ABSTRACT
INTRODUCCIÓN: La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha incidido de forma negativa en los programas de rehabilitación cardiaca (PRC) españoles. OBJETIVO: Este trabajo tiene como objetivo fundamental el analizar la posibilidad de mantenerlos abiertos y como secundario valorar si se mantienen los beneficios demostrados a nivel físico y psicológico. MÉTODOS: Analizamos los resultados de nuestro PRC en el año 2020 (119 pacientes) y los comparamos con los del año 2019 (121 pacientes), libre de COVID-19. Se comparan distintas variables generales, y los resultados obtenidos en capacidad física, a nivel psicológico, así como las complicaciones y abandonos. RESULTADOS: No existen diferencias significativas entre ambos grupos en la edad (61.6 vs. 61.5), sexo (mujeres: 12.6 vs. 14.8%), diagnóstico de cardiopatía isquémica (106 vs. 99) y fracción de eyección de ventrículo izquierdo (55.9 vs. 55.8%). La ansiedad media-alta fue superior al inicio (p = 0.02) y final (p = 0.002) del programa en el año 2019, así como las puntuaciones del patrón de conducta tipo A (p = 0.041 vs. 0.034). El porcentaje de depresión fue similar. Más del 95% de los pacientes del año 2020 referían miedo al contagio. La capacidad funcional aumentó, pero menos en el año 2020 (p = 0.001). La duración del programa fue superior en el año 2020 (p = 0.001). Los abandonos (15 vs. 11 pacientes) no mostraron diferencias significativas. CONCLUSIONES: Los PRC en época COVID-19 son posibles y siguen mostrando beneficios. La duración del programa fue mayor por periodos de falta de asistencia. La menor capacidad física puede estar relacionada con el uso de la mascarilla. INTRODUCTION: COVID-19 pandemic has had a negative impact on Spanish Cardiac Rehabilitation Programmes (CRP). OBJECTIVES: The main objective of this study is to analyze the possibility of keeping these units open and, secondly, to assess whether demonstrated physical and psychological benefits are preserved. METHODS: We analyzed results of our CRP in 2020 (119 patients) and compared them with those of 2019 (121 patients), year free of Covid. We compare different general variables, and results obtained in physical capacity, psychological level, as well as complications and dropouts. RESULTS: There were no significant differences between two groups in age (61.6 vs. 61.5), sex (women: 12.6% vs. 14.8%), diagnosis of ischemic heart disease (106 vs. 99) and left ventricular ejection fraction (55.9% vs. 55.8%). Mean-high anxiety was higher at baseline (p = 0.02) and endline (p = 0.002) of program in 2019, as well as type A behavior pattern scores (p=0.041 and 0.034). Percentage of depression was similar. More than 95% of patients in 2020 reported fear of infection. Functional capacity increased, but less in 2020 (p = 0.001). Programme duration was longer in 2020 (p=0.001). Dropouts (15 vs. 11 patients) showed no significant differences. CONCLUSIONS: CR programmes in COVID-19 era are possible and continue to show benefits. The duration of programme was longer due to periods of non-attendance. Lower physical capacity may be related to mask use.
Subject(s)
COVID-19 , Cardiac Rehabilitation , Female , Humans , Male , Middle Aged , Pandemics , Patient Dropouts , Retrospective Studies , Spain , Stroke Volume , Ventricular Function, LeftABSTRACT
The coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020; one consequence has been the increase in sedentary lifestyle and reduction of sports activity. Exercise benefits the immune defense system especially in older adults; it is recommended to keep a distance of 1.5 meters between people, and if walking or jogging is carried out, the space must be up to 5 and 10 meters respectively. The reported cases are mostly mild up to 80% and can be critical in up to 4.7%; the risk factors are well known, hypertension, diabetes and previous heart disease. Severe or critical cases present as symptoms of acute respiratory distress syndrome, and in the case of cardiovascular disease, they mainly occur as myopericarditis, acute coronary syndromes, cardiogenic shock, thrombotic events, among others. Returning to exercise after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is always recommended, however it will depend on the clinical picture what measures should be taken prior to its onset, and it is in moderate cases and especially in the severe ones where the evaluation and prescription prior to returning to exercise or sport should be guided by medical personnel experts in cardiopulmonary rehabilitation, especially in athletes.
La enfermedad por coronavirus 2019 (COVID-19) fue declarada pandemia el 11 de marzo de 2020; una consecuencia ha sido el incremento en el sedentarismo y la reducción de la actividad deportiva. El ejercicio beneficia el sistema inmunitario de defensa, especialmente en adultos mayores. Se recomienda guardar distancia de 1.5 metros entre personas, y si se realiza caminata o trote, el espacio debe ser de hasta 5 y 10 metros respectivamente. Los casos reportados son en su mayoría leves hasta en un 80%, y pueden ser críticos hasta en 4.7%; los factores de riesgo son bien conocidos: hipertensión, diabetes y enfermedad cardiaca previa. Los casos graves o críticos se presentan como cuadros de síndrome de distrés respiratorio agudo y ante afección cardiovascular cursan principalmente como miopericarditis, síndromes coronarios agudos, choque cardiogénico y eventos trombóticos, entre otros. El ejercicio después de la recuperación de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) siempre está recomendado, sin embargo, dependerá del cuadro clínico qué medidas se deben tomar previo a su inicio, y es en casos moderados y especialmente en los graves donde la evaluación y prescripción previa al retorno al ejercicio o deporte debe ser guiada por personal médico experto en rehabilitación cardiopulmonar, en especial en deportistas.
Subject(s)
COVID-19 , Return to Sport , Cardiac Rehabilitation , Cardiology , Humans , Mexico , PandemicsABSTRACT
INTRODUCTION AND OBJECTIVE: Cardiac rehabilitation has the highest level of recognition in medical guideline references. The rise of COVID-19 pandemic, particularly during the first months of strict containment, cause to temporally stop most of the ongoing programs. We studied the effects of an interdisciplinary phase II secondary prevention in patients diagnosed with a recent acute coronary syndrome with the use of new technologies, home-exercise and telemedicine. METHODS: Between the 2nd and 11th of March 2020, we included 37 patients with recent acute coronary syndrome (76.4%), low-risk and preserved systolic function and underwent a 12-week treatment. A dynamic muscle toning with overload domiciliary training program was applied, in addition to nutritional counselling, as well as psychological and educational therapy. RESULTS: Of the initial cohort, 30 patients finished. At the end of the program, we observed and increased functional capacity over the 6-min walking test (+47.13m; 95% CI: 32.82-61.45, P<.001), and improvement to the subjective feeling of dyspnoea on the modified Borg scale (-0.5 units; 95% CI: -0.76 to -0.24, P=.001), and an improvement over both initial and final training systolic blood pressure (-6.67mmHg; 95% CI: -10.98 to -2.35, P=.004) (-7mmHg; 95% CI: -12.86 to -1.14, P=.021). We also observed an increase in the level of physical activity during leisure time in the IPAQ questionnaire (+1162.93min/week; 95% CI: 237.36-2088.5, P=.016), and in the Mediterranean eating habits on the PREDIMED test (+2.1units; 95% CI: 1.32-2.28, P<.001). CONCLUSIONS: After three months of a domiciliary cardiac rehabilitation program, patients increased their functional capacity, feeling of dyspnoea, blood pressure and eating habits. Domiciliary telemedicine cardiac rehabilitation program produces an improvement in the patient after acute coronary syndrome.