Pubblicazioni recenti - cardiac rehabilitation
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Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial.
J Diabetes2020 Aug;():. doi: 10.1111/1753-0407.13106.
Albarrati Ali, Taher Mohammed, Nazer Rakan,
Abstract
BACKGROUND:
Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM).
METHODS:
This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six-minute walking test (6MWT) were measured at baseline and 8?weeks post incremental inspiratory muscle training.
RESULTS:
At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8?weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ±?5.30?cm H2O vs 2.8 ±?4.8 cm H2O) and MIP (mean difference: 19.4 ±?4.3 Vs 5.4 ±?3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70?±?29?m vs 34?±?24?m) compared to the placebo group, P .05.
CONCLUSION:
Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity.
© 2020 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.
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Type 2 Myocardial Infarction: CURRENT CONCEPTS AND OUR EXPERIENCE WITH CARDIAC REHABILITATION.
J Cardiopulm Rehabil Prev2021 Jan;():. doi: 10.1097/HCR.0000000000000550.
Smer Aiman, Squires Ray W, Aboeata Ahmed, Bowman Melissa J, Mahlmeister Kasara A, Medina-Inojosa Jose R, Bonikowske Amanda R, Patel Apurva, Del Core Michael, Williams Mark A,
Abstract
BACKGROUND:
Type 2 myocardial infarction (T2MI) is commonly encountered in clinical practice, yet little is known about this challenging condition. Outpatient cardiac rehabilitation (CR) is an integral component in the care of patients with MI. However, specific recommendations for CR, information on the feasibility of participation, and outcome measures for patients with T2MI are lacking.
CLINICAL CONSIDERATIONS:
The frequency of T2MI is markedly variable and depends on the studied population, disease definition, adjudication process, cardiac troponin assays, and cutoff values used to make the diagnosis of T2MI. Clinically, it is difficult to distinguish T2MI from type 1 MI or myocardial injury. Type 2 myocardial infarction occurs due to myocardial oxygen supply-demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses. Currently, there are substantial gaps in knowledge regarding T2MI and there are no clear guidelines for the optimal management of these patients.
SUMMARY:
In this article, we present important current concepts surrounding T2MI including the definition, pathophysiology, epidemiology, diagnosis, prognosis, and management. We also discuss referral patterns to CR and participation rates and provide our experience with a case series of 17 patients. Very few patients with T2MI are referred to and participate in CR. Our small case series indicated that patients with T2MI respond favorably to CR and that exercise training following standard guidelines appears safe and is well tolerated.
Copyright © Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Management of Anaemia of Chronic Disease: Beyond Iron-Only Supplementation.
Nutrients2021 Jan;13(1):. doi: E237.
Pasini Evasio, Corsetti Giovanni, Romano Claudia, Aquilani Roberto, Scarabelli Tiziano, Chen-Scarabelli Carol, Dioguardi Francesco S,
Abstract
Chronic diseases are characterised by altered autophagy and protein metabolism disarrangement, resulting in sarcopenia, hypoalbuminemia and hypo-haemoglobinaemia. Hypo-haemoglobinaemia is linked to a worse prognosis independent of the target organ affected by the disease. Currently, the cornerstone of the therapy of anaemia is iron supplementation, with or without erythropoietin for the stimulation of haematopoiesis. However, treatment strategies should incorporate the promotion of the synthesis of heme, the principal constituent of haemoglobin (Hb) and of many other fundamental enzymes for human metabolism. Heme synthesis is controlled by a complex biochemical pathway. The limiting step of heme synthesis is D-amino-levulinic acid (D-ALA), whose availability and synthesis require glycine and succinil-coenzyme A (CoA) as precursor substrates. Consequently, the treatment of anaemia should not be based only on the sufficiency of iron but, also, on the availability of all precursor molecules fundamental for heme synthesis. Therefore, an adequate clinical therapeutic strategy should integrate a standard iron infusion and a supply of essential amino acids and vitamins involved in heme synthesis. We reported preliminary data in a select population of aged anaemic patients affected by congestive heart failure (CHF) and catabolic disarrangement, who, in addition to the standard iron therapy, were treated by reinforced therapeutic schedules also providing essential animo acids (AAs) and vitamins involved in the maintenance of heme. Notably, such individualised therapy resulted in a significantly faster increase in the blood concentration of haemoglobin after 30 days of treatment when compared to the nonsupplemented standard iron therapy.
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Cardiac Rehabilitation in Primary Care. Impact of an Intervention on Perceived Self-Efficacy.
J Funct Morphol Kinesiol2019 Jun;4(2):. doi: E32.
Madueño-Caro Antonio J, Mellado-Fernández Manuel L, Pardos-Lafarga Manuel, Muñoz-Ayllón Marta, Saez-Garcia Laura, Gómez-Salgado Juan,
Abstract
Cardiac rehabilitation is cost-effective and should be considered a part of the care system provided to patients who have suffered a myocardial infarction or another heart disease. The main variable to study was the scoring, prior to and after the intervention in the General Scale of Self-Efficacy by Baessler & Schwarzer. A clinical community trial that was open controlled and randomised was used. All adult subjects of both sexes who had completed a cardiac rehabilitation program for 12 months at the reference hospital were selected and offered to participate. The psychometric variables registered were the Salamanca screening questionnaire, the Hamilton Anxiety Rating Scale, and the Beck Depression Inventory. Eighty-nine subjects accepted to participate in the study (93.89% response rate), with an average age of 63.01 years (SD 8.75). Once the study was concluded, the main outcome was a difference in means of 6.09 points in the General Scale of Self-Efficacy ( < 0.0053, 96% confidence interval-4.1950-10.29), showing that the group exposed to the intervention reached a higher score in the above-mentioned scale. However, there were no significant differences (-student 0.1211; = 0.943) after the estimation and contrast of population means for score differences between the groups regarding the Hamilton scale. Similarly, there were no significant differences between the groups regarding the means obtained in the variable score difference in the Beck Depression Inventory (-student -0.1281; = 0.8987). The results showed an increase in those scores related to general self-efficacy among the population that completed the intervention program, as compared to the control group.
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Fatigability and Cardiorespiratory Impairments in Parkinson's Disease: Potential Non-Motor Barriers to Activity Performance.
J Funct Morphol Kinesiol2020 Oct;5(4):. doi: E78.
Pechstein Andrew E, Gollie Jared M, Guccione Andrew A,
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative condition after Alzheimer's disease, affecting an estimated 160 per 100,000 people 65 years of age or older. Fatigue is a debilitating non-motor symptom frequently reported in PD, often manifesting prior to disease diagnosis, persisting over time, and negatively affecting quality of life. Fatigability, on the other hand, is distinct from fatigue and describes the magnitude or rate of change over time in the performance of activity (i.e., performance fatigability) and sensations regulating the integrity of the performer (i.e., perceived fatigability). While fatigability has been relatively understudied in PD as compared to fatigue, it has been hypothesized that the presence of elevated levels of fatigability in PD results from the interactions of homeostatic, psychological, and central factors. Evidence from exercise studies supports the premise that greater disturbances in metabolic homeostasis may underly elevated levels of fatigability in people with PD when engaging in physical activity. Cardiorespiratory impairments constraining oxygen delivery and utilization may contribute to the metabolic alterations and excessive fatigability experienced in individuals with PD. Cardiorespiratory fitness is often reduced in people with PD, likely due to the combined effects of biological aging and impairments specific to the disease. Decreases in oxygen delivery (e.g., reduced cardiac output and impaired blood pressure responses) and oxygen utilization (e.g., reduced skeletal muscle oxidative capacity) compromise skeletal muscle respiration, forcing increased reliance on anaerobic metabolism. Thus, the assessment of fatigability in people with PD may provide valuable information regarding the functional status of people with PD not obtained with measures of fatigue. Moreover, interventions that target cardiorespiratory fitness may improve fatigability, movement performance, and health outcomes in this patient population.
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V180I genetic Creutzfeldt-Jakob disease with cardiac sympathetic nerve denervation masquerading as Parkinson's disease: A case report.
Medicine (Baltimore)2021 Jan;100(2):e24294. doi: 10.1097/MD.0000000000024294.
Fujita Hiroaki, Ogaki Keitaro, Shiina Tomohiko, Onuma Hiroki, Sakuramoto Hirotaka, Satoh Katsuya, Suzuki Keisuke,
Abstract
RATIONALE:
Creutzfeldt-Jakob disease (CJD) with a point mutation of valine to isoleucine at codon 180 of the prion protein gene (V180I) is the most frequent form of genetic CJD in Japan. However, peripheral nerve involvement, especially cardiac sympathetic denervation, has not been investigated in cases with V180I genetic CJD.We herein report a genetically confirmed case of V180I genetic CJD presenting with parkinsonism and cardiac sympathetic nerve denervation.
PATIENT CONCERNS:
The patient was a 79-year-old Japanese woman who presented with subacute progressive gait disturbance and cognitive impairment. Clinical diagnosis of Parkinson's disease (PD) with mild cognitive impairment was initially suspected based on parkinsonism, such as bradykinesia, rigidity and tremor, and reduced accumulation of cardiac meta-iodobenzylguanidine (MIBG) scintigraphy.
INTERVENTIONS:
Based on parkinsonism and impaired cardiac MIBG findings, levodopa/decarboxylase inhibitor was administered up to 300?mg/day; however, her symptoms were not improved.
OUTCOMES:
Her motor and cognitive function progressively deteriorated.
DIAGNOSIS:
Although the patient had no family history of CJD, genetic CJD was diagnosed according to extensive hyperintensities in the bilateral cortices on diffusion-weighted magnetic resonance images, positive tau protein and 14-3-3 protein in the cerebrospinal fluid and a V180I mutation with methionine homozygosity at codon 129 by prion protein gene analysis.
LESSONS:
We should be aware that reduced uptake of cardiac MIBG scintigraphy in patients presenting with parkinsonism cannot confirm a diagnosis of PD. CJD should be considered when patients show a rapid progressive clinical course with atypical manifestations of PD.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Acute thoracoabdominal and hemodynamic responses to tapered flow resistive loading in healthy adults.
Respir Physiol Neurobiol2021 Jan;286():103617. doi: S1569-9048(21)00002-1.
Manifield James, Chynkiamis Nikolaos, Alexiou Charikleia, Megaritis Dimitrios, Hume Emily, Barry Gill, Vogiatzis Ioannis,
Abstract
We investigated the acute physiological responses of tapered flow resistive loading (TFRL) at 30, 50 and 70 % maximal inspiratory pressure (PI) in 12 healthy adults to determine an optimal resistive load. Increased end-inspiratory rib cage and decreased end-expiratory abdominal volumes equally contributed to the expansion of thoracoabdominal tidal volume (captured by optoelectronic plethysmography). A significant decrease in end-expiratory thoracoabdominal volume was observed from 30 to 50 % PI, from 30 to 70 % PI, and from 50 to 70 % PImax. Cardiac output (recorded by cardio-impedance) increased from rest by 30 % across the three loading trials. Borg dyspnoea increased from 2.36?±?0.20 at 30 % PI, to 3.45?±?0.21 at 50 % PI, and 4.91?±?0.25 at 70 % PI. End-tidal CO decreased from rest during 30, 50 and 70 %PI (26.23?±?0.59, 25.87?±?1.02 and 24.30?±?0.82?mmHg, respectively). Optimal intensity for TFRL is at 50 % PI to maximise global respiratory muscle and cardiovascular loading whilst minimising hyperventilation and breathlessness.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease.
Am J Cardiol2021 Jan;():. doi: S0002-9149(21)00032-1.
Aggarwal Monica, Ornish Dean, Josephson Richard, Brown Todd M, Ostfeld Robert J, Gordon Neil, Madan Shivank, Allen Kathleen, Khetan Aditya, Mahmoud Ahmed, Freeman Andrew M, Aspry Karen,
Abstract
The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the U.S., the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation (CR). However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in CR in individuals with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the U.S. The chronic care model (CCM), an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the CCM.
Copyright © 2021. Published by Elsevier Inc.
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Patient-Reported Outcomes in Adults With Congenital Heart Disease Following Hospitalization (From APPROACH-IS).
Am J Cardiol2021 Jan;():. doi: S0002-9149(21)00046-1.
Moons Philip, Luyckx Koen, Thomet Corina, Budts Werner, Enomoto Junko, Sluman Maayke A, Wang Jou-Kou, Jackson Jamie L, Khairy Paul, Cook Stephen C, Chidambarathanu Shanthi, Alday Luis, Oechslin Erwin, Eriksen Katrine, Dellborg Mikael, Berghammer Malin, Johansson Bengt, Mackie Andrew S, Menahem Samuel, Caruana Maryanne, Veldtman Gruschen, Soufi Alexandra, Fernandes Susan M, White Kamila, Callus Edward, Kutty Shelby, Apers Silke, Kovacs Adrienne H, ,
Abstract
In this international study, we (i) compared patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) who had vs. had not been hospitalized during the previous 12 month, (ii) contrasted PROs in patients who had been hospitalized for cardiac surgery vs. non-surgical reasons, (iii) assessed the magnitude of differences between the groups (i.e. effect sizes), and (iv) explored differential effect sizes between countries. APPROACH-IS was a cross-sectional, observational study that enrolled 4,028 patients from 15 countries (median age 32y; 53% females). Self-report questionnaires were administered to measure PROs: health status; anxiety and depression; and quality of life. Overall, 668 patients (17%) had been hospitalized in the previous 12 months. These patients reported poorer outcomes on all PROs, with the exception of anxiety. Patients who underwent cardiac surgery demonstrated a better quality of life compared to those who were hospitalized for non-surgical reasons. For significant differences, the effect sizes were small, whereas they were negligible in non-significant comparisons. Substantial inter-country differences were observed. For various PROs, moderate to large effect sizes were found comparing different countries. In conclusion, adults with CHD who had undergone hospitalization in the previous year had poorer PROs than those who were medically stable. Researchers ought to account for the timing of recruitment when conducting PRO research as hospitalization can impact results.
Copyright © 2021. Published by Elsevier Inc.
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Comparison of cardiac rehabilitation (exercise + education), exercise only, and usual care for patients with coronary artery disease: A non-randomized retrospective analysis.
Pharmacol Res Perspect2021 Feb;9(1):e00711. doi: 10.1002/prp2.711.
Hu Yanqun, Li Li, Wang Taihao, Liu Yuanyuan, Zhan Xiaohong, Han Shuyan, Huang Li,
Abstract
Cardiac rehabilitation program is well-established but the Rehabilitation After Myocardial Infarction Trial (RAMIT) is reported that it does not affect mortality and morbidity of patients after myocardial infarction during follow-up period. The objectives of the study were to compare functional walking capacity, risk factor control, and morbidities in follow-up for cardiac rehabilitation (exercise + education), exercise only, and usual care among patients with coronary artery disease. A total of 492 male and female patients (age range: 45-73 years) with coronary artery disease after myocardial infarction or underwent percutaneous coronary intervention or coronary artery bypass grafting surgeries referred to cardiac rehabilitation were included in the study. Patients were participating in a cardiac rehabilitation program (exercise + education, CRP cohort, n = 125), exercise only (USC cohort, n = 182), or usual care (NCR cohort, n = 185). Data regarding incremental shuttle walk test, lipid profile, the Patient Health Questionnaire 9, and morbidities in follow-up of patients were retrospectively collected and analyzed. After completion of 1 year, cardiac rehabilitation program (p < 0.0001, q = 20.939) and exercise (p < 0.0001, q = 6.059) were successfully increased incremental shuttle walk test. After completion of 1 year, cardiac rehabilitation program reduced low-density lipoprotein (p = 0.007, q = 3.349) and depressive symptoms (p < 0.0001, q = 5.649). Morbidities were reported fewer in the patients of CRP cohort than those of USC (p = 0.003, q = 3.427) and NCR (p = 0.003, q = 4.822) cohorts after completion of 1 year of program. Cardiac rehabilitation program (exercise +education) improved functional walking capacity, controlled risk factors, and reduced morbidities of patients with coronary artery disease than exercise only and usual care (Level of evidence: III).
© 2021 The Authors. Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd.
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The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem.
CJC Open2021 Jan;3(1):1-11. doi: 10.1016/j.cjco.2020.10.009.
Jaffer Shahin, Foulds Heather J A, Parry Monica, Gonsalves Christine A, Pacheco Christine, Clavel Marie-Annick, Mullen Kerri A, Yip Cindy Y Y, Mulvagh Sharon L, Norris Colleen M,
Abstract
Background:
This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status.
Methods:
CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group.
Results:
Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada.
Conclusions:
Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc.
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Effect of lung recruitment on blood gas index, hemodynamics, lung compliance, and rehabilitation index in children with acute respiratory distress syndrome.
Transl Pediatr2020 Dec;9(6):795-801. doi: 10.21037/tp-20-383.
Li Bo, Li Duoling, Huang Wei, Che Yuanyuan,
Abstract
Background:
Acute respiratory distress syndrome (ARDS) is a common pediatric disease, with an increasing mortality rate in recent years. This study aims to explore the effects of lung recruitment on blood gas indexes, hemodynamics, lung compliance, and rehabilitation index in children with ARDS.
Methods:
Seventy children with ARDS admitted to our hospital from December 2017 to December 2018 were selected as the study subjects, and were divided into a study group (35 cases, treated with lung recruitment strategy) and a control group (35 cases, treated with routine therapy). The changes of blood gas indexes, such as partial pressure of oxygen (PO), partial pressure of carbon dioxide (PCO), and partial pressure of oxygen/fraction of inspired oxygen (PO/FiO) levels, as well as hemodynamic indexes, including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), were compared before and after treatment in the two groups.
Results:
Results showed that the difference in blood gas indexes between the two groups was statistically significant after treatment (P<0.05), and that the levels of PaO, PaCO, pondus Hydrogenii (pH), and PO/FiO in the study group were all higher compared to the control group (P<0.05). The hemodynamic indexes showed that CO was significantly different between the two groups (P<0.05), but HR, MAP, and CVP were not (P>0.05). The lung compliance values of the two groups continued to increase at different time points after treatment (P<0.05), and the lung compliance of the study group was higher than that of the control group immediately after recruitment, as well as at 10 and 60 min of lung recruitment (P<0.05). In addition, the ventilator use, ICU stay, and hospital stay times of the study group were shorter than those in the control group (P<0.05), and the mortality rate of the study group was lower than that of the control group (P>0.05).
Conclusions:
The lung recruitment strategy has a significant therapeutic effect on children with ARDS. It can effectively improve blood and gas function and lung compliance, and has a positive effect on the hemodynamic stability of children with ARDS.
2020 Translational Pediatrics. All rights reserved.
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The utility of boxing for cardiac prehabilitation.
Proc (Bayl Univ Med Cent)2020 Sep;34(1):182-184. doi: 10.1080/08998280.2020.1818050.
Brown Katelyn D, Adams Jenny, Meyer Dan M, Gottlieb Robert L, Hall Shelley A,
Abstract
A 56-year-old man with end-stage heart failure performed a 4-week, symptom-limited, progressive inpatient cardiac prehabilitation program while confined to the cardiovascular intensive care unit awaiting heart transplantation. Mobility was limited by an acute gout flare and multiple central venous access lines. He received a tailored prescription of intermittent boxing, supervised hallway ambulation, stair training, and golfing on a putting green on four consecutive weekdays and was encouraged to mobilize with nursing on the remaining days. The patient progressed and by the last week demonstrated increased activity tolerance. He had a successful transplant after 40 days in the intensive care unit and was discharged with stamina sufficient to participate in outpatient cardiac rehabilitation, demonstrating the value, safety, and feasibility of an individualized inpatient cardiac prehabilitation program for patients with advanced cardiac disease medically confined to the intensive care unit.
Copyright © 2020 Baylor University Medical Center.
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Systemic manifestations of Ehlers-Danlos syndrome.
Proc (Bayl Univ Med Cent)2020 Aug;34(1):49-53. doi: 10.1080/08998280.2020.1805714.
Song Bo, Yeh Peter, Harrell John,
Abstract
Ehlers-Danlos syndrome (EDS) is a multifaceted debilitating disease. Affected patients are at risk for complications such as joint hypermobility and cardiac disease, but the prevalence, course, and management of these conditions are not well understood. The objective of this retrospective cohort study was to investigate the demographic characteristics and systemic manifestations in EDS. We performed a retrospective analysis of 98 EDS patients seen in a physical medicine and rehabilitation clinic between January 2015 and April 2019. Charts were reviewed for demographic information, subtype of EDS, characteristics of musculoskeletal pain, and presence of certain systemic comorbid diagnoses: autonomic dysfunction, headaches/migraines, gastrointestinal conditions, cardiovascular anomalies, mast cell activation syndrome, and temporomandibular joint dysfunction. Of 98 patients, 75 were diagnosed with EDS-hypermobile type (EDS-HT); 94 patients were women, and the mean age was 36.7 years. On average, each patient reported involvement of 5.4 joints, with the shoulder, knee, and lumbar spine as the most common. The average number of comorbid systemic conditions was 2.8, of which autonomic dysfunction was the most common. This study aims to provide a better understanding of this disease to promote earlier and more accurate diagnoses to guide treatment and prevent complications.
Copyright © 2020 Baylor University Medical Center.
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A multiprofessional face-to-face and remote real-time hybrid mode of exercise-based cardiac rehabilitation: an innovative proposal during COVID-19 pandemic.
Can J Cardiol2021 Jan;():. doi: S0828-282X(21)00007-6.
Soares DE AraÚjo C L A U D I O G I L, DE Souza E Silva C H R I S T I N A G R Ü N E,
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Effect of self-tailored high-intensity interval training versus moderate-intensity continuous exercise on cardiorespiratory fitness after myocardial infarction: A randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101490. doi: S1877-0657(21)00008-7.
Marcin Thimo, Trachsel Lukas D, Dysli Michelle, Schmid Jean Paul, Eser Prisca, Wilhelm Matthias,
Abstract
BACKGROUND:
Whether high-intensity interval training (HIIT) is more efficient than moderate-intensity continuous exercise (MICE) to increase cardiorespiratory fitness in patients with acute coronary syndrome at moderate-to-high cardiovascular risk is controversial. The best approach to guide training intensity remains to be determined.
OBJECTIVE:
We aimed to assess intensities achieved with self-tailored HIIT and MICE according to perceived exertion and to compare the effect on cardiorespiratory fitness in patients early after ST-elevation myocardial infarction (STEMI).
METHODS:
We included 69 males starting cardiac rehabilitation within 4 weeks after STEMI. After a 3-week run-in phase with MICE, 35 patients were randomized to 9 weeks of HIIT (2×HIIT and 1×MICE per week) and 34 patients to MICE (3×MICE). Training workload for MICE was initially set at the patients' first ventilatory threshold (VT). HIIT consisted of 4×4-min intervals with a workload above the second VT in high intervals. Training intensity was adjusted weekly to maintain the perceived exertion (Borg score 13-14 for MICE, ?15 for HIIT). Session duration was 38 min in both groups. Peak oxygen consumption (VO2) was measured by cardiopulmonary exercise testing pre- and post-intervention.
RESULTS:
Both groups improved peak VO2 (ml/kg/min) (HIIT +1.9, p<0.001; MICE +3.2, p<0.001, Cohen's d -0.4), but changes in VO2 were not significantly different between groups (p=0.104). Exercise regimes did not differ between groups in terms of energy expenditure or training time, but perceived exertion was higher with HIIT.
CONCLUSIONS:
Self-tailored HIIT was feasible in patients early after STEMI. It was more strenuous but not superior nor more time efficient than MICE in improving peak VO2.
Copyright © 2021. Published by Elsevier Masson SAS.
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Profound bilateral deafness complicating aortic arch surgery.
Interact Cardiovasc Thorac Surg2020 Nov;():. doi: ivaa256.
Carré Fabienne, Mamelle Elisabeth, Ferrier Suzanne, Achouh Paul,
Abstract
Hearing loss is a rare complication of cardiac surgery; bilateral profound deafness has never been reported in this setting. A 45-year-old male presented with profound bilateral sudden deafness following arch surgery and frozen elephant trunk. Patient's presentation, surgery details and aetiological mechanisms are discussed.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Sex Differences in Cardiometabolic Health Indicators following HIIT in Patients with Coronary Artery Disease.
Med Sci Sports Exerc2021 Jan;():. doi: 10.1249/MSS.0000000000002596.
Way Kimberley L, Vidal-Almela Sol, Moholdt Trine, Currie Katharine D, Aksetøy Inger-Lise Aamot, Boidin Maxime, Cornelissen Veronique A, Joa Kyung-Lim, Keech Andrew, Jayo-Montoya Jon Ander, Taylor Jenna L, Fouriner Karine, Reed Jennifer L,
Abstract
PURPOSE:
Cardiorespiratory fitness (CRF) is an independent predictor of mortality, and females typically achieve smaller improvements in CRF than males following exercise-based cardiac rehabilitation (CR). High-intensity interval training (HIIT) has been shown to produce superior improvements in CRF than traditional CR, but the sex-differences are unknown. The purpose of this systematic review and meta-analysis was to evaluate sex-differences for changes in CRF and cardiometabolic health indicators following HIIT in adults with coronary artery disease (CAD).Methods and ResultsA systemic search of 5 electronic databases for studies examining the effect of HIIT on measured CRF and cardiometabolic health indicators in adults with CAD was performed. Data (published and unpublished) from 14 studies were included in the meta-analyses with ~8-fold greater male than female participation (n=836 vs. n=103). Males with CAD achieved a near significant absolute improvement in CRF (mean difference [MD]: 1.07, 95% CI: -0.08 to 2.23 mL/kg/min, p=0.07) following HIIT when compared to control; there were insufficient data to conduct such an analysis in females. Significantly smaller improvements in CRF were experienced by females than males (MD: -1.10, 95% CI: -2.08 to -0.12 mL/kg/min; p=0.03); there was no sex-difference for the relative (percentage) change in CRF following HIIT. Females achieved significantly smaller reductions in body mass index (MD: -0.25, 95% CI: -0.03 to -0.47 kg/m2; p=0.02) and fasting blood glucose (MD: -0.38, 95% CI: -0.05 to -0.72; p=0.03); no sex-differences were observed for other cardiometabolic health indicators.
CONCLUSION:
There are no sex-differences for relative improvements in CRF following HIIT; however, females are greatly underrepresented in trials. Future studies should increase female participation and perform sex-based analyses to determine sex-specific outcomes with HIIT.
Copyright © 2021 American College of Sports Medicine.
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Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19 - an observational cohort study.
Eur J Phys Rehabil Med2021 Jan;():. doi: 10.23736/S1973-9087.21.06549-7.
Puchner Bernhard, Sahanic Sabina, Kirchmair Rudolf, Pizzini Alex, Sonnweber Bettina, WÖll Ewald, MÜhlbacher Andreas, Garimorth Katja, Dareb Bernhard, Ehling Rainer, Wenter Johanna, Schneider Sybille, Brenneis Christian, Weiss Günter, Tancevski Ivan, Sonnweber Thomas, LÖeffler-Ragg Judith,
Abstract
BACKGROUND:
The Corona Virus Disease 2019 (COVID-19) pandemic increases the demand for post-acute care in patients after a severe disease course. Various longterm sequelae are expected and rehabilitation medicine is challenged to support physical and cognitive recovery.
AIM:
We aimed to explore the dysfunctions and outcome of COVID-19 survivors after early post-acute rehabilitation.
DESIGN:
Observational cohort study.
METHODS:
This study evaluated the post-acute sequelae of patients hospitalized for SARS-Cov-2 infection and analyzed rehabilitative outcomes of a subgroup of patients included in the prospective observational multicenter CovILD study.
RESULTS:
A total of 23 subjects discharged after severe to critical COVID-19 infection underwent an individualized, multi-professional rehabilitation. At the start of post-acute rehabilitation, impairment of pulmonary function (87%), symptoms related to postintensive care syndrome, and neuropsychological dysfunction (85%) were frequently found, whereas cardiac function appeared to be largely unaffected. Of interest, multidisciplinary rehabilitation resulted in a significant improvement in lung function, as reflected by an increase of forced vital capacity (p=0.007) and forced expiratory volume in one second (p=0.014), total lung capacity (p=0.003), and diffusion capacity for carbon monoxide (p=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of six-minute walking distance by 176 (SD ± 137) meters. Contrarily, a considerable proportion of patients still had limited diffusion capacity (83%) or neurological symptoms including peripheral neuropathy at the end of rehabilitation.
CONCLUSIONS:
Individuals discharged after a severe course of COVID-19 frequently present with persisting physical and cognitive dysfunctions after hospital discharge. Those patients significantly benefit from multi-disciplinary inpatient rehabilitation.
CLINICAL REHABILITATION IMPACT:
Our data demonstrate the highly promising effects of early post-acute rehabilitation in survivors of severe or critical COVID-19. This finding urges the need for further prospective evaluations and may impact future treatment and rehabilitation strategies.
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Gender differences and long term outcome of over 75 elderlies in cardiac rehabilitation: highlighting the role of psychological and physical factors through a secondary analysis of a cohort study.
Eur J Phys Rehabil Med2021 Jan;():. doi: 10.23736/S1973-9087.21.06484-4.
Panzeri Anna, Komici Klara, Cerutti Paola, Sacco Daniela, Pistono Massimo, Rossi Ferrario Silvia,
Abstract
BACKGROUND:
Despite cardiac rehabilitation for elder people already showed its usefulness, to date it is still not clear the impact of gender and of psychological constructs in influencing the rehabilitation outcomes.
AIM:
This study aimed at exploring the gender differences of great elders (over 75 years old) in cardiac rehabilitation, with particular attention to the impact of physical and psychological conditions, as depressive symptoms, on long-term post-discharge outcomes.
DESIGN:
A cohort study design was used and a secondary analysis was conducted.
SETTING:
Cardiac rehabilitation unit of a post-acute rehabilitation Institute.
POPULATION:
Elderly patients over 75 years old admitted to the cardiac rehabilitation program.
METHODS:
Psychological and functional variables, such as Barthel Index, BMI, quality of life, and depression measured at admission and discharge from CR were matched with mortality information up to 4 years, used as long-term outcomes.
RESULTS:
523 patients, 228 females and 295 males, with a mean age of 76.27 years ± 3.46 were progressively enrolled. Barthel index at admission and discharge was higher for males than females, 74.10 ± 17.31 vs 68.90 SD ± 16.81 (p < .001), and 95.45±10.64 vs 92.95±13.03 (p = 0.021), respectively, while the relative change from admission to discharge ?% of Barthel was higher for females 0.25±0.18 than for males 0.21±0.17 (p < 0.05). Compared to males, either at admission or discharge females presented more severe depressive symptoms (5.21±3.46 vs 3.86±2.79, p<0.001; 4.15±3.21 vs 2.93±2.45, p < 0.001) and a worse quality of life (10.58±2.15 vs 9.55±2.24, p<0.001; 7.5±1.63 vs 7.02±1.08, p=0.018). Cox proportional analysis revealed that female gender, depression at discharge, Barthel, and Comorbidity Index were associated with higher hazard and shorter survival time. On the other hand, higher BMI was associated with lower hazard and longer survival time.
CONCLUSIONS:
Elderly women following a CR program present more disability, depression, and a worse QoL than men. Obviously, these characteristics influence the length of hospitalization but with significant improvement. Despite the frail-gender paradox regarding survival, after CR program women have a higher risk of mortality than men. Depression has a significant negative impact on elderly psychophysical health.
CLINICAL REHABILITATION IMPACT:
Gender-specific and individualized rehabilitation programs should be implemented by considering the discussed physical and psychological risk factors. Further insight about gender differences among over 75 elderlies in CR is provided, this knowledge may be useful for clinicians scheduling recovery plans to promote elderlies' psychological and physical health. Psychological interventions should be implemented to relieve the depressive symptoms among elders.
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