Observational Study of Recurrent Heart Attacks and Barriers to Participation in Exercise Training Cardiac Rehabilitation: A Serial Case Report

Exercise induced bundle branch block is a rare observation in exercise testing, accounting for 0.5 percent of exercise tests. The best treatment of this condition and its association with coronary disease remain unclear. We describe a case associated with normal coronary arteries which was successfully treated with exercise training. While this treatment has been used previously, our case has a longer followup than previously reported and demonstrates that the treatment is not durable in the absence of continued exercise.

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A cardiac rehabilitation program increases the acute respond of endothelial progenitor cells after maximum exercise in patients with chronic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1070 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Kourek ◽

E Karatzanos ◽

D Delis ◽

M Alshamari ◽

V Linardatou ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Exercise Training ◽

Cardiac Rehabilitation ◽

Progenitor Cells ◽

Endothelial Progenitor Cells ◽

Rehabilitation Program ◽

Vascular Endothelial ◽

Endothelial Progenitor ◽

Maximum Exercise

Abstract Background Chronic heart failure (CHF) remains a leading cause of morbidity and mortality and it is characterized by vascular endothelial dysfunction. During the last decades, endothelial progenitor cells (EPCs) are being used as an index of the endothelium restoration potential, therefore reflecting the vascular endothelial function. Exercise training has been shown to stimulate the mobilization of EPCs at rest in CHF patients. However, the effect of exercise training on the acute respond of EPCs after maximum exercise in CHF patients remains unknown. Purpose The purpose of the study was to assess the effect of a cardiac rehabilitation (CR) program on the acute respond of EPCs after maximum exercise in patients with CHF. Methods Forty-four consecutive patients (35 males) with stable CHF [mean±SD, Age (years): 56±10, BMI (kg/m2): 28.7±5.2, EF (%): 33±8, Peak VO2 (ml/kg/min): 18.4±4.4, Peak work rate (watts): 101±39] enrolled a 36-session CR program based on high-intensity interval exercise training. All patients underwent an initial symptom limited maximal cardiopulmonary exercise testing (CPET) on an ergometer before the CR program and a final maximal CPET after the CR program. Venous blood was drawn before and after each CPET. Five circulating endothelial populations were identified and quantified by flow cytometry; CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2, CD34+/CD133+/VEGFR2, CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2. EPCs values are expressed as cells/million enucleated cells in medians (25th-75th percentiles). Results The acute mobilization of EPCs after the final CPET was higher than after the initial CPET in 4 out of 5 circulating endothelial populations. Most specifically, difference of the acute mobilization of CD34+/CD45-/CD133+ cells [initial CPET: 25 (15–46) vs final CPET: 49 (26–71), p=0.002], CD34+/CD45-/CD133+/VEGFR2 cells [initial CPET: 3 (2–5) vs final CPET: 8 (5–12), p<0.001], CD34+/CD45-/CD133- cells [initial CPET: 129 (52–338) vs final CPET: 250 (129–518), p=0.03] and CD34+/CD45-/CD133-/VEGFR2 cells [initial CPET: 2 (1–4) vs final CPET: 6 (3–9), p<0.001] increased after the final CPET. The acute mobilization of CD34+/CD133+/VEGFR2 cells [initial CPET: 3 (−1–7) vs final CPET: 5 (0–15), p=0.441] did not differ between the 2 CPETS. Conclusion A 36-session cardiac rehabilitation program increases the acute respond of endothelial progenitor cells after maximum cardiopulmonary exercise training in patients with chronic heart failure, therefore indicating the beneficial effect of exercise training on the vascular endothelial function. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project

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Tai Chi and workplace wellness for health care workers: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1375 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

B Dorelli ◽

R A Cocchiara ◽

G Gholamalishahi ◽

W Longo ◽

E Musumeci ◽

...

Keyword(s):

Systematic Review ◽

Case Report ◽

Observational Study ◽

Methodological Quality ◽

Healthcare Workers ◽

Tai Chi ◽

Work Related Stress ◽

Work Related ◽

Positive Effects ◽

Related Stress

Abstract Background Several studies show positive effects of new non-medical therapies known as complementary and alternative medicines, such as the discipline of tai chi. As healthcare professions are among the most vulnerable for work-related stress, this systematic review aims to investigate the relationship between tai chi practice and wellness of healthcare workers. Methods Cinahl, Scopus, Web of Science and PubMed were searched in September 2019. Full-text articles, written in English and published after 1995, were recruited if they focused on positive effects of tai chi on the psychophysical wellbeing of healthcare workers, in comparison with alternative techniques (such as yoga or traditional care). Outcomes were reduced work-related stress, better physical and psychological function, improvement in attention and/or productivity; no restrictions about study design were applied. Quality assessment was performed with the Newcastle-Ottawa Scale on cohort/cross-sectional studies, the Jadad scale for randomized clinical trial, AMSTAR for systematic reviews and CASE REPORT scale for case study. Results 6/111 papers were included: 3 clinical trials, 1 observational study, 1 systematic review and 1 case report. The methodological quality was of medium level. 2/3 trials found a significant increase in individuals' wellbeing and improvements in stress levels and nursing staff’s motivation in their work. In the observational study tai chi was a prevalent mind-body practice to reduce stress. The systematic review suggested that tai chi could be a useful tool to reduce stress-related chronic pain. In case report the effectiveness was observed in medical students. Conclusions This study highlights the full potential and possible beneﬁts derived from tai chi but its application to improve health professionals' wellbeing is still limited, and the absence of a standardized intervention impacts on the methodological quality and reduces the robustness of the retrieved evidence. Key messages Tai chi can improve many pathological conditions and reduce work-related stress. Further research is needed to gain robust evidence of its efficacy for wellbeing of healthcare workers.

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Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.366 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

NPD Cunha ◽

I Aguiar-Ricardo ◽

T Rodrigues ◽

P Silverio Antonio ◽

S Couto Pereira ◽

...

Keyword(s):

Exercise Training ◽

Left Ventricle ◽

Cardiac Rehabilitation ◽

Phase Ii ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Ischemic Disease ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive. Purpose Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram. Methods Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP. Results 205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%). After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device. Conclusions A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

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Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.335 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

P Alves Da Silva ◽

I Aguiar-Ricardo ◽

N Cunha ◽

T Rodrigues ◽

B Valente-Silva ◽

...

Keyword(s):

Exercise Training ◽

Cardiac Rehabilitation ◽

Cardiovascular Health ◽

Training Session ◽

Educational Status ◽

Drop Out ◽

Therapeutic Adherence ◽

Validated Questionnaire ◽

Home Based ◽

Degree Of Participation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors. Purpose To assess adherence to the various components of a CR-HB program. Methods Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers; 5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments Adherence to the program was assessed by drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points). Results 116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week. The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40). Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education. Conclusion Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.

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Cardiac rehabilitation in the elderly: Are the long-term results depending on the programme characteristics? Data from EU CaRe observational study

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.247 ◽

2021 ◽

Vol 13 (1) ◽

pp. 118

Author(s):

K. Mzoughi ◽

F. Moatemri ◽

J. Blanchard ◽

F. Ledru ◽

P. Cristofini ◽

...

Keyword(s):

Observational Study ◽

Cardiac Rehabilitation ◽

The Elderly ◽

Long Term Results

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Enhancing Patient Motivation through Intelligibility in Cardiac Tele-rehabilitation

Interacting with Computers ◽

10.1093/iwc/iwz008 ◽

2019 ◽

Vol 31 (2) ◽

pp. 122-137

Author(s):

Supraja Sankaran ◽

Kris Luyten ◽

Dominique Hansen ◽

Paul Dendale ◽

Karin Coninx

Keyword(s):

Medication Adherence ◽

Exercise Training ◽

Physical Exercise ◽

Health Outcomes ◽

Cardiac Rehabilitation ◽

Field Studies ◽

Activity Levels ◽

Patient Motivation ◽

Physical Exercise Training ◽

The Impact

Abstract Physical exercise training and medication compliance are primary components of cardiac rehabilitation. When rehabilitating independently at home, patients often fail to comply with their prescribed medication and find it challenging to interpret exercise targets or be aware of the expected efforts. Our work aims to assist cardiac patients in understanding their condition better, promoting medication adherence and motivating them to achieve their exercise targets in a tele-rehabilitation setting. We introduce a patient-centric intelligible visualization approach to present prescribed medication and exercise targets to patients. We assessed efficacy of intelligible visualizations on patients’ comprehension in two lab studies. We evaluated the impact on patient motivation and health outcomes in field studies. Patients were able to adhere to medication prescriptions, manage their physical exercises, monitor their progress and gained better self-awareness on how they achieved their rehabilitation targets. Patients confirmed that the intelligible visualizations motivated them to achieve their targets better. We observed an improvement in overall physical activity levels and health outcomes of patients. Research Highlights Presents challenges currently faced in cardiac tele-rehabilitation. Demonstrates how intelligibility was applied to two core aspects of cardiac rehabilitation- promoting medication adherence and physical exercise training. Lab., field and clinical studies to demonstrate efficacy of intelligible visualization, impact on patient motivation and resultant health outcomes. Reflection on how similar HCI approaches could be leveraged for technology-supported management of critical health conditions such as cardiac diseases.

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Walking tests during the exercise training: Specific use for the cardiac rehabilitation

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2013.09.003 ◽

2013 ◽

Vol 56 (7-8) ◽

pp. 561-575 ◽

Cited By ~ 26

Author(s):

J.-M. Casillas ◽

A. Hannequin ◽

D. Besson ◽

S. Benaïm ◽

C. Krawcow ◽

...

Keyword(s):

Exercise Training ◽

Cardiac Rehabilitation ◽

Walking Tests

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Home-based Cardiac Rehabilitation - the real barriers of programs at distance

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.336 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

J Brito ◽

I Aguiar-Ricardo ◽

P Alves Da Silva ◽

B Valente Da Silva ◽

N Cunha ◽

...

Keyword(s):

Exercise Training ◽

Cardiac Rehabilitation ◽

Real Time ◽

Training Session ◽

Real Life ◽

Participation Rate ◽

Exercise Session ◽

Exterior Space ◽

Supervised Exercise ◽

Home Based

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. Home-based CR (CR-HB) programs should offer the same core CR components as Centre-based programs (CR-CB) but several aspects need to be adapted, communication and supervision must be improved. Although CR-HB has been successfully deployed and is a valuable alternative to CR-CB, there is less structured experience with these non-uniform programs and further studies are needed to understand which patients (pts) are indicated to this type of program. Purpose To investigate pt-perceived facilitators and barriers to home-based rehabilitation exercise. Methods Prospective cohort study which included pts who were participating in a CR-CB program and accepted to participate in a CR-HB program after CR-CB closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including pt risk evaluation and regular assessment, exercise, educational and psychological sessions. The online exercise training sessions consisted of recorded videos and real time online supervised exercise training group sessions. It was recommended to do each session 3 times per week, during 60 min. A pictorial exercise training guidebook was available to all participants including instructions regarding safety, clothing and warm-up, and a detailed illustrated description of each exercise sessions. Also, for questions or difficulties regarding the exercises, an e-mail and telephone was provided. Once a month, real time CR exercise sessions was provided with a duration of 60min. Results 116 cardiovascular disease pts (62.6 ± 8.9years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. The majority of the pts had coronary artery disease (89%) and 5% valvular disease. Regarding risk factors, obesity was the most common (75%) followed by hypertension (60%), family history (42%), dyslipidaemia (38%), diabetes (18%), and smoking (13%). Almost half (47%) of the participants did at least one online exercise training session per week: 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week. Participants who did less than one exercise session per week reported as cause: lack of motivation (38%), preference of a different mode of exercise training such as exercise in the exterior space (26%), technology barrier such as impossibility to stream online videos (11%), fear of performing exercise without supervision (4%), and limited space at home (4%). Conclusions Our study based on real-life results of a CR-HB program shows a sub-optimal rate of participation in exercise sessions due to different causes, but mainly for the lack of motivation to exercise alone or preference for walking in exterior space. The knowledge of the CR-HB program barriers will facilitate to find out strategies to increase the participation rate and to select the best candidates for this type of programs.

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