How to do: Telerehabilitation in heart failure patients

According to the present guidelines for heart failure patients, regular exercise training has obtained the class of recommendation I, level of evidence A. Despite the benefits of cardiac rehabilitation, many heart failure patients are inactive. Common patient’s rejection of existing forms of rehabilitation and limitations resulting from the disease itself hinder the outpatient cardiac rehabilitation. That is why home telerehabilitation seems to be the optimal form of physical activity for heart failure patients

Kardiologiczna telerehabilitacja hybrydowa

Current recommendations of the European Society of Cardiology and American Cardiac Societies clearly indicate that regular exercise training should be recommended in all stable patients with cardiovascular disease (class I of recommendation, level of evidence A). Despite this, there are large regional disparities in access to rehabilitation, both in Poland and in Europe. One of the possibilities to solve this problem is to introduce hybrid cardiac telerehabilitation. Published data indicate that this form of rehabilitation is effective, safe and well accepted by patients. Moreover, the adherence to telerehabilitation was high and promising. The transfer of cardiac rehabilitation to the patients’ homes creates the opportunity to increase access to rehabilitation programs.Aktualne rekomendacje Europejskiego Towarzystwa Kardiologicznego i Amerykańskich Towarzystw Kardiologicznych jednoznacznie wskazują, że regularny trening fizyczny powinien być zalecany u wszystkich stabilnych chorych ze schorzeniami układu krążenia (I klasa wskazań, poziom dowodów A). Mimo tego istnieją duże dysproporcje regionalne w dostępie do rehabilitacji zarówno w Polsce, jak i w Europie. Jedną z możliwości rozwiązania tego problemu jest wprowadzenie kardiologicznej telerehabilitacji hybrydowej. Opublikowane dane wskazują, że ta forma rehabilitacji jest efektywna, bezpieczna i dobrze akceptowana przez chorych, co przekłada się na dobrą interaktywną współpracę pacjentów. Przeniesienie rehabilitacji kardiologicznej do miejsca zamieszkania pacjentów stwarza sposobność zwiększenia dostępności do programów rehabilitacji

The influence of water-based training on arrhythmia in patients with stable coronary artery disease and preserved left ventricular function

Background: Water immersion may cause adverse cardiovascular events, including arrhythmias in patients with damaged cardiac muscle, e.g. with cardiac failure. So far, there have been rather few reports on arrhythmia induced by water training in patients with coronary artery disease (CAD). The aim of the study was to assess the influence of exercise training in moderately cold water (28–30°C) on arrhythmia and physical capacity in stable CAD patients with preserved left ventricular (LV) function. Methods: Sixty-two post-myocardial infarction male patients, mean age 50.9 ± 7.9 years, participated in 16 water-based trainings (WBT), which lasted 55-min, twice a week in water at 28–30°C. Each subject underwent 24 h Holter on-land monitoring (Holter-24) once during the study and twice in-water Holter monitoring (Holter-W) during WBT. Before and after WBT cardiopulmonary exercise test (CPET) was performed. The following parameters were analyzed: peak oxygen consumption (peak VO2), mean number of ventricular ectopic beats (VEBs) and supraventricular ectopic beats (SVEBs) during Holter-24 and Holter-W, the percentage of men who developed arrhythmia during CPET vs. Holter-24 and vs. Holter-W. Results: WBT significantly improved patients’ physical capacity, and more often provoked arrhythmia, mainly SVEBs, than CPET or daily activity assessed during Holter-24. During WBT 58% men developed VEBs and 62% SVEBs. Conclusions: 1. WBT provoked arrhythmias significantly more often than did CPET and normal daily activity. 2. Owing to WBT patients improved their physical capacity which was still maintained at 1-year follow-up.

Patterns in the multiannual course of growing season in Central Europe since the end of the 19th century

The research identified patterns in the multiannual course of start and end dates, and length of growing sea son (GS) in Central Europe since the end of the 19th century in selected cities of Central Europe in the period 1893-2020. GS start in the analysed stations was characterised by high year-to-year variability, particularly in those located more southwards, i.e. in Prague and Vienna. A smaller variability occurred in GS end dates. The GS was subject to prolon gation, although these changes in particular cities were uneven and had different causes. In Toruń and Potsdam, its increase was caused by a greater shift of the end date, and in the remaining stations, it was determined by its earlier start date. Two subperiods were distinguished that differ in terms of intensity of changes of the start and end dates, as well as the length of the GS. The intensification was observed recently

Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study

Background: Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients’ acceptance of and adherence to HTCR.Methods: The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes — in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR.Results: HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients.Conclusions: HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.

Influence of exercise training on left ventricular diastolic function and its relationship to exercise capacity in patients after myocardial infarction

Background: The study&#8217;s aim was to examine the effect of exercise training on left ventricular diastolic function (LVDF) and whether LVDF could predict an improvement in exercise capacity (EC) in post-myocardial infarction patients. Methods: Forty-eight males, aged 56.4 &#177; 7.2 years, with preserved left ventricular systolic function (LVSF) and mild diastolic dysfunction (the ratio of transmitral early left ventricular filling velocity to early diastolic mitral annulus velocity E/E&#8217; > 8 as the average of the septal and lateral annulus velocities), were assigned to either a training group (TG, n = 32) or controls (n = 16). Before, and at the end of the study, all patients underwent a cardiopulmonary test and echocardiography with tissue Doppler imaging (TDI). Results: After a 4.5-month training program, maximal oxygen consumption increased significantly in TG (26.66 &#177; 3.88 vs. 28.79 &#177; 5.00 mL/kg/min, p < 0.0001). TDI-derived E/E&#8217; did not change after the training program. After dividing TG according to septal E/E&#8217;s > 10 and 8 and < 8, exercise capacity improved significantly only in patients with E/E&#8217;s < 10 and E/E&#8217;l < 8. Conclusions: A 4.5-month training program in post-myocardial infarction patients with preserved LVSF and mild diastolic dysfunction led to improved exercise capacity only in TG. The diastolic function did not change significantly. The improvement in exercise capacity was significantly greater in patients with a better LVDF measured by TDI. (Cardiol J 2010; 17, 2: 136-142