scholarly journals Evaluating Exercise Progression in an Australian Cardiac Rehabilitation Program: Should Cardiac Intervention, Age, or Physical Capacity Be Considered?

Author(s):  
Kym Joanne Price ◽  
Brett Ashley Gordon ◽  
Stephen Richard Bird ◽  
Amanda Clare Benson

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

2019 ◽  
Vol 27 (5) ◽  
pp. 633-641
Author(s):  
Kym Joanne Price ◽  
Brett Ashley Gordon ◽  
Kim Gray ◽  
Kerri Gergely ◽  
Stephen Richard Bird ◽  
...  

This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Elaine T Miller ◽  
Kari Dunning ◽  
Dustyn Whitesel ◽  
Amber Deinlein ◽  
Brett Kissela ◽  
...  

Background and Purpose: Physical inactivity after stroke stymies motor recovery, perpetuates further deconditioning, and contributes to a high long-term risk of cardiac events and recurrent stroke. This study used stakeholder input to develop a cardiac rehabilitation program specific to stroke. Methods: An exploratory qualitative study was performed consisting of separate focus groups of stroke survivors, caregivers, rehabilitation clinicians, nurse practitioners along with individual physician interviews. Two experienced researchers in qualitative research methodology independently identified themes, patterns, and issues prioritized by participants. Results: Four major themes emerged: safety, individualization of the cardiac rehabilitation program, return to function and living at highest potential, and need to maintain prolonged activity. Major components identified in developing the cardiac rehabilitation program included: Individualized stroke survivor education pertaining to fall prevention, safe aerobic exercise and learning how to live well after stroke (e.g., fitness, nutrition, chronic disease management, etc.); Exercise/stress testing prior to aerobic exercise; Determine when to begin cardiac rehabilitation post stroke (e.g., readiness, needs, resources, benefit, etc.), individualize approach and timing after holistic assessment; Education/training of cardiac rehabilitation professionals regarding best care practices for stroke survivors; Interdisciplinary approach to assure safety and continuum of care; Referral programs for IADLs, driving, sexual function, etc.; Motivational interviewing to overcome barriers with inclusion of peer mentoring/coaching; Discharge to cost effective community programs or a sustainable home program. Conclusions: Addressing safety concerns along with the creation of an individualized cardiac rehabilitation program that enables stroke survivors to achieve and maintain their highest level of function long-term are fundamental components. Partnering with the major stakeholders and incorporating a coordinated interdisciplinary approach are crucial to the creation of a feasible and cost effective cardiac rehabilitation program for stroke survivors.


Author(s):  
Kym Joanne Price ◽  
Brett Ashley Gordon ◽  
Stephen Richard Bird ◽  
Amanda Clare Benson

Long-term maintenance of changes in cardiovascular risk factors and physical capacity once patients leave the supervised program environment have not previously been reported. This study investigated the changes in physical capacity outcomes and cardiovascular risk factors in an Australian cardiac rehabilitation setting, and the maintenance of changes in these outcomes in the 12 months following cardiac rehabilitation attendance. Improvements in mean (95% CI) cardiorespiratory fitness (16.4% (13.2–19.6%), p < 0.001) and handgrip strength (8.0% (5.4–10.6%), p < 0.001) were observed over the course of the cardiac rehabilitation program, and these improvements were maintained in the 12 months following completion. Waist circumference (p = 0.003) and high-density lipoprotein cholesterol (p < 0.001) were the only traditional cardiovascular risk factors to improve during the cardiac rehabilitation program. Vigorous-intensity aerobic exercise was associated with significantly greater improvements in cardiorespiratory fitness, Framingham risk score, and waist circumference in comparison to moderate-intensity exercise. An increase in the intensity of the exercise prescribed during cardiac rehabilitation in Australia is recommended to induce larger improvements in physical capacity outcomes and cardiovascular risk. A standardized exercise test at the beginning of the rehabilitation program is recommended to facilitate appropriate prescription of exercise intensity.


2014 ◽  
Vol 3 (2) ◽  
pp. 102-108
Author(s):  
Mostafa Bahremand ◽  
Nahid Salehi ◽  
Alireza Rai ◽  
Mansour Rezaee ◽  
Ahmad Ali Raeisei

Background: Cardiac rehabilitation is known as a powerful non-pharmacological approach for improving functional capacity, and left ventricular systolic function; however, some limited data have suggested an attenuation of the decline in diastolic function with this program. This study investigated the effect of high intensity aerobic exercise following coronary artery bypass surgery (CABG) on diastolic dysfunction.Materials and Methods: Forty four patients with different levels of diastolic dysfunction who underwent CABG surgery were included. The participants attended the complete cardiac rehabilitation program three times per week for two months (totally 24 sessions). The patients underwent complete transthoracic echocardiographic studies including two-dimensional and spectral Doppler echocardiography immediately before attending rehabilitation program and also after the completion of rehabilitation sessions.Results: There was a significant decrease of isovolumic relaxation time (IVRT) after participating complete cardiac rehabilitation (94.0 to 89.0; P=0.001). The diastolic function parameters of early diastolic mitral inflow peak velocity to late diastolic mitral inflow peak velocity (E/A) ratio (0.94 to 1.04; P=0.001), deceleration time (DT) of the mitral E wave (192.7 to 219.0; P=0.011), and velocity of early diastolic mitral annular motion (Ea) (5.9 to 6.7; P=0.026) were improved after the rehabilitation, whereas mitral A duration to pulmonary A duration (MAD/PAD) ratio was slightly improved (1.07 to 1.12; P=0.056) and pulmonary veins systolic flow to pulmonary vein diastolic flow (PVS/PVD) ratio (0.89 to 1.04; P=0.345) remained unchanged.Conclusion: A complete cardiac rehabilitation program with high intensity aerobic exercise approach can reverse diastolic impairment in patients undergoing CABG.


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