Identification of Good Practices in Long-Term Exercise-Based Rehabilitation Programs in Stroke Patients.

Physical activity is an important factor for primary and secondary stroke prevention. The process of stroke rehabilitation includes early and late physical activity and exercise, which prevents further stoke and improve patients' quality of life. MY WAY project, an ERASMUS+ SPORT program, is aimed at analyzing and developing or transferring best innovative practices related to physical activity and exercise enhancing health in poststroke patients. The aim of the study was to identify, analyze, and present the good practices and strategies to encourage participation in sport and physical activity and engage and motivate chronic stroke patients to perform physical activity changing their lifestyle and to maintain a high adherence to long-term exercise-based rehabilitation programs. Our results demonstrated that unified European stroke long-term exercise-based rehabilitation guidelines do not exist. It seems that low training frequency with high aerobic exercise intensity may be optimal for improved physical performance and quality of life in combination with a high adherence. It is important to optimize the training protocols suitable for each patient. The continuous education and training of the specialized professionals in this field and the presence of adequate structures and cooperation between different healthcare centers are important contributors. The clear objective for each country should be to systematically make the necessary steps to enhance overall exercise-based stroke rehabilitation attendance in the long term. Long-term interventions to support the importance of physical exercise and lifelong exercise-based rehabilitation in chronic stroke patients should be created, what coincides with the goal of the MY WAY project.

Effectiveness of risk minimization measures for cabergoline-induced cardiac valve fibrosis in clinical practice in Italy.

On June 2008, the European Medicines Agency (EMA) introduced changes to the Summary of Product Characteristics (SPC) for cabergoline and pergolide, to reduce the risk of cardiac valvulopathy in users of these drugs. To assess the effectiveness of EMA recommendations in Italian clinical practice, we retrospectively reviewed medical charts of patients with degenerative Parkinsonism treated with cabergoline in three large Italian clinics between January 2006 and June 2012. The prevalence and the severity of cardiac valve regurgitation were assessed in patients who stopped cabergoline therapy prior to June 2008 or continued therapy after that date. In addition, the proportion of patients undergoing echocardiographic examination in each cohort was evaluated. A total of 61 patients were available for evaluation. The proportion of patients who underwent a baseline echocardiographic examination increased from 64 % in the period before the 2008 SPC changes to 71 % among those who continued treatment after that date. However, only 18 and 29 % of patients underwent at least two echocardiographic examinations during the pre-SPC and cross-SPC change period, respectively. No severe cardiac valve regurgitation was documented in any of the study patients using cabergoline either prior or after 26th June 2008. Our findings show that the 2008 changes to the SPC resulted in an increase in physicians' awareness of cabergoline-induced valvulopathy risk in Italy. However, only a small percentage of patients underwent serial echocardiography. Further efforts are needed to achieve better compliance with the prescribing guidelines for cabergoline treated patients in clinical practice.

Cardiovascular risk profile and blood pressure control in Italian hypertensive patients under specialist care.

BACKGROUND: Information on the association between high hypertension and metabolic risk factors in Italy is limited. Furthermore, data on the rate of blood pressure control in the Italian hypertensive population are restricted to some Italian regions only, and refer usually to surveys performed, in most instances, several years ago. METHODS: In the present study, a total of 4059 essential hypertensive patients were examined consecutively from March to June 2000 by 450 cardiovascular specialists (cardiologists, internists and diabetologists) operating throughout the Italian territory. Analysable data were obtained in 3812 patients. RESULTS: Blood pressure control by treatment (< 140/90 mmHg) was infrequent (11.9%), this being particularly the case for systolic as compared to diastolic blood pressure (15.1 versus 33.7%). Hypertension was the only risk factor in only 13.7% of the patients, the association with diabetes, hypercholesterolaemia or obesity characterizing the remaining cases. About 60% of the patients fell into the high or very high cardiovascular risk category of the World Health Organization/International Society of Hypertension (WHO/ISH) Guidelines. Compared to low or moderate cardiovascular risk, multiple antihypertensive drug treatment was more frequently used in individuals at high or very high risk. These conditions were frequently underdiagnosed by physicians. CONCLUSIONS: Thus, in Italy, hypertension continues to be a poorly controlled condition. Despite being a Mediterranean country, the occurrence of hypertension is commonly associated with metabolic risk factors and often with a high or very high cardiovascular risk profile. This is not properly identified by specialist physicians.