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1.
Medicine (Baltimore) ; 99(11): e19546, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176110

RESUMEN

BACKGROUND: Cardiovascular diseases are highly prevalent and represent leading causes of morbidity worldwide, including in Central Europe. Cardiac rehabilitation (CR) is an effective method of secondary prevention, but utilization is low. Barriers to CR use in the Czech Republic are not well-characterized, and therefore we propose a protocol to translate and validate the cardiac rehabilitation barriers scale (CRBS). METHODS: In this multi-method study, we translated and cross-culturally validated the CRBS to Czech (CRBS-CZE) first through the following main steps: professional translation, reconciliation/harmonization, and cross-cultural adaptation, and piloting in 50 cardiac patients. A prospective study will be undertaken to psychometrically-validate the CRBS-CZE, where 300 to 600 cardiac inpatients eligible for phase II/outpatient CR will be recruited. Consenting participants will be informed about the CR program and their sociodemographic, clinical characteristics, and the CRBS-CZE administered. Factor analysis will be performed with oblique rotation, factors will be extracted based on eigenvalues, the examination of the scree plot, and factor loadings. The internal reliability of the total scale and subscales will be assessed with Cronbach alpha. Overall CRBS scores will be compared by patient characteristics such as sex, socioeconomic indicators, risk factor burden, and travel time to investigate content validity. Their CR enrollment, adherence (% of 24 prescribed sessions attended), and completion will be tracked. The second administration of CRBS-CZE will be undertaken in patients at 3 weeks after enrollment. To test criterion validity, t tests and Pearson correlation (for adherence) will be used to determine the association of these utilization indicators with CRBS scores. RESULTS: The translated version was considered by 2 bilingual CR experts. Some revisions and example additions were made to the items. Upon piloting with patients, some further edits were made. No additional barriers were raised. DISCUSSION: Through this study, a reliable and valid means of assessing patient's CR barriers will be established. Results will be used to identify ways to help patients overcome barriers to CR utilization.


Asunto(s)
Rehabilitación Cardiaca , Enfermedades Cardiovasculares/psicología , Psicometría , República Checa , Humanos , Estudios Prospectivos , Reproducibilidad de los Resultados , Proyectos de Investigación , Encuestas y Cuestionarios , Traducciones
2.
Medicine (Baltimore) ; 99(11): e19556, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176113

RESUMEN

BACKGROUND: Telerehabilitation in cardiology has the potential to become the alternative to regular outpatient cardiac rehabilitation. Our study focuses on the wrist heart rate monitor as a telerehabilitation device, defines detected limitations, and compares results between home-based and regular outpatient rehabilitation methods, related to physical fitness, quality of life, and training adherence. The study design was a randomized controlled trial. METHODS: Eligible 56 cardiac rehabilitation patients were randomized into a 12-week regular outpatient training group (ROT) and interventional home-based telerehabilitation group (ITG). For both groups, the intensity of the training was prescribed to be performed at 70% to 80% of heart rate reserve for 60 minutes, 3 times a week. The ITG patients started their training with a wrist heart rate monitor in their home environment. These patients received feedback once a week, reflecting data uploaded on the internet application. The ROT patients performed their exercise under the direct supervision of a physical specialist in a regular outpatient clinic. Physical fitness and health-related quality of life were assessed at baseline and after 12 weeks. Training adherence in both groups was determined and compared. RESULTS: Fifty-one patients comleted the intervention (91%); no serious adverse events were recorded. Physical fitness expressed as peak oxygen uptake showed significant improvement (P < .001) in ROT group from 23.4 ±â€Š3.3 to 25.9 ±â€Š4.1 mL/kg/min and (P < .01) in ITG group from 23.7 ±â€Š4.1 to 26.5 ±â€Š5.7 mL/kg/min without significant between-group differences after 12 weeks of intervention. The training adherence between groups was similar. CONCLUSION: Our study shows that telerehabilitation via wrist heart rate monitor could become an alternative kind of cardiac rehabilitation which deserves attention and further analyzing.


Asunto(s)
Rehabilitación Cardiaca/instrumentación , Enfermedades Cardiovasculares/psicología , Monitoreo Fisiológico/instrumentación , Cooperación del Paciente , Telerrehabilitación/instrumentación , Muñeca , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida
3.
Bratisl Lek Listy ; 121(3): 206-210, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32115978

RESUMEN

OBJECTIVES: The aim of the present study was to evaluate the relationship between exercise capacity and n/lymphocyte ratio (NLR) in patients enrolled in a cardiopulmonary rehabilitation program. BACKGROUND: NLR has recently been used as a potential marker to determine inflammation in cardiac and non-cardiac diseases. METHODS: In this retrospective study, an exercise test and six-minute walking test (6MWT) were carried out in 23 patients with coronary artery disease and 28 patients with pulmonary disease before cardiopulmonary rehabilitation program, and routine hemogram test results were evaluated. RESULTS: The result of 6MWT test distance was 333.43 ± 86.58 m in the cardiac rehabilitation group and 348.46 ± 81.37 m in the pulmonary rehabilitation group. There was a negative correlation between 6MWT and NLR in the cardiac rehabilitation group (p < 0.05). As NLR increased, the MET value and duration of exercise decreased in the pulmonary rehabilitation group (p < 0.05). CONCLUSION: NLR could be used as a predictor to evaluate the exercise capacity in patients to be enrolled in cardiopulmonary rehabilitation program (Tab. 3, Ref. 30) Keywords: exercise capacity, neutrophil/lymphocyte ratio, rehabilitation.


Asunto(s)
Rehabilitación Cardiaca , Tolerancia al Ejercicio , Linfocitos , Neutrófilos , Humanos , Estudios Retrospectivos , Caminata
4.
Adv Exp Med Biol ; 1216: 131-147, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894553

RESUMEN

Comprehensive cardiac rehabilitation programmes include multifactorial components to optimise cardiovascular risk reduction, promote healthy behaviours and an active lifestyle, reduce disability and improve health and wellbeing. There is compelling evidence that older people with certain cardiovascular conditions, such as heart failure, can benefit both physically and mentally from cardiac rehabilitation. This chapter discusses the evolution of cardiac rehabilitation, frailty assessment in cardiac rehabilitation and guideline recommendations in the context of ageing populations. Contemporary cardiac rehabilitation service models are presented along with potential solutions to meeting older people's preferences and improving access to effective treatment for those with frailty. Innovations in catheter-based surgical interventions mean that more people with frailty are undergoing cardiovascular surgery than ever before. Although traditionally, cardiac rehabilitation has been associated with secondary prevention after cardiac diagnoses, events and interventions, new models of preconditioning rehabilitation or 'prehab' are being offered to frail older people before surgery to improve functional outcomes and reduce hospital stay. Individual tailoring of cardiac rehabilitation programme components is a cornerstone of high-quality care. Importantly, participation in core components, such as exercise and nutritional interventions, can impact on both cardiac vascular disease and frailty, providing the potential to change the trajectory of both conditions.


Asunto(s)
Rehabilitación Cardiaca , Anciano Frágil , Cardiopatías/rehabilitación , Anciano , Anciano de 80 o más Años , Insuficiencia Cardíaca/rehabilitación , Humanos
5.
Rehabilitation (Stuttg) ; 59(1): 17-25, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31207652

RESUMEN

PURPOSE: Physical inactivity is considered the most important modifiable risk factor of cardio-vascular diseases. Therefore medical rehabilitation is focused on the improvement of physical activity. To maintain physical activity after rehabilitation aftercare strategies are necessary which help to transfer the skills learned during rehabilitation into daily routine. In this study the aftercare concept "Neues Credo" which has been evaluated several times has been implemented and evaluated into cardiological follow-up rehabilitation. METHODS: Prospective, controlled, multicentre study with 4 cardiological rehabilitation institutions. INCLUSION CRITERIA: rehabilitants with initial diagnosis from the ICD groups I20-25 and I34-43. In the first phase of the study, patients received standard rehabilitation and standard aftercare (control group (KG)). In the second phase, patients received rehabilitation based on the conditions of "Neues Credo" with the focus on increasing physical activity (intervention group (IG)). Data for evaluation were collected by paper-and-pencil questionnaires at 3 points in time. Primary outcome variable: restriction in participation (IMET); secondary outcome variables: depression (CES-D), several scales of subjective health and physical activity. Analysis of variance with repeated measures was used for the evaluation of long-term effects. RESULTS: Complete data could be evaluated from 152 patients of the IG and from 165 patients of the KG. At the end of rehabilitation both IG and KG showed improvements in outcome variables. In the period after rehabilitation patients in the IG improved their physical activity significantly more often than members of the KG (66 vs. 42%, p<0,01), they showed more physical activity than the KG (p=0,040) and they performed endurance sports more often (58 vs. 38%, p<0,01). The primary outcome of participation shows significant improvements in both groups (p<0,01) 12 months after the rehabilitation, difference between groups did not reach statistical significance but indicated a clear tendency in favour of the IG. Similar trends could be found for the secondary outcome-data CONCLUSION: In this study, the "Neues Credo" was applied and evaluated in cardiologic rehabilitation for the first time. Participants reported high practicability and high satisfaction. Health- related outcomes show a trend of positive effects in favour of the IG, but the interaction effects did not reach statistical significance in most cases. Regarding physical activity the intervention group shows clear advantage and will probably benefit from the long-term effects of regular endurance training.


Asunto(s)
Cuidados Posteriores , Rehabilitación Cardiaca , Estudios de Seguimiento , Alemania , Humanos , Estudios Prospectivos , Resultado del Tratamiento
6.
Rehabilitation (Stuttg) ; 59(1): 26-33, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31117132

RESUMEN

PURPOSE: The aim of this study was the development and psychometric evaluation of a questionnaire which measures barriers and facilitators of medication adherence of patients with cardiovascular diseases in medical rehabilitation. METHODS: A total of 133 inpatients in medical rehabilitation returned the questionnaire in a cross-sectional study in one center of cardiological rehabilitation. The dimensional analysis of the instrument was conducted by explorative factor analysis (EFA). RESULTS: The questionnaire "Freiburger Fragebogen zur Medikamentenadhärenz (FF-MedAd)" consists of 30 items distributed among 8 factors. Five of these factors represent barriers (e. g. forgetting/interchanging) and 3 facilitators (e. g. trust, communication) of medication adherence. Five scales have acceptable to good internal consistency with Cronbachs α between 0.72 and 0.87. Three scales were just below the acceptable range (0.61-0.67). Correlations between the FF-MedAd scales indicate the factorial validity of the questionnaire. CONCLUSION: The psychometric results of the FF-MedAd to measure self-estimated medication adherence of patients with cardiovascular diseases were satisfactory.


Asunto(s)
Rehabilitación Cardiaca , Enfermedades Cardiovasculares , Estudios Transversales , Alemania , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
7.
Rehabilitation (Stuttg) ; 59(1): 42-47, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31096291

RESUMEN

PURPOSE: Physical exercise interventions are well accepted and widely used in cardiac rehabilitation programs. To ensure long-lasting effects on physical fitness and the maintenance of work ability a subsequent transfer to rehabilitation sport programs following cardiac rehabilitation is intended in a timely manner. The aim of the present study is to evaluate prescription and utilization rates of rehabilitation sport programs following cardiac rehabilitation. METHODS: The present paper analyzes referral rates and the actual utilization of those programs in patients who had a cardiac rehabilitation in the years 2006-2013 using insurance data of the German pension fund. RESULTS: Overall, reductions in the prescription of rehabilitation sport programs can be observed. In 2013 55.7% (m) and 62.6% (w) of patients received a prescription for rehabilitation sport programs following cardiac rehabilitation. In contrast to declining prescription rates from 64.2 to 55.7% (m) and 68.0 to 62.6% (w) an increase in sports participation between 3-7% can be observed. CONCLUSION: Overall, participation rates between 9.7% and 22.5% (2012) seem not sufficient to promote long-term physical activity behavior change. Next to our evaluation, determinants and barriers for program participation should be investigated.


Asunto(s)
Rehabilitación Cardiaca , Deportes , Alemania , Humanos , Actividad Motora , Aptitud Física
9.
Mayo Clin Proc ; 94(12): 2390-2398, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31806097

RESUMEN

OBJECTIVE: To determine the association between cost sharing and adherence to cardiac rehabilitation (CR). PATIENTS AND METHODS: We collected detailed cost-sharing information for patients enrolled in CR at Baystate Medical Center in Springfield, Massachusetts, including the presence (or absence) and amounts of co-pays and deductibles. We evaluated the association between cost sharing and the total number of CR sessions attended as well as the influence of household income on CR attendance. RESULTS: In 2015, 603 patients enrolled in CR had complete cost-sharing information. In total, 235 (39%) had some form of cost sharing. Of these, 192 (82%) had co-pays (median co-pay, $20; interquartile range [IQR], $10-$32) and 79 (34%) had an unmet deductible (median, $500; IQR, $250-$1800). The presence of any amount or form of cost sharing was associated with 6 fewer sessions of CR (16; IQR, 4-36 vs 10; IQR, 4-27; P<.001). Patients hospitalized in November or December with deductibles that renewed in January attended 4.5 fewer sessions of CR (8.5; IQR, 3.25-12.50 vs 13; IQR, 5.25-36.00; P=.049). After adjustment for differences in baseline characteristics, every $10 increase in co-pay was associated with 1.5 (95% CI, -2.3 to -0.7) fewer sessions of CR (P<.001). Household income did not moderate these relationships. CONCLUSION: Cost sharing was associated with lower CR attendance and exhibited a dose-response relationship such that higher cost sharing was associated with lower CR attendance. Given that CR is cost-effective and underutilized, insurance companies and other payers should reevaluate their cost-sharing policies for CR.


Asunto(s)
Rehabilitación Cardiaca/estadística & datos numéricos , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/psicología , Seguro de Costos Compartidos/economía , Cooperación del Paciente/estadística & datos numéricos , Anciano , Rehabilitación Cardiaca/economía , Enfermedades Cardiovasculares/epidemiología , Utilización de Instalaciones y Servicios , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
Revista do DERC ; 25(4): 100-107, nov., 2019. tab., graf.
Artículo en Portugués | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1049372

RESUMEN

Os defeitos cardíacos congênitos são relevantes do ponto de vista médico, epidemiológico, social e econômico, com prevalência que varia entre 0,8% nos países mais desenvolvidos a 1,2% nos países subdesenvolvidos. A maior parcela dessa população no Brasil é atendida pelo Sistema Único de Saúde, a incidência na população brasileira é superior a 25.000 novos casos/ano ou 9,1 para cada 1.000 (mil) nascidos vivos. Com o desenvolvimento da cardiologia etal, neonatal e procedimentos invasivos terapêuticos complexos, híbridos e suporte de terapia intensiva, a sobrevida dessas crianças com cardiopatia congênita (CC) aumentou de modo significativo. O teste cardiopulmonar de exercício (TCPE) ganha cada vez mais espaço dentro do cenário propedêutico médico e se destaca especialmente na cardiologia pediátrica ao contribuir para a tomada de decisão clínica. Assim, é fundamental ao possibilitar melhor resposta para questões chaves como: chegou a hora de intervenção cirúrgica? Qual o motivo para a limitação funcional? Apresenta resposta broncomotora frente ao exercício? As respostas metabólica e ventilatória estão adequadas? As crianças e adolescentes com cardiopatias complexas apresentam reduzida qualidade de vida em relação a seus pares, principalmente aquelas com reduzida capacidade funcional. Orientar e prescrever treinamento físico para essa jovem população é um desafio mais facilmente enfrentado com a utilização do TCPE. Assim, ao mesmo tempo em que a reabilitação cardíaca infantil começa se tornar uma realidade promotora de qualidade de vida, o TCPE torna-se a ferramenta orientadora para o treinamento físico dentro dos programas de treinamento físico e reabilitação cardíaca (RC). Nesse sentido, o entendimento em conjunto das análises clínicas, cardiovasculares, metabólicas, ventilatórias e de troca gasosa torna-se fundamental dentro da análise fisiopatológica no auxílio à tomada de decisão clínica. Nesse caso clínico, o TCPE auxiliou na prescrição do treinamento físico para realização das sessões de RC. Os ganhos na mobilidade, cognição e aspectos gerais de qualidade de vida foram extremamente evidentes após 24 sessões de RC. (AU)


Asunto(s)
Humanos , Niño , Adolescente , Ejercicio , Prueba de Paso , Rehabilitación Cardiaca , Cardiopatías Congénitas
11.
BMJ ; 367: l5456, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31575520

RESUMEN

The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000803/cardiac-rehabilitation-for-heart-failure-can-improve-quality-of-life-and-fitness.


Asunto(s)
Rehabilitación Cardiaca , Insuficiencia Cardíaca , Ejercicio , Terapia por Ejercicio , Humanos , Calidad de Vida
12.
Vasc Health Risk Manag ; 15: 301-308, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31616150

RESUMEN

Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered. Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2-0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3-0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1-0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients' occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.


Asunto(s)
Síndrome Coronario Agudo/rehabilitación , Rehabilitación Cardiaca , Motivación , Alta del Paciente , Pacientes/psicología , Reinserción al Trabajo , Evaluación de Capacidad de Trabajo , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/psicología , Adulto , Comorbilidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
13.
Zhonghua Nei Ke Za Zhi ; 58(10): 763-769, 2019 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-31594175

RESUMEN

Objective: The aim of the study was to explore the influencing factors of exercise tolerance in patients with myocardial infarction (MI) after percutaneous coronary intervention (PCI) revascularization in acute state. Methods: A total of 112 patients with first MI undergoing PCI revascularization in acute state and completing cardiopulmonary exercise testing (CPET) were enrolled. Exercise capacity was evaluated by peak oxygen consumption percentage (VO(2 peak)%) in CPET. Patients were divided into normal exercise capacity (NEC) group (n=40) and abnormal (AEC) group (n=72) according to VO(2 peak)% value. Clinical manifestations, histories of hypertension and diabetes, medications, coronary arterial angiography and echocardiography findings of patients were compared. The onsets of diabetes and blood glucose levels during the period of CPET were evaluated in the MI patients with diabetes. The patients were followed up for major adverse cardiovascular events (MACE) (admission due to chest pain, re-revascularization, re-infarction and all-cause death) within 24 months after PCI. Multivariate logistic regression analyses were conducted to examine influencing factors for exercise tolerance. Results: The ratio of diabetes, type C lesions in the AEC group were higher than those in the NEC group (diabetes: 37.5% vs. 17.5%; type C lesions: 69.4% vs. 42.5%, respectively, all P<0.05). The left ventricular ejection fraction (LVEF) in patients in the AEC group was lower than that in the NEC group [(60.6±10.0)% vs. (65.0±8.2)%, P=0.019]. Multivariate logistic regression analyses showed that history of diabetes and history of type C lesions were the independent risk factors for the declined exercise capacity in the MI patients after PCI revascularization (OR=3.14, 95%CI 1.167-8.362, P=0.023; OR=3.32, 95%CI 1.444-7.621, P<0.01). Among the MI patients with diabetes, the duration of diabetes in the AEC group was significantly longer than that in the NEC group[(7.7±3.6)years vs. (5.0±2.4)years] and the proportions of subjects reaching target levels of fasting plasma glucose (40.7% vs. 57.1%) and glycosylated hemoglobin A1c(HbA1c) (55.6% vs. 71.4%) in this group were significantly lower than those in the NEC group (all P<0.05). A multivariate logistic regression analysis showed that reaching HbA1c target was an independent predictor of improved exercise tolerance in MI patients with diabetes who received PCI (OR=2.518, 95%CI 1.395-7.022, P=0.021). No significant differences were observed in incidence of admission due to chest pain, re-revascularization and re-infarction between the two groups within 24 months after PCI between the groups. Conclusions: Diabetes and type C lesions are independent risk factors of declined exercise capacity in patients with first myocardial infarction who received revascularization in acute state. Reaching target HbA1c is independent factor of improved exercise capacity in patients with myocardial infarction and diabetes.


Asunto(s)
Rehabilitación Cardiaca , Tolerancia al Ejercicio , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Angiografía Coronaria , Humanos , Revascularización Miocárdica , Resultado del Tratamiento , Función Ventricular Izquierda
14.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 483-489, Sept-Oct. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1040100

RESUMEN

Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery


Asunto(s)
Humanos , Masculino , Femenino , Periodo Posoperatorio , Cirugía Torácica , Terapia por Estimulación Eléctrica/métodos , Rehabilitación Cardiaca , Presión Sanguínea , Ejercicio , Nivel de Oxígeno/métodos , Diagnóstico de la Situación de Salud , Análisis Estadístico , Análisis de Varianza , Ensayo Clínico Controlado Aleatorio , Evaluación de Resultado (Atención de Salud)/métodos , Presión Arterial , Frecuencia Cardíaca
17.
Artículo en Inglés | MEDLINE | ID: mdl-31561424

RESUMEN

The association between physical activity (PA) and mental well-being in individuals with a cardiovascular disease (CVD) is poorly studied. The objective of this study was to assess the association between mental well-being and adherence to the recommended guidelines for PA in a Scottish adult population with CVD. The study used data from 3128 adults who had CVD conditions (1547 men and 1581 women; mean age 63.29 years) who participated in the Scottish Health Survey between 2014 and 2017. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used as a surrogate measure of mental health. PA was classified as "met" or "unmet" on the basis of the recommended PA guidelines (150 min of moderate activity or 75 min of vigorous activity per week). The relationship between PA guidelines being met and the WEMWBS score was explored using hierarchical linear regression accounting for a set of health and sociodemographic characteristics. Of the participants, ~41.8% met the recommended PA levels. Among those with CVD, the mean (SD) WEMWBS scores of individuals who did not have a long-standing illness (51.14 ± 7.65 vs 47.07 ± 9.54; p < 0.05), diabetes (48.44 ± 9.05 vs 46.04 ± 10.25; p < 0.05), or high blood pressure (48.63 ± 9.08 vs 47.52 ± 9.47; p < 0.05) were significantly higher than those of individuals with such conditions. Meeting PA recommendations was significantly associated with a higher mean WEMWBS score (50.64 ± 7.97 vs 46.06 ± 9.75; p < 0.05). Multiple regression analysis of health-related behaviors improved the prediction of mental well-being over and above meeting the recommended PA levels. Mental well-being was strongly correlated with PA adherence in CVD patients. It seems that for patients with CVD, PA should be tailored to meet patients' health conditions in order to promote mental well-being and improve overall health.


Asunto(s)
Rehabilitación Cardiaca/métodos , Enfermedades Cardiovasculares/psicología , Enfermedades Cardiovasculares/terapia , Terapia por Ejercicio/psicología , Terapia por Ejercicio/normas , Ejercicio/psicología , Adhesión a Directriz/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Escocia , Adulto Joven
18.
Artículo en Inglés | MEDLINE | ID: mdl-31561473

RESUMEN

There is ample evidence of adverse cardiovascular health outcomes associated with exposure to air pollution and cardiac rehabilitation patients are at increased risk for future adverse health events related to air quality. Risk communication and health messaging about recommended behaviors to reduce exposure to air pollution can be integrated into existing care routines and structures. How this can be achieved most appropriately and effectively is not well understood. A focus group design is used to investigate cardiovascular patient and provider experiences, attitudes and beliefs about the risks of air pollution, related health risk messaging and factors that may influence integrating that topic into patient care and communication. Three discussions were hosted, one with cardiac patients, a second with non-physician cardiac rehabilitation providers and a third with physicians who treat cardiac patients. A within-case thematic inductive analysis of each discussion is used to understand the nature of communication, logistics, guidance and overall substance of the cardiac rehabilitation educational experience. Results suggest that air pollution may be an unrecognized risk factor for cardiac patients and cardiac rehabilitation is a prime setting for communicating air pollution health risk messaging. However, to effectively integrate air quality health risk messaging into cardiac rehabilitation, it is critical to account for the existing knowledge-base and behaviors of both providers and patients.


Asunto(s)
Contaminación del Aire/efectos adversos , Rehabilitación Cardiaca/psicología , Comunicación en Salud/métodos , Cardiopatías/etiología , Cardiopatías/rehabilitación , Médicos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Sudeste de Estados Unidos
19.
BMC Health Serv Res ; 19(1): 615, 2019 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-31477103

RESUMEN

BACKGROUND: Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its' worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a low-resource setting. METHODS: In this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale. RESULTS: Thirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01). CONCLUSIONS: The inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed.


Asunto(s)
Rehabilitación Cardiaca , Países en Desarrollo , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud , Administradores de Hospital/psicología , Anciano , Brasil , Enfermedades Cardiovasculares , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Encuestas y Cuestionarios
20.
Arch Med Res ; 50(3): 122-132, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31495389

RESUMEN

BACKGROUND: Rehabilitation measures are crucial for maintaining clinical benefits of coronary artery bypass grafting (CABG) surgery. We evaluated the clinical efficacy of a medical centre- and home-based cardiac rehabilitation (CR) for patients after CABG in an out-patient setting. METHODS: The study included 36 male patients 3-8 weeks after CABG that were randomly assigned to either study or control group. Patients from the study group performed a 60 min excercise in controlled setting 3 times a week for 4 months followed by home-based excercise later on, while patients from the control group only received a recommendation to perform the excercise at home in an uncontrolled setting. Total duration of the follow-up was 12 months. RESULTS: Physical endurance in the study group increased by 32.6% (p <0.05) in comparison to baseline after 4 months, and was maintained at this level after 12 months, while in the control group, an improvement of 9.8% (p <0.05) was observed after 12 months. Moreover, patients from the study group demonstrated a stable level of such risk factors as blood total and low-density lipoprotein cholesterol, while in the control group, these parameters increased by 10.2% (p <0.05) and 15.6% (p <0.05) respectively by the end of follow-up. Controlled medical centre-based exercise resulted in improvement of patients' quality of life and reduction of cardiovascular complications (11.1% against 39.2% in the control group). CONCLUSION: The integral (medical centre and home-based) stage III CR program after CABG helped reducing cardiovascular risk factors, and improved clinical parameters and functional capacity of patients.


Asunto(s)
Rehabilitación Cardiaca/métodos , Puente de Arteria Coronaria/psicología , Enfermedad Coronaria/rehabilitación , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Calidad de Vida/psicología , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
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