Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

{"title":"Impact of Home-Based Cardiac Rehabilitation on Physical Function, Outcomes, and Costs.","authors":"Jonathan Myers, Karen Owoc, Holly Fonda, Khin Chan, Thant Zin Oo, Shriram Nallamshetty, Patricia Nguyen","doi":"10.1097/HCR.0000000000000931","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000931","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiac rehabilitation (CR) improves health outcomes in patients with cardiovascular disease (CVD), but referral, participation, and completion rates are low. Home-based CR (HBCR) is a proposed solution, but studies on its efficacy are limited. We report our experience from a Veterans Affairs HBCR program on physical function, costs, and outcomes overlapping with the coronavirus disease-2019 (COVID-19) pandemic.</p><p><strong>Methods: </strong>A 12-week HBCR program included case-managed individualized exercise and risk management. Six functional tests were conducted remotely, safety was monitored, and quality of life and costs were quantified. A composite outcome (death, myocardial infarction, stroke, and cardiac-related hospitalization) was compared between 70 HBCR participants, 131 patients referred to Community Care, and 71 patients undergoing usual care (no CR) over a mean follow-up of 2.5 ± 0.90 years.</p><p><strong>Results: </strong>Among HBCR participants, there were significant improvements in right and left leg balance (145 and 56%, respectively, P < .001), 30-second chair stand (47%, P < .001), 2-minute step performance (41%, P < .001), right and left 30-second arm curl (31 and 30%, respectively, P < .001), 50-foot walk test (20%, P = .002), 8-foot up and go test (28%, P < .001), and steps/day (82%, P < .001). Composite events were lower among patients in the HBCR group versus those referred to Community Care (P = .002). Health care costs were significantly lower among patients in the HBCR group compared to those in Community Care ($2101 vs $3289/subject, P < .001).</p><p><strong>Conclusions: </strong>A HBCR program that included a broad spectrum of patients with CVD and multiple co-morbidities, performed largely during the COVID-19 pandemic, resulted in significant functional and outcome benefits and reduced costs.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Physical Exercise in Pulmonary Rehabilitation Does Not Alter Endothelial Function and Vascular Structure in Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial.","authors":"Talmir Nolasco, Renata Figueiredo, Priscila Zanella, Francini Porcher, Ricardo Gass, Melina Hauck, Marli Knorst","doi":"10.1097/HCR.0000000000000940","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000940","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to analyze the effect of exercise on endothelial function and other cardiovascular risk factors in patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>Forty patients were randomized to an 8-week pulmonary rehabilitation (PR) program or usual care. Symptoms, exercise capacity, and quality of life were measured at baseline and after intervention or observation. Flow-mediated brachial artery dilation (FMD), ankle-brachial index, intermittent claudication questionnaire, cardiovascular risk score, blood pressure, daily steps count, glucose, lipids, and C-reactive protein were evaluated before and after intervention.</p><p><strong>Results: </strong>Participants had a mean age of 64.2 ± 6.7 years in the PR group and 62.2 ± 8.0 years in the usual care group. The forced expiratory volume in the first second was 45.5 ± 15.4% predicted in the PR group and 48.1 ± 24.3% predicted in the usual care group. Attending PR was associated with reduced symptoms, improved exercise capacity and quality of life in patients with COPD (P < .005 for all). Endothelial function did not improve after PR (FMD% at baseline 9.38 ± 4.40 vs 9.67 ± 6.56 post PR; P = .87), and there was no difference between the 2 groups (P = .61). However, exercise reduced C-reactive protein, triglycerides, and glucose and improved cardiovascular risk score, systemic blood pressure, and ankle-brachial index (P < .005 for all).</p><p><strong>Conclusions: </strong>Pulmonary rehabilitation elicited improvement in symptoms, exercise capacity, quality of life, and parameters related to cardiorespiratory fitness. The endothelial function measured by FMD did not change with exercise. However, other cardiovascular risk factors such as blood markers, systemic blood pressure, and lower limb blood flow improved after PR.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Unique Needs and Challenges of Young Females After Spontaneous Coronary Artery Dissection.","authors":"Kathleen Lalande, Karen Bouchard, Thais Coutinho, Sharon Mulvagh, Christine Pacheco, Shuangbo Liu, Jacqueline Saw, Derek So, Jennifer L Reed, Alexandra Chiarelli, Helen Robert, Nadia Lappa, George Wells, Heather Tulloch","doi":"10.1097/HCR.0000000000000929","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000929","url":null,"abstract":"<p><strong>Purpose: </strong>Spontaneous coronary artery dissection (SCAD) disproportionately affects females who are often younger in age. Age-based comparisons of the post-SCAD experience are required to adequately inform rehabilitation programming that is sensitive to patient life circumstances and needs. This multi-site qualitative study investigated the experiences of SCAD in females analyzed according to their age (<50 and ≥50 years).</p><p><strong>Methods: </strong>Females who had experienced a SCAD event were recruited from 5 large tertiary care hospitals. Participants completed sociodemographic and medical questionnaires and took part in a semi-structured interview. Transcribed data were subject to the framework method using deductive coding. Constructed codes and overarching themes were then compared in the <50 and ≥50-year patient groups. Themes that highlighted the central differences between demographic groups were then constructed inductively.</p><p><strong>Results: </strong>Overall, females with SCAD (n = 77; mean age = 52.9 ± 10.8 years; range = 29-77) reported struggling with a lack of information from their health care team with regards to the diagnosis, management, and long-term prognosis of SCAD. Younger patient (n = 32; mean age = 40.2 ± 6.7 years) transcripts evidenced more prominent themes of uncertainty, dissatisfaction with cardiac rehabilitation programming, difficulty adjusting to lifestyle and vocational changes, and family-related distress in comparison to those over 50 (n = 45; mean age = 57.8 ± 6.9 years).</p><p><strong>Conclusions: </strong>Females with SCAD who are <50 years old appear to experience their recovery from SCAD differently than those who are older in age. These differences suggest that tailored approaches may be required in cardiovascular rehabilitation programming for younger SCAD patients.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation in a Patient With Takotsubo Syndrome and Postural Orthostatic Tachycardia Syndrome.","authors":"Ashley E Carlisle, Kevin G Tayon, Artur Schneider, Brian P Shapiro, Bryan J Taylor","doi":"10.1097/HCR.0000000000000938","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000938","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Technologies and Artificial Intelligence in Cardiac Rehabilitation: A Narrative Review.","authors":"David E Hamilton, Jeffrey X Xie, Alyssa L Chang, Alexis L Beatty, Jessica R Golbus","doi":"10.1097/HCR.0000000000000935","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000935","url":null,"abstract":"<p><strong>Purpose: </strong>This review explores the role and impact of digital technology in cardiac rehabilitation (CR), assessing its potential to enhance patient outcomes and address barriers to CR delivery.</p><p><strong>Review methods: </strong>A comprehensive literature search was conducted using curated search terms to target CR studies using digital technologies as an adjunct to in-person CR or as part of remote (ie, asynchronous) or virtual (ie, synchronous audiovisual communication) formats. The literature search focused on studies that evaluated the implementation and efficacy of using digital technologies within CR.</p><p><strong>Summary: </strong>Digital technology offers significant opportunities to improve CR by providing flexible and scalable solutions that can overcome traditional barriers to CR such as accessibility and capacity constraints. Remote or virtual CR delivery that incorporates digital technologies improves CR adherence and achieves similar improvements in exercise capacity when compared to in-person CR. While the majority of studies have focused on exercise, digital technologies are increasingly used to deliver comprehensive CR solutions as part of remote and virtual CR programs. However, challenges and gaps in the literature remain, such as the impact of digital literacy and promoting equitable CR access, particularly in high-risk and vulnerable populations. Further research needs to focus on longer term outcomes to evaluate the safety, efficacy, and cost-effectiveness of digital CR interventions. The potential of digital health to transform CR and reduce the burden of cardiovascular disease is substantial and warrants further investigation.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation Among Veterans: A Narrative Review.","authors":"Merilyn S Varghese, Wen-Chih Wu, Kariann R Drwal, Matthew M Burg, Dhruv S Kazi, Allison E Gaffey, Kristin M Mattocks, Cynthia A Brandt, Lori A Bastian, Parul U Gandhi","doi":"10.1097/HCR.0000000000000932","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000932","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiac rehabilitation (CR) is a valuable secondary preventive intervention for Veterans given their increased risk of cardiovascular disease. Adults cared for in the Veterans Affairs (VA) healthcare system are a unique population that receives healthcare from the largest integrated care network in the United States. Yet, this group faces distinct challenges in utilizing CR. In this review, we evaluated the existing data regarding CR utilization and outcomes among U.S. Veterans.</p><p><strong>Review methods: </strong>A literature search was conducted using PubMed and Scopus for cardiac rehabilitation and U.S. Veterans.</p><p><strong>Summary: </strong>Veterans have 3 potential options for attending CR: in-person at their local VA medical centers, home-based CR through their local VA medical centers, and in-person at community CR centers. However, participation remains low. A significant barrier to participation is transportation to in-person CR. Home-based CR shows promise in addressing this barrier and has demonstrated resilience in the face of pandemic restrictions. Cardiac rehabilitation outcomes among Veterans who participate include improved exercise capacity, fewer depressive symptoms, and decreased mortality. Despite its benefits for secondary prevention among Veterans, there remains a paucity of data about the current uptake of CR, the impact of mental health on uptake, possible sex-based or racial disparities, and long-term outcomes.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"78-84"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commercial Insurance Coverage for Outpatient Cardiac Rehabilitation for Heart Failure With Preserved Ejection Fraction in the United States.","authors":"Umair Iftikhar, Joshua R Smith, Sophie A Miller, Ray W Squires, Randal J Thomas","doi":"10.1097/HCR.0000000000000937","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000937","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"155-156"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily Path Areas and Location Use During and After Cardiac Rehabilitation.","authors":"Jodi Langley, Nerissa Campbell, Darren Warburton, Ryan E Rhodes, Shane Sweet, Nicholas Giacomantonio, Daniel Rainham, Shaelyn Strachan, Travis Saunders, Chris Blanchard","doi":"10.1097/HCR.0000000000000917","DOIUrl":"10.1097/HCR.0000000000000917","url":null,"abstract":"<p><strong>Purpose: </strong>Little research has focused on the potential impact that the environment plays in shaping cardiac rehabilitation (CR) patient sedentary time (ST) and physical activity (PA). To address this, the current study generated daily path areas (DPAs) based on the locations they visited during and after they completed CR.</p><p><strong>Methods: </strong>Patients in CR (n = 66) completed a survey and wore an accelerometer and Global Positioning System receiver for 7 days early (first month), late (last 2 weeks of program), and 3 months after completing CR.</p><p><strong>Results: </strong>Individual DPAs were approximately 24 km 2 at baseline and remained stable over time. Location-based analyses showed that most patients' ST and PA time was spent at home, followed by other residential, commercial, work, and CR locations. However, the time spent in certain locations (eg, parks and recreation locations) fluctuated during and after CR by intensity.</p><p><strong>Conclusions: </strong>CR patient DPA was stable over time. Within this space, they primarily engaged in ST and PA at home. However, when not home, the distribution of location use varied across a number of locations that extended well beyond their neighborhoods. Therefore, proximity to home may not be a barrier for CR patients in relation to their ST and PA.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"103-109"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combatting Infectious Disease With Physical Activity.","authors":"Steven J Elmer, Isaac J Wedig, Isaac M Lennox, Barry A Franklin","doi":"10.1097/HCR.0000000000000919","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000919","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"E4-E5"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Endothelial Function in Individuals With Post-Acute Sequelae of COVID-19: Effects of Combined Exercise Training.","authors":"Tae Gu Choi, Jae Yeop Kim, Joon Youp Seong, Ho Jeong Min, Yong Joon Jung, Yun Wook Kim, Min Jeong Cho, Hyun Jeong Kim, Setor K Kunutsor, Kevin S Heffernan, Sae Young Jae","doi":"10.1097/HCR.0000000000000928","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000928","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the presence of impaired endothelial function in individuals with post-acute sequelae of coronavirus disease-2019 (PASC) compared to healthy individuals and explored the efficacy of combined exercise training in restoring or improving endothelial function in those with PASC.</p><p><strong>Methods: </strong>Study I was a cross-sectional study which compared endothelial function between individuals with PASC (n = 29, mean age 22.9 ± 3.9 year) and healthy individuals (n = 42, mean age 21.7 ± 2.0 year). Study II, an intervention design, explored if combined exercise training (n = 14) could reverse the decline in endothelial function associated with PASC compared to controls (n = 14). The combined exercise program included aerobic, resistance, and inspiratory muscle training administered for 8 weeks. We measured endothelial function using flow-mediated dilation of the brachial artery and assessed peak oxygen uptake (VO2peak), dyspnea, and fatigue before and after the intervention.</p><p><strong>Results: </strong>Individuals with PASC exhibited significantly lower endothelial function compared to healthy controls (4.95 ± 2.0% vs 8.00 ± 2.4%, P < .001). The exercise group showed a significant increase in endothelial function (4.73 ± 1.5% to 7.98 ± 2.4%) as opposed to the control group (5.31 ± 2.5% to 6.30 ± 2.5%) (interaction effect: P = .008), reaching levels similar to those in healthy individuals. Additionally, the exercise group demonstrated improvement in VO2peak (38.3 ± 6.4 ml/min/kg to 42.8 ± 7.3 ml/min/kg, P < .001) and a reduction in dyspnea and fatigue compared to the control group (P < .001).</p><p><strong>Conclusions: </strong>Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"146-152"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}