Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

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Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients

Scientific Reports ◽

10.1038/s41598-021-83231-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Raquel Bravo-Escobar ◽

Alicia González-Represas ◽

Adela María Gómez-González ◽

Ángela Heredia-Torres

Keyword(s):

Quality Of Life ◽

Cardiac Rehabilitation ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Cardiac Rehabilitation Program ◽

Moderate Risk ◽

Risk Patients ◽

The Impact

AbstractExploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.

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CHANGES IN ANXIETY AND DEPRESSION LEVELS OF CABG PATIENTS FOLLOWING A CLINIC OR HOME-BASED PHASE II CARDIAC REHABILITATION PROGRAM

Journal of Cardiopulmonary Rehabilitation ◽

10.1097/00008483-199109000-00041 ◽

1991 ◽

Vol 11 (5) ◽

pp. 314 ◽

Cited By ~ 1

Author(s):

J. Porcari ◽

M. Sierzant ◽

J. Bird ◽

T. Herrewig ◽

P. Olson

Keyword(s):

Cardiac Rehabilitation ◽

Phase Ii ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Cardiac Rehabilitation Program ◽

Home Based ◽

Cabg Patients

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The measure of effectiveness of a short-term 2-week intensive Cardiac Rehabilitation program in decreasing levels of anxiety and depression

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.858 ◽

2018 ◽

Vol 88 (1) ◽

Cited By ~ 3

Author(s):

Floriana Caccamo ◽

Simone Saltini ◽

Enrico Carella ◽

Roberto Carlon ◽

Cristina Marogna ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Rehabilitation ◽

Trait Anxiety ◽

Positive Impact ◽

Rehabilitation Program ◽

The State ◽

Anxiety And Depression ◽

Paired Samples ◽

Significant Difference ◽

Anxiety Subscale

Research on heart disease have found a strong and consistent evidence of association between some psychosocial risk factors, including depression, anxiety, self-efficacy, lack of social support and outcome of disease. Depression increases the risk of cardiac death and is highly predictive of reduced adherence to recommended treatments; anxiety appears to be linked to adverse cardiac outcomes. It was demonstrated that Cardiac Rehabilitation (CR) leads to substantial improvements and positive outcomes because combines the prescription of physical activity with the modification of risk factors and aims to reduce symptoms related to the disease and the risk of new cardiovascular events. The main objective of this study is to determine if a short and intense CR program can produce a positive impact on anxious and depressive symptoms revealed in cardiac patients, confirming results of previous researches. The protocol was proposed to all patients referred for an outpatient CR after an acute event who attended the short 2-week intensive rehabilitation program. A total of 157 patients recruited at the operating unit of Cardiology, in the Hospital of Cittadella (Italy), was included in the analysis. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to the patients. SPSS 17.0 was used for statistical analysis. T-tests for paired samples were used to evaluate differences between the beginning and the end of the CR program. There was a statistically significant difference between the beginning and the end of the CR program. Results for paired samples showed significant differences in all factors of the BDI-II and in the total score. In addition, a statistically significant difference was found even in the state - anxiety subscale. No significant difference was detected for the trait anxiety. According to recent studies, this research shows that the CR program has a significant impact on levels of anxiety and depression, because all activities focus their commitment on changing the patient’s personal beliefs and perception of illness, promoting the exchange of information and sharing of concerns and fears, increasing the patient’s resilience with the aim of enabling him/her to reorganize positively his/her personal, family and professional sphere.

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CLINICAL EFFECTIVENESS OF A PHASE 2 CARDIAC REHABILITATION PROGRAM IN PARTICIPANTS WITH AND WITHOUT ARTHRITIS

Medicine & Science in Sports & Exercise ◽

10.1097/00005768-200205001-01387 ◽

2002 ◽

Vol 34 (5) ◽

pp. S248

Author(s):

S S. Haapaniemi ◽

B A. Franklin ◽

L S. Sperling ◽

D T. Badenhop ◽

R D. Salmon ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Clinical Effectiveness ◽

Rehabilitation Program ◽

Cardiac Rehabilitation Program ◽

Phase 2

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The impact of cardiac rehabilitation program on anxiety and depression levels after coronary artery bypass graft surgery

Cor et Vasa ◽

10.1016/j.crvasa.2016.01.001 ◽

2016 ◽

Vol 58 (4) ◽

pp. e384-e390 ◽

Cited By ~ 6

Author(s):

Leili Pourafkari ◽

Samad Ghaffari ◽

Arezou Tajlil ◽

Jafar Shahamfar ◽

Solmaz Hedayati ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Cardiac Rehabilitation ◽

Artery Bypass ◽

Bypass Graft ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Artery Bypass Graft ◽

Cardiac Rehabilitation Program ◽

The Impact

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Effects of Acupuncture on the Symptoms of Anxiety and Depression Caused by Premenstrual Dysphoric Disorder

Acupuncture in Medicine ◽

10.1136/acupmed-2013-010394 ◽

2013 ◽

Vol 31 (4) ◽

pp. 358-363 ◽

Cited By ~ 15

Author(s):

Fabiana Carvalho ◽

Kelly Weires ◽

Márcia Ebling ◽

Maristela de Souza Rabbo Padilha ◽

Ygor Arzeno Ferrão ◽

...

Keyword(s):

Rating Scales ◽

Premenstrual Dysphoric Disorder ◽

Randomised Clinical Trial ◽

Sham Acupuncture ◽

Anxiety And Depression ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Single Blind ◽

Group 1

Objective The objective of this investigation was to evaluate the effects of acupuncture and sham acupuncture on the symptoms of anxiety and depression brought on by premenstrual dysphoric disorder (PMDD). Methods In a single-blind randomised clinical trial, 30 volunteers with PMDD were assigned alternately to group 1 (acupuncture) or group 2 (sham acupuncture), and completed an evaluation of symptoms of anxiety and depression using the Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) Rating Scales. The procedure was performed twice a week for two menstrual cycles, for a total of 16 attendances for each participant. Results Before the intervention the mean HAM-A and HAM-D scores did not differ between groups. Following the intervention symptoms of anxiety and depression were reduced in both groups; however, the improvement was significant in group 1 compared to group 2, as shown by a mean reduction in HAM-A scores of 58.9% in group 1 and 21.2% in group 2 (p<0.001). The reduction in the mean HAM-D scores was 52.0% in group 1 and 19.6% in group 2, resulting in a significant difference (p=0.012). Conclusions The results suggest that acupuncture could be another treatment option for PMDD patients.

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Effect of a phase 2 cardiac rehabilitation program on obese and non-obese patients with stable coronary artery disease

The Egyptian Heart Journal ◽

10.1186/s43044-020-00119-4 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Ahmed El Missiri ◽

Walaa Adel Abdel Halim ◽

Abdo Saleh Almaweri ◽

Tarek Rashid Mohamed

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Stable Coronary Artery Disease ◽

Rehabilitation Program ◽

Obese Patients ◽

Cardiac Rehabilitation Program ◽

Phase 2 ◽

Rehabilitation Programs ◽

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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High-Intensity Interval Versus Moderate-Intensity Continuous Training in Cardiac Rehabilitation

Journal of Clinical Exercise Physiology ◽

10.31189/2165-6193-9.1.10 ◽

2020 ◽

Vol 9 (1) ◽

pp. 10-16

Author(s):

Dalynn T. Badenhop ◽

Meghan M. Long ◽

C. Matt Laurent ◽

K. Todd Keylock

Keyword(s):

Cardiac Rehabilitation ◽

Functional Capacity ◽

High Intensity ◽

Rehabilitation Program ◽

Moderate Intensity ◽

Phase 2 ◽

Continuous Training ◽

Exercise Tests ◽

Significant Difference ◽

High Intensity Interval

ABSTRACT Background: Past research has compared the effects of moderate-intensity continuous training (MCT) versus high-intensity interval training (HIIT) in phase 2 cardiac rehabilitation patients, but with conflicting results. Therefore, the purpose of this study was to evaluate if HIIT leads to greater improvements in functional capacity when compared with MCT in a group of phase 2 cardiac rehabilitation patients. Methods: Eighteen patients in a phase 2 cardiac rehabilitation program completed precardiopulmonary and postcardiopulmonary exercise tests, a 12-min walk test (12MWT), and resting blood pressure (BP). After 2 weeks of run-in, patients were randomly assigned to 10 weeks of HIIT (alternating periods of 80%–90% heart rate [HR] reserve and 60%–70% HR reserve) or MCT (60%–80% HR reserve) exercise group. Changes in VO2 peak, 12MWT distance, and BP (mm Hg) were analyzed by independent t test. Results: The average patient was 65 years old, 1.75 m tall, and overweight. VO2 peak values improved for individuals in both exercise modalities. There was no significant difference between the exercise groups (P = 0.174). In addition, both groups improved their 12MWT distance, resting systolic, and diastolic BP (DBP), with no significant difference in improvements between the 2 exercise groups. Conclusion: In this study, HIIT was not more effective than MCT for improving functional capacity in a group of phase 2 cardiac rehabilitation patients. However, since HIIT was equally effective compared with MCT in several measures, it provides another option for exercise prescription to the traditional prescription for this population.

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