multidimensional evaluation of two cardiac rehabilitation programs in patients with coronary artery disease

This study was performed to study the impact of two different cardiac rehabilitation programs [high frequency versus low frequency exercises] on the cardiopulmonary outcome of patients with stable coronary artery disease. Relation of these exercise programs on the recurrence of myocardial morbidity was also defined. Fifty patients with stable ischemic heart disease were divided into two groups: Group 1: including 25 patients who were subjected to a six-week high frequency exercise training and Group 2: including 25 patients who were subjected to a six-week low frequency exercise training. All the patients were subjected to full clinical assessment, laboratory investigations and Doppler echo cardio graphic studies. A statistically significant difference [p<0.05] was found after both the cardiac rehabilitation programs were instituted regarding all the exercise test characteristics studied. As regards quality of life [Qol] questionnaire there was also a highly statistical significant difference p<0.001]. Exercise training has a well-documented efficacy in the overall rehabilitation of patients with coronary artery disease. Beneficial effects of exercise training are evident along the different parameters of cardiac functions i.e. exercise capacity, exercise tolerance, cardiac hemodynamics as well as the patient's QoL

Role of exercise rehabilitation in fibromyalgia syndrome patients

The aim of the present work was to evaluate the effect of exercise in improving the physical function and mood in fibromyalgia syndrome patients [FMS]. Forty female FMS patients were included in this study. They were'assigned to an exercise program and the subjects were tested at entry and at 20 weeks. Tests included the Beck Depression Inventory [EDI], State Trait Anxiety Inventory [STAI], Health Assessment Questionnaire [HAQ], six-minute walk test, Fibromyalgia Impact Questionnaire [FIQ], a measure of tender points and knee strength. Our results showed that all variables measuring physical function improved significantly after exercise from baseline to end of treatment. this study supports the role of exercise rehabilitation in the management of FMS. We have found improvement in physical function and mood of patients with FMS. Exercise led to significantly more improvement in physical function and mood. Exercise is a simple, cheap, effective and potentially widely available treatment for FMS patients

Role of exercise rehabilitation in coronary artery disease patients

The aim of the present work was to evaluate the effect of exercise rehabilitation [high frequency versus low frequency exercises] in improving the functional capacity and quality of life in patients with stable coronary artery disease. Fifty patients with documented manifestations of coronary artery diseases were included in this study. Patients were randomly divided into two groups. Group I: included 25 patients who were subjected to a six-week high-frequency exercise training program and group II: included 25 patients who were subjected to a six-week low-frequency exercise training program. Tests included exercise testing protocol according to the standard protocols of Bruce and assessment of the quality of life. Our results showed that both the high frequency and the low frequency exercise training have led to an improvement in the exercise capacity and the quality of life parameters. The improvement was better in the high frequency exercise training program. this study supports the role of exercise rehabilitation in the management of patients with coronary artery disease. We have found improvement in functional capacity and quality of life in patients with stable coronary artery disease. Beneficial effects of exercise training were evident along the different parameters of cardiac function i.e. exercise capacity, exercise tolerance, hemodynamics of exercise stress test as well as the patient's quality of life. Compared with low frequency exercise, high frequency exercise led to significantly more improvement in functional capacity and quality of life

Intima-media thickness of the common carotid artery in systemic lupus erythematosus

SLE patients appear to have increased morbidity and mortality from cardiovascular disease [CVD] that is not explained by traditional risk factors. Leptin, an adipocyte-derived protein regulating food intake and metabolism has been implicated in the development of coronary artery disease. To measure the intima-media thickness [IMT] of the common carotid artery [as an index of subclinical atherosclerosis] and to evaluate its relation to cardiovascular risk factors, lupus-related factors and serum leptin level. We used high-resolution B-mode ultrasound, to compare common carotid artery [CCA] intima-media wall thickness [IMT] in 40 SLE patients and 40 matching controls. We investigated the association between [IMT] of the [CCA] in SLE, clinical and therapeutic variables. The mean level of IMT of the CCA showed a statistically highly significant increase [p<0.001] in SLE patients as compared to controls. Insignificant correlations [p>0.05] were found between IMT of the CCA in SLE and HDL-c, triglycerides, C3, C4, SLEDAI, anti-dsDNA, anticardiolipin antibodies and drug treatment. There were statistically significant correlations [p<0.05] between IMT of the CCA in SLE and systolic BP, diastolic BP, total cholesterol, LDL-c, fibrinogen, and CRP. Highly statistically significant correlations [p<0.001] were found in relation to age, disease duration, body mass index, HAQ, SLICC damage score, and serum leptin level. Age, disease duration, body mass index and serum leptin level in that order were the variables predicting atherosclerosis among SLE patients. Aggressive control of SLE and lowering of leptin concentrations are potential means to retard development and progression of atherosclerosis in SLE

Bone mineral density in premenopausal systemic lupus erythematosus patients: influence of serum leptin, disease related variables and use of corticosteroids

To evaluate bone mineral density [BMD] in premenopausal female patients with SLE and to assess the influence of serum leptin, disease related variables and use of corticosteroids. We analyzed only the premenopausal SLE patients to eliminate the confounding effect of menopause on bone loss. Forty pre-menopausal systemic lupus erythematosus patients [SLE] who fulfilled the revised criteria for classification of SLE of the American College of Rheumatology [ACR] and twenty healthy control subjects apparently free from any relevant disease were included in this study. All patients were subjected to full history taking, thorough clinical examination and assessment of disease activity using the SLE disease activity index [SLEDAI], assessment of functional status using Steinbrocker grades as well as measurement of serum leptin level with ELISA. Bone densitometry was performed by Dual Energy X-Ray Absorptiometry [DEXA] at the lumbar spine from L2-4 and left hip [femoral neck, trochanter]. Our results showed a high frequency of low BMD at the lumbar spine [L2-L4] and left hip [femoral neck, trochanter] as diagnosed by using DEXA in premenopausal female patients with SLE as compared to controls. BMD correlated negatively with age, disease activity, functional capacity, and corticosteroid treatment and correlated positively with bone mass index [BMI] and serum leptin level. Premenopausal SLE patients had significantly lower BMD than controls. Also, a high incidence of osteopenia and osteoporosis was found in premenopausal patients with SLE. Bone diminution in SLE seemed to be attributable to age, BMI, disease activity, functional capacity and serum leptin level and corticosteroid treatment. Regular DEXA screening, controlling of disease activity, improving of functional capacity and reduction of steroid dose as much as possible may be of beneficial effects upon BMD in SLE patients. Leptin may be useful in the future for further research in the treatment of osteoporosis

Cognitive functions in systemic lupus erythematosus patients

To assess cognitive function in patients with SLE and to determine its correlation to demographics, quality of life, and disease- related variables. Twenty patients with systemic lupus erythematosus [SLE] who fulfilled the revised criteria for classification of SLE of the American College of Rheumatology and twenty healthy control subjects apparently free from any relevant disease were included in this study. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using SLAM index and assessment of quality of life using Beck Questionnaire as well as detection of IgG anticardiolipin antibodies using ELISA. Cognitive function tests were performed by Stanford-Binet IV scale which measure verbal ability, visual/ abstract ability, short-term memory, and general intelligence quotient [IQ]. The mean scores of all cognitive function tests] verbal ability, visual ability, short term memory and [I.Q.] [in SLE patients showed a statistically significant decrease [p<0.05] as compared to controls. Cognitive functions of SLE patients correlated positively with quality of life and correlated negatively with disease activity, antiphospholipid antibodies, and CNS manifestations of SLE patients. Cognitive functions of SLE patients showed a significant impairment compared with normal people. Disease activity, antiphospholipid antibodies, quality of life and CNS manifestations of SLE patients were associated with impairment in cognitive functions. Evaluation of cognitive function, improving of disease activity and quality of life should be given greater emphasis in SLE patients especially in the presence of antiphospholipid antibodies and CNS manifestations

Intima-media thickness of the common carotid artery in rheumatoid arthritis patients

To measure the intima-media thickness [IMT] of the common carotid artery [as an index of subclinical atherosclerosis] and to evaluate the factors associated with arterial wall thickness in RA patients. We used an accurate and reliable imaging technique, high-resolution B-mode ultrasound, to compare common carotid artery [CCA] intima-media wall thickness [IMT] in 40 RA patients and 40 controls. The apparently healthy subjects were comparable with the RA patients as regards the risk factors for atherosclerosis, including age, sex, menopause status, body mass index [BMI], blood pressure, and serum lipid levels. We investigated the association between [IMT] of the [CCA] in RA and clinical and therapeutic variables. The mean level of IMT of the CCA showed a statistically highly significant increase [p<0.001] in RA patients as compared to controls. There were statistically significant correlations [p<0.05] between IMT of the CCA in RA and disease related variables; duration of morning stiffness, articular index, grip strength, ESR, hemoglobin level, pain severity and rheumatoid factor. Highly statistically significant correlations [p<0.001] were found in relation to age, disease duration, spread severity index, Larsen score, HAQ and CRP. Insignificant correlations [p>0.05] were found between IMT of the CCA in RA patients and sex, B.M.I, systolic and diastolic blood pressure, lipid profile and drug treatment. RA patients exhibited greater thickness of the common carotid artery than healthy controls, so RA patients have an ultrasonic marker of early atherosclerosis. The age, disease duration, disease activity and severity, decreased physical activity, but not therapeutic variables, were associated with the increased arterial wall thickness

Detection of carotid atherosclerosis in systemic lupus erythematosus and its relation to risk factors

To detect early atherosclerotic changes in SLE patients and to evaluate its relation to traditional cardiovascular risk factors and lupus-related factors. Forty female SLE patients were included in this study. Their age ranged from 20 to 63 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and assessment of SLE-related disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] damage index. Intima-media thickness [IMT] and carotid plaques were measured with carotid B-mode ultrasound. Risk factors associated with carotid plaques and IMT were determined. They included traditional cardiovascular risk factors, SLE-related disease factors and inflammation markers. Eighteen patients out of the 40 [45%] had plaques. Those patients were statistically significantly [p<0.05] older and had higher systolic and diastolic blood pressure, greater body mass index, higher levels of total cholesterol, low-density lipoprotein [LDL] cholesterol, fibrinogen and C-reactive protein [CRP] than patients without plaques. The patients with plaques had a statistically significant [p<0.05] longer disease duration, higher SLICC damage score and longer duration of prednisone use than those without plaques. The mean level of IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly [p<0.001] as correlated with the age, CRP, and SLICC damage index. The prevalence of the plaques in the studied SLE patients was 45%. There were statistically significant differences between the patients with and those without plaques regarding disease-related factors [disease duration, SLICC damage score and duration of prednisone use] and inflammation markers [fibrinogen and C-reactive protein]. IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly correlated with SLICC damage index. These findings show that SLE-related disease factors and inflammation markers are associated with carotid atherosclerosis in the SLE patients. SLE patients at risk of atherosclerosis should be examined by high resolution ultrasonography for identification of early stage atherosclerosis. Also, dampening of the inflammatory activity has a favorable impact on the progression of atherosclerosis in SLE patients

Assessment of pulmonary function in ankylosing spondylitis patients

This study was carried out to assess pulmonary function in ankylosing spondylitis [AS] patients. Pulmonary function tests and integrative cardiopulmonary exercise testing [CPET] were studied in 20 AS patients and 20 healthy individuals. All subjects were also assessed for functional status with BASFI, measurement of chest expansion, lumbar spinal flexion with the modified Schober's method, and peripheral muscle function]assessed by measuring both muscle strength [knee extensors] and amount [lean body mass][. The typical respiratory function abnormalities in AS were those of restrictive changes with decreased FVC, FEV1, VO2 max., and normal FEV1/FVC. Pulmonary function showed correlations with chest expansion, lumbar stiffness as well as peripheral muscle function. This study showed that, in AS patients, pulmonary function tests were defective and confirmed a restrictive type of impairment. Evaluation of pulmonary function and encouragement for more regular exercise to improve spinal mobility and muscle function should be given greater emphasis in ankylosing spondylitis patients