Effects of a WhatsApp-Assisted Health Educational Intervention for Cardiac Rehabilitation: A Randomized Controlled Clinical Trial Protocol.

Although the effectiveness of cardiac rehabilitation (CR) programs in secondary prevention is well-recognized, there is a lack of studies exploring the potential of mobile health to enhance educational interventions within CR. The objective is to assess the impact of a structured WhatsApp-assisted health educational intervention, in conjunction with the usual care, compared to the usual care alone among participants enrolled in a CR program. The trial will recruit 32 participants enrolled in a CR program, who will be randomly assigned to a structured WhatsApp-assisted health educational intervention plus usual care or usual care alone group. The intervention will span 4 weeks, with assessments at baseline, 4 weeks, and 3, 6, and 12 months. The primary outcome measure is the cardiovascular risk factors knowledge score. Secondary outcomes include physical activity levels, anxiety and depression, and quality of life. Expected results include improved knowledge of cardiovascular risk factors, increased physical activity levels, and better mental health outcomes in the intervention group. Additionally, an enhancement in the overall quality of life is anticipated. These findings are expected to underscore the value of integrating mHealth with traditional CR methods, potentially shaping future approaches in chronic disease management and prevention.

Physical Exercise Effects on Cardiovascular Autonomic Modulation in Postmenopausal Women-A Systematic Review and Meta-Analysis.

BACKGROUND: The cardioprotective effect of physical exercise has been demonstrated in several studies. However, no systematic or updated analysis has described the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women. AIM: to describe the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women. METHODS: The Scopus, PubMed, and Embase databases were searched for randomized clinical trials published between January 2011 and December 2021, and regarding the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women. Two independent authors processed the citations. The methodological quality was evaluated using the PEDRo scale. RESULTS: Of the 91 studies identified, only 8 met the inclusion criteria, of which 7 had fair or poor methodological quality. The analyzed studies investigated the effects of functional training, whole-body vibration, muscular resistance, stretching, and aerobic exercises performed at home or at the gym. The majority of these exercise modalities showed improvements in heart-rate variability (HRV) indices and in the low-frequency band of blood pressure variability. The meta-analysis shows that exercise increased the standard deviation of instantaneous beat-to-beat variability (SD1) (mean difference (MD) = 3.99; 95% confidence interval (CI) = 1.22 to 6.77, n = 46; I2: 0%) and the standard deviation of long-term variability (SD2) (MD = 11.37; 95% CI = 2.99 to 19.75; n = 46; I2: 0%). CONCLUSIONS: Aerobic exercise and some nonconventional training modalities may have beneficial effects on cardiovascular autonomic modulation in postmenopausal women. More high-quality studies are still needed to further confirm their efficacy and safety.

Efectos de la rehabilitación cardíaca de fase I. Revisión sistemática / Effects of phase I of cardiac rehabilitation. Systematic review

Resumen Introducción: La rehabilitación cardíaca de fase I es un programa hospitalario que tiene como objetivo reducir los efectos que se pueden derivar del reposo prolongado en cama e instruir al paciente para el ingreso a la fase ambulatoria de rehabilitación. Objetivo: Analizar los efectos de la rehabilitación cardíaca de fase I en pacientes sometidos a revascularización miocárdica y cambios valvulares, mediante una revisión sistemática de la literatura. Método: La revisión incluyó ensayos clínicos controlados aleatorizados que analizaran los efectos de la rehabilitación cardíaca de fase I. Se emplearon las bases de datos Scopus, ScienceDirect, Embase y Embase classic OVID. La búsqueda se limitó a los artículos publicados entre los años 2000 y 2017, en inglés, portugués y español. Los estudios que cumplieron los criterios de inclusión recibieron un análisis de la calidad metodológica, el nivel de evidencia y el grado de recomendación según las escalas PEDro y Scottish. Resultados: Fueron elegibles 298 artículos, de los cuales cuatro fueron seleccionados y analizados; todos estos incluyeron población que había sido sometida a revascularización quirúrgica cardíaca y dos a población con reparación o reemplazo valvular quirúrgico. En cuanto a la calidad metodológica, dos fueron categorizados como de buena calidad con un nivel de evidencia 1+ y 1++ y un grado de recomendación A y B. Los protocolos de tratamiento utilizados fueron las técnicas respiratorias, los ejercicios activos de extremidades y la deambulación. Conclusiones: La literatura analizada sugiere incluir los procesos de rehabilitación cardíaca de fase I, lo cual puede mejorar la función pulmonar y disminuir la ansiedad, variable que se asoció de manera directa con la estancia hospitalaria en los pacientes posquirúrgicos cardíacos.

Abstract Introduction: The phase I of cardiac rehabilitation have the proposed decrease the effects on the bed rest and better adherence at the phase II. Objective: To analyze the effects of phase I CR in patients undergoing myocardial revascularization and valve changes, through a systematic review of the literature. Method: The review includes randomized clinical trials looking at the effects of phase I. The base date Scopus, Science Direct, Embase & Embase classic OVID. The search was limited between 2000 and 2017, in English Portuguese and Spanish. Results: 298 articles were were eligible, and only four were selected and analyzed. The articles included a population with bypass coronary and two articles with surgery to valve replacement or repair. Regarding quality methodology, Two were rated to be good quality with an evidence level of 1+ and 1++ and a degree of recommendation A y B. The protocols used for treatment include breathing techniques, upper and lower limps exercise and ambulation. Conclusions: The phase I cardiac rehabilitation, could improve lung function and reduce anxiety, this is associated directly with stay hospital post-surgical cardiac patients

Impacto de la implementación de la estrategia del Aprendizaje Basado en Casos (ABC) en estudiantes de prácticas clínicas en fisioterapia / Impact of case-based learning for students of clinical practices in physiotherapy

RESUMEN Introducción: el Aprendizaje Basado en Casos (ABC) es una estrategia pedagógica por descubrimiento que permite la articulación de los conocimientos nuevos con los ya adquiridos, estimula la autonomía, desarrolla el pensamiento crítico y las competencias argumentativas en contextos reales, desarrollando la fase del "saber" según lo explica la pirámide de Miller. Objetivo: evaluar el impacto en la motivación y en el aprendizaje que produce la implementación de la estrategia del ABC en estudiantes del último nivel de Fisioterapia. Metodología: diseño mixto cuasiexperimental con 12 estudiantes y 3 profesores. Se desarrolló presencialmente en horas de asesorías durante 18 semanas, cada 15 días con 2 horas por encuentro. La información fue recolectada a través de pruebas de conocimiento antes y después de la intervención, grupos focales con estudiantes y docentes y observaciones no participantes. Resultados: se evidenciaron cambios significativos entre la evaluación pre y la post intervención (16,7 %; 83,3 %, p < 0,05). Los estudiantes describieron la experiencia como altamente motivante y los docentes como enriquecedora. Discusión: esta investigación sustenta el efecto del ABC en el aprendizaje activo y la mediación pedagógica desarrollada por el profesor a través de las fases de la estrategia. Conclusión: el Aprendizaje basado en casos implementado de manera sistemática, organizada y planeada es una estrategia útil en el proceso de formación de los fisioterapeutas. Promueve el desarrollo de la capacidad crítica, reflexiva y analítica y el logro de las competencias profesionales.

SUMMARY Introduction: The Case Based Learning (CBL) is a teaching and learning strategy that allows the articulation of acquired and new knowledge, stimulates the autonomous learning, improves the critical thinking and the argumentative skills in real contexts, developing the phase of "knowing" as explained by the Miller pyramid. The main goal of this research was to evaluate the impact on motivation and student learning produced by the implementation of cases-based learning strategy in last year students of a Physiotherapy Program. Methodology: Mixed design, quasi-experimental type, with twelve students selected by convenience. Intervention was developed in person at advisory times, for 18 weeks, every 15 days for 2 hours per meeting. The information was collected using knowledge test after and before of the intervention, focal groups with teachers and students and not members observations. Results: There were significant changes between the pre and post-intervention evaluation (16.7 %, 83.3 %, p <0.05), and the students described the experience as highly motivating and teachers as enriching. Our research supports the effect of the active learning, with the CBL and the pedagogic mediation developed with the teacher through the phases and sequences of the strategy. Conclusion: Case-based learning, implemented in a systematic, organized and planned manner, is a useful strategy in the training process of physical therapists. Promotes the development of critical, reflective and analytical capacity and the achievement of professional skills.

Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives.

Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.

Reliability of the Scale of Barriers for Cardiac Rehabilitation in the Colombian Population.

Cardiac rehabilitation is supported by the highest level of scientific evidence. However, less than 25% of those eligible to participate in a cardiac rehabilitation program initiate it; and of these, 50% drop out prematurely. A modified Spanish Cardiac Rehabilitation Barriers Scale (CRBS) has been translated, culturally adapted and validated in Colombia, however, the reliability remains to be evaluated. This study aimed to determine the internal consistency and test-retest reliability of the CRBS in a Colombian population. In total, 193 patients (67% men, average age = 65 ± 12 years) completed the scale twice, with an average of eight days between applications. Cronbach's Alpha and intraclass correlation coefficients (ICC) were calculated. The internal consistency of the Colombian version of the CRBS was acceptable (Cronbach's alpha = 0.84). The ICC of the CRBS was 0.69 (95% CI 0.61-0.76); 0.78 (95% CI 0.71-0.84) when the CRBS was completed by interview; and 0.47 (95% CI 0.21-0.67) when the CRBS was self-reported. The reliability of the interview version of the CRBS was substantial in the Colombian population; however, the reliability of the self-report version was lower. The use of this scale will allow developing strategies to increase participation and adherence to cardiac rehabilitation programs.

The effects of maintenance cardiac rehabilitation: A systematic review and Meta-analysis, with a focus on sex.

Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during Phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception-January 2020. Randomized controlled trials on the effects of maintenance CR in cardiovascular disease patients who had graduated from CR were included. Level of evidence was evaluated with GRADEPro. 819 citations were identified, with 10 trials (21 papers) included (5238 participants; 859 [16.4%] female). Maintenance CR resulted in lower low-density lipoprotein (mean difference [MD]=-0.58; 95% confidence interval [CI]=-1.06--0.10, n = 392) and greater quality of life (MD = 0.28, 95% CI = 0.05-0.52, n = 118) when compared to usual care only. Outcomes for women and sex differences were mixed. In conclusion, maintenance programs appear to sustain patient's quality of life, but more focus on women's outcomes is needed.

The Effects of Maintenance Cardiac Rehabilitation: A SYSTEMATIC REVIEW.

PURPOSE: Maintenance cardiac rehabilitation (M-CR) programs aim to preserve the health benefits achieved during phase II cardiac rehabilitation (CR). The aim of this study was to establish the effects of M-CR on functional capacity, quality of life, risk factors, costs, mortality, and morbidity, among other outcomes. METHODS: Scopus, ISI Web of Science, PubMed, Embase & Embase classic OVID, and Lilacs were searched. Randomized controlled trials, published between 2000 and 2016, on the effects of M-CR in patients with cardiovascular disease, who had graduated from CR, having a control or comparison arm were included. Citations were processed by two authors, independently. Methodological quality was assessed using PEDro, and level of evidence graded with the Scottish scale. Outcomes were qualitatively synthesized. RESULTS: The searches retrieved 1901 studies with 26 articles meeting inclusion criteria (3752 participants). Some trials tested M-CR in nonclinical settings, and others used resistance or high-intensity interval training. The methodological quality of 11 articles was good, with a level of evidence (1+) and a grade B recommendation. Results showed M-CR resulted in increased or maintained functional capacity, quality of life, and physical activity levels, when compared with the control. No adverse events were reported. Few studies assessed rehospitalizations and mortality. CONCLUSION: Quality of included trials was low because it is not possible to double-blind in M-CR trials and also due to the heterogeneity of M-CR interventions. Understanding, availability, and use of M-CR programs should be increased.

Efecto agudo del ejercicio físico de intensidad moderada sobre las variables espirométricas en sujetos asmáticos broncodilatados. Prueba piloto / Acute effect of moderate-intensity exercise on spirometric variables in broncodilated asthmatic subjects. A pilot study

RESUMEN Introducción: el broncoespasmo inducido por el ejercicio (BIE) ocurre entre el 70 y 80 % de los asmáticos y su aparición es más frecuente al terminar una sesión de ejercicio físico, principalmente de intensidad vigorosa. Objetivo: evaluar el efecto agudo que puede tener el ejercicio físico de intensidad moderada sobre las variables espirométricas en sujetos asmáticos broncodilatados. Metodología: se realizó un estudio cuasi-experimental de tipo antes y después. Se incluyeron diez sujetos (edad promedio = 23 ± 4 años), los cuales fueron divididos en dos grupos: cinco sujetos asmáticos y cinco sanos. Los dos grupos realizaron 10 minutos de calentamiento, 20 minutos de ejercicio en banda sin fin al 60 % de la frecuencia cardíaca de entrenamiento, seguido de 5 minutos de recuperación. La función pulmonar fue evaluada antes del ejercicio y 15 minutos después del ejercicio. Resultados: se encontraron diferencias estadísticamente significativas entre grupos (con asma 6 % vs. sin asma -1 %, p = 0,03) en los cambios pre y pos del ejercicio de la relación del volumen espiratorio forzado en el primer segundo (VEF1) sobre la capacidad vital forzada (CVF). El análisis multivariado mostró que la CVF post ejercicio en el grupo con asma fue significativamente menor que el del grupo sin asma, ajustado por evaluación basal y masa corporal total. Conclusión: el ejercicio de intensidad moderada en banda sin fin, no mostró diferencias clínicamente significativas sobre los cambios del pre y post ejercicio de las variables espirométricas estudiadas, puesto que estos cambios en VEF1 o CVF no superaron el 10 % teniendo como referencia la evaluación basal.

SUMMARY Background: Exercise-Induced Bronchospasm (BIE) occurs in 70 % to 80 % of asthmatics and its occurrence is more frequent at the end of a session of physical exercise, mainly of vigorous intensity. Objective: To evaluate the acute effect of moderateintensity physical exercise on spirometric variables in asthmatic subjects. Methodology: A before-and-after type quasi-experimental design. Ten subjects were included (mean age= 23 ± 4 years), which were divided into two groups: five asthmatic subjects and five healthy subjects. Both groups performed 10 min of warm-up, 20 min of treadmill exercise at an intensity of 60 % of the Heart Rate Reserve, and a final cool-down of 5 minutes. Lung function was assessed before and 15 minutes after exercise. Results: There were statistically significant differences between groups (with asthma = 6 % vs. without asthma = -1 %, p = 0.03) in the pre-post-exercise changes of the ratio of the forced expiratory volume in one second and the forced vital capacity (FEV1/FVC). The multivariate analysis showed that post-exercise FVC in subjects with asthma was significantly lower than in subjects without asthma, after adjusting for the baseline assessment and total body mass. Conclusion: Moderate-intensity exercise on a treadmill did not shows clinically significant differences on the changes pre-post exercise of the studied spirometric variables, since the changes on FEV1 or FVC did not exceed 10 % having as reference the baseline evaluation.

Barreras para la participación en programas de rehabilitación cardiaca en pacientes sometidos a revascularización percutánea por enfermedad coronaria / Barriers for the participation in cardiac rehabilitation programmes in patients undergoing percutaneous revascularisation due to a coronary disease

Introducción: Los programas de rehabilitación cardiaca promueven cambios de estilo de vida y disminuyen la recurrencia de enfermedad y mortalidad en un 25%. No obstante, la tasa de asistencia a éstos varía entre el 7,5 al 29%, y cerca del 40 al 50% de los usuarios abandonan el tratamiento en forma prematura. Objetivo: describir las barreras encontradas en quienes participaron o no en programas de rehabilitación cardíaca después de ser sometidos a una revascularización percutánea. Métodos: estudio de corte transversal, realizado en treinta sujetos, a quienes se les aplicó la escala de barreras para la rehabilitación cardiaca, que usa preguntas tipo Likert, donde los puntajes más altos indican mayor percepción de barrera para participar en un programa de rehabilitación cardíaca. Resultados: Las mayores barreras por ítem fueron: «yo encuentro al ejercicio fatigante y/o doloroso¼, con un promedio de 2,86, seguido por «Yo hago actualmente ejercicio¼ y «Yo no sabía de la rehabilitación cardiaca¼ con un promedio de 2,73. El de menor puntaje fue: «Muchas personas sufren del corazón y no van¼, con 1,73. Presentaron más barreras quienes no asistieron a un programa de rehabilitación cardíaca (p < 0,05) que quienes sí lo hicieron; además las mayores barreras se encontraron en los dominios de necesidades percibidas y comorbilidades/estado funcional (p < 0,05). Lo anterior hace suponer falta de orientación y educación respecto a los beneficios que pueden obtener los usuarios al ingresar y adherirse a un programa de rehabilitación cardíaca, independiente de como se sientan o el tipo de limitación funcional que tengan.

Introduction: Cardiac rehabilitation programmes encourage lifestyle changes and reduce the recurrence of morbidity and mortality by 25 %. Nevertheless, attendance rate to such programmes varies between 7.5 and 29%, and around 40 to 50 % of users abandon the treatment during the early stages. Motivation: To describe the barriers found in those who participated or not in cardiac rehabilitation programmes after percutaneous revascularisation. Methods: Cross-sectional study of 30 patients, who were applied the barrier scale for cardiac rehabilitation, using Likert-type questions, where the highest scores indicated a bigger perception of the barrier to participate in a cardiad rehabilitation programme. Results: The major barriers per item were: «I find this exercise is tiring and/or painful¼ with an average of 2.86, followed by «I currently exercise¼ and «I did not know about cardiac rehabilitation¼ with an average of 2.73. The lowest score was: «Many people have heart problems and do not go¼, with 1.73. More barriers were shown in those who did not attend a cardiac rehabilitation programme (p < 0.05) than whose who did; in addition, most barriers were found in the fields of perceived needs and comorbidities/functional state (p < 0.05). This indicates a lack of orientation and education when it comes to the benefits that users could obtain by joining and participating in a cardiac rehabilitation programme, no matter how they feels or the type of functional limitations they may have.

Validez de contenido de la escala de barreras para la rehabilitación cardiaca / Content validity of the scale of barriers to cardiac rehabilitation

Introducción: La ausencia de instrumentos con adecuadas propiedades psicométricas adaptados para Colombia, que evalúen las barreras de acceso a los programas de rehabilitación cardiovascular justifica esta investigación. Objetivo: Determinar la validez de contenido de la Escala de Barreras para la Rehabilitación Cardiaca en población colombiana. Métodos y materiales: Se realizó un estudio de pruebas diagnósticas. En la primera fase se requiririeron dos traductores de lengua materna español y uno de lengua materna inglesa para la traducción y retrotraducción del cuestionario original. En la segunda fase se realizó la adaptación transcultural y se evaluó la validez de contenido mediante un panel de cuatro expertos con experiencia en investigación, medicina deportiva y rehabilitación cardiaca. Resultados: El instrumento fue traducido y adaptado al español colombiano. El panel de expertos decidió eliminar el ítem 18 de la escala original. El índice de validez de contenido fue aceptable para la mayoría de los ítems, excepto para los ítems 10, 15 y 18, por lo cual se realizaron modificaciones en palabras, frases o conjugaciones verbales según las recomendaciones del panel. Por otra parte, el Indice de Validez de Contenido en relevancia fue de 0,86 y en pertinencia de 0,88. Conclusión: Se cuenta con un instrumento que evalúa barreras de acceso a los programas de rehabilitación cardiovascular adaptada a población colombiana y con validez de contenido, por lo cual los resultados que se obtengan de la aplicación de la escala serán válidos. No obstante, se sugiere continuar con la evaluación de la reproducibilidad del instrumento.

Introduction: This research was based on the absence of instruments with appropriate psychometric properties, adapted for Colombia, which evaluate the barriers of access to cardiovascular rehabilitation programs. Objective: To determine the validity of content of the barriers scale for the cardiac rehabilitation in Colombian population. Methods and materials: A study of diagnostic tests was done. In the first phase, two native speakers of Spanish and one of English were required to translate and retro translate the original questionnaire. In the second phase, the transcultural adaptation was done and the validity of content was assessed by a panel of four experts with experience in research, sports medicine and cardiac rehabilitation. Results: The instrument was translated and adapted to the Colombian Spanish. The panel of experts decided to remove the item 18 from the original scale. The content validity index was acceptable for the majority of the items, except for items 10, 15 and 18, where modifications were made in terms of words, phrases or conjugations according to the recommendations of the panel. On the other hand, the IVC in relevance was 0.86 and relevance of 0.88. Conclusion: There is an instrument that evaluates the barriers of access to cardiovascular rehabilitation adapted to the Colombian population programs and with content validity, so the results to be obtained from the application of the scale will be valid. However, it is suggested to continue with the evaluation of the reproducibility of the instrument.