Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

Abstract Background The impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline. Methods Patients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed. Results Sixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β =  − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01). Conclusions Remote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals. Trial registration This interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564 ; registration date: 2020/09/09)

Circulating levels of fatty acid-binding protein family and metabolic phenotype in the general population.

OBJECTIVE: Fatty acid-binding proteins (FABPs) are a family of 14-15-kDa proteins, and some FABPs have been to be used as biomarkers of tissue injury by leak from cells. However, recent studies have shown that FABPs can be secreted from cells into circulation. Here we examined determinants and roles of circulating FABPs in a general population. METHODS: From the database of the Tanno-Sobetsu Study, a study with a population-based cohort design, data in 2011 for 296 subjects on no medication were retrieved, and FABP1~5 in their serum samples were assayed. RESULTS: Level of FABP4, but not the other isoforms, showed a gender difference, being higher in females than in males. Levels of all FABPs were negatively correlated with estimated glomerular filtration rate (eGFR), but a distinct pattern of correlation with other clinical parameters was observed for each FABP isoform; significant correlates were alanine aminotransferase (ALT), blood pressure (BP), and brain natriuretic peptide (BNP) for FABP1, none besides eGFR for FABP2, age, BP, and BNP for FABP3, age, waist circumference (WC), BP, BNP, lipid variables, high-sensitivity C-reactive protein (hsCRP), and HOMA-R for FABP4, and age, WC, BP, ALT, BNP, and HOMA-R for FABP5. FABP4 is the most strongly related to metabolic markers among FABPs. In a multivariate regression analysis, FABP4 level was an independent predictor of HOMA-R after adjustment of age, gender, WC, BP, HDL cholesterol, and hsCRP. CONCLUSIONS: Each FABP isoform level showed a distinct pattern of correlation with clinical parameters, although levels of all FABPs were negatively determined by renal function. Circulating FABP4 appears to be a useful biomarker for detecting pre-clinical stage of metabolic syndrome, especially insulin resistance, in the general population

Multiple regression analysis for log FABPs.

<p>Multiple regression analysis for log FABPs.</p

Simple and multiple regression analyses for log U-FABP4 (n = 299).

<p>FABP, fatty acid-binding protein; GFR, glomerular filtration rate; hsCRP, high-sensitivity C-reactive protein; UACR, urine albumin-to-creatinine ratio; NS, not selected.</p><p>Simple and multiple regression analyses for log U-FABP4 (n  =  299).</p

Simple and multiple regression analyses for log UACR (n = 392).

<p>FABP, fatty acid-binding protein; GFR, glomerular filtration rate; hsCRP, high-sensitivity C-reactive protein; UACR, urine albumin-to-creatinine ratio; NS, not selected.</p><p>Simple and multiple regression analyses for log UACR (n = 392).</p

Characteristics of the studied subjects.

<p>Variables are expressed as n or means ± SEM.</p>*<p>P<0.05,</p>**<p>P<0.01 vs. male.</p

Characteristics of the subjects with and without detectable U-FABP4.

<p>Variables are expressed as means ±SD, ^a number (%), or ^b medians (interquartile ranges).</p><p>FABP, fatty acid-binding protein; GFR, glomerular filtration rate; hsCRP, high-sensitivity C-reactive protein; UACR, urine albumin-to-creatinine ratio.</p><p>*P<0.05,</p><p>**P<0.01 vs. Undetectable FABP4.</p><p>Characteristics of the subjects with and without detectable U-FABP4.</p