Faculty Opinions recommendation of The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life.

Abstract Background/Aims Axial spondyloarthritis (axSpA) is a chronic rheumatic condition, characterised by inflammatory back pain - often associated with impaired function and mobility, sleep disturbance, fatigue, and reduced quality of life. Despite the vast advances in pharmacological treatments for axSpA over the last few decades, physical activity and rehabilitation remain vital for effective disease management. At the Royal National Hospital for Rheumatic Diseases in Bath (RNHRD), the 2-week inpatient axSpA rehabilitation programme has been integral to axSpA care since the 1970’s. Prior research has demonstrated significant short-term improvements in spinal mobility (BASMI), function (BASFI) and disease activity (BASDAI) following course attendance. However, the long-term outcomes are yet to be evaluated in this unique cohort. Methods Since the early 1990’s, clinical measures of spinal mobility, function and disease activity have been routinely collected at the RNHRD at all clinical appointments through administration of the BASMI, BASFI and BASDAI, respectively. Dates of attending the axSpA course and standard clinical and treatment follow-up data were also collected. Multiple linear regression models were used to investigate the impact of course attendance on final reported BASMI, BASDAI and BASFI scores (final score=most recent). Length of follow-up was defined as time between first and last recorded BASMI. Results Of the 203 patients within the Bath SPARC200 cohort, 77.8% (158/203) had attended at least one rehabilitation course throughout follow-up. 70.0% (140/203) of patients were male. The mean duration of follow-up was 13.5 years (range 0-35 years); 28.1% (57/203) of individuals with 20+ years of follow-up. Course attendance (yes versus no) significantly reduced final BASMI score by 0.84 (p = 0.001, 95%CI -1.31 to -0.37) and final BASDAI score by 0.74 (p = 0.018, 95%CI -1.34 to -0.13). Although course attendance reduced final BASFI by 0.45 (95%CI -1.17 to 0.28), this relationship did not reach significance (p = 0.225). Whilst minimally clinically important difference (MCID) is, to our knowledge, yet to be defined for BASMI, MCIDs were achieved long-term for both BASDAI and BASFI - defined by van der Heijde and colleagues in 2016 as 0.7 and 0.4 for BASDAI and BASFI, respectively. Conclusion These results provide novel evidence to support the integral role of education, physical activity and rehabilitation in the management of axSpA. Future work should investigate additional outcomes of critical importance to patients and clinicians, such as fatigue, quality of life and work productivity. Furthermore, a greater understanding of the factors that confound these outcomes may provide insights into those patients who may most benefit from attending a 2-week rehabilitation course. In addition to facilitating identification of those patients who may require additional clinical support. Disclosure R. Barnett: None. A. McGrogan: None. M. Young: None. C. Cavill: None. M. Freeth: None. R. Sengupta: Honoraria; Biogen, Celgene, AbbVie, Novartis, MSD. Grants/research support; Novartis, UCB.

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Impact of a 12-month web and smartphone-based intervention initiated during spa therapy to improve long-term physical activity of patients with chronic diseases: randomized controlled trial. (Preprint)

10.2196/preprints.29640 ◽

2021 ◽

Author(s):

Florie FILLOL ◽

Ludivine PARIS ◽

Sébastien PASCAL ◽

Aurélien MULLIEZ ◽

Christian-François ROQUES ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Waist Circumference ◽

Controlled Trial ◽

Intervention Group ◽

Group Versus ◽

Control Group ◽

Spa Therapy

BACKGROUND Lack of physical activity (PA) and sedentary behaviors are leading risk factors for non-communicable diseases (NCD). Web-based interventions are effective in increasing PA in older adults and in NCD patients. In many countries a course of spa therapy is commonly prescribed to NCD patients and represents an ideal context to initiating lifestyle changes. OBJECTIVE The main objective of this study was to evaluate in NCD patients the effectiveness of an intervention combining an individual face-to-face coaching during spa therapy and, when returning home, a web- and smartphone-based PA program including a connected wrist pedometer and a connected weighing scale, on the achievement of physical activity guidelines (PAG) 12 months after the end of spa therapy. METHODS This was a 12-month, prospective, parallel-group, randomized controlled trial. Patients were enrolled during spa therapy and randomized 1:1 to intervention or control group who received usual advices about PA. From the end of spa therapy, PA, weight, waist circumference, and quality of life of the participants in both groups, were assessed by phone every 2 months. Primary outcome was meeting PAG (PA≥600 METs) at 12 months after the end of spa therapy. Secondary outcomes were: meeting current PAG at 6 months of follow-up; sedentary time, weight and waist circumference, PA and quality of life, at 6 and 12 months. Objective use data of the web-and smartphone-based PA program were collected. Analytic methods include intention-to-treat and constrained longitudinal data analyses. RESULTS The study sample was 228 patients (female : 77.2% (176/228), mean age: 62.4 years (SD 6.7), retired: 53.9% (123/228), mean BMI = 28.2 kg.m-2 (SD 4.2)). No group differences were found for any baseline variable. At 12 months, the proportion of patients achieving PAG was significantly higher in intervention group versus control group (81% vs 67% respectively, OR = 2.34 (95% CI 1.02- 5.38; P=.045). No difference between intervention and control group was found neither in achieving PAG at 6 months nor for sedentary time, weight and waist circumference, at 6 and 12 months. Regarding quality of life, the physical component subscale score was significantly higher at 12 months in intervention group versus control group (mean difference: 4.1 (95% CI 1.9-6.3; P<.001). The mean duration use of the program was 7.1 months (SD 4.5). Attrition rate during the first 2 months of the program was 20.4% (23/113) whereas 39.8% (45/113) of the participants used the program for at least 10 months. CONCLUSIONS The results showed significantly more participants meeting PAG at one year in the intervention group compared to controls. A course of spa therapy offers the ideal time and setting to implement education in PA. Digital coaching seems to be more efficient than usual coaching for increasing the level of PA and decreasing sedentariness on the long term. CLINICALTRIAL ClinicalTrials.gov NCT02694796; https://clinicaltrials.gov/ct2/show/NCT02694796.

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Ross procedure and aortic valve repair: long-term echocardiographic outcomes, quality of life and physical activity of different aortic valve surgery procedures

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.409 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

F Bianco ◽

M Colaneri ◽

V Bucciarelli ◽

FC Surace ◽

FC Iezzi ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Aortic Valve ◽

Aortic Surgery ◽

Ross Procedure ◽

Valve Repair ◽

Sf 36

Abstract Funding Acknowledgements Type of funding sources: None. Background To compare long-term outcomes of aortic valve repair (AVr) and pulmonary autograft replacement (Ross procedure) in terms of echocardiographic parameters, quality of life (QoL), physical activity (PA). Methods In 2005-19, 129 patients (median age 22 [13, 33 IQR], 75% males) underwent aortic surgery in our Department: 40 were Ross (22 years [19, 51 IQR]), 67 AVr (17 years [1, 50 IQR]) and 22 aortic valve replacements (52 years [30, 80 IQR]). We focused on Ross and AVr. Retrospectively, relevant data were collected from medical records and phone re-calls. Physical activity (spontaneous and active) and QoL were assessed utilizing the IPAQ and SF-36 questionnaires. All patients underwent echocardiography pre/post-surgery and the follow-up lasted 12 ± 4 years. Results At the baseline, Ross patients had more aortic stenosis than insufficiency (P = 0.045). At the follow-up, Ross procedures presented more right-ventricle and aortic annulus dilatation (P = 0.002 and P = 0.030, respectively), but higher left-ventricular global longitudinal strain (LV GLS: 18 ± 3.2 % vs. 16 ± 3.3, P = 0.0027). Conversely, AVr experienced more re-do operations (Log-rank P = 0.005). Ross reported better QoL (SF-36: 0.8 ± 0.07 vs. 19 ± 0.4, P-0.045) and were also more active in daily PA (IPAQ ≥ 2500 Mets: 63.8% vs. 6%; P = 0.006). Ross patients practiced more sports activities than AVr (P = 0.011). Conclusions In a relatively small cohort of young and adults post aortic surgery patients, Ross procedures had better prognosis in terms of re-do operations; presented better ventricular function, as assessed by LV GLS. Ross patients had better long-term QoL and showed more spontaneous PA and involvement in sports activity.

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P6215Limited functional capacity and physical activity associated with patient withdrawals from cardiac rehabilitation

European Heart Journal ◽

10.1093/eurheartj/ehz746.0820 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Ding ◽

M Gonzalez-Garcia ◽

M Varnfield ◽

A Krumins ◽

Y Martin ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Cardiac Rehabilitation ◽

Functional Capacity ◽

The Body ◽

Analysis Of Covariance ◽

Exact Test ◽

Related Quality ◽

Age And Sex

Abstract Background Cardiac rehabilitation (CR) assists patients with cardiovascular disease (CVD) in improving physical activity and effectively managing their health conditions. With numerous clinical benefits including reduced risks of mortality (by 25%) and all-cause hospitalizations (by 18% - 25%), CR has been strongly recommended by evidence-based clinical guidelines for secondary prevention of CVD. However, many CR participant withdraw and hence fail to fully benefit from their CR programme. To address this issue, knowledge on risk stratification of patients' characteristics to appropriate CR care pathways is important. Purpose The purpose of this study is to identify clinical baseline characteristics associated with patients who withdraw from a CR programme. Methods We retrospectively analysed patients who participated in the centre-based CR programmes of a research study in Queensland, Australia. The CR programmes provided structured sessions (training and education) once or twice a week for six weeks in community care centres. We compared the patients who withdrew from their CR programme (Group-W) with those who did not withdraw (or simply completion) (Group-C). Withdrawal was defined as discontinuing within the first four weeks of the CR programme. In the comparison, the one-way analysis of variance (ANOVA) and Fisher's exact test were used for analysing age and sex respectively. The analysis of covariance (ANCOVA) with an adjustment for age and sex was used for the body mass index (BMI), six-minute walk test (6WMT), and health-related quality of life (HeartQoL, ESC 2012), comprising physical (HeartQoL-Phy), emotional (HeartQoL-Emo), and global (HeartQoL-Glo) subscales. The study was approved by the Human Research Ethics Committee (Reference: HREC/16/QPAH/636). Results From Dec 2016 to Dec 2017, 600 outpatients with CVD were consented, and enrolled in the study. Seventy participants withdrew. Between the two groups (Group-W vs Group-C), no significant differences were found in age (64±12 years vs 65±10 years; p=0.4221), sex (Female, 31% vs 25%; p=0.2461) and BMI (30.5±6.2 vs 30.1±11.2; p=0.8211). The 6MWT distance was significantly lower in Group-W than Group-C (346±103 m vs 394±92 m; p=0.001). Significantly lower scores of HeartQoL-Phy (1.66±0.86 vs 1.93±0.74; p=0.0072) and HeartQoL-Glo scores (1.80±0.78 vs 2.02±0.67; p=0.0205) were found in Group-W. HeartQoL-Emo scores were lower in Group-W but the difference was not significant (2.19±0.73 vs 2.28±0.72; p=0.4550). Conclusions The levels of functional capacity measured by 6MWT and physical activity related quality of life were found to be significantly lower in withdrawal patients than those who completed their CR programme. The finding indicates that new care strategies, especially for patients with limited functional capacity and physical activity, are needed to improve the adherence and effectiveness of CR intervention in future studies. Acknowledgement/Funding CSIRO and Metro South Health

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