A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps.

BACKGROUND: After 2020, clinical practice recommendations have been released to inform cardiac rehabilitation (CR) programs of best practices for post-COVID programming. The objective of this systematic review was to identify and summarize recommendations from clinical practice guidelines (CPGs) and consensus statements for CR delivery postpandemic. METHODS: Five databases (March 2020 through April 2023), grey literature and Web sites of CR international associations were searched. Inclusion criteria were local, national, and international association-endorsed CPGs, and/or position, expert, and scientific statements related to CR delivery (program models, program elements, and core components). Two researchers independently screened the citations for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE) II was used for quality assessment. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guidelines. RESULTS: Overall, 4890 records were identified; 4 CPGs, 9 position/scientific statements, and 6 expert/Delphi consensus papers were included. All guidelines/statements included information related to program delivery models, with 95% endorsing the use of virtual, hybrid, home-based, and telerehabilitation, especially during the pandemic. Outside of the context of COVID-19, program components including referral, CR indications, CR contraindications, timing, and structure were included in the 4 CPGs and 2 of 15 statements. Recommendations related to CR core components were primarily focused on exercise, with no changes since before the pandemic except for COVID-19 considerations for safety. One guideline was specific to women, and 1 scientific statement to heart failure with preserved ejection fraction. CONCLUSIONS: Although 19 documents were identified, CR delivery in low resource settings and for culturally and linguistically diverse populations require attention. Additionally, few recommendations on nutrition, psychosocial counselling, and patient education were reported.

Validity of Bioelectric Impedance in Relation to Dual-Energy X-Ray Absorptiometry for Measuring Baseline and Change in Body Composition After an Exercise Program in Stroke.

ABSTRACT: Vanzella, LM, Lawand, R, Shuaib, M, Oh, P, Corbett, D, and Marzolini, S. Validity of bioelectric impedance in relation to dual-energy x-ray absorptiometry for measuring baseline and change in body composition after an exercise program in stroke. J Strength Cond Res 36(12): 3273-3279, 2022-Exercise is an important strategy to improve fat-free mass (FFM) and reduce percent fat mass (FM%). However, no study has reported on a valid, cost-effective method to measure changes in body composition after stroke. The purpose of the study is to determine the level of agreement between bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DXA) for assessing baseline and change in FFM and FM% after an exercise training intervention for individuals with mobility deficits after stroke. Fat-free mass and FM% were measured by BIA and DXA at the beginning and after 6 months of participation in an exercise program for individuals with mobility deficits after stroke. Forty-two subjects after stroke were included. Overall, Bland-Altman plots revealed that BIA overestimated the baseline FFM and FM% by only -0.4 ± 1.8 kg and -2.8 ± 1.8%, respectively. BIA underestimated changes in FFM by 0.33 ± 0.45 kg and overestimated changes in FM% by -0.40 ± 0.68%. The 95% CI of the mean bias for baseline FFM was -7.1 to 6.3 kg and -11.8 to 6.0% for FM%, demonstrating good agreement. The 95% CI for the change in FFM was -3.8 to 4.5 kg and -5.0 to 4.2% for FM%, which reflected good agreement. BIA is a good tool for assessing qualitative baseline and change in FFM and FM%. Body composition is important for the prescription and evaluation of rehabilitation programs designed for individuals after stroke. Our results provide clinicians and researchers with a better understanding of the utility of BIA to measure body composition at baseline and in response to exercise interventions in this population.

A Social-Ecological Perspective of the Perceived Barriers and Facilitators to Virtual Education in Cardiac Rehabilitation: A MIXED-METHODS APPROACH.

PURPOSE: This study explored the perceived barriers and facilitators to participation in patients who did and did not attend virtual cardiac rehabilitation (CR) education sessions. METHODS: A mixed-methods approach was used. Virtual patient education was delivered during the coronavirus-19 pandemic. Phase 1 included a cross-sectional online survey completed by individuals who did and did not participate in these sessions. For phase 2, six virtual focus group sessions were conducted using the social-ecological framework to guide thematic analysis and interpretation of findings. RESULTS: Overall, 106 online surveys were completed; 60 (57%) attended Cardiac College Learn Online (CCLO) sessions only, one (1%) Women with Heart Online (WwHO) only, 21 (20%) attended both, and 24 (22%) did not attend virtual sessions. Half of the participants who attended virtual sessions viewed between one and four sessions. Most participants were from Canada (95%) and included the Toronto Rehabilitation Institute/Toronto Western Hospital centers (76%). Focus group findings revealed six overarching themes: Intrapersonal (mixed emotions/feelings; personal learning preferences); Interpersonal (desire for warmth of human contact and interaction); Institutional (the importance of external endorsement of sessions); and Environmental (technology; perceived facilitators and barriers). CONCLUSION: These findings highlight the unprecedented situation that patients and CR programs are facing during the pandemic. Virtual patient education may be more accessible, convenient, and responsive to the complex needs of these CR participants.