. Purpose To assess adherence to the various components of a CR-HB program.  Methods Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers;  5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments Adherence to the program was assessed by drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points). Results 116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).  Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week.  The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40).  Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education.  Conclusion Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.

scholarly journals Digital home-based multidisciplinary cardiac rehabilitation: the way to counteract physical inactivity during the COVID-19 pandemic?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R Pinto ◽  
M Lemos Pires ◽  
M Borges ◽  
M Linan Pinto ◽  
C Sousa Guerreiro ◽  
...  
Keyword(s):  
Risk Factor ◽  
Exercise Training ◽  
Adverse Events ◽  
Cardiac Rehabilitation ◽  
Physical Inactivity ◽  
Dietary Habits ◽  
Training Session ◽  
Drop Out ◽  
Risk Factor Control ◽  
Home Based

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested. Purpose To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program. Methods One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse. Results Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred. Conclusion Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.

A pilot study of individualized exercise prescription to improve physical activity in cancer survivors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24030-e24030
Author(s):  
Priyanka Avinash Pophali ◽  
Urshila Durani ◽  
John Shin ◽  
Melissa C. Larson ◽  
Adam Shultz ◽  
...  
Keyword(s):  
Physical Activity ◽  
Pilot Study ◽  
Cardiac Rehabilitation ◽  
Cancer Survivors ◽  
Solid Tumor ◽  
Exercise Prescription ◽  
Exercise Session ◽  
Exercise Interventions ◽  
Time Points ◽  
Supervised Exercise

e24030 Background: Physical activity (PA) in cancer survivors improves quality of life (QOL), functioning, fatigue, and reduces the risk of treatment complications, cancer recurrence and death. However, the optimal intervention for increasing PA is not established. Most prospective studies have shown a 6-12-week program to be an effective intervention but this is often not feasible. Therefore, we piloted a one-time individualized exercise prescription in our cardiac rehabilitation center to improve PA in cancer survivors. Methods: We prospectively enrolled cancer survivors who had completed curative intent treatment, with no evidence of active disease in this pilot study. Survivors who consented underwent a consultation with an exercise physiologist for needs assessment followed by a supervised exercise session with a tailored exercise prescription. Survivors also filled out surveys assessing their PA and QOL at baseline (bl), 3, 6 and 12 months after intervention. Clinical information was collected via chart review. We estimated longitudinal PA score and change in PA using mixed models incorporating scores from all available time points using SAS (v 9.4). Results: Between May 2018 and January 2020, 50 participants (26 lymphoma and 24 solid tumor survivors) completed the intervention. 20% participants were on maintenance therapy during the study. Clinical characteristics of 42 evaluable participants are summarized in Table. The survey response rate was 82%, 58%, 58%, 46% at bl, 3, 6 and 12 months respectively. The level of PA improved with time [mean (SE) PA score: 58.5 (4.3) bl, 63.9 (4.8) at 3, 57.6 (4.8) at 6, 62.6 (5.3) at 12 months]. The change in PA from baseline to follow-up time-points [bl vs 3m p=0.41; bl vs 6m p=0.88; bl vs 12m p=0.55] or between the lymphoma and solid tumor survivors was not statistically significant and limited by sample size. No significant trend in QOL was seen. Conclusions: Individualized exercise prescription using the cardiac rehabilitation program may be a feasible, widely applicable tool to implement a PA intervention among cancer survivors. The trend towards improvement in PA in this novel one-time intervention provides intriguing evidence and deserves future study in larger sample sizes to understand if it can improve and create sustainable PA change comparable to longer term exercise interventions.[Table: see text]

Cardiac Rehabilitation after an Acute Coronary Syndrome: The Impact in Elderly Patients

Cardiology ◽  
2015 ◽  
Vol 131 (3) ◽  
pp. 177-185 ◽  
Author(s):  
Patrícia Rodrigues ◽  
Mário Santos ◽  
Maria João Sousa ◽  
Bruno Brochado ◽  
Diana Anjo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
Heart Rate Recovery ◽  
Real Life ◽  
The Elderly ◽  
Chronotropic Response ◽  
Coronary Syndrome ◽  
Supervised Exercise ◽  
The Impact

Introduction: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity, improve the control of risk factors and the quality of life of patients with coronary artery disease. However, the elderly are underrepresented in most studies and in real-life CR programs. Our goal was to evaluate the impact of CR after an acute coronary syndrome in the elderly population. Methods: A cutoff of 65 years was used to dichotomize age. Our main focus was on the effects of ambulatory supervised exercise training on several surrogate markers, namely total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, body mass index, fasting glucose, glycated hemoglobin, probrain natriuretic peptide, International Physical Activity Questionnaire score, maximal exercise capacity, chronotropic response index and heart rate recovery. We evaluated those variables at the beginning and at the end of phase II of the CR program (after 3 months) and repeated the treadmill test at 12 months. Results: A total of 548 patients with a recent acute coronary syndrome were enrolled; 37% were 65 years old or older. Both age groups had a statistically significant improvement in all the evaluated parameters. Interestingly, at 12 months both groups maintained the improvement in functional capacity seen immediately after 3 months. Conclusions: The benefits of CR in terms of functional capacity, metabolic profile and other prognostic parameters were significant in both younger and older patients. Therefore, all eligible patients should be referred to CR programs, irrespective of age.

An Exercise Training Programme Produces Significant Improvements in Quality of Life (QoL), Muscle Strength and Cardiorespiratory Function in Patients with Myeloma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3323-3323
Author(s):  
Lara J. Groeneveldt ◽  
Rachel Garrod ◽  
Kwee L. Yong ◽  
Flora Dangwa ◽  
Andrew P. Jewell ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Exercise Training ◽  
Stress Test ◽  
Well Being ◽  
Training Programme ◽  
Prophylactic Surgery ◽  
Exercise Session ◽  
Adherence Rate ◽  
Supervised Exercise ◽  
Exercise Training Programme

Abstract Cancer patients frequently suffer with anxiety, fatigue, loss of well-being and functionality. In myeloma patients this is compounded by the effects of lytic bone disease, causing chronic pain and impaired mobility. The result is a decrease in physical fitness and loss of confidence in carrying out day-to-day activities, contributing to a reduced QoL. The development of novel therapies has extended the survival of these patients, hence such issues are of increasing importance and effective rehabilitation programmes are urgently needed. We carried out a pilot study of a tailored exercise training programme in patients in stable plateau phase. The primary aims were to determine the feasibility, adherence rate, and the effects on QoL, physiological and cardiorespiratory functions. Eligible patients underwent radiological and cardiac screening prior to study entry. There was a 25% screening failure rate due to disease progression or fracture risk, these patients proceeding to prophylactic surgery or radiotherapy. Twenty-five patients were given a programme based on their current exercise capacity, level of functioning and individual rehabilitative needs. Patients undertook exercise training 3 times a week for 6 months, with 1 supervised exercise session each week in the hospital outpatient gym. Each session comprised stretching and mobility, aerobic (treadmill, cycle ergometer or walking to 50–60% of heart rate reserve and 15–30 minutes duration) and resistance training (theraband, ankle, hand weights and body-weight) in order to improve flexibility, cardiorespiratory fitness and muscle strength. QoL and physiological outcomes were assessed at baseline, 4-weekly for 3 months, then 6 weekly for 3 months during the 6-month study period. A preliminary analysis of 17 patients who completed 3 months on the programme has been performed. Average attendance at the weekly exercise class was 84%. Adherence to the exercise programme, as assessed by inspection of a log-book was >50% in all patients; 35% achieved >90% adherence. Significant improvements were found in the FACT G (baseline: median 85; range 62 – 104, 3 months: 90; range 70 – 108, p<0.01), FACIT-Fatigue (baseline: 40; range 14 – 50, 3 months: 43; range 19 – 52, p<0.05) and HAD anxiety scores (baseline: 5; range 0 – 19, 3 months: 2; range 0 – 11, p<0.01). Upper limb strength, assessed by handgrip dynamometry also improved significantly (baseline: 28.80kg; range 8.75 – 51.30, 3 months: 30.65kg; range 18.15 – 50.00, p<0.05), as did VO2max, assessed by a submaximal stress test (baseline: 24.8 ml/kg/min; range 19.2 – 34.7, 3 months: 26.7 ml/kg/min; range 21.1 – 35.0, p<0.01). Several patients reduced their analgesia usage, and many are now able to undertake new activities such as lifting a grandchild, climbing ladders to decorate, and walking along a pebbled beach. Such reports of personal benefits are being captured using qualitative methods. In summary, an exercise training programme is feasible in patients with myeloma, resulting in significant benefits as assessed by QoL, physiological and cardio-respiratory measures. Our results provide the evidence base for the regular use of exercise prescription in the rehabilitation of myeloma patients.

scholarly journals Home-based Cardiac Rehabilitation in Covid Era: Is it a safe option?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Couto Pereira ◽  
I Aguiar-Ricardo ◽  
R Pinto ◽  
N Cunha ◽  
P Alves Da Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Pacemaker Implantation ◽  
Funding Sources ◽  
Stent Restenosis ◽  
Home Based ◽  
Minor Adverse Event ◽  
Online Assessments

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Home-based Cardiac Rehabilitation (CR-HB) models have been shown to be effective, however, there is a large variation of protocols and minimal evidence of effectiveness in higher risk populations, in which exercise at distance might be concerning. In addition, lack of reimbursement models has discouraged the widespread adoption of CR-HB. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has emerged due to the decreased availability of on-site services. Purpose Evaluation of the safety of a CR-HB program during COVID-19 pandemic.  Methods Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.pts regular clinical and exercise risk assessment; 2.psychological tele-appointments and group sessions; 3. online exercise training sessions, which consisted of recorded videos and real time online exercise training sessions (each session recommended 3 times per week, during 60 minutes); 4.structured online educational program for pts and family members/caregivers, including educational videos and webinars; 5. follow-up fortnightly questionnaire to evaluate risk factors control and need for appointments or directing to hospital; 6. nutrition tele-appointments; 7. physician tele-appointments, scheduled according to follow-up questionnaire or at patients request (e-mail or telephone) to avoid unnecessary exposure and overload in the hospital. Minor and major adverse events such as hospitalizations due to cardiac event or other non CV reason, cardiac or noncardiac death, during or immediately after the exercise sessions, were collected. Results 116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure. The mean LVEF was 52 ± 11%; 31,1% of the population had at least moderate risk. Regarding risk factors, obesity was the most common risk factor (74.7%) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).  98 CVD pts (85.5%) successfully completed all the online assessments. Three male participants dropped out for hospitalization due to knee surgery, pacemaker implantation and in-stent restenosis without relation to exercise sessions. No major events were registered during the exercise training sessions and only one minor adverse event, sprained ankle, was reported during the training sessions. Conclusions This CR-HB program, originated by the need of social distancing during  COVID-19 pandemic, revealed to be a valuable and safe strategy to reach at distance most patients previously in a Centre-based CR program.

scholarly journals Current Status of Cardiac Rehabilitation in the Regional Cardiocerebrovascular Centers in Korea

2021 ◽  
Vol 10 (21) ◽  
pp. 5079
Author(s):  
Chul Kim ◽  
Jidong Sung ◽  
Jae-Young Han ◽  
Sungju Jee ◽  
Jang Woo Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Patient Education ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Acute Care ◽  
Participation Rate ◽  
Current Status ◽  
Annual Number ◽  
Government Initiative

Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study’s results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.

scholarly journals Home-Based Exercise Training for Heart Failure Patients: a Systematic Review

Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 155
Author(s):  
Roby Aji Permana ◽  
Wikan Purwihantoro Sudarmaji ◽  
Wahyu Sukma Samudera ◽  
Agostinha Soares ◽  
Yanuar Aga Nugraha
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Search Algorithm ◽  
Rehabilitation Program ◽  
Heart Failure Patients ◽  
Home Based

Exercise training is one of the recommendations for a cardiac rehabilitation program to increase exercise capacity and thus quality of life, decreasing both readmission and mortality in terms of heart failure. In spite of the evidence on the benefits and safety of cardiac rehabilitation, the uptake and participation of cardiac rehabilitation by patients with heart failure is currently poor. This study aimed to systematically review the effect of home-based exercise training on heart failure patients. The studies were systematically identified by searching through the chosen electronic databases (Scopus, Science Direct, Proquest, Pubmed, and CINAHL) for articles from the 5 last years. The search algorithm identified a total 164 articles and 15 articles were selected based on the inclusion and exclusion criteria. For the 15 articles, 13 were RCTs, 1 was quasi-experimental and 1 was a retrospective study. The major result of this review shows that home-based exercise has an effect on functional and exercise capacity, quality of life and a decreased rate of readmission within 2-12 months follow up. Home-based exercise has a long-term effect that is more effective than exercise that is hospital-based.

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