An Evaluation of 12-months in Phase IV Cardiac Rehabilitation

Abstract Aims To evaluate key health and fitness parameters of cardiac patients participating in a Phase IV cardiac rehabilitation (CR) circuit class over a 12-month period. Introduction: Exercise-based CR is a fundamental part of recovery from heart-related issues and is also an important secondary prevention strategy for risk factor management. Methods 25 cardiac patients referred to a community Phase IV CR circuit class (males = 16; females = 9; mean age 74.1 ±5.9 years) were evaluated for key health and functional capacity parameters over a 12-month period (2018 and 2019). Anthropometric: body mass index [BMI] and waist circumference [WC]; health: resting systolic [SBP], diastolic blood pressure [DBP) and resting heart rate [RHR]; and functional capacity measurement: 6-minute shuttle walking distance [6MWD]. Results BMI, WC, SBP, DBP and RHR did not significantly change. BMI was reported in an overweight classification (26.41 ±2.98 kg.m2). 40% of participants had a WC that exceeded recommended levels for substantially increased health risk (females ≥ 88 cm; males ≥ 102 cm). SBP and DBP both decreased and remained in a normotensive range. However, 6MWD significantly increased from 492.16 ±79.97 m to 509.20 ± 90.85 m (p=0.037). Conclusion A once a week circuit-based exercise training session did not positively impact on anthropometric and health parameters. Additional interventions are needed at Phase IV to effectively manage risk factors (BMI, WC) and to preserve health. However, functional capacity improvement was achieved in 6MWD indicating increased fitness. [email protected]

Staying alive: The meaning of a cardiac rehabilitation exercise group

Exercise is considered to be a cornerstone intervention in cardiac rehabilitation, which is normally delivered through exercise groups run by clinical staff. Continued attendance at community exercise groups is therefore important in maintaining this lifestyle change (Clark, Mundy, Catto, & MacIntyre, 2010; Martin & Woods, 2012; Thow, Rafferty, & Kelly, 2008). The aim of this study was to explore what makes cardiac patients stay with an exercise group. Two focus groups were conducted with 25 cardiac rehabilitation exercise group participants (mean age = 61, SD = 10.42) from two exercise groups in England, the questions focused on what makes them return to the group and what they perceived to be benefits of the group exercise. Thematic analysis demonstrated that the structure of the exercise group was the main source why exercisers returned to the group, this included the six sub-themes social support, routine, progression, enjoyment, leadership skills, and health benefits. Confidence, survival, and getting back to normality were identified as perceived benefits of the exercise group. Participants felt that the exercise groups helped them getting back to normality and without the exercise groups they would not achieve the required exercise prescription. This study demonstrates the importance of exercise groups in the process of changing cardiac patients’ lifestyle and getting them back to normality. The group environment appears to contribute to longer term adherence to community organised cardiac rehabilitation exercise, and group leaders could be educated on how to facilitate social support, progression, and they could help to increase group participants’ confidence

The therapeutic effects of multimodal exercise for people with Parkinson's: A longitudinal community-based study

Abstract Introduction Individuals with Parkinson’s Disease (PD) can develop a range of motor and non-motor symptoms due to its progressive nature and lack of effective treatments. Exercise interventions, such as multimodal (MM) programmes, may improve and sustain physical or cognitive function in PD. However, studies usually evaluate physical performance, cognition, and neuroprotective biomarkers separately and over short observation periods. Methods Part one evaluates the effects of a weekly community-based MM exercise class (60 min) on physical function in people with PD (PwP). Exercise participants (MM-EX; age 65 ± 9 years; Hoehn and Yahr (H&Y) scale ≤ IV) completed a battery of functional assessments every 4 months for one (n = 27), two (n = 20) and three years (n = 15). In part two, cognition and brain-derived neurotrophic factor (BDNF) levels were assessed over 6-to-8 months and compared to aged-matched non-active PwP (na-PD, n = 16; age 68 ± 7 years; H&Y scale ≤ III) and healthy older adults (HOA, n = 18; age 61 ± 6 years). Results MM-EX significantly improved walking capacity (5% improvement after 8 months), functional mobility (11% after 4 months), lower extremity strength (15% after 4 months) and bilateral grip strength (9% after 28 months), overall, maintaining physical function across 3 years. Group comparisons showed that only MM-EX significantly improved their mobility, lower extremity strength, cognition and BDNF levels. Conclusion Weekly attendance to a community-based MM exercise group session can improve and maintain physical and cognitive function in PD, with the potential to promote neuroprotection

Singing and COPD: a pilot randomized controlled trial of wellbeing and respiratory outcomes

Aims/objectives To test whether a ten-week regular weekly group singing programme, with guided home practice, leads to improvement in COPD-specific health status, as assessed by the COPD Assessment Test (CAT, primary outcome). To test whether the programme results in changes to health-related quality of life, mental health, breathlessness, lung function, functional exercise performance and breathing patterns (secondary outcomes). Rationale A number of randomized controlled trials (RCTs) exist which suggest that there are potential benefits to health and wellbeing of regular singing for people with COPD (Chronic Obstructive Pulmonary Disease). However, most rely on small samples, and findings across the different outcome measures are inconsistent, while interview studies tend to report consistent positive physical and psychological outcomes. Further research is therefore needed. Approach A single-blind, randomized controlled trial compared a structured, weekly group singing programme plus home practice between sessions over ten weeks, with a usual COPD treatment control. The sample was drawn from a local NHS population of people with COPD. Following baseline assessments, participants were allocated to a 10-week singing programme or a control. Findings Twenty-four individuals completed to follow-up. Measures at 12 weeks showed no significant differences between singing and control groups except for one item on the health status questionnaire (SF-36) which suggested the singers were less limited in their activities of daily living post-singing. Final follow-up, planned for 6 months post intervention, was aborted due to the COVID-19 pandemic. Discussion and conclusion The study failed to recruit to target. There remains a recruitment problem in RCTs of singing for COPD, resulting in inconclusive findings, which conflict with the positive qualitative evidence. A wide variety of research methods, as well as RCTs, are suggested to enable a better understanding of the impact of singing on COPD