Efficacy of Intensive Lifestyle Education and Forest-Based Exercise for the Primary Prevention of the Risk of Coronary Artery Disease.

Introduction: Despite its efficacy, conventional center-based cardiac rehabilitation has several limitations which have led to the emergence of home-based programs and intensive cardiac rehabilitation as alternative methods for overcoming these limitations. Alternative methods for primary prevention have been recommended for similar reasons. Lifestyle modification is considered key to success in both primary and secondary prevention. Therefore, this primary prevention study aimed to investigate the efficiency of intensive lifestyle education and home-based programs involving unstructured exercise in urban forests to prevent coronary artery disease (CAD). The availability of urban forests as preventive exercise environments was also examined. Methods: Patients with risk factors for CAD participated in primary prevention using either FBEG (forest-based exercise group (FBEG, n = 11) or CBEG (center-based exercise group (CBEG, n = 17) for 12 weeks. The FBEG was provided with intensive residential lifestyle education and followed a home program that included performing exercise in an urban forest. The CBEG followed a conventional supervised exercise program at a fitness facility. Changes in body composition, cardiometabolic variables, and functional capacity were tested using a 2-way repeated ANOVA measurement. An independent t-test was used to examine the differences in weekly energy expenditure between the two groups. Results: Significant within-group differences were identified in body composition, cardiometabolic variables, and the 10-yr probability of CAD in both groups. However, the functional capacity, weekly energy expenditure, and attendance rate showed between-group differences, with superiority in the FBEG. Conclusion: Intensive lifestyle education and subsequent home-based programs with unstructured exercise in the forest were as effective as a conventional center-based program, with superiority in terms of the change of some variables. Intensive education on experiencing and habituating a healthy lifestyle seemed to play an important role in improving motivation.

Contemporary Approaches to Prescribing Exercise in Coronary Artery Disease Patients.

Health care professionals engaged in the management of coronary artery disease (CAD) patients, both in primary and secondary prevention settings, should possess the knowledge to develop and modify both aerobic exercise as well as musculoskeletal resistance exercise training programs. The traditional exercise prescription (ExRx) for aerobic-type exercise describes the intensity, frequency, duration, and mode of exercise, as well as the rate of progression. The more contemporary ExRx focuses on the energy expenditure associated with all physical activity not just structured exercise bouts. The total "volume or dose" of physical activity is associated with important health outcomes, including the potential to prevent and potentially reverse CAD lesions. Also, emerging evidence supporting the use of high-intensity interval training in CAD patients will also be provided. Furthermore, this review will also address the issue of generating an appropriate ExRx in the absence of maximal exercise "stress" test data, a common occurrence in the primary care setting and in this era of health care cost containment. Prescribing resistance exercise for CAD patients requires careful consideration and will be discussed in this review. Finally, this review will conclude with a section that describes the special considerations and/or modifications for some common comorbidities seen in CAD patients.

Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis.

BACKGROUND: The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking. METHODS: Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training. RESULTS: Significant differences were observed in the change in %body fat (TW: -2.7%, AW: -2.8%, CON: -0.4%), total cholesterol level (TW: -23.6 mg/dL, AW: -27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: -6.3 bpm, AW: -6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO2 peak (TW: 2.3 mL/kg·min-1, AW: 2.0 mL/kg·min-1, CON: -2.5 mL/kg·min-1) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups. CONCLUSION: AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation.

PURPOSE: For patients starting a cardiac rehabilitation program, exercise intensity often is set 20 beats per minute above the standing resting heart rate (RHR+20) or in a range of 11 to 13 on Borg's Scale for Rating of Perceived Exertion (RPE 11-13). The purpose of this study was to determine the actual exercise intensity, expressed as a percentage of peak oxygen uptake reserve (%VO2R) using these techniques. METHODS: For this study, 11 new referrals to a phase 2 cardiac rehabilitation program voluntarily underwent a symptom-limited exercise test and a field test that consisted of self-paced over-the-ground walking for 10 minutes at levels corresponding to RPE 11-13 and RHR+20. During both tests, gas exchange data were obtained via the Cosmed K4b and heart rate via the Polar monitor. RESULTS: The mean %VO2R at RHR+20 (41.8 +/- 12.3%) and RPE 11-13 (71 +/- 15.3% mL.kg.min) were significantly different. Exercise at RHR+20 resulted in 4 of the 11 patients (36%) exercising at less than 40% VO2R, 6 of the patients (55%) exercising at 40% to 60% VO2R, and 1 of the patients (9%) exercising at more than 60% VO2R. Exercise at RPE 11-13 resulted in 1 of the 11 patients (9%) exercising at less than 40% VO2R, 1 of the patients at exercising at 40% to 60% VO2R (9%), and 9 of the patients (82%) exercising at more than 60% VO2R. CONCLUSIONS: The results of this study indicate that using RHR+20 or RPE 11-13 to prescribe exercise intensity during over-the-ground walking for phase 2 cardiac rehabilitation patients results in substantial intersubject variability and raises questions about the safety and efficacy of these approaches.