Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study

ABSTRACT BACKGROUND: Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE: To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING: Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS: Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS: From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION: Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.

Short-Term Effects of a Resistance Training Program Using Elastic Tubing in Patients with Heart Disease

Abstract Background Resistance training is effective in cardiac rehabilitation; however, it is conventionally performed using free weights or machines, which can pose logistic challenges to patients with restricted mobility. For its ease of access and cost-effectiveness, elastic tubing is a particularly appealing alternative, but it remains underutilized for this purpose. Objective To evaluate muscle strength, functional capacity, aerobic capacity, and quality of life in patients with heart disease in phase II of cardiovascular rehabilitation after a resistance training intervention based solely on elastic tubing. Methods Thirteen patients with heart disease (age 63.33±10.80 years) trained with elastic tubing twice weekly for 6 weeks, with progressive load increase every 15 days. The following muscle groups were evaluated and trained: shoulder abductors and flexors, elbow flexors, and knee flexors and extensors. Muscle strength was evaluated using a dynamometer; functional capacity, with a 6-minute walk test and cardiopulmonary exercise test; and quality of life, using the SF-36 questionnaire. Data normality was assessed using the Shapiro-Wilk test. The paired Student's t-test was used for comparisons before and after training, at a significance level of <5%. Results There were significant differences in muscle strength (except for elbow flexion) and functional capacity (485.5 ± 123.3 vs 578.7 ± 110.5; p=0.0399) after the intervention. No statistical differences were found in cardiorespiratory fitness or quality of life. Conclusions Short-term resistance training with elastic tubing improved peripheral muscle strength and functional capacity in patients with heart disease, and should be encouraged for this population. (Int J Cardiovasc Sci. 2020; xx(x):xxx-xxx)

Perfil do desenvolvimento motor em escolares com excesso de peso / Profile of the motor development in children with overweight

INTRODUÇÃO: Diferenças relacionadas ao peso e às habilidades motoras em crianças em idade escolar ainda apresentam controvérsias. OBJETIVO: Analisar a relação entre desenvolvimento motor e nível de atividade física com o índice de massa corporal (IMC) de escolares com excesso de peso. MÉTODOS: Foram avaliados 85 escolares de ambos os sexos, de 6 a 10 anos, de Presidente Prudente, São Paulo, Brasil. Os instrumentos utilizados foram a classificação do IMC/idade, a Escala de Desenvolvimento Motor e o Questionário do Nível de Atividade Física Modificado e Adaptado. A amostra foi dividida em dois grupos: grupo com excesso de peso (GEP), com 50 escolares com diagnóstico nutricional de sobrepeso e obesidade; e grupo com normopeso (GNP), com 35 escolares eutróficos. Para análise dos dados obtidos foram utilizados: Shapiro Wilk (normalidade), teste t de Student não pareado ou Mann Whitney (amostras independentes), teste de Spearman (correlação) e teste do χ2 (proporção), com nível de significância p<0,05. RESULTADOS: O GEP apresentou resultados inferiores significantes no desenvolvimento motor geral (91,32±10,68 versus 97,14±9,06; p=0,010), nas áreas de motricidade fina ­ QM1 (93,21±21,59 versus 103,1±13,12; p=0,0138) e motricidade global ­ QM2 (90,31±23,54 versus 112,6±16,07; p<0,0001). Observou-se correlação positiva significativa entre o nível de atividade física e o desenvolvimento motor no GEP, nas áreas de equilíbrio ­ QM3 (0,35080; p=0,0125) e organização espacial ­ QM5 (0,41820; p=0,0025). CONCLUSÃO: O GEP, quando comparado com o GNP, demonstrou resultados inferiores no quociente motor geral (QMG), QM1 e QM2.

INTRODUCTION: In school-age children, differences in weight and motor skills are still controversial. OBJECTIVE: To analyze the relation between motor development, level of physical activity, and body mass index (BMI) in children with overweight. METHODS: 85 students of both genders, aged 6 to 10 years, living in Presidente Prudente, São Paulo, Brazil, were evaluated. The instruments used were: the classification of BMI/age, the Motor Development Scale and the Modified and Adapted Questionnaire of Level of Physical Activity. The sample was divided into two groups: the overweight group (OWG) was composed of 50 students with nutritional diagnosis of overweight and obesity; the normal weight group (NWG) was composed of 35 eutrophic students. The following tests were used for statistical analysis: Shapiro Wilk (data normality), Student's t test or Mann-Whitney (independent samples), Spearman's test (correlation) and χ2 test (proportion), with significance level set at p<0.05. RESULTS: The OWG had significantly lower results for general motor development (91.32±10.68 versus 97.14±9.06; p=0.010), fine motricity (93.21±21.59 versus 103.1±13.12; p=0.0138) and gross motricity (90.31±23.54 versus 112.6±16.07; p=0.0001). A significant positive correlation was found between level of physical activity and motor development in OWG subjects in the domains balance (0.35080; p=0.0125) and spatial organization (0.41820; p=0.0025). CONCLUSION: When OWG is compared to NWG, results are inferior for general motricity, fine motricity, and gross motricity.