Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis.

QUESTION: What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease? DESIGN: Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS: Adults with coronary heart disease. INTERVENTION: Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise. OUTCOME MEASURES: Oxygen consumption, quality of life and mortality. RESULTS: This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74). CONCLUSION: People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality. REGISTRATION: PROSPERO CRD42022344545.

Cardiac rehabilitation of Baduanjin exercise in coronary heart disease after PCI: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Percutaneous coronary intervention (PCI) is an effective revascularization strategy in patients with coronary heart disease (CHD). However, recent studies had indicated that postPCI patients usually suffer from a low-quality life. Cardiac rehabilitation (CR) has been recommended by numerous guidelines in the clinic for these patients. And Baduanjin exercise can significantly benefit patients with CHD. Regrettably, the effect of Baduanjin exercise on postPCI patients is still not clear. Therefore, this systematic review and meta-analysis protocol is planned to explore the effect of Baduanjin exercise in patients with CHD who have undergone PCI. METHODS: PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Wanfang Database, SINOMED, China Science and Technology Journal Database, and China National Knowledge Infrastructure will be searched for appropriate articles from respective inceptions until December 1th, 2020. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Disagreements will be resolved first by discussion and then by consulting a third author for arbitration. The primary outcome will include left ventricular ejection fraction. And the change in the scores on the Seattle Angina Questionnaire, SF-36 health survey scale, Zung Self-rating Anxiety scale and self-rating depression scale will be used as the secondary outcomes. RevMan 5.3 will be used for meta-analysis. RESULTS: This systematic review and meta-analysis will explore whether Baduanjin exercise is an effective intervention in postPCI patients. CONCLUSION: This systematic review and meta-analysis will provide convincing evidence of Baduanjin exercise that specifically focuses on CR of Baduanjin exercise on CHD after PCI. REGISTRATION NUMBER: INPLASY202130065.

Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study.

BACKGROUND: Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. METHODS: Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by 13N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). RESULTS: For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and - 10.3%; ES = - 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (- 2.0%, ES = - 0.08). CONCLUSIONS: These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. TRIAL REGISTRATION: ClinicalTrials.gov registration # NCT01810029.

Safety and effectiveness of a Tai Chi-based cardiac rehabilitation programme for chronic coronary syndrom patients: study protocol for a randomised controlled trial.

INTRODUCTION: Preliminary evidence from clinical observations suggests that Tai Chi exercise may offer potential benefits for patients with chronic coronary syndrom (CCS). However, the advantages for CCS patients to practice Tai Chi exercise as rehabilitation have not been rigorously tested and there is a lack of consensus on its benefits. This study aims to develop an innovative Tai Chi Cardiac Rehabilitation Program (TCCRP) for CCS patients and to assess the efficacy, safety and acceptability of the programme. METHODS AND ANALYSIS: We propose to conduct a multicentre randomised controlled clinical trial comprising of 150 participants with CCS. The patients will be randomly assigned in a 1:1 ratio into two groups. The intervention group will participate in a supervised TCCRP held three times a week for 3 months. The control group will receive supervised conventional exercise rehabilitation held three times a week for 3 months. The primary and secondary outcomes will be assessed at baseline, 1 month, 3 months after intervention and after an additional 3-month follow-up period. Primary outcome measures will include a score of 36-Item Short Form Survey and Chinese Perceived Stress Scale. The secondary outcome measures will include body composition, cardiopulmonary exercise test, respiratory muscle function, locomotor skills, echocardiogram, New York Heart Association classification, heart rate recovery time and laboratory examination. Other measures also include Seattle Angina Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Berg Balance Scale. All adverse events will be recorded and analysed. ETHICS AND DISSEMINATION: This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of Chinese People's Libration Army General Hospital (approval number: S2019-060-02). Findings from this study will be published and presented at conferences for widespread dissemination of the results. TRIAL REGISTRATION NUMBER: NCT03936504.

Capacidade funcional em populações especiais antes e após cinesioterapia passiva e alongamento / Functional capacity in special populations before and after passive kinesiotherapy and stretching / Capacidad funcional en poblaciones especiales antes y después de la kinesioterapia pasiva y el estiramiento

Objetiva-se analisar a capacidade funcional antes e depois de um tratamento com cinesioterapia passiva e alongamento em populações especiais. Estudo de caso, exploratório, retrospectivo, com uma abordagem quantitativa dos dados. A amostra da pesquisa foi constituída por homens na faixa etária entre 60 a 76 anos de idade, sedentários, com coronariopatias e co-morbidades associadas. Foram analisadas as fichas de avaliação e da reavaliação realizadas com o Senior Fitness Test entre julho a agosto de 2017. A estatística foi realizada através do software SISVAR. As co-morbidades associadas mais frequentes foram: dislipidemia e Hipertensão Arterial Sistêmica. No teste T1, houve um aumento no número de repetições nos movimentos de sentar e levantar da cadeira nos participantes 3, 7 e 10. No T2, ocorreu uma melhora no movimento de flexão do antebraço nos participantes 7 e 8. No T3, os participantes 3, 9, e 10 apresentaram uma melhora na flexibilidade dos MMII. O T4 verificou que os participantes 3 e 7 foram melhores na velocidade, agilidade e equilíbrio dinâmico. O T5 confirmou que apenas o participante 8 apresentou resultados significativos quanto à flexibilidade dos MMSS. No T6 e T7, não houve diferença significativa entre paciente x tempo quanto à resistência aeróbica e IMC respectivamente após o tratamento. Os resultados do Senior Fitness Test em populações especiais parece ser uma ferramenta capaz de analisar individualmente as necessidades de cada participante de um protocolo com reabilitação cardíaca de forma segura e prática; no entanto, se faz necessária uma amostra mais significativa.

Objective: To analyze the functional capacity before and after a treatment with passive kinesiotherapy and stretching in special populations. Method: Exploratory, retrospective case study with a quantitative data approach.The research sample consisted of men in the age group between 60 and 76 years of age, sedentary, with coronary diseases and associated comorbidities. We analyzed the evaluation and revaluation sheets made with Senior Fitness Test between July and August 2017. The statistics were performed using the SISVAR software. Results: The most frequent associated comorbidities were: dyslipidemia and Systemic Arterial Hypertension. In the T1 test, there was an increase in the number of repetitions in the sit and stand movements in the participants 3, 7 and 10. In T2 there was an improvement in the movement of forearm flexion in participants 7 and 8. In T3 participants 3, 9, and 10 presented an improvement in the flexibility of LLLs. T4 found that participants 3 and 7 were better at speed, agility, and dynamic balance. The T5 confirmed that only the participant 8 presented significant results regarding the flexibility of the MMSS. At T6 and T7, there was no significant difference between patient and time for aerobic endurance and BMI respectively after treatment. Conclusion: The results of Senior Fitness Test in special populations seem to be a tool capable of analyzing individually the needs of each participant of a protocol with cardiac rehabilitation in a safe and practical way, however a more significant sample is necessary.

El objetivo es analizar la capacidad funcional antes y después de un tratamiento con kinesioterapia pasiva y estiramiento en poblaciones especiales. Estudio de caso, exploratorio, retrospectivo, con un enfoque cuantitativo de los datos. La muestra de investigación consistió en hombres sedentarios de 60 a 76 años, con enfermedades coronarias y comorbilidades asociadas. Se analizaron los formularios de evaluación y reevaluación realizados con la Prueba de aptitud física para adultos mayores entre julio y agosto de 2017. Las estadísticas se realizaron con el software SISVAR. Las comorbilidades asociadas más frecuentes fueron: dislipidemia e hipertensión arterial sistémica. En la prueba T1, hubo un aumento en el número de repeticiones en los movimientos de sentarse y levantarse de la silla en los participantes 3, 7 y 10. En T2, hubo una mejora en la flexión del antebrazo en los participantes 7 y 8. En T3, los participantes 3, 9 y 10 mostraron una mejora en la flexibilidad de las extremidades inferiores. T4 encontró que los participantes 3 y 7 fueron mejores en velocidad, agilidad y equilibrio dinámico. T5 confirmó que solo el participante 8 presentó resultados significativos con respecto a la flexibilidad del MMSS. En T6 y T7, no hubo diferencias significativas entre el paciente x el tiempo en términos de resistencia aeróbica e IMC respectivamente después del tratamiento. Los resultados del Senior Fitness Test en poblaciones especiales parecen ser una herramienta capaz de analizar individualmente las necesidades de cada participante en un protocolo con rehabilitación cardíaca de una manera segura y práctica; sin embargo, se necesita una muestra más significativa.

Traditional Chinese medicine training for cardiac rehabilitation: a randomized comparison with aerobic and resistance training.

BACKGROUND: The aim of this study was to investigate the efficacy and safety of different exercise regimens in the rehabilitation of patients with stable coronary heart disease. PATIENTS AND METHODS: This study was a randomized controlled trial to screen 141 patients with stable coronary heart disease who were admitted to the General Administration of Sport of China Sports Medical Science Institute from January 2018 to September 2018. They were randomly divided into the aerobic and resistance training (ART) group for 12 weeks (36 cases), the traditional Chinese medicine training (TCMT) group 12 weeks (37 cases), and the control (CON) group (39 cases). We analyzed the baseline parameters of all participants and the 12-week exercise plate test parameters and related physical and body parameters. RESULT: After 12 weeks of intervention, volume of oxygen (VO2), VO2/kg, metabolic equivalents, VO2/heart rate, stroke volume, and peaked grip strength and flexibility parameters of the ART group and the TCMT group were significantly higher than those of the control group (P<0.05). Resting heart rate of the TCMT group was significantly lower than the CON group, but there was no significant difference between the ART and CON groups (P>0.05). Ventilation/VO2 of the TCMT group was significantly higher than that of the CON group. BMI of the ART group was significantly lower than that of the TCMT group and the CON group, and body fat mass of the TCMT group was significantly smaller than that of the ART group, but there was no difference between the TCMT group and the CON group for BMI and body fat mass. CONCLUSION: Both ART and TCMT can improve the cardiopulmonary aerobic exercise capacity and physical fitness of patients with stable coronary heart disease. Although the degree of improvement is different, they all have certain effects on the rehabilitation of patients with stable coronary heart disease and the application is safe.

Effects of traditional Chinese exercise on cardiac rehabilitation after percutaneous coronary intervention: study protocol for network meta-analysis of randomised controlled trials.

INTRODUCTION: Coronary heart disease (CHD) is the most common cause of death worldwide. Percutaneous coronary intervention (PCI) has been shown to reduce mortality in patients with CHD. However, there are still recurrences of cardiovascular events after PCI. Cardiac rehabilitation (CR) in patients with established CHD is associated with reductions in cardiovascular mortality and hospital admissions, as well as improved quality of life. More and more clinical trials suggest that traditional Chinese exercise (TCE) plays a positive role in patients post-PCI. The primary purposes of the current study are to conduct a network meta-analysis of randomised trials to determine the effects of TCE in patients after PCI, and to separately compare the effects of tai chi, baduanjin and yijinjing on CR after PCI. METHODS AND ANALYSIS: Studies will be retrieved from the following databases: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, Chinese BioMedical Database and Chinese Science and Technology Periodicals Database, from inception to December 2018. We will include randomised controlled trials that are related to the effects of TCE therapies in patients after PCI. The primary outcomes will be all-cause mortality, revascularisations, health-related quality of life and hospitalisations. Two reviewers will independently select eligible articles. For each included article, two reviewers will independently extract the data and assess the risk of bias by using the Cochrane risk of bias tool. Bayesian network meta-analyses will be conducted to pool all treatment effects. The ranking probabilities for the optimal intervention of various treatments (tai chi, baduanjin or yijinjing) will be estimated by the mean ranks and surface under the cumulative ranking curve. The Grading of Recommendations Assessment, Development and Evaluation System will be used to assess the quality of evidence. ETHICS AND DISSEMINATION: The results will be disseminated through peer-reviewed publications. They will provide consolidated evidence to inform clinicians on the potential functions of TCE in CR, and to provide reliable evidence for the application of TCE. TRIAL REGISTRATION NUMBER: CRD42018088415.

Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial.

OBJECTIVE: Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD). METHODS: Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O2max at 12 weeks (inferiority margin=-1.25 mL/kg/min); inferiority margins were not set for secondary outcomes. RESULTS: 162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI -0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=-61.5 (95% CI -117.8 to -5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20). CONCLUSION: REMOTE-CR is an effective, cost-efficient alternative delivery model that could-as a complement to existing services-improve overall utilisation rates by increasing reach and satisfying unique participant preferences.

Effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: A systematic review and meta-analysis.

INTRODUCTION: Tai Chi is an attractive exercise to improve cardiovascular health. This review aimed to synthesize articles written both in Chinese and in English to evaluate the effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being and cardiovascular diseases risk reduction for coronary heart diseases patients. METHODS: PRISMA guidelines were used to search major health databases to identify randomized controlled trials or non-randomized controlled clinical trials that evaluated Tai Chi intervention compared with active or non-active control groups in coronary heart disease patients. When suitable, data were pooled using a random-effects meta-analysis model. RESULTS: Thirteen studies met the inclusion criteria. Tai Chi groups showed a large and significant improvement in aerobic endurance compared with both active and non-active control interventions (standard mean difference (SMD) 1.12; 95% confidence interval (CI): 0.58-1.66; p <0.001). Tai Chi groups also showed a significantly lower level of anxiety (SMD=9.28; CI: 17.46-1.10; p=0.03) and depression (SMD=9.42; CI: 13.59-5.26; p <0.001), and significantly better quality of life (SMD=0.73; 95% CI: 0.39-1.08; p <0.001) compared with non-active control groups. CONCLUSION: Significant effects of Tai Chi have been found in improving aerobic endurance and psychosocial well-being among coronary heart disease patients. Tai Chi could be a cost-effective and safe exercise option in cardiac rehabilitation. However, the effect of Tai Chi on cardiovascular disease risk reduction has not been amply investigated among coronary heart disease patients. Caution is also warranted in view of a small number of studies for this meta-analysis and potential heterogeneity in differences in the varied designs of Tai Chi intervention.

Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation.

BACKGROUND: More than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction. Options to improve physical activity (PA) and other risk factors in these high-risk individuals are limited. We conducted a phase 2 randomized controlled trial to determine feasibility, safety, acceptability, and estimates of effect of tai chi on PA, fitness, weight, and quality of life. METHODS AND RESULTS: Patients with coronary heart disease declining cardiac rehabilitation enrollment were randomized to a "LITE" (2 sessions/week for 12 weeks) or to a "PLUS" (3 sessions/week for 12 weeks, then maintenance classes for 12 additional weeks) condition. PA (accelerometry), weight, and quality of life (Health Survey Short Form) were measured at baseline and 3, 6, and 9 months after baseline; aerobic fitness (stress test) was measured at 3 months. Twenty-nine participants (13 PLUS and 16 LITE) were enrolled. Retention at 9 months was 90% (LITE) and 88% (PLUS). No serious tai chi-related adverse events occurred. Significant mean between group differences in favor of the PLUS group were observed at 3 and 6 months for moderate-to-vigorous PA (100.33 min/week [95% confidence interval, 15.70-184.95 min/week] and 111.62 min/week; [95% confidence interval, 26.17-197.07 min/week], respectively, with a trend toward significance at 9 months), percentage change in weight, and quality of life. No changes in aerobic fitness were observed within and between groups. CONCLUSIONS: In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6-month tai chi program was safe and improved PA, weight, and quality of life compared with a 3-month intervention. Tai chi could be an effective option to improve PA in this high-risk population. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02165254.

Efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation in patients undergoing off-pump coronary artery bypass grafting.

BACKGROUND: Postoperative complications after cardiac surgery increase mortality. This study aimed to evaluate the efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation (ASV) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS AND RESULTS: A total of 66 patients undergoing OPCAB were enrolled and divided into 2 groups according to the use of ASV (ASV group, 30 patients; non-ASV group, 36 patients). During the perioperative period, all patients undertook cardiopulmonary rehabilitation. ASV was used from postoperative day (POD) 1 to POD5. Hemodynamics showed a different pattern in the 2 groups. Blood pressure (BP) on POD6 in the ASV group was significantly lower than that in the non-ASV group (systolic BP, 112.9±12.6 vs. 126.2±15.8 mmHg, P=0.0006; diastolic BP, 62.3±9.1 vs. 67.6±9.3 mmHg, P=0.0277). The incidence of postoperative atrial fibrillation (POAF) was lower in the ASV group than in the non-ASV group (10% vs. 33%, P=0.0377). The duration of oxygen inhalation in the ASV group was significantly shorter than that in the non-ASV group (5.1±2.2 vs. 7.6±6.0 days, P=0.0238). The duration of postoperative hospitalization was significantly shorter in the ASV group than in the non-ASV group (23.5±6.6 vs. 29.0±13.1 days, P=0.0392). CONCLUSIONS: Cardiopulmonary rehabilitation with ASV after OPCAB reduces both POAF occurrence and the duration of hospitalization.

Religiosity and Spirituality During Cardiac Rehabilitation: A LONGITUDINAL EVALUATION OF PATIENT-REPORTED OUTCOMES AND EXERCISE CAPACITY.

PURPOSE: This study is a longitudinal evaluation of religiosity/spirituality (R/S) and religious coping in post-myocardial infarction and post-coronary artery bypass surgery patients during a 12-week cardiac rehabilitation program. This study examines change in R/S and the relationship between R/S and psychosocial outcomes and exercise capacity over time. METHODS: Cardiac rehabilitation patients (N = 105) completed measures of R/S, religious coping, quality of life (QOL), self-efficacy (SE), and energy expenditure (EE) at the beginning (baseline) and end of a 12-week program. Relationships between R/S and religious coping and QOL, SE, and EE were evaluated. RESULTS: A negative relationship emerged between baseline measures of R/S and religious coping and QOL, SE, and EE. There were significant increases in Good Deeds Coping, QOL, SE, and EE from baseline to end of program (Ps < .05). Baseline measures of Interpersonal Religious Support Coping were positively correlated with the change in EE from baseline to end (r = 0.21; P = .059), and there were positive correlations between the change in Experiential Religiosity (r = 0.32; P = .004) and Overall Religiosity (r = 0.25; P = .024) with the change in EE. DISCUSSION: The demonstrated relationships between R/S and Religious Coping and outcomes in cardiac patients provide compelling support for the development of spiritual care interventions for cardiac patients and evaluation of the impact of these interventions on physiological, medical, and psychological outcomes in these patients.

[The technical peculiarities of the application of therapeutic physical exercises for the rehabilitation of the patients presenting with post-infarction cardiosclerosis].

The article reports the results of clinical and physiological studies of 93 patients presenting with post-infarction cardiosclerosis and sings of cerebrovascular disease. The experience with the application of the combined rehabilitative treatment including therapeutic physical exercises is based on the results of the observation of two groups of the patients. Those of the study group performed special physical exercises designed to act on brain hemodynamics. The patients of the control group used traditional therapeutic exercises usually prescribed to those suffering from coronary artery disease. It was shown that the treatment including therapeutic physical exercises offered to the patients of the study group has an advantage of the significant positive impact on haemodynamics and functional activity of the brain; moreover, it reduces the severity of cardio-vascular cerebral symptoms and thereby contributes to complete rehabilitation of the patients with post-infarction cardiosclerosis.

[The effectiveness of comprehensive rehabilitation of the patients presenting with coronary heart disease with the application of underwater shower massage and electrical stimulation].

The underwater shower massage and electrical stimulation were applied to treat 120 patients presenting with coronary heart disease. The estimation of the effectiveness of this treatment with the use of functional diagnostic methods revealed its psychocorrective effect manifested in the form of reduced frequency and duration of painful and painless angina seizures, restricted sympathetic influences on the heart as well as normalized sympathovagal balance, lipid status, antioxidative system, central and peripheral hemodynamics, improved systolic and diastolic function of the myocardium, enhanced tolerability of mental, emotional, and physical workload. The study allowed the predictors of the effectiveness of therapeutic and health-promoting measures to be identified.

[MORFOHISTOHIMICHNA EVALUATION OF REHABILITATION PATIENTS WITH GENERALIZED PERIODONTAL DISEASE AGAINST CORONARY HEART DISEASE].

Un the basis of morphological studies examined the effectiveness of complex pathogenetic treatment of generalized periodontal disease with the use of products based on natural ingredients: dental paste "Fitopasta-3K" and drug "plantain juice" for the local treatment and drugs "Granules quercetin" and "Energoton" for systemic treatment. Established that one of the important mechanisms of complex pathogenetic treatment is the effect on energy metabolism of periodontal tissues, including the reduction of tissue hypoxia, metabolic stabilization was observed structural changes navkolozubnyh tissues. It should be noted positive effects of integrated treatment on the whole body.

How many meta-analyses does it take to settle a question?

Psychological treatments (PTs) are used as adjuncts to cardiac care. This issue of Psychosomatic Medicine provides a meta-analysis by Rutledge et al. (3) on the effects of PT and cardiac rehabilitation on depression and cardiac outcomes, and the journal recently published a systematic review and meta-regression on a similar topic by Dickens et al. (4). This editorial compares the results from these two meta-analyses and discusses the problems associated with combining different types of PT and other treatments, dose-response effects, floor effects, collapsing across outcomes, and therapist qualifications. PTs have mixed but generally positive effects on reducing mortality and cardiac outcomes, but it remains a challenge explaining how such beneficial outcomes can be achieved by relatively small effects on well-being (typical effect sizes: d = 0.2-0.3). Randomized controlled trials are needed on timing of PT, patients with cardiac problems who will benefit most from PT, and the mechanisms by which PT improves cardiac outcomes.

Tai chi exercise for patients with heart disease: a systematic review of controlled clinical trials.

CONTEXT: To summarize and evaluate the available evidence from controlled clinical trials of tai chi (TC) exercise for patients with heart disease. SEARCH METHODS: Fourteen databases were searched up to November 2010 with the terms tai chi, taichi, tai ji, taiji, taijichuan, cardiac, heart, coronary, myocardial, and atrial fibrillation in the title, abstract, or key words. No language restrictions were imposed. The quality and validity of randomized clinical trials (RCTs) were evaluated using the Jadad Scale. The strength of the evidence for all included studies was evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS: Nine studies including 5 RCTs and 4 nonrandomized controlled clinical trials met the inclusion criteria. Three studies examined the effectiveness of TC exercise for patients with chronic heart failure (CHF), and 6 studies examined the effectiveness of TC exercise among patients with coronary heart disease (CHD). Overall, these studies demonstrated favorable effects of TC exercise for the patients with heart disease. CONCLUSIONS: The existing evidence suggests that TC exercise is a good option for heart patients with very limited exercise tolerance and can be an adjunct to rehabilitation programs for patients with CHD or CHF.

[Conservative therapy of patients with stable coronary heart disease]. / Konservative Therapie der stabilen koronaren Herzkrankheit.

The main treatment goals of conservative treatment of patients with stable coronary heart disease are prevention of symptoms, prevention of myocardial infarction, and heart failure and reduction of mortality. Lifestyle changes (smoking cessation, physical activity) are essential to reduce risk factors. For symptomatic treatment and prevention of angina pectoris, beta-blockers, calcium channel blockers, nitrates, I((f)) (funny channel) blockers and ranolazine are effective. Cornerstones of pharmacological prevention are drugs with prognostic effects, specifically aspirin and statins, as well as treatment of co-existing disorders such as hypertension and diabetes.

[Cardiac rehabilitation: current status and future challenges]. / Kardiologische Rehabilitation: Aktueller Stand und zukünftige Anforderungen.

The goal of cardiac rehabilitation is to support heart patients using a multidisciplinary team in order to obtain the best possible physical and mental health and achieve long-term social reintegration. In addition to improving physical fitness, cardiac rehabilitation restores self-confidence, thus better equipping patients to deal with mental illness and improving their social reintegration ("participation"). Once the causes of disease have been identified and treated as effectively as possible, drug and lifestyle changes form the focus of cardiac rehabilitation measures. In particular diseases, rehabilitation offers the opportunity for targeted educational courses for diabetics or drug dose escalation, as well as special training for heart failure patients. A nationwide network of outpatient heart groups is available for targeted follow-up. Cardiac patients predominantly rehabilitated in follow-up rehabilitation are older and have greater morbidity than in the past; moreover, they generally come out of acute clinical care earlier and are discharged from hospital more quickly. The proportion of severely ill and multimorbid patients presents a diagnostic and therapeutic challenge in cardiac rehabilitation, although cardiac rehabilitation was not initially conceived for this patient group. The benefit of cardiac rehabilitation has been a well documented reduction in morbidity and mortality. However, hurdles remain, partly due to the patients themselves, partly due to the health insurers. Some insurance providers still refuse rehabilitation for non-ST-segment elevation infarction. In principle rehabilitation can be carried out in an inpatient or an outpatient setting. Specific allocation criteria have not yet been established, but the structure and process quality of outpatient rehabilitation should correspond to that of the inpatient setting. The choice between the two settings should be based on pragmatic criteria. Both settings should be possible for an individual patient. Cardiac rehabilitation is already focusing on older, sicker and polymorbid patients; this will become ever more the case in the future. There is still a need for future clinical research for these patients.