Secondary Prevention Through Cardiac Rehabilitation: Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology

The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for C

Decreased wheel-running activity in hamsters post myocardial infarction

Reduced exercise capacity is a key symptom and an independent determinant of mortality in patients with heart failure. We analyzed the running activity of hamsters with cardiac dysfunction after myocardial infarction. In 39 male Syrian hamsters aged 10 to 12 weeks, a myocardial infarction (MI) was produced by permanent ligation of the left coronary artery. Spontaneous running activity in a wheel was monitored daily. After four weeks, left ventricular (LV) hemodynamics (catheter tip manometry) were measured at baseline and during inotropic stimulation (isoprenaline 0.03, 0.1 and 0.3 μg/kg/min i.v.). LV infarct size was quantified using planimetry. Four weeks post MI, daily running distance was reduced stepwise in animals with small (4–15 % of LV: 9.8 ± 3.4 km/d) and large (> 15 % of LV: 7.5 ± 3.5 km/d) MI, compared to sham-operated hamsters (11.5 ± 1.5 km/d). Similar reductions were observed in maximum speed and distance of longest running period. MI size influenced daily running distance, maximum speed, and longest running period (linear correlations, all p < 0.05). MI size also impaired LV systolic and diastolic function under isoprenaline stimulation. The results suggest that myocardial infarction reduces running capacity and isoprenaline stimulated LV function in hamsters, mimicking impaired exercise performance in patients with heart failure. Analysis of running activity in hamsters with myocardial infarction offers a unique opportunity for non-invasive and serial functional assessment of heart failure in the experimental setting

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&#8217;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

Exercise physiologists: essential players in interdisciplinary teams for noncommunicable chronic disease management

Noncommunicable diseases (NCDs), such as obesity and type 2 diabetes mellitus, are a growing public health challenge in Australia, accounting for a significant and increasing cost to the health care system. Management of these chronic conditions is aided by interprofessional practice, but models of care require updating to incorporate the latest evidence-based practice. Increasing research evidence reports the benefits of physical activity and exercise on health status and the risk of inactivity to chronic disease development, yet physical activity advice is often the least comprehensive component of care. An essential but as yet underutilized player in NCD prevention and management is the “accredited exercise physiologist,” a specialist in the delivery of clinical exercise prescriptions for the prevention or management of chronic and complex conditions. In this article, the existing role of accredited exercise physiologists in interprofessional practice is examined, and an extension of their role proposed in primary health care settings

CHANGES IN LIPOPROTEIN INDICATOR AND INDICATOR OF ENDOTHELIAL FUNCTION AFTER IMPLEMENTED CARDIOVASCULAR REHABILITATION PROGRAM

Insufficient physical activity in the world annually is the cause of death of 1.9 million people. According to the data from the World Health Report, physical inactivity is about to become the global problem. Regular physical activity and good physical shape raise the functional capacity and the quality of patient’s life. With physical activity it is possible to improve metabolic, endothelial, lateral-muscular, pulmonary and cardiovascular functions of an organism, but also the function of the autonomous nervous system. The endothelium has the important role in maintaining the normal cardiovascular tonus and blood fluidity by reducing the platelet activity and the adhesion of leukocytes, and also by restricting the reaction of vascular inflammation. The aim of this paper was to present the recent data about effects of cardiovascular rehabilitation and physical training on lipoproteins’ status and markers of endothelial function. The impact of physical activity on the lipid status is accomplished by affecting the enzymes of lipoprotein metabolism, including the lipoprotein and the liver lipase and the movable protein of cholesterol ester (11). The studies point out that aerobic physical activity result in increasing of HDL concentration and the decrease of the triglycerides value, total and LDL cholesterol. The connection, which is dose-dependant, exists between physical activity and the lipid level, as the arguments which suggest that the duration of physical activity is the key parameter in modification of the lipid metabolism. Physical activity leads to the beneficial changes in the cardiovascular and lipid indicators and improves the endothelial function in the secondary prevention of coronary disease. Reduction of the lipid parameters by introducing physical rehabilitation and dietetic regime lie in the basis of secondary prevention of coronary disease. Furthermore, there is a constant improvement in NO biodisposability and therewith the improvement in endothelial function

Heart Rate Dynamics During A Treadmill Cardiopulmonary Exercise Test in Optimized Beta-Blocked Heart Failure Patients

BACKGROUND: Calculating the maximum heart rate for age is one method to characterize the maximum effort of an individual. Although this method is commonly used, little is known about heart rate dynamics in optimized beta-blocked heart failure patients. AIM: The aim of this study was to evaluate heart rate dynamics (basal, peak and % heart rate increase) in optimized beta-blocked heart failure patients compared to sedentary, normal individuals (controls) during a treadmill cardiopulmonary exercise test. METHODS: Twenty-five heart failure patients (49±11 years, 76% male), with an average LVEF of 30±7%, and fourteen controls were included in the study. Patients with atrial fibrillation, a pacemaker or noncardiovascular functional limitations or whose drug therapy was not optimized were excluded. Optimization was considered to be 50 mg/day or more of carvedilol, with a basal heart rate between 50 to 60 bpm that was maintained for 3 months. RESULTS: Basal heart rate was lower in heart failure patients (57±3 bpm) compared to controls (89±14 bpm; p<0.0001). Similarly, the peak heart rate (% maximum predicted for age) was lower in HF patients (65.4±11.1%) compared to controls (98.6±2.2; p<0.0001). Maximum respiratory exchange ratio did not differ between the groups (1.2±0.5 for controls and 1.15±1 for heart failure patients; p=0.42). All controls reached the maximum heart rate for their age, while no patients in the heart failure group reached the maximum. Moreover, the % increase of heart rate from rest to peak exercise between heart failure (48±9%) and control (53±8%) was not different (p=0.157). CONCLUSION: No patient in the heart failure group reached the maximum heart rate for their age during a treadmill cardiopulmonary exercise test, despite the fact that the percentage increase of heart rate was similar to sedentary normal subjects. A heart rate increase in optimized beta-blocked heart failure patients during cardiopulmonary exercise test over 65% of the maximum age-adjusted value should be considered an effort near the maximum. This information may be useful in rehabilitation programs and ischemic tests, although further studies are required

Reabilitação cardíaca em Portugal: a intervenção que falta!

A Organização Mundial de Saúde definiu Reabilitação Cardíaca (RC), em 1964, como “… o conjunto de actividades necessárias para fornecer ao doente com cardiopatia uma condição física, mental e social tão elevadas quanto possível, que lhe permita retomar o seu lugar na vida da comunidade, pelos seus próprios meios e de uma forma tão normal quanto possível”. Os Programas de Reabilitação Cardíaca (PRC) foram lançados para promover uma recuperação física rápida após enfarte agudo do miocárdio (síndrome coronário agudo - SCA, na nomenclatura actual), orientada para reintegração social rápida e plena, nomeadamente para a retoma da actividade profissional, após SCA ou cirurgia cardíaca (coronária, valvular ou transplante). Para além dos doentes que sofreram SCA complicado ou após cirurgia cardíaca, a obtenção de uma boa capacidade física tem uma importância significativa nos trabalhadores cuja actividade exige esforço físico violento, como os agrícolas ou da construção civil, assim como nos doentes idosos e nas mulheres. Actualmente, para além da promoção da capacidade funcional, os PRC assumiram-se como programas de prevenção secundária, implementando também a adopção de um estilo de vida saudável, a observância da terapêutica farmacológica e a educação dos doentes e dos seus familiares, de forma a auxiliá-los a viver com a doença. Por este motivo, passaram a ter grande interesse e indicação, mesmo para doentes que não apresentam limitações físicas como os submetidos a angioplastia coronária e os que sofrem de angina de peito. Na última década acumulou-se evidência científica de benefício dos PRC em relação a novos grupos de doentes, como os que apresentam insuficiência cardíaca, sendo ou não portadores de pacemaker de ressincronização ou de cardioversor desfibrilhador. O estilo de vida e as medidas de prevenção secundária preconizados pelos PRC compreendem actividade física regular, nutrição saudável, controlo do stress e dos factores de risco clássicos, em particular o tabagismo e a obesidade que deverão ser objecto de programas especiais. O exercício físico adaptado, de intensidade moderada e ajustado ao gosto e à patologia dos participantes, é talvez o componente mais importante do programa pelas suas propriedades anti-ateroscleróticas, anti-trombóticas, anti-isquémicas, antiarrítmicas e benefícios psicológicos. Está indicado não só como antagonista dos efeitos nefastos do sedentarismo, mas também como promotor das outras mudanças de comportamento que se devem manter por tempo indeterminado. Duas meta-análises, publicadas no final dos anos 80 do século passado, que incluíram estudos com cerca de 9.000 doentes tratados segundo as recomendações da época, demonstraram sobrevivência 25% superior à dos doentes do grupo controlo. Apesar dos grandes avanços verificados nas últimas décadas no tratamento farmacológico da doença coronária e nas técnicas de revascularização, em particular na angioplastia, que poderiam ter reduzido a probabilidade dos programas de reabilitação demonstrarem benefícios, duas meta-análises recentes, publicadas em 2004 e 2005, voltaram a demonstrar redução da mortalidade superior ou igual a 25 % no grupo de RC relativamente ao grupo controlo. A redução de mortalidade e de hospitalizações condicionadas pela RC dos doentes com insuficiência cardíaca está demonstrada na meta-análise europeia ExTrAMATCH e no estudo americano HF-ACTION, recentemente publicado. Também há alguma evidência de que os PRC diminuem os custos para o Sistema de Saúde pela redução do número de eventos verificados no período de seguimento