Clinical Study The Effect of Park and Urban Environments on Coronary Artery Disease Patients: A Randomized Trial

Aim. To test the hypothesis that walking in a park has a greater positive effect on coronary artery disease (CAD) patients' hemodynamic parameters than walking in an urban environment. Methods. Twenty stable CAD patients were randomized into two groups: 30-minute walk on 7 consecutive days in either a city park or busy urban street. Wilcoxon signed-rank test was employed to study short-term (30 min) and cumulative changes (following 7 consecutive days of exposure) in resting hemodynamic parameters in different environments. Results. There were no statistically significant differences in the baseline and peak exercise systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), exercise duration, or HR recovery in urban versus park exposure groups. Seven days of walking slightly improved all hemodynamic parameters in both groups. Compared to baseline, the city park group exhibited statistically significantly greater reductions in HR and DBP and increases in exercise duration and HR recovery. The SBP and DBP changes in the urban exposed group were lower than in the park exposed group. Conclusions. Walking in a park had a greater positive effect on CAD patients' cardiac function than walking in an urban environment, suggesting that rehabilitation through walking in green environments after coronary events should be encouraged

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology

Aims: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature ofprogrammes, and to compare these by European region (geoscheme) and with other high-income countries.Methods: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engagedto facilitate programme identification. Density was computed using global burden of disease study ischaemic heartdisease incidence estimates. Four high-income countries were selected for comparison (N¼790 programmes) toEuropean data, and multilevel analyses were performed.Results: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8%country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey.Programme volumes (median 300) were greatest in western European countries, but overall were higher than inother high-income countries (

Cardiac Rehabilitation Availability and Density around the Globe

BackgroundDespite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.MethodsA survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.FindingsCR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N?=?1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p

Cardiac Rehabilitation Availability and Delivery in Europe: How does it Differ by Region and Compare to other High-Income Countries?

Aims To establish:(1a) CR availability and density, as well as (1b) the nature of programs, and (2) compare these (a) by European region (geoscheme) and (b) to other high-income countries (HICs).Methods A survey was administered to CR programs globally. Cardiac associations were engaged to facilitate program identification. Density was computed using Global Burden of Disease study ischemic heart disease (IHD) incidence estimates. Four HICs were selected for comparison (N=790programs)to European data, and multi-level analyses performed. Results CR was available in 40/44(90.9%)European countries. Data were collected in 37(94.8% country response rate). 455/1538 (29.6%response rate) program respondents initiated the survey. Program volumes (median=300) were greatest in Western European countries, but overall were higher than other HICs (p<.001).Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programs were funded by social security (n=25, 59.5%; with significant regional variation, p<0.001), but in 72 (16.0%) patients paid some or all of program costs (or ~ 18.5%of the ~€150.0/program) out-of-pocket. Guideline-indicated conditions were accepted in ≥70% of programs (lower for stable coronary disease), with 4no regional variation. Programs had a multidisciplinary team of 6.5±3.0 staff (number and type varied regionally; and European programs had more staff than other HICs), offering 8.5±1.5/10 core components (consistent with other HICs) over 24.8±26.0hours (regional differences, p<0.05). Conclusion European CR capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally