Can influence anxiety and depression the six-minute walking test performance in post-surgical heart valve patients? A pilot study

Various functional indicators are utilized to measure outcome in cardiac rehabilitation. Little information exists regarding the role played by psychological variables during the rehabilitative period, after cardiac valve surgery. The present study aims at exploring the relationship existing between different levels of functional capacity measured by six-minute walking test, (6MWT) and emotional aspects such as anxiety and depression. Materials and methods. 126 post-surgical heart valve patients underwent at the beginning and at the end of the rehabilitative programme: 1) 6MWT; 2) assessment of anxiety and depression (A-D Questionnaire according to the CBA-2.0 Primary Scale). Results. Cardiac rehabilitation was associated with a general and significant improvement in the 6MWT (273+98 metres versus 363+96; p<0.001) and the functional performance parameters (diastolic blood pressure; p<0.001 and fatigue p<0.001). Simultaneously there was a significant improvement of patient-reported quality of life, revealed by the A-D questionnaire in both male and female patients. The Depression Questionnaire score is predictive of functional capacity. It was demonstrated that no matter what the clinical condition of the patient, the depression score influences the patient’s performance during the 6MWT, not only regards the distance covered (p=.008), but also fatigue expressed by the Borg RPE index (p=.044). Conclusion. Depression, an emotional variable, selfevaluated by the standardized questionnaire can, even if only partially, influence the 6MWT, a functional indicator of exercise tolerance, widely utilized in cardiac rehabilitation

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs

Entanglement entropy in a periodically driven Ising chain

In this work we study the entanglement entropy of a uniform quantum Ising chain in transverse field undergoing a periodic driving of period \u3c4. By means of Floquet theory we show that, for any subchain, the entanglement entropy tends asymptotically to a value \u3c4-periodic in time. We provide a semi-analytical formula for the leading term of this asymptotic regime: It is constant in time and obeys a volume law. The entropy in the asymptotic regime is always smaller than the thermal one: because of integrability the system locally relaxes to a generalized Gibbs ensemble (GGE) density matrix. The leading term of the asymptotic entanglement entropy is completely determined by this GGE density matrix. Remarkably, the asymptotic entropy shows marked features in correspondence to some non-equilibrium quantum phase transitions undergone by a Floquet state analog of the ground state

Il protocollo “CardioLavoro” per la valutazione del reinserimento lavorativo dopo evento cardiaco acuto: dati a 12 mesi

A multidisciplinary protocol (“CardioWork”) for work resumption after cardiosurgery (for ischaemic heart disease or valvulopathy) and cardiological rehabilitation was applied. 101 patients (93% males; 7% females) in working age (mean 50 years) were enrolled. The education level was medium-high. The patients underwent psychological and occupational medicine evaluation collecting personal data, cardiovascular risk factors, comorbility, cardiologic and occupational history. The jobs were classified as multiples of basal metabolism (METS), according to the entity of physical strain: in the 71% of patients the tasks were defined as sedentary (< 2 METS) or light (2-4 METS). These data were integrated with those obtained from instrumental cardiological evaluation (24 hours Holter ECG, echocardiography, treadmill ergometric testing) to formulate indications regarding the timing and modality of work resumption, and possible limitations to job fitness. The patients have been re-evaluated after 12 months: 84% of them have resumed working. Among these, only 8% required a change of the previous tasks. A very high compliance (almost 100%) with our indications was observed. These data strongly confirm that the intervention of the occupational physician in the rehabilitative process after cardiosurgery may optimize the evaluation of the patients’ ergonomic capacity aimed at work resumption

Reinserimento lavorativo dopo angioplastica coronarica o cardiochirurgia: aggiornamento dei dati del protocollo “CardioLavoro”

Il miglioramento della prognosi delle malattie cardiovascolari determina aumento dei casi cronicizzati in età lavorativa, ponendo il problema del giudizio di idoneità al lavoro. Presso il nostro Istituto è operativo dal 2005 un protocollo multi-disciplinare denominato “CardioLavoro”, finalizzato al reinserimento dopo evento cardiaco acuto e successiva riabilitazione. Sono qui aggiornati i dati presentati al congresso SIMLII 2009. Il dato più rilevante è l’elevata percentuale di soggetti che riprendono il lavoro (circa il 90%) e il breve tempo in cui questo avviene, con ripresa lavorativa anche per i meno giovani e per chi svolgeva mansioni pesanti. Il dispendio energetico dell’attività precedente è il parametro che maggiormente condiziona i tempi di ripresa. Si conferma l’utilità dell’approccio interattivo tra cardiologo e medico del lavoro, finalizzato al reinserimento di pazienti sottoposti a trattamenti cardiologici invasivi, adattando l’attività lavorativa alle mutate capacità funzionali

Elettrocardiografia da sforzo nella sorveglianza sanitaria di lavoratori con impegnativo dispendio energetico

To evaluate the opportunity of exercise electrocardiography (ECG) in the sanitary surveillance of workers with physical strain, we estimated the energy consumption of the duties of 22 electrical workers (males; age: 35-56 years). They subsequently underwent Treadmill exercise ECG, determining for each worker the maximal METs (multiples of basal metabolism) and the critical potency (P(CRIT)). In one subject, myocardial ischemia arose 9 minutes after the beginning of the test. The others interrupted the test after 7-13 minutes for tiring; 5 of them showed ventricular extra systoles, paired or isolated. Twelve subjects presented arterial hypertension, at rest and/or during exercise. Ergonomic analysis revealed that the occupational duties were between 1.5 and 8.0 METs. The energy consumption of the job on the whole was 4-6 METs (medium intensity). The maximal METs reached by the examined subjects were between 8.8 and 15.6; however, only 11 workers went reassuringly over the 4 METs required by duty analysis at P(CRIT). One subject was declared unfit for the job, and a judgement of partial idoneity was expressed for 3 workers. Preventive and therapeutic indications were given to 12 subjects. Aerobic training was suggested to 10 workers. The study indicates that an ergonomic evaluation is advisable for the most energy consuming occupational duties. In such cases, the sanitary surveillance should include a cardiologic assessment with exercise ECG, reproducing the physical strain of the specific job

Un nuovo test (VITTORIO Test) per la valutazione dell’efficienza fisica in soggetti ammessi a programmi di riabilitazione dopo intervento di chirurgia cardiaca

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery. G. Calsamiglia, F. Camera, A. Mazza, P. Villa, F. Gigli Berzolari, R. Tramarin, F. Cobelli. An adequate assessment of physical function (PF) in Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs