Baduanjin exercise for patients with ischemic heart failure on phase-II cardiac rehabilitation (BEAR trial): study protocol for a prospective randomized controlled trial.

BACKGROUND: Preliminary evidence based on clinical observations suggests that meditative exercise may offer potential benefits for patients with chronic heart failure (CHF). Cardiac rehabilitation (CR), as a class-IA indication in clinical practice guidelines, has been established as an effective strategy to improve quality of life and prognosis of CHF patients. Baduanjin exercise is an important component of traditional Chinese Qigong exercises. However, its benefits for CHF have not been rigorously tested. We sought to investigate whether Baduanjin, as an adjunct to standard care, improves cardiopulmonary function, exercise tolerance, and quality of life in patients with CHF caused by coronary artery disease (CAD). METHODS/DESIGN: In this randomized controlled trial, 120 patients will be randomly allocated in a 1:1 ratio to Baduanjin exercise combined with conventional exercise of CR (Baduanjin exercise group) or conventional exercise of CR alone (conventional exercise group). In addition to conventional physical activity, participants in the Baduanjin exercise group will participate in a 45-min Baduanjin exercise training session twice a week, for 12 weeks. The primary outcome is walking distance in the 6-min Walk Test (6MWT), and the secondary outcomes are peak oxygen uptake (VO2 peak), ventilatory anerobic threshold (VAT), The minute ventilation to carbon dioxide production relationship (VE/VCO2 slope), left ventricular end-diastolic volume index (LVEDVi), left ventricular ejection fraction (LVEF), quality of life assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), amino-terminal pro-brain natriuretic peptide (NT-proBNP), hs-CRP, heart rate variability (HRV), New York Heart Association (NYHA) classification, and major adverse cardiovascular events. DISCUSSION: This is the first trial to evaluate the effects of a Baduanjin exercise-based CR program on cardiopulmonary function and exercise tolerance in ischemic CHF patients. If successful, it will prove the value of Baduanjin exercise in improving cardiopulmonary function and exercise tolerance in patients with ischemic heart failure on phase-II CR, and may further develop a Chinese Qigong exercise-based CR framework. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03229681 . Registered retrospectively on 23 July 2017.

[The combined application of enhanced external counterpulsation for the rehabilitation of the patients presenting with coronary heart disease].

We have studied the influence of enhanced external counterpulsation (EECP) applied in the combination with gaseous carbon dioxide baths and infrared laser therapy on the dynamics of clinical and functional abnormalities in the patients presenting with coronary heart disease (CHD) including those after surgical myocardial revascularization. The study was conducted on 40 patients of whom 20 suffered from chronic coronary heart disease and FC II-III angina of effort and the remaining 20 ones presented with coronary artery disease following myocardial revascularization (including 5 patients six months after coronary bypass grafting (CBG) and 15 ones three months after translumbar angioplasty (TLAP) in the combination with stenting of the coronary arteries). The study demonstrated that EECP in the combination with gaseous carbon dioxide baths and infrared laser therapy produced anti-ischemic and antianginal effects, stimulated myocardial contractility, contributed to economization of the cardiac activity, increased exercise tolerance, myocardial and coronary reserves. These changes resulted in the improvement of both the psychological status and the quality of life of the patients.

[Acceptance and understandability of various methods of health valuations for the chronically ill: willingness to pay, visual analogue scale and rating scale]. / Akzeptanz und Verständlichkeit verschiedener Methoden der Gesundheitsbewertung bei chronisch Kranken: Willingness to pay, visuelle Analogskala und verbale Ratingskala

OBJECTIVE OF THE STUDY: Health valuations are one way of measuring patient preferences with respect to the results of their treatment. The study examines three different methods of health valuations--willingness to pay (WTP), visual analogue scale (VAS), and a rating question for evaluating the subjective significance. The goal is to test the understandability and acceptance of these methods for implementation in questionnaires. METHOD: In various rehabilitation centres, a total of six focus groups were conducted with 5-9 patients each with a mean age of 57.1 years. The illnesses considered were chronic-ischaemic heart disease, chronic back pain, and breast cancer. Patients filled out a questionnaire that was then discussed in the group. In addition to the quantitative evaluation of the data in the questionnaire, a qualitative analysis of the contents of the group discussion protocols was made. RESULTS: We have results from a total of 42 patients. 14.6% of the patients had "great difficulties" understanding the WTP or rated it as "completely incomprehensible"; this value was 7.3% for VAS and 0% for the rating scale. With respect to acceptance, 31.0% of the patients indicated that they were "not really" or "not at all" willing to answer such a WTP question in a questionnaire; this was 6.6% for the VAS, and again 0% for the rating scale. The qualitative analysis provided an indication as to why some patients view the WTP question in particular in a negative light. Many difficulties in understanding it were related to the formulation of the question and the structure of the questionnaire. However, the patients' statements also made it apparent that the hypothetical nature of the WTP questionnaire was not always recognised. The most frequent reason for the lack of acceptance of the WTP was the patients' fear of negative financial consequences of their responses. DISCUSSION: With respect to understandability and acceptance, VAS questions appear to be better suited for reflecting patient preferences than WTP questions. The rating scale for assessing the personally estimated importance was understandable, but had poor distribution properties and was considered by patients to be superfluous.

Relaxation therapy for rehabilitation and prevention in ischaemic heart disease: a systematic review and meta-analysis.

AIMS: To establish the effects of relaxation therapy on the recovery from a cardiac ischaemic event and secondary prevention. METHODS AND RESULTS: A search was conducted for controlled trials in which patients with myocardial ischaemia were taught relaxation therapy, and outcomes were measured with respect to physiological, psychological, cardiac effects, return to work and cardiac events. A total of 27 studies were located. Six studies used abbreviated relaxation therapy (3 h or less of instruction), 13 studies used full relaxation therapy (9 h of supervised instruction and discussion), and in eight studies full relaxation therapy was expanded with cognitive therapy (11 h on average). Physiological outcomes: reduction in resting heart rate, increased heart rate variability, improved exercise tolerance and increased high-density lipoprotein cholesterol were found. No effect was found on blood pressure or cholesterol. Psychological outcome: state anxiety was reduced, trait anxiety was not, depression was reduced. Cardiac effects: the frequency of occurrence of angina pectoris was reduced, the occurrence of arrhythmia and exercise induced ischaemia were reduced. Return to work was improved. Cardiac events occurred less frequently, as well as cardiac deaths. With the exception of resting heart rate, the effects were small, absent or not measured in studies in which abbreviated relaxation therapy was given. No difference was found between the effects of full or expanded relaxation therapy. CONCLUSION: Intensive supervised relaxation practice enhances recovery from an ischaemic cardiac event and contributes to secondary prevention. It is an important ingredient of cardiac rehabilitation, in addition to exercise and psycho-education.

[Efficacy of climate therapy in patients with chronic cardiac failure at a climate-balneological resort]. / Effektivnost' klimatoterapii patsientov c khronicheskoi serdechnoi nedostatochnost'iu na klimatobal'neologicheskom kurorte.

The aim of our study was to estimate clinical effects of spa therapy (ST) at Sochi-Macesta resort in patients with heart failure (HF). Spa therapy was given to 116 patients with HF functional class (FC) 0-II by NYHA classification. It is shown that ST leads to improvement of the patients' clinical status, reduction of HF FC (from 1.32 +/- 0.09 to 0.66 +/- 0.01, p < 0.001), to increased exercise tolerance (p < 0.05) and better 6-minute walk test results (from 460.3 +/- 11.4 m to 511.2 +/- 11.8 m, p < 0.01), higher myocardial coronary reserve, favourable shifts in blood pressure. ST also has a cardiotonic effect and corrects vegetative status, there was also antiatherogenic effect and an increase in blood coagulation potential. The received data allow us to conclude that ST can be an effective tool of medical rehabilitation in patients with initial stages of heart failure.

Yoga in cardiac health (a review).

This review studies the efficacy of yoga in the primary and secondary prevention of ischaemic heart disease and post-myocardial infarction patient rehabilitation. Yoga is an unconventional form of physical exercise that has been practised over a long period of time in the Indian sub-continent. It has gained immense popularity as a form of recreational activity all over the world. Its possible contributions to healthy living have been studied and many interesting revelations have been made. Benefits of yoga in the modification of cardiovascular risk factors and in the rehabilitation of the post-myocardial infarction patient are areas of significant importance. It is important to assess the practical significance and the suitability of incorporating yoga into the comprehensive cardiac rehabilitation programme. Majority of the rehabilitation workers believes that incorporating nonconventional forms of physical exercise such as yoga definitely would enhance efficacy and add value. This article attempts to study the history and the science of yoga and evaluate its effects on cardiovascular health.

[The use of a program of medical and psychological support after coronary artery bypass surgery in patients with ischemic heart disease]. / Primenenie programmy meditsinskoi i psikhologicheskoi podderzhki u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh aortokoronarnoe shuntirovanie.

The paper contains analysis of results of restorative treatment in a sanatorium and subsequent ambulatory care for 1 year of 167 patients after coronary artery bypass surgery. All patients received similar curative and preventive aid, 127 patients in addition participated in a special program of medical and psychological support while 40 patients comprised control group. The program was carried out in a sanatorium and consisted of several sessions of various types of group psychotherapy. Participation in this program allowed to achieve sufficiently high level of motivation to comply with recommendations of a physician and to implement self-psychoregulation and self-control of the functions of own body. Program participants had better quality of life and more frequently returned to work.

[The efficiency of low-intensity laser radiation in the treatment of arterial hypertension complicated by ischemic heart disease]. / Effektivnost' ispol'zovaniia nizkointensivnogo lazernogo izlucheniia pri lechenii arterial'noi gipertonii i ee sochetaniia s ishemicheskoi bolezn'iu serdtsa.

The efficiency of low-intensity laser radiation (LILR) was studied in the treatment of 291 patients with arterial hypertension and ischemic heart disease. Clinical grounds are given for use of LILR red and infrared rays in rehabilitation of hypertensive patients with ischemia. The rehabilitation regimens can be differentiated according to the disease severity, type of hemodynamics, state of cerebral circulation.

[Psychotherapy impact on effectiveness of in-hospital physical rehabilitation in patients with acute coronary syndrome]. / Vliianie psikhoterapii na éffektivnost' statsionarnoi fizicheskoi reabilitatsii bol'nykh s ostrym koronarnym sindromom.

Of 103 patients with acute coronary syndrome (mean age 51.6 +/- 0.9 years) 47 patients participated in 5 group psychotherapeutic sessions added to conversional rehabilitation program. Psychotherapy included progressive muscular relaxation, neurolinguistic programming, eriksonian hypnosis, therapeutic metaphora. Psychotherapy decreased the hear rate, number of ventricular extrasystoles, stimulated tonicity of the parasympathetic nervous system. Compared to the controls, the test patients developed higher exercise tolerance and lower reactivity of the central hemodynamics in all the exercise tests.

[The characteristics of the geroprotective action of magnetotherapy in elderly patients with combined cardiovascular pathology]. / Osobennosti geroprotektornogo deistviia magnitoterapii u pozhilykh bol'nykh s sochetannoi serdechno-sosudistoi patologiei.

Central hemodynamics, diastolic and pumping functions of the heart, myocardial reactivity, microcirculation and biological age of cardiovascular system were studied in 66 elderly patients suffering from hypertension and ischemic heart disease. The patients received systemic magnetotherapy which produced a geroprotective effect as shown by improved microcirculation, myocardial reactivity, central hemodynamics reducing biological age of cardiovascular system and inhibiting its ageing.

[The modulating action of balneotherapy on the peroxidation processes in patients with ischemic heart disease]. / Moduliruiushchee deistvie bal'neoterapii na protsessy peroksidatsii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The state of the system lipid peroxidation-antioxidant defense (LPO-AOD) was studied in 187 patients with ischemic heart disease on combined balneorehabilitation. The balneotherapy comprised effervescent magnesium-calcium and effervescent arsenic mineral water, artificial baths. Balneorehabilitation produced optimal results in high functional capacity of LPO-AOD system. In low functional activity of the system LPO-AOD balneological procedures may impair adaptive mechanisms and provoke balneoreactions. Combination of balneofactors with diet including polyunsaturated fatty acids enhanced antioxidant blood activity and modified LPO.

[The influence of vitamin C and e or beta-carotene on peroxidative processes in persons with myocardial ischemia]. / Wplyw witamin C i E oraz beta-karotenu na procesy peroksydacyjne u osób z niedorkrwienna choroba serca.

An increasing body of evidence suggests that beside hypercholesterolemia peroxidative processes and natural antioxidant defence system play important role in the development of atherosclerosis. Our earlier investigation showed the increased intensity of the peroxidative processes in the course of the acute myocardial infarction and unsatisfactory tocopherol, ascorbic acid and retinol status. The purpose of the present study was the evaluation of the effect of antioxidant vitamins supplementation by the period of 21 days on the peroxidative processes in patients after heart attack or after "bypass" admitted to the cardiological rehabilitation centre. Daily oral supplementation with vitamin C, E and beta-carotene decreased significantly plasma lipid peroxide concentration (TBARS). The highest drop in TBARS activity was found in the group after bypass. No significant effect of vitamin supplementation was observed on antioxidant enzymes activity.

[THe development of systems for the early rehabilitation of patients with ischemic heart disease following aortocoronary bypass]. / Razrabotka kompleksov rannei reabilitatsii bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

Two rehabilitation complexes are described for coronary heart disease patients early after aortocoronary shunting. The first complex includes "dry" effervescent baths, magnetolaser therapy applied to the heart area, cryomassage of the abdomen. The second complex consisted of the above modalities plus dry air baths. Indications and contraindications to these complexes are specified.