Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study.

OBJECTIVE: To determine the feasibility of a cardiac prehabilitation (Prehab) program for patients waiting for elective coronary artery bypass graft (CABG). DESIGN: A two-group parallel randomized controlled trial. SETTING: Medical fitness facility. SUBJECTS: Seventeen preoperative elective CABG surgery patients were randomized to standard care (n = 9) or Prehab (n = 8). INTERVENTION: Standard care: three-hour preassessment appointment. Prehab: exercise and education classes for 60 minutes/day, twice weekly for at least four weeks. MAIN MEASURES: Data were collected at baseline, one week preoperatively, and three months postoperatively. The primary outcome measure was walking distance using a 6-minute walk test. Secondary outcome variables included 5-meter gait speed, and cardiac rehabilitation attendance three months postoperatively. RESULTS: Fifteen patients (standard care, n = 7; Prehab, n = 8) completed the study. No Prehab patients developed cardiac symptoms during study participation. Walking distance remained unchanged in the standard care group; whereas, the Prehab group increased their walking distance to mean ± SD 474 ±101 and 487 ±106 m at the preoperative and three month postoperative assessments (p < 0.05). Gait speed was unchanged in the standard care group, but improved in the Prehab group by 27% and 33% preoperatively and three months postoperatively, respectively (p < 0.05). Enrollment in cardiac rehabilitation three months postoperatively was higher for Prehab participants (100%) than standard care participants (43%; p < 0.05). CONCLUSION: These data provide evidence for the feasibility of a Prehab intervention to improve the health status of patients waiting for elective CABG surgery. A larger trial of 92 patients will be utilized to demonstrate the safety and efficacy of Prehab.

Effects of a long-term, community-based cardiac rehabilitation program on middle-aged and elderly cardiac patients.

The purpose of this retrospective study was to compare the effects of a 2-year, community-based cardiac rehabilitation exercise program on cardiovascular fitness, body fatness, and blood lipids in middle-aged (65 years, n=40) male cardiac patients. Estimated maximal metabolic equivalents increased in both groups; however, the increase was greater for middle-aged patients (p=0.003). High-density lipoprotein cholesterol level increased significantly after 1 year in both groups, but the change was greater for the middle-aged subjects by Year 2 (p=0.02). The total cholesterol/high-density lipoprotein cholesterol ratio and serum triglyceride levels decreased in both groups, whereas total cholesterol and low-density lipoprotein cholesterol levels decreased only in the elderly group (p<0.01). Body fatness did not change in either group. These findings reinforce the importance of referring elderly as well as middle-aged patients to community-based cardiac rehabilitation exercise programs.

Relationship of functional fitness with daily steps in community-dwelling older adults.

BACKGROUND: Walking is the main type of physical activity among community-dwelling older adults and it is associated with various health benefits. However, there is limited evidence about the relationship between functional fitness and walking performed under independent living conditions among older adults. PURPOSE: This study examined the relationship between functional fitness and steps walked per day among older adults, both assessed objectively, with performance-based measures accounting for the effect of age, gender, and chronic conditions. METHODS: In this cross-sectional study, 60 participants aged 65 years or older (mean = 76.9 ± 7.3 years, range 65-92 years) wore pedometers for 3 consecutive days. Functional fitness was measured using the Functional Fitness Test (lower and upper body strength, endurance, lower and upper body flexibility, agility/balance). The outcome measure was the mean number of steps walked for 3 days with participants classified into tertiles: low walkers (<3000 steps), medium walkers (≥3000 < 6500 steps), and high walkers (≥6500 steps). RESULTS: After controlling for age, gender, and the number of chronic conditions, none of the functional fitness parameters was significantly associated with steps taken per day when comparing medium walkers with low walkers. In contrast, all functional fitness parameters, except upper body flexibility, were significantly associated with steps taken per day when comparing high walkers with low walkers. CONCLUSION: In this sample of older adults, greater functional fitness was associated only with relatively high levels of walking involving 6500 steps per day or more. It was not related to medium walking levels. The findings point to the importance of interventions to maintain or enhance functional fitness among older adults.

The economic benefits of risk factor reduction in Canada: tobacco smoking, excess weight and physical inactivity.

OBJECTIVE: Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to apply a recently developed approach in addressing the issue of double counting in estimating the combined current economic burden of these risk factors (RFs) and to estimate the economic benefits of long-term RF reduction in Canada. METHODS: We used an approach based on population attributable fractions (PAF) to estimate the economic burden associated with the various RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling when available. Excess weight was modelled as a trichotomous exposure (normal weight, overweight, obese) while tobacco smoking was modelled as a tetrachotomous exposure (non-smoker, light, medium or heavy smoker). All costs are given in constant 2012 Canadian dollars. RESULTS: The annual economic burden of the RFs of tobacco smoking, excess weight and physical inactivity in Canada are estimated at $50.3 billion in 2012. Sensitivity analysis suggests a range for the economic burden of $41.6 to $58.7 billion. Of the $50.3 billion, $21.3 ($20.0 to $22.6) billion is attributable to tobacco smoking, $19.0 ($13.8 to $24.0) billion to excess weight and $10.0 ($7.8 to $12.0) billion to physical inactivity. A 1% relative annual reduction in each of the three RFs would result in an $8.5 billion annual reduction in economic burden by 2031. CONCLUSION: A modest annual 1% relative reduction in the RFs of tobacco smoking, excess weight and physical inactivity can have a substantial health and economic impact over time at the population level.

Energy expenditure during golfing and lawn mowing in older adult men.

This study compared the intensity and energy cost of playing 9 holes of golf with 40 min of lawn mowing in older men and determined whether both met the current recommendations for health benefits. Eighteen men (age 71.2 +/- 4.4 yr, BMI 27.3 +/- 2.3; M +/- SD) completed a graded treadmill test. During golfing and lawn-mowing field tests, oxygen consumption and walking velocity and distance were measured using a portable metabolic system and global positioning system receiver. The net energy costs of golfing and lawn mowing were 310 and 246 kcal, respectively. The average intensities in metabolic equivalents of golfing and lawn mowing were 2.8 +/- 0.5 and 5.5 +/- 0.9, respectively. Both lawn mowing and golfing met the original intensity and energy expenditure requirements for health benefits specified by the American College of Sports Medicine in 1998, but only lawn mowing met the 2007 intensity recommendations.

Personal factors, perceived environment, and objectively measured walking in old age.

This study examined the associations between walking behavior and the perceived environment and personal factors among older adults. Sixty participants age 65 yr or older (mean 77 +/- 7.27, range 65-92) wore pedometers for 3 consecutive days. Perceived environment was assessed using the Neighborhood Environment Walkability Scale (abbreviated version). Physical function was measured using the timed chair-stands test. The mean number of steps per day was 5,289 steps (SD = 4,029). Regression analyses showed a significant association between personal factors, including physical function (relative rate = 1.05, p < .01) and income (RR = 1.43, p < .05) and the average daily number of steps taken. In terms of perceived environment, only access to services was significantly related to walking at the univariate level, an association that remained marginally significant when controlling for personal characteristics. These results suggest that among this sample of older adults, walking behavior was more related to personal and intrinsic physical capabilities than to the perceived environment.

Canada's physical activity guide recommendations are a low benchmark for Manitoba adults.

Canada's Physical Activity Guide to Healthy Active Living (CPAG) is the national reference for messaging on physical activity for health benefits, yet few studies have examined population activity levels in relation to its recommendations. As part of the province-wide in motion initiative, we obtained a baseline measurement of the physical activity levels of adult Manitobans. Physical activity levels were benchmarked against CPAG recommendations and were compared with criteria used in previous surveys. A stratified random sample of adults from the 9 Regional Health Authorities outside of Winnipeg, and from the 12 Community Areas within the Winnipeg Health Region, was surveyed by telephone. Respondents (n = 6,536) reported all light, moderate, and vigorous physical activity of 10 min or more in the previous week. Intensity levels were corrected to reflect standard MET equivalents, using the Ainsworth Compendium. A total of 69.5% of respondents met the minimum CPAG requirements; however, only 29.1% of those did so with vigorous activity. Relative to energy expenditure, 18.3% were classified as inactive (<1.50 kcal.kg-1.day-1 (KKD)), 16.4% as moderately active (1.50 to 2.99 KKD), and 65.3% as active (>or=3.00 KKD). When assessed against the CPAG recommendations, which promote integration of physical activity into one's daily routine, a higher proportion of Manitobans met recommended physical activity levels than that reported in previous surveys, which focused on leisure activity. Given the corresponding increase in levels of obesity and chronic disease, and equivocal nutrient intake data, we recommend that the CPAG recommendations be reviewed, especially with respect to the inclusion of routine baseline activities of daily living.

The effects of a moderate physical activity program on thermoregulatory responses in a warm environment in men.

Moderate intensity training induces health benefits, but its influence on thermoregulatory responses during exercise in a warm environment is unclear. Twelve inactive men (mean age 24.0 +/- 6.5 yrs) underwent exercise heat tests, and peak VO2 tests, before and after a moderate training program (n= 8) or no training intervention (n = 4). Assignment to groups was random. All subjects were initially below the guidelines for physical activity set forth by Health Canada, the Canadian Society for Exercise Physiology (CSEP), and the U.S. Surgeon General. Those in the 12-week training program participated in activities such as cycling, walking, and recreational sports. Subjects were instructed to train at 50% VO2 reserve, and to gradually increase energy expenditure beyond the above mentioned recommendations. In the training group, peak VO2 increased 13%, p < 0.01, and resting peripheral blood flow during heat stress increased, p < 0.01, indicating some initial thermoregulatory benefits. No significant differences were observed in esophageal temperature or sweating threshold. Health benefits associated with thermoregulatory adaptations to exercise in a warm environment may require more vigorous exercise than recommended by current physical activity guidelines.

Adoption of Canada's Physical Activity Guide and Handbook for Older Adults: impact on functional fitness and energy expenditure.

This study investigated whether a behaviour change program, based on Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults (Health Canada, 1999a), would elicit greater benefits than adoption of the guide and handbook alone. Fifteen older adults received the guide and accompanying handbook and completed the 8-week behaviour change program (mean age 73.2 +/- 5.2 yrs), while 14 others received only the guide and handbook (mean age 76.8 +/- 10.0 yrs). Functional fitness (lower body strength/endurance, flexibility, agility/dynamic balance) (Rikli and Jones, 1999), and estimated energy expenditure (DiPietro et al., 1993) were measured at baseline and after 8 weeks. Lower body strength/endurance and agility/dynamic balance differed between groups at baseline, p < 0.05. All three functional fitness tests improved in both groups over time, p< 0.05. Estimated energy expended in physical activity increased in both groups over time, p < 0.05; however, there was a significantly greater increase in the behaviour-change group (Group x Time interaction, p < 0.05). Participant response to using the guide and handbook was positive. These results indicate that introduction to Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults leads to benefits, whether or not accompanied by program supports. The group receiving the behaviour change program had a greater increase in energy expenditure, which suggests that such an intervention may ultimately lead to greater health benefits.