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 (&gt;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

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

Il protocollo “CardioLavoro” per il reinserimento lavorativo del cardiopatico: follow-up a 10 anni

Introduzione Presso il nostro Istituto è attivo dal 2005 un protocollo denominato “CardioLavoro”, in cui sono arruolati soggetti operati per rivascolarizzazione miocardica (angioplastica o by-pass) o valvulopatia: definito il profilo funzionale, il medico del lavoro analizza l’attività lavorativa precedente l’evento cardiopatologico, formulando indicazioni circa tempi e modalità della ripresa lavorativa, consigliando eventuali limitazioni alla mansione. I pazienti sono rivalutati periodicamente, fornendo loro eventuali nuove indicazioni. Obiettivi Verificare lo stato di salute e la situazione lavorativa dei pazienti nei 5-10 anni successivi il loro inserimento nel protocollo. Metodi Per 125 soggetti, arruolati tra il 2005 e il 2011 (2), sono stati raccolti i dati clinici (estrapolati dall’archivio informatico ospedaliero) e informazioni riguardanti l’aderenza alle prescrizioni e la ripresa lavorativa (tramite intervista). Inoltre, è stato loro chiesto di esprimere un giudizio soggettivo (con punteggio da 0 a 10) sul proprio stato di salute cardiologica, sul reinserimento lavorativo e sull’utilità delle prescrizioni riguardanti la mansione. Risultati Hanno risposto all’intervista 101 soggetti, in prevalenza (n = 94) maschi (4 pazienti risultavano deceduti). L’aderenza alle prescrizioni e ai controlli periodici è stata quasi totale (solo 4 soggetti hanno riferito difficoltà nel seguire la terapia farmacologica o gli esercizi fisici). Al controllo cardiologico più recente, la frazione d’eiezione (FE) del ventricolo sinistro era ≥ 49% in 78 pazienti, 36÷48% in 39 e ≤ 35% in 7, risultando migliorata in 27, peggiorata in 8, stazionaria per i rimanenti. Pure migliorata la tolleranza alla sforzo: mediamente, da 7,4 a 8,2 METs, dalla dimissione dopo riabilitazione all’ultimo follow-up. 20 pazienti hanno sofferto ricadute cardiache (in 17 casi con necessità di assentarsi dal lavoro): 12 ischemiche, 4 aritmiche, 4 altro. 76 (su 101) soggetti sono risultati occupati (9 con cambio di mansione), 17 pensionati, 8 disoccupati. Al questionario di autovalutazione, 100 soggetti si sono espressi sul loro attuale stato di salute cardiologico (con un punteggio medio di 8,3), 91 hanno risposto riguardo il reinserimento lavorativo (punteggio medio: 8,7), 74 sull’utilità delle limitazioni (punteggio medio: 9). Conclusione Dati rilevanti sono: l’elevata sopravvivenza, il mantenimento di soddisfacenti condizioni cliniche (buona FE, tolleranza allo sforzo, poche assenze per malattia), l’aderenza alle prescrizioni, l’alto tasso di ripresa lavorativa, l’elevato grado di soddisfazione soggettiva. L’esperienza conferma che un’appropriata riabilitazione e l’approccio interattivo tra medico del lavoro e cardiologo facilitano la ripresa lavorativa dopo evento cardiaco acuto, adattando le mansioni alle residue capacità fisiche

Salute e lavoro dopo procedure invasive cardiache, riabilitazione e valutazione occupazionale: studio prospettico pluriennale

BACKGROUND: Our previous experience with the "CardioWork" protocol (activated in 2005) demonstrated the usefulness of the interaction between occupational physician and cardiologist to facilitate work resumption after invasive heart procedures and subsequent rehabilitation, adapting the work tasks of the patients to the changed physical capabilities. OBJECTIVES: We surveyed the health conditions and employment status of the subjects previously studied, years after their completion of the protocol in order to verify its effectiveness over a long period of time. METHODS: We contacted 125 patients included in the protocol from 2005 to 2011: 4 were deceased; 101 (94 males and 7 females; mean age: 49.2 years) participated in the study. We collected clinical data (from the hospital computer archive), as well as information on prescriptions compliance and occupation (by interview). Respondents were also asked to give a subjective judgment on their health, their re-employment, and the usefulness of the indications regarding job fitness. RESULTS: In addition to the high survival rate, the survey showed maintenance of satisfactory clinical conditions (good left ventricular function, exercise tolerance, rare cardiological relapses, few sick-leave days), adherence to prescriptions, high employment rate, high level of subjective satisfaction. CONCLUSIONS: The study confirms the importance of appropriate rehabilitation after acute cardiac event, and the need for an interdisciplinary approach involving the occupational physician. By following this strategy, patients not only can return to work early, satisfactorily and with minimal risks, but they also tend to keep their work and to reach retirement age in good health

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