scholarly journals Usability of and Adherence to a Novel, Home-based Cardiac Telerehabilitation Program for Heart Attack Survivors: The MI-PACE Cohort Study (Preprint)

2020 ◽  
Author(s):  
Eric Y Ding ◽  
Nathaniel Erskine ◽  
Wim Stut ◽  
Emily Ensom ◽  
Amy Peterson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Pilot Study ◽  
Stress Test ◽  
Academic Medical Center ◽  
Exercise Stress ◽  
Exercise Heart Rate ◽  
Management Interventions ◽  
System Usability Scale ◽  
At Home

BACKGROUND Cardiac rehabilitation (CR) programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after an acute myocardial infarction (AMI). OBJECTIVE In this pilot study, we developed and assessed the feasibility of delivering a novel health watch-informed 12-week tele-CR program to AMI survivors who declined participation in center-based CR. METHODS We enrolled hospitalized AMI survivors at an academic medical center who were eligible for, but declined, center-based CR. All participants underwent a baseline exercise stress test. Participants received a health watch that monitored heart rate (HR) and activity, and a tablet computer with an application that displayed progress towards accomplishing weekly walking and exercise goals. Results were transmitted to a CR nurse via a secure connection. For 12 weeks, participants exercised at home using HR and walking targets, and also participated in weekly phone counseling sessions with the CR nurse, who provided personalized CR problem solving and standard CR education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. RESULTS Eighteen participants completed the 12-week telerehabilitation program. Their mean age was 59 (SD 7) years, 33% were women, and 33% had an ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (Q1, Q3: 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants on average walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their targeted exercise heart rate zone. Overall, participants found the system to be highly usable (median System Usability Scale score of 83 (Q1, Q3: 65, 100). CONCLUSIONS This pilot study established the feasibility of delivering tele-CR at home to AMI survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Additional studies with larger patient samples are warranted to compare center-based rehabilitation and telerehabilitation on patient outcomes and healthcare resource utilization.

scholarly journals MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study

10.2196/18130 ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. e18130
Author(s):  
Eric Y Ding ◽  
Nathaniel Erskine ◽  
Wim Stut ◽  
David D McManus ◽  
Amy Peterson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Pilot Study ◽  
Cardiac Rehabilitation ◽  
Exercise Stress ◽  
Exercise Heart Rate ◽  
Management Interventions ◽  
System Usability Scale ◽  
At Home

Background Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch–informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.

Obesity Modifies the Effect of Fitness on Heart Rate Indices during Exercise Stress Testing in Asymptomatic Individuals

Cardiology ◽  
2015 ◽  
Vol 132 (4) ◽  
pp. 242-248
Author(s):  
Ehimen C. Aneni ◽  
Ebenezer T. Oni ◽  
Chukwuemeka U. Osondu ◽  
Seth S. Martin ◽  
Michael J. Blaha ◽  
...  
Keyword(s):  
Heart Rate ◽  
Stress Test ◽  
Statistical Significance ◽  
Normal Weight ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Exercise Heart Rate ◽  
Cross Sectional ◽  
Metabolic Equivalents ◽  
The Impact

Objective: To assess the impact of aerobic fitness on exercise heart rate (HR) indices in an asymptomatic cohort across different body mass index (BMI) categories. Methods: We performed a cross-sectional analysis of 506 working-class Brazilian subjects, free of known clinical cardiovascular disease (e.g. ischemic heart disease and stroke) who underwent an exercise stress test. Results: There was a significant trend towards decreased HR at peak exercise, HR recovery and chronotropic index (CI) measures as BMI increased, but resting HR increased significantly across BMI categories. In multivariate analysis, the change in CI per unit change in metabolic equivalents of task was greater among the obese subjects than the normal-weight (2.7 vs. -0.07; p interaction = 0.029) and overweight (2.7 vs. 0.7; p interaction = 0.044) subjects. A similar pattern was seen with peak HR and HR recovery, although the formal tests of interaction did not achieve statistical significance. Conclusion: Our findings strongly suggest that fitness is associated with a favorable HR profile and is modified by BMI. Intervention programs should place emphasis on fitness and not only on weight loss.

scholarly journals Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research

2021 ◽  
Vol 10 (11) ◽  
pp. 2253
Author(s):  
Agnieszka Grochulska ◽  
Sebastian Glowinski ◽  
Aleksandra Bryndal
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Physical Performance ◽  
Stress Test ◽  
Maximal Oxygen Consumption ◽  
Exercise Stress Test ◽  
Health Condition ◽  
Exercise Stress ◽  
Test Time ◽  
Before And After

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days’ break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

P331Effect of exercise stress test on platelet function in patients with recent acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Dalcoquio ◽  
M A Santos ◽  
L S Alves ◽  
F B B Arantes ◽  
L Ferreira-Santos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Platelet Function ◽  
Stress Test ◽  
Area Under The Curve ◽  
Exercise Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Platelet Aggregability ◽  
Cardiopulmonary Exercise

Abstract Background Exercise-based cardiac rehabilitation for coronary artery disease (CAD) is associated with lower cardiovascular mortality. On the other hand, acute strenuous exercise has been linked to cardiovascular complications such as acute myocardial infarction (AMI) and sudden cardiac death. One of the pathophysiological mechanisms involved in these outcomes might be an increase in platelet aggregability after exercise. Although previous studies showed higher platelet aggregability after exercise among stable CAD patients on aspirin treatment, there is no data regarding the effect of exercise on platelet activity in post-AMI patients on dual anti-platelet therapy (DAPT). Purpose To evaluate the effect of high-intensity exercise on platelet aggregability in sedentary post-AMI patients on DAPT. Methods Platelet function was analyzed immediately before and after maximal cardiopulmonary exercise test (CPET) on cycle ergometer utilizing a personalized ramp protocol and aiming to achieving peak exercise in around 10 min. The CPET was done within 31±4 days after uncomplicated AMI. Platelet aggregability was assessed by Multiplate®ADPtest (MP-ADP) and Multiplate® ASPItest (MP-ASPI) measured as area under the curve (AUC). Reticulated platelets were measured concomitantly to MP-ADP e MP-ASPI using a fully automated flow cytometer (Sysmex XN-2000®) to determine absolute immature platelet count (IPC) per 103/microliter. Continuous variables were expressed as means ±standard deviation or as median and 25th–75th percentiles if not Gaussian distributed. Comparisons between the pre- and post-CPET assessments were performed using Wilcoxon signed rank test. Results We analyzed 81 sedentary patients (mean age 58.3±10.1 years-old, 76.5% men) after AMI (50.6% with ST-elevation myocardial infarction, mean left ventricular ejection fraction after index event 55±11.7%, 98.8% on statin and 85.5% on beta-blocker treatment). Platelet aggregability, either by MP-ADP or MP-ASPI, and IPC were significantly increased after CPET (table). Platelet function after CPET Before CPET After CPET p-value Multiplate® ADPtest (AUC) – median (25th–75th percentiles) 32.0 (22.0–48.5) 37.0 (26.0–55.2) 0.003 Multiplate® ASPItest (AUC) – median (25th–75th percentiles) 17.0 (12.7–22.0) 22.0 (16.7–28.0) <0.001 Immature platelet count (103/microliter) – median (25th–75th percentiles) 9.5 (6.8–13.8) 9.6 (6.6–16.5) 0.006 CPET: cardiopulmonary exercise test; AUC: area under the curve. Conclusion On this post-AMI population, platelet was hyperactivated after exercise stress test despite the use of DAPT. These findings suggest that, even when properly treated, post-AMI patients might be at higher risk of ischemic complications after high-intensity exercises, reinforcing the importance of tailoring exercise prescription in this population. Acknowledgement/Funding Sao Paulo Research Foundation, FAPESP

Effects of polymorphisms in β1-adrenoceptor and α-subunit of G protein on heart rate and blood pressure during exercise test. The Finnish Cardiovascular Study

2006 ◽  
Vol 100 (2) ◽  
pp. 507-511 ◽  
Author(s):  
Tuomo Nieminen ◽  
Terho Lehtimäki ◽  
Jarno Laiho ◽  
Riikka Rontu ◽  
Kari Niemelä ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Confidence Interval ◽  
G Protein ◽  
Exercise Test ◽  
Odds Ratio ◽  
Stress Test ◽  
Exercise Stress ◽  
Α Subunit ◽  
Time Interaction

We tested whether the Arg389Gly and Ser49Gly polymorphisms of the β1-adrenergic receptor gene ADRB1 and the T393C polymorphism of the G protein α-subunit gene GNAS1 modulate heart rate (HR) and blood pressure responses during an exercise stress test. The study population comprised 890 participants (563 men and 327 women, mean age 58.1 ± 12.6 yr) of the Finnish Cardiovascular Study. Their HR, systolic (SAP), and diastolic arterial pressures (DAP) at rest, during exercise, and 4 min after the test were measured and analyzed by repeated-measurement ANOVA (RANOVA). Genotypes were detected by TaqMan 5′ nuclease assay. In all subjects, and in men and women separately, the T393C of GNAS1 was the only polymorphism with genotype × time interaction in HR over the three study phases ( P = 0.04, RANOVA). None of the polymorphisms presented genotype × time interaction in SAP or DAP responses ( P > 0.10, RANOVA). In all subjects at rest, the Ser49Gly polymorphism of ADRB1 tended ( P = 0.06, ANOVA) to differentiate HR. Arg389Gly polymorphism of ADRB1 affected maximal SAP during exercise ( P = 0.04, ANOVA) and the change in SAP from rest to maximal ( P = 0.03, ANOVA). Arg389 homozygotes, particularly men, were less likely to have ventricular extrasystoles during the exercise (odds ratio = 0.68, 95% confidence interval = 0.51–0.91, P = 0.009, and odds ratio = 0.60, 95% confidence interval = 0.42–0.86, P = 0.006, respectively) than did Gly389 carriers. In conclusion, polymorphisms examined appear to have modulatory effects on hemodynamics in a clinical exercise test setting. However, the effects in absolute numbers were minor and clinically possibly insignificant.

scholarly journals Prognostic value of symptom limited versus low level exercise stress test before discharge in patients with myocardial infarction treated with thrombolytics

Heart ◽  
1999 ◽  
Vol 82 (2) ◽  
pp. 199-203 ◽  
Author(s):  
K Jensen-Urstad ◽  
B A Samad ◽  
F Bouvier ◽  
J Hulting ◽  
J Hojer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Low Level

Sympathetic-parasympathetic interaction and accentuated antagonism in conscious dogs

1991 ◽  
Vol 260 (2) ◽  
pp. H335-H340 ◽  
Author(s):  
M. Stramba-Badiale ◽  
E. Vanoli ◽  
G. M. De Ferrari ◽  
D. Cerati ◽  
R. D. Foreman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Sympathetic Activity ◽  
Vagal Stimulation ◽  
Inhibitory Effect ◽  
Conscious Dogs ◽  
Exercise Heart Rate ◽  
Bipolar Electrode ◽  
The Right ◽  
Frequency Of Stimulation

The heart rate response to vagal stimulation and the interaction with sympathetic activity was evaluated in conscious dogs at rest and during exercise; the latter was used as a tool to physiologically elevate sympathetic activity. In 20 dogs with a healed myocardial infarction and in 7 healthy dogs a bipolar electrode was chronically implanted around the right cervical vagus. Vagal stimulation (3 ms; 2.1 +/- 0.7 mA; 2, 4, 6, 8, 10, 12 Hz) was performed while dogs stood on the treadmill (heart rate 120 +/- 25 beats/min) and while they exercised (201 +/- 17 beats/min). Gradual increases of the frequency of vagal stimulation gradually enhanced the inhibitory effect on heart rate both before and during exercise. During exercise, heart rate reduction was significantly greater than that produced at rest at any frequency of stimulation (P less than 0.001). This difference widened as the frequency of stimulation increased and the interaction with or without the presence of exercise was significant (P less than 0.02). Vagal stimulation produced similar effects in the seven dogs without myocardial infarction. These data demonstrate that the vagal-sympathetic "accentuated antagonism" described in anesthetized animals is also present in conscious dogs.

Abstract P326: Myocardial Ischemia and Mobilization of Circulating Progenitor Cells

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Muhammad Hammadah ◽  
Ayman Samman Tahhan ◽  
Ibhar Almheid ◽  
Bryan Ross Kindya ◽  
Mazen Ghafeer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Progenitor Cells ◽  
Linear Models ◽  
Stress Test ◽  
Exercise Stress ◽  
Previous Myocardial Infarction ◽  
Pharmacological Stress ◽  
Pharmacological Stress Test

Background: Circulating progenitor cells (CPCs) are involved in vascular repair and regeneration. Low levels of CPCs in patients with CAD have been linked to adverse cardiovascular outcomes. The response of CPCs to transient myocardial ischemia in patients with CAD has not been studied before. We aimed to investigate the CPC response to exercise provoked myocardial ischemia (demand ischemia), and compare it to myocardial ischemia detected during pharmacological stress test (flow mismatch). Methods: 570 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during exercise (69%), or pharmacological stress (31%). myocardial ischemia was defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. CD34+ CPCs were enumerated by flow cytometry at rest and 30 min after stress testing. The change in CPC count was compared between patients with and without myocardial ischemia using mixed linear models. Results: Mean age was 63±9 years, 76% males, 36% with previous myocardial infarction. The incidence of myocardial ischemia was 31% and 41% during exercise and pharmacological stress test, respectively. No difference was observed in resting CPC between patients undergoing exercise vs pharmacological stress test, nor between patients with or without myocardial ischemia. However, patients who developed myocardial ischemia during exercise stress had a significant decrease in CPC with stress in comparison to those without myocardial ischemia (-12% vs 4%, respectively, p=0.006). Furthermore, the change in CPCs was inversely correlated with the magnitude of myocardial ischemia (R=-0.13, p=0.023), suggesting a greater CPC reduction with larger ischemic burden. These findings remained significant even after adjustment for age, gender, race, BMI, previous myocardial infarction, resting levels of CPCs and hematocrit change with stress. No difference was observed in CPC response to pharmacological stress test (change of -1% vs 3%, for patients with and without myocardial ischemia, respectively, p=0.96). Conclusion: Exercise stress-induced myocardial ischemia is associated with a decrease in CPC counts, likely due to increased homing of stem cells to the ischemic myocardium. Whether the extent of CPC uptake has prognostic implication, or whether the CPC response can be altered with intervention needs further investigation.

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