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1.
Sensors (Basel) ; 21(1)2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33374322

RESUMO

Promoting regular physical activity (PA) and improving exercise capacity are the primary goals of cardiac rehabilitation (CR). Mobile technologies (mTechs) like smartphones, smartwatches, and fitness trackers might help patients in reaching these goals. This review aimed to scope current scientific literature on mTechs in CR to assess the impact on patients' exercise capacity and to identify gaps and future directions for research. PubMed, CENTRAL, and CDSR were systematically searched for randomized controlled trials (RCTs). These RCTs had to utilize mTechs to objectively monitor and promote PA of patients during or following CR, aim at improvements in exercise capacity, and be published between December 2014 and December 2019. A total of 964 publications were identified, and 13 studies met all inclusion criteria. Home-based CR with mTechs vs. outpatient CR without mTechs and outpatient CR with mTechs vs. outpatient CR without mTechs did not lead to statistically significant differences in exercise capacity. In contrast, outpatient CR followed by home-based CR with mTechs led to significant improvement in exercise capacity as compared to outpatient CR without further formal CR. Supplying patients with mTechs may improve exercise capacity. To ensure that usage of and compliance with mTechs is optimal, a concentrated effort of CR staff has to be achieved. The COVID-19 pandemic has led to an unprecedented lack of patient support while away from institutional CR. Even though mTechs lend themselves as suitable assistants, evidence is lacking that they can fill this gap.


Assuntos
Reabilitação Cardíaca/métodos , Exercício Físico/fisiologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Smartphone , Telemedicina/métodos
3.
R I Med J (2013) ; 103(9): 30-33, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33126784

RESUMO

BACKGROUND: Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD: Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS: Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS: Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.


Assuntos
Reabilitação Cardíaca/métodos , Infecções por Coronavirus , Terapia por Exercício/métodos , Cardiopatias/reabilitação , Pneumopatias/reabilitação , Pandemias , Pneumonia Viral , Doenças Vasculares/reabilitação , Adaptação Psicológica , Idoso , Betacoronavirus , Terapia por Exercício/organização & administração , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional/métodos , Melhoria de Qualidade , Terapia de Relaxamento/métodos
4.
Environ Health Prev Med ; 25(1): 48, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891113

RESUMO

BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, people need to practice social distancing in order to protect themselves from SARS-CoV-2 infection. In such stressful situations, remote cardiac rehabilitation (CR) might be a viable alternative to the outpatient CR program. METHODS: We prospectively investigated patients hospitalized for heart failure (HF) with a left ventricular ejection fraction of < 50%. As for patients who participated in the remote CR program, telephone support was provided by cardiologists and nurses who specialized in HF every 2 weeks after discharge. The emergency readmission rate within 30 days of discharge was compared among the outpatient CR, remote CR, and non-CR groups, and the EQ-5D score was compared between the outpatient CR and remote CR groups. RESULTS: The participation rate of HF patients in our remote CR program elevated during the COVID-19 pandemic. As observed in the outpatient CR group (n = 69), the emergency readmission rate within 30 days of discharge was lower in the remote CR group (n = 30) than in the non-CR group (n = 137) (P = 0.02). The EQ-5D score was higher in the remote CR group than in the outpatient CR group (P = 0.03) 30 days after discharge. CONCLUSIONS: Remote CR is as effective as outpatient CR for improving the short-term prognosis of patients hospitalized for heart failure post-discharge. This suggests that the remote CR program can be provided as a good alternative to the outpatient CR program.


Assuntos
Reabilitação Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Insuficiência Cardíaca/reabilitação , Pneumonia Viral/epidemiologia , Autocuidado , Telemedicina/métodos , Idoso , Betacoronavirus , Humanos , Japão , Pessoa de Meia-Idade , Monitorização Ambulatorial , Pandemias , Estudos Prospectivos , Telefone
5.
Am J Phys Med Rehabil ; 99(10): 865-869, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32732746

RESUMO

The COVID-19 pandemic affects a large number of patients with a rapid progression of respiratory failure often requiring hospitalization or intensive care unit treatment in some patients. Survivors of severe COVID-19 experience persistent weakness and cardiorespiratory failure. Feasibility and potential benefit of cardiopulmonary rehabilitation after COVID-19 remains unclear. Therefore, we retrospectively analyzed a cohort of COVID-19 patients in a single-center inpatient rehabilitation clinic and describe performance and outcome during cardiopulmonary rehabilitation.Patients were referred from acute care hospitals for rehabilitation after severe COVID-19. The cohort (N = 28) was divided in ventilated or not ventilated patients for further analysis. Fifty percent were female, the mean age was 66 yrs, and patients stayed in the acute hospital for 19.3 ± 10.7 days before referral for cardiopulmonary rehabilitation. Seventeen patients (61%) needed previous intensive care unit treatment in the acute care hospital. Risk factors, assessments, and questionnaires on admission were comparable in both groups. Significant enhancements were observed in 6-min walking test and feeling thermometer, which were independent of previous ventilation status.In conclusion, comprehensive cardiopulmonary rehabilitation after COVID-19 is safe, feasible, and effective. Improvements in physical performance and subjective health status were independent of previous ventilation.


Assuntos
Betacoronavirus , Reabilitação Cardíaca/métodos , Infecções por Coronavirus/reabilitação , Pneumonia Viral/reabilitação , Terapia Respiratória/métodos , Idoso , Infecções por Coronavirus/virologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(31): e20972, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756084

RESUMO

BACKGROUND: Home-based cardiac rehabilitation is considered as an alternative strategy of cardiac rehabilitation, aims to enhance patients participation rate. Since it emphasizes patients subjective initiative, patients require a better understanding of their illness and manage their conditions. We perform this systematic review and meta-analysis to identify the role and effectiveness of the self-management program in home-based cardiac rehabilitation. METHOD: We conduct the search strategy from an online database: PubMed, web of science, CINAL, EMBASE, OVID/Medline, and google scholar. Studies meet the inclusion criterion and published in the English language in recent 10 years will be screened by 2 independent reviewers. Then they extract data and assess the risk of bias. The disagreement between them will be resolved by the third reviewer. Data analysis is performed by Review Manager (Version 5.3). RESULT: This is systematic review and meta-analysis will identify the role of self-management in home-based cardiac rehabilitation program and evaluate its effectiveness. CONCLUSION: The findings of this study will be published in a related peer-reviewed journal.Protocol registration number: INPLASY202050093.


Assuntos
Reabilitação Cardíaca , Serviços de Assistência Domiciliar , Autogestão , Reabilitação Cardíaca/métodos , Humanos , Avaliação de Programas e Projetos de Saúde , Autogestão/métodos
7.
Medicine (Baltimore) ; 99(34): e21592, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846768

RESUMO

OBJECTIVE: This trial aims to evaluate the efficacy and safety of the Baduanjin exercise in patients with acute myocardial infarction (AMI). METHODS: A single-center, open, randomized controlled clinical trial will be conducted to evaluate the effectiveness of the Baduanjin exercise on the rehabilitation of AMI patients. It plans to enroll 64 patients. Patients will be divided evenly into 2 groups using a random number table method. There will be 32 cases in each group. Patients in the experimental group will be treated with standardized drug therapy combined with Baduanjin exercise, while patients in the control group will be treated with standardized drug therapy combined with routine exercise. The primary outcome is the peak oxygen consumption (Peak VO2) during cardiopulmonary exercise test (CPET). The secondary outcomes include CPET, echocardiography, Seattle angina pectoris scale, hospital depression and anxiety scale, Pittsburgh Sleep Quality Index scale, scores of 4 examinations, and diagnostic methods of traditional Chinese medicine and composite endpoint events, etc. DISCUSSION:: This study will be the first to evaluate the effect of the Baduanjin exercise on the Peak VO2 in patients with AMI. STUDY REGISTRATION: This study has been registered on the Chinese Clinical Trial Registry (No: ChiCTR1800016209, protocol version 1.2).


Assuntos
Reabilitação Cardíaca/métodos , Terapia por Exercício , Infarto do Miocárdio/reabilitação , Terapia Combinada , Humanos , Medicina Tradicional Chinesa , Infarto do Miocárdio/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Open Heart ; 7(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32855212

RESUMO

OBJECTIVE: The COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity. METHODS: We analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision. RESULTS: There has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation. CONCLUSIONS: As ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.


Assuntos
Reabilitação Cardíaca , Cardiologia , Doenças Cardiovasculares , Infecções por Coronavirus , Assistência à Saúde , Pandemias , Pneumonia Viral , Medicina Estatal , Betacoronavirus/isolamento & purificação , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/estatística & dados numéricos , Cardiologia/métodos , Cardiologia/organização & administração , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/reabilitação , Procedimentos Clínicos/tendências , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/reabilitação , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Reino Unido
9.
J Cardiopulm Rehabil Prev ; 40(5): 285-286, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32804796

RESUMO

PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death. METHODS: Daily PA of 24 patients was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems. RESULTS: During the forced 40-d in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-d confinement-free period (1.2 ± 0.3 vs 1.6 ± 0.5 hr/d, respectively, P = .0001). CONCLUSIONS: This objective quantification of the impact of the COVID-19 pandemic on PA determined by an ICD device showed an abrupt and statistically significant reduction of PA in primary prevention ICD patients, during the in-home confinement quarantine. To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs.


Assuntos
Reabilitação Cardíaca , Infecções por Coronavirus , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Exercício Físico/fisiologia , Pandemias , Pneumonia Viral , Telerreabilitação/organização & administração , Idoso , Betacoronavirus , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Cardioversão Elétrica/instrumentação , Feminino , Humanos , Itália/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/métodos
10.
PLoS One ; 15(8): e0237197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790796

RESUMO

BACKGROUND: Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. DESIGN: Observational study. METHODS: We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. RESULTS: Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). CONCLUSION: The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.


Assuntos
Reabilitação Cardíaca/métodos , Aptidão Cardiorrespiratória , Terapia por Exercício/métodos , Idoso , Redes Comunitárias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
11.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(4): 193-197, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195080

RESUMO

INTRODUCCIÓN: La educación interprofesional favorece que profesionales de diversas disciplinas trabajen en conjunto para mejorar el abordaje terapéutico del paciente. OBJETIVO: Valorar el desempeño de los alumnos de fisioterapia y medicina sobre el trabajo interprofesional durante un escenario de simulación para el manejo de la rehabilitación cardíaca con paciente estandarizado. Sujetos y métodos: Participaron un total de 331 alumnos de medicina y fisioterapia. Se diseñó un escenario de simulación sobre rehabilitación cardíaca, una lista de comprobación de habilidades y una encuesta de opinión. Se formaron equipos compuestos por alumnos de ambas licenciaturas y se calcularon los porcentajes de ambos instrumentos. RESULTADOS: Para los alumnos de medicina, el ítem que obtuvo mayor respuesta fue el 1 (82,3%), mientras que el que tuvo menor respuesta fue el ítem 6 (27,8%). Para los alumnos de fisioterapia, el ítem 7 tuvo el mayor porcentaje (100%), mientras que el que tuvo menor porcentaje fue el ítem 6 (16,7%). Las opiniones favorables se obtuvieron en un 90% de calificación entre el totalmente de acuerdo y de acuerdo. CONCLUSIÓN: Se requiere diseñar escenarios e instrumentos que permitan valorar el trabajo interprofesional y documentar los resultados, así como el desarrollo de estudios longitudinales que muestren la efectividad de la educación interprofesional en profesionales de salud


INTRODUCTION: Interprofessional education encourages professionals from various disciplines to work together to improve the patient's therapeutic approach. AIM: To assess the performance of physiotherapy and medicine students on interprofessional work during a simulation scenario for the management of cardiac rehabilitation with a standardized patient. Subjects and methods: A total of 331 medical and physical therapy students participated. A simulation scenario on cardiac rehabilitation, a skills checklist, and opinion survey were designed. Teams made up of students from both degrees were formed and percentages of both instruments were calculated. RESULTS: For medical students, the item with the highest response was 1 (82.3%), while the item with the lowest response was item 6 (27.8%). For physiotherapy students, item 7 had the highest percentage (100%), while the one with the lowest percentage was item 6 (16.7%). The favorable opinions were obtained in a 90% rating between the totally agree and agree. CONCLUSION: It is required to design scenarios and instruments that allow evaluating interprofessional work and documenting the results, as well as the development of longitudinal studies that show the effectiveness of interprofessional education in health professionals


Assuntos
Humanos , Reabilitação Cardíaca/métodos , Simulação de Paciente , Educação de Graduação em Medicina , Estudantes de Medicina/estatística & dados numéricos , Educação Interprofissional/métodos , Fisioterapia/educação , Estudos Transversais , Relações Médico-Paciente , Inquéritos e Questionários , México
13.
PLoS One ; 15(7): e0235274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628688

RESUMO

The aim of this study is to explore participants' views and experiences of an eHealth phase 3 cardiac rehabilitation (CR) intervention: Physical Activity Towards Health (PATHway). Sixty participants took part in the PATHway intervention. Debriefs were conducted after the six-month intervention. All interviews were audio recorded and transcribed verbatim. Transcripts were analysed with Braun and Clarke's thematic analysis. Forty-four (71%) debriefs were conducted (n = 34 male, mean (SD) age 61 (10) years). Five key themes were identified: (1) Feedback on the components of the PATHway system, (2) Motivation, (3) Barriers to using PATHway, (4) Enablers to using PATHway, and (5) Post programme reflection. There were a number of subthemes within each theme, for example motivation explores participants motivation to take part in PATHway and participants motivation to sustain engagement with PATHway throughout the intervention period. Participant engagement with the components of the PATHway system was variable. Future research should focus on optimising participant familiarisation with eHealth systems and employ an iterative approach to development and evaluation.


Assuntos
Reabilitação Cardíaca/psicologia , Doenças Cardiovasculares/psicologia , Exercício Físico/psicologia , Telemedicina/métodos , Idoso , Reabilitação Cardíaca/métodos , Convalescença/psicologia , Retroalimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Pesquisa Qualitativa , Inquéritos e Questionários
15.
Arch Cardiol Mex ; 90(Supl): 100-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523138

RESUMO

The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.


Assuntos
Cardiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Reabilitação Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/virologia , Humanos , México , Pandemias , Sociedades Médicas
16.
J Rehabil Med ; 52(7): jrm00083, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32511741

RESUMO

OBJECTIVE: To investigate the relation between body mass index class and changes in health-related quality of life in patients participating in cardiac rehabilitation. DESIGN: Prospective cohort study. PATIENTS: A total of 503 patients with acute coronary syndrome. METHODS: Data from the OPTICARE trial were used, in which health-related quality of life was measured with the MacNew Heart Disease HRQOL Instrument at the start, directly after, and 9 months after completion of cardiac rehabilitation. Patients were classed as normal weight, overweight, or obese. RESULTS: During cardiac rehabilitation, global health-related quality of life improved in patients in all classes of body mass index. Patients classed as overweight had a significantly greater improvement in social participation than those classed as normal weight (5.51-6.02 compared with 5.73-5.93, respectively; difference in change 0.30, p = 0.025). After completion of cardiac rehabilitation, health-related quality of life continued to improve similarly in patients in all classes of body mass index. CONCLUSION: Health-related quality of life improved during cardiac rehabilitation in patients of all classes of body mass index. Patients classed as overweight showed the greatest improvement. The beneficial effects were maintained during extended follow-up after completion of cardiac rehabilitation.


Assuntos
Síndrome Coronariana Aguda/psicologia , Síndrome Coronariana Aguda/terapia , Índice de Massa Corporal , Reabilitação Cardíaca/métodos , Qualidade de Vida/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Obesity (Silver Spring) ; 28(7): 1245-1253, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475048

RESUMO

OBJECTIVE: This study aimed to investigate the effect of exercise intensity on visceral adipose tissue (VAT) and liver fat reduction in patients with coronary artery disease (CAD) over 3 months and the maintenance of improvements over 12 months. METHODS: Forty-two participants with CAD were randomized to three sessions/week of either 4 × 4-minute high-intensity interval training (HIIT) or 40 minutes of usual care moderate-intensity continuous training (MICT) for a 4-week supervised cardiac rehabilitation program, followed by three home-based sessions/week for 11 months. Liver fat (as intrahepatic lipid) and VAT were measured via magnetic resonance techniques. Data are mean change (95% CI). RESULTS: HIIT and MICT significantly reduced VAT over 3 months (-350 [-548 to -153] cm3 vs. -456 [-634 to -278] cm3 ; time × group effect: P = 0.421), with further improvement over 12 months (-545 [-818 to -271] cm3 vs. -521 [-784 to -258] cm3 ; time × group effect: P = 0.577) and no differences between groups. Both groups improved liver fat over 3 months, with HIIT tending to show greater reduction than MICT (-2.8% [-4.0% to -1.6%] vs. -1.4% [-2.4% to -0.4%]; time × group effect: P = 0.077). After 12 months, improvements were maintained to a similar degree. Higher exercise intensity predicted liver fat reduction (ß = -0.3 [-0.7 to 0.0]; P = 0.042). CONCLUSIONS: HIIT and MICT reduced VAT over 3 and 12 months. For liver fat, HIIT tended to provide a slightly greater reduction compared with MICT. These findings support HIIT as a beneficial adjunct or alternative to MICT for reducing visceral and liver fat in patients with CAD.


Assuntos
Tecido Adiposo/metabolismo , Reabilitação Cardíaca/métodos , Doença da Artéria Coronariana/terapia , Treinamento Intervalado de Alta Intensidade/métodos , Gordura Intra-Abdominal/patologia , Fígado/metabolismo , Adiposidade/fisiologia , Idoso , Composição Corporal/fisiologia , Feminino , Humanos , Gordura Intra-Abdominal/metabolismo , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Resultado do Tratamento
18.
Can J Cardiol ; 36(8): 1317-1321, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32553606

RESUMO

Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and repurposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed before COVID-19, and to improve cardiac rehabilitation delivery, moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.


Assuntos
Reabilitação Cardíaca , Doenças Cardiovasculares , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Telerreabilitação , Betacoronavirus , Canadá , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/organização & administração , Modelos Organizacionais , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medição de Risco , Telerreabilitação/métodos , Telerreabilitação/organização & administração
19.
Isr Med Assoc J ; 22(6): 357-363, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32558441

RESUMO

BACKGROUND: Cardiac rehabilitation (CR) is underutilized globally despite evidence of clinical benefit. Major obstacles for wider adoption include distance from the rehabilitation center, travel time, and interference with daily routine. Tele-cardiac rehabilitation (tele-CR) can potentially address some of these limitations, enabling patients to exercise in their home environment or community. OBJECTIVES: To evaluate the clinical and physiological outcomes as well as adherence to tele-CR in patients with low cardiovascular risk and to assess exercise capacity, determined by an exercise stress test, using a treadmill before and following the 6-month intervention. METHODS: A total of 22 patients with established coronary artery disease participated in a 6-month tele-CR program. Datos Health (Ramat Gan, Israel), a digital health application and care-team dashboard, was used for remote monitoring, communication, and management of the patients. RESULTS: Following the 6-month tele-CR intervention, there was significant improvement in exercise capacity, assessed by estimated metabolic equivalents with an increase from 10.6 ± 0.5 to 12.3 ± 0.5 (P = 0.002). High-density lipoproteins levels significantly improved, whereas low-density lipoproteins, triglyceride, glycosylated hemoglobin, and systolic and diastolic blood pressure levels were not significantly changed. Exercise adherence was consistent among patients, with more than 63% of patients participating in a moderate intensity exercise program for 150 minutes per week. CONCLUSIONS: Patients who participated in tele-CR adhered to the exercise program and attained clinically significant functional improvement. Tele-CR is a viable option for populations that cannot, or elect not to, participate in center-based CR programs.


Assuntos
Reabilitação Cardíaca/métodos , Doença da Artéria Coronariana/reabilitação , Terapia por Exercício , Aplicativos Móveis , Telemedicina , Reabilitação Cardíaca/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Resultado do Tratamento
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