scholarly journals Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Marinella Sommaruga ◽  
Elisabetta Angelino ◽  
Paola Della Porta ◽  
Mara Abatello ◽  
Giacomo Baiardo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Social Factors ◽  
High Intensity ◽  
Best Practice ◽  
Cardiovascular Prevention ◽  
Position Paper ◽  
Ventricular Assist Devices ◽  
Psychological Interventions ◽  
Evidence Based

Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on ‘new’ conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

scholarly journals Cardiovascular prevention and rehabilitation in the elderly: evidence for cardiac rehabilitation after myocardial infarction or chronic heart failure

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Francesco Fattirolli ◽  
Alessandra Pratesi
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Functional Dependence ◽  
Cardiovascular Prevention ◽  
The Elderly ◽  
Medical Community ◽  
Coronary Syndrome ◽  
Esercizio Fisico ◽  
Sindrome Coronarica Acuta

<p>Cardiac rehabilitation in the elderly today often represents a utopia. The international scientific literature takes little into account this type of prescription for old people, although they represent a large and growing proportion of cardiac patients, with acute coronary syndrome or heart failure, which we have to manage in everyday life. Furthermore, interventions of health education, clinical follow up, rehospitalisation prevention and prescription of tailored exercise, are sometimes more necessary in this kind of patients, given the presence of multimorbidity, functional dependence, frailty, sarcopenia, social neglect. Most of the data on the feasibility, safety and efficacy of cardiac rehabilitation are favourable, but they are few and apparently not strong enough to convince the medical community. Therefore is necessary to join efforts to identify the geriatric patient's peculiarities and plan a suitable program of cardiac rehabilitation, which takes into account the multi-dimensionality and complexity of typical problems of the elderly, for which the classical cardiac outcomes can be limited.</p><p><strong>Riassunto</strong></p><p>La riabilitazione cardiologica nel paziente anziano rappresenta ad oggi in molte realtà una utopia. La letteratura scientifica internazionale prende poco in considerazione questo tipo di prescrizione nei soggetti in età avanzata, per quanto essi rappresentino una grande e crescente quota dei pazienti cardiopatici con sindrome coronarica acuta o scompenso cardiaco. Inoltre proprio su questa tipologia di pazienti interventi di educazione sanitaria, monitoraggio clinico e prescrizione di esercizio fisico personalizzato, risultano più necessari, data la presenza di multimorbilità, dipendenza funzionale, fragilità, sarcopenia, isolamento sociale. La maggior parte dei dati su fattibilità, sicurezza ed efficacia della riabilitazione cardiologica dopo infarto miocardico e nello scompenso sono favorevoli, ma risultano limitati nella numerosità delle casistiche e non condotti su pazienti assimilabili a quelli del mondo reale. E’ necessario dunque identificare le peculiarità del paziente geriatrico e pianificare e personalizzare un programma di riabilitazione cardiologica che tenga in considerazione la multidimensionalità e la complessità dei problemi tipici del soggetto anziano, per il quale gli outcome cardiologici abituali possono risultare limitati o non significativi.</p>

High-intensity interval training in patients with heart failure

2020 ◽  
Vol 15 (4) ◽  
pp. 1-13
Author(s):  
Kara J Callum ◽  
Trish Gorely ◽  
Daniel R Crabtree ◽  
David J Muggeridge ◽  
Stephen J Leslie
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
High Intensity ◽  
Current Knowledge ◽  
Interval Training ◽  
Moderate Intensity ◽  
Alternative Mechanism ◽  
High Intensity Interval Training ◽  
Patients With Heart Failure ◽  
High Intensity Interval

Cardiac rehabilitation is a key component in the secondary prevention of cardiovascular disease. However, uptake and adherence to programmes is suboptimal, especially for patients with heart failure. Traditionally, cardiac rehabilitation programmes have involved moderate-intensity continuous training; however, there is growing evidence that high-intensity interval training can produce equal or superior effects in both healthy and diseased populations. High-intensity interval training has already been shown to be both safe and effective, but the optimal protocols and delivery mechanisms are yet to be determined. Despite this, high-intensity interval training has the potential to offer an alternative mechanism of cardiac rehabilitation delivery to patients with heart failure, with the possibility of overcoming some of the challenges usually faced (such as patients' lack of time) in implementing successful cardiac rehabilitation programmes. This article aims to summarise the current knowledge surrounding the inclusion of high-intensity interval training in cardiac rehabilitation programmes, specifically focusing on those patients living with heart failure.

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