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Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.
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In 2020, the European Association of Preventive Cardiology proposed the important role of exercise-based cardiac rehabilitation (CR) in the management of cardiovascular and metabolic diseases, and called on everyone to take action. This paper discusses the current status and future perspective of individualized active exercise-based CR for coronary artery disease (CAD) from 4 dimensions, including the basic and clinical research progress of exercise-based CR for CAD, evidence on the benefits of exercise-based CR on ameliorating CAD complications, the exercise-based CR guidelines in different countries, and the implementation of exercise-based CR under coronavirus disease 2019 pandemic, so as to provide reference for research and clinical work.Copyright © 2022, Second Military Medical University Press. All rights reserved.
ABSTRACT
In 2020, the European Association of Preventive Cardiology proposed the important role of exercise-based cardiac rehabilitation (CR) in the management of cardiovascular and metabolic diseases, and called on everyone to take action. This paper discusses the current status and future perspective of individualized active exercise-based CR for coronary artery disease (CAD) from 4 dimensions, including the basic and clinical research progress of exercise-based CR for CAD, evidence on the benefits of exercise-based CR on ameliorating CAD complications, the exercise-based CR guidelines in different countries, and the implementation of exercise-based CR under coronavirus disease 2019 pandemic, so as to provide reference for research and clinical work.Copyright © 2022, Second Military Medical University Press. All rights reserved.
ABSTRACT
Background: The COVID-19 pandemic has disrupted cardiac rehabilitation (CR) around the world with an estimated 50-75% of CR programmes discontinuing or reducing services. Alternative models such as TeleHealth have been encouraged and adopted in place of face to face (F2F) CR. There is a paucity of published data on the continuation of F2F CR during the pandemic. Method(s): A retrospective database audit examined the CR participation rates at an Australian quaternary public hospital during the pre-COVID (2018/2019) and in-COVID (2020/2021) periods. Socio-demographic status, diagnosis at CR entry, CR modalities, and outcome measures (wait times, completion rates) were analysed. Result(s): There were no COVID-19 cases or cross infections occurring in CR during the in-COVID period. An audit of 1623 consecutive patients who attended our CR programme (pre-COVID n=760: In-COVID n=863) were included in this study. No significant differences were observed in age, male sex, CR wait times and completion rates between the two groups. Participation rates of patients diagnosed with heart failure (CCF) increased (p=0.02) and those who entered CR after elective PCI decreased (p=0.03) during the in-Covid period in comparison with the pre-COVID period. Total F2F CR was maintained in the in-COVID period compared to the pre- COVID period (85%: 89%, p=not significant (NS)). A significant increase in F2F utilising home walking (p<0.0001) and a decrease in F2F utilising supervised exercise (p<0.0001) was seen. TeleHealth, introduced during the in-COVID period, only contributed to 6% of the total CR participation. More detailed results of this study are presented in Table 1 below. Conclusion(s): During the COVID-19 pandemic our CR programme adhered to state health orders, recorded zero transmissions, maintained face to face services, and increased CR uptake only partially due to the introduction of TeleHealth. Our blueprint for the successful continuation of CR during COVID involves having expert nursing management, medical CR champions, dedicated CR gym, and well-established, flexible patientcentric programme modalities. (Table Presented).
ABSTRACT
Background: Long COVID emerged as a new condition, following the acute episode of coronavirus disease 2019 (COVID-19),exerting a significant impact on patients' quality of life [1]. Several studies involving COVID- 19 survivors emphasized the presence of cardiac abnormalities following the acute infection. However, data on possible mechanisms associated to long COVID remain limited. Clinical applications of myocardial work (MW) analysis, assessed by transthoracic echocardiography (TTE) have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard parameters such as left ventricle ejection fraction (LVEF) or global longitudinal strain (GLS) in various pathologies, including COVID-19 [2]. Nevertheless, its potential role in detecting subclinical cardiac dysfunction in long COVID remained unexplored. Purpose(s): We assessed the association between subclinical cardiac dysfunction evaluated by global work index (GWI) and global constructive work (GCW) and long COVID. Method(s): We included 310 COVID-19 patients hospitalized between March and April 2020. All patients were invited to a systematic one-year follow-up, including clinical evaluation, TTE with MW assessment, chestcomputed tomography and spirometry. 140 patients completed the followup. Normal values for GWI and GCW were defined as 1926+/-247 mmHg% and 2224+/-229 mmHg% [3]. The primary endpoint was long COVID, characterized by a cluster of symptoms such as fatigue or dyspnea more than 3 months after the acute infection, without any other explanation. Result(s): 140 patients (57.1+/-13.9 years, 90 (64.3%) males) had a mean follow-up of 337.1+/-34.5 days.The mean values of LVEF, GWI and GCW were 55.2+/-3.2%, 2105.9+/-403.3 mmHg% and 2377.8+/-446.2 mmHg%. 83 (61%) patients had long COVID. No significant differences in terms of comorbidities, clinical evaluation and COVID-19 severity were found between patients with and without long COVID. GCW (2276.7+/-410.3 vs 2516.5+/-458.6, p=0.006) and GWI (2008.5+/-358.9 vs 2242.2+/-427.0, p=0.003) were the only TTE parameters different between patients with and without long COVID. Multivariable regression analysis showed that GWI <1926 mmHg% (OR 6.095;CI: 2.024-18.355, p=0.001) and GCW <2224 mmHg% (OR 3.205;CI: 1.181-8.694, p=0.022) were the only MW parameters independently associated with long COVID, irrespective of age or the severity of the acute infection, at one year. In a subgroup analysis of 77 patients without previous cardiovascular diseases, long COVID was diagnosed in 45 (58.4%)patients. GWI <1926 mmHg% (OR 8.015;CI: 2.149-29.887, p=0.002) remained independently associated with long COVID at 1 year follow-up. Conclusion(s): Long COVID, frequently observed in recovered COVID-19 patients may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the left ventricle performance, assessed by GWI and GCW.Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs.
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Background: Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose(s): This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Method(s): We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospitalbased CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [DELTA]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Result(s): Sixteen patients (72.2+/-10.4 years) completed remote-based CR and fifteen patients (77.3+/-4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0+/-2.7 mL min-1 kg-1;after: 14.9+/-3.9 mL min-1 kg-1;p<0.05) and the WHOQOL-BREF score (before: 77.4+/-12.8 points;after: 93.9+/-12.9 points;p<0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9+/-13.2 points;after: 11.3+/-6.8 points;p<0.05) after rehabilitation than at baseline. The post- CR physical function differed significantly between the two groups (DELTApeak VO2, remote: 2.8+/-3.0 mL min-1 kg-1;hospital: 0.84+/-1.8 mL min-1 kg-1;p<0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (DELTAWHODAS 2.0 score, remote: -8.56+/-14.2 points;hospital: 2.14+/-7.6 points;p<0.01). Conclusion(s): Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed.
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Background Cardiac rehabilitation (CR) is a Class 1 indication for patients following acute coronary syndrome, coronary intervention and in patients with chronic, stable heart failure. However, rates of participation remain abysmal. Following the COVID-19 pandemic, interest in remote cardiac rehabilitation (R-CR) has increased. Efficacy of R-CR versus the current standard of care remains unclear. Methods A systematic review of the available literature was performed according to the PRISMA 2020 checklist. Of the identified studies, further screening was done to isolate randomized controlled trials (RCT) that measured objective markers of physical fitness such as peak oxygen consumption during exercise (VO2 max) and distance traveled during 6 minute walk test (6MWT). Results 20 RCTs were identified that compared R-CR versus either standard CR or usual care that did not include a component of CR. There is no difference in the change in exercise capacity achieved based on whether a patient underwent R-CR versus standard CR. There was a significant difference in the change in exercise capacity achieved in patients who underwent R-CR versus usual care. R-CR is associated with a significant change in VO2 max but not distance walked on 6MWT. Conclusion R-CR is not inferior to standard CR in improving VO2 max and distance walked on 6MWT. R-CR may be superior to usual care that does not include an element of CR. This is potentially beneficial as increased adoption of R-CR may improve participation in CR as a whole. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Background/Introduction: Clinical applications of myocardial work(MW) analysis have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard echocardiographic parameters such as left ventricle ejection fraction(LVEF) or global longitudinal strain(GLS). Nevertheless, its role in detecting subclinical cardiac dysfunction in long COVID remained unexplored. Purpose(s): We assessed the association between subclinical cardiac dysfunction evaluated by MW and long COVID. Method(s): All COVID-19 discharged patients were invited to a systematic one-year follow-up, including clinical evaluation, echocardiography, chest-computed tomography and spirometry. Normal values for global work index(GWI) and global constructive work(GCW) were defined as 1926 +/-247mmHg% and 2224+/-229mmHg%. The primary endpoint was long COVID, characterized by a cluster of symptoms (e.g. fatigue or dyspnea) more than 3 months after the acute infection, without any other explanation. Result(s): 140 patients(57.1 +/-13.9 years, 90(64.3%)males) had a mean follow-up of 337.1+/-34.5 days. The mean values of LVEF, GWI and GCW were 55.2+/-3.2%,2105.9+/-403.3mmHg% and 2377.8 +/-446.2mmHg%. 83(61%)patients had long COVID. No significant differences in terms of comorbidities or COVID-19 severity were found between groups.GCW(2276.7 +/-410.3 vs 2516.5+/-458.6, p=0.006) and GWI(2008.5+/-358.9 vs 2242.2+/-427.0, p=0.003) were significantly different between patients with and without long COVID. Additionally, GWI <1926mmHg%(OR 6.095 CI2.024-18.355, p=0.001) and GCW <2224mmHg%(OR 3.205, CI 1.181-8.694, p=0.022) were the only MW parameters associated with long COVID, irrespective of age or the disease severity, at one-year. In a subgroup analysis of 77 patients without cardiovascular diseases, long COVID was diagnosed in 45(58.4%)patients. GWI <1926mmHg%(OR 8.015, CI 2.149-29.887, p=0.002)remained independently associated with the primary endpoint. Conclusion(s): Long COVID may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the cardiac performance, assessed by MW. Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs.
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Background: Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery. Method(s): This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests. Result(s): Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 +/- 59.90 m in the pre-CR program, increased to 415.37 +/- 46.46 m in the post-CR program. The mean HRR1 was 15.16 +/- 9.44, and HRR2 was 56.59+/- 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12). Conclusion(s): The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests;neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
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Background Cardiac rehabilitation is accessed by only ~50% of eligible patients. Virtual options have become more important since Covid. The Our Hearts Our Minds (OHOM) programme used wearable technology (Fitbit) for virtual physical activity monitoring. Aim To examine whether a Fitbit smartwatch/dashboard component was an acceptable option to improve physical activity levels in the absence of supervised exercise classes. Methods Initial multidisciplinary assessments were conducted via telephone/video as per patient preference. Patients were offered a Fitbit, if they did not have their own smartwatch and to synchronise to a cloud based dashboard visible to the clinical team. Using behaviour change techniques, tailored physical activity advice was provided including personalised notifications pushed to the patient's Fitbit app. Patients also received coaching calls and virtual group education sessions. Average daily step count and active minutes (over a 7 day period) were calculated at the start and end of programme. Results 1066 referrals were received from 01/04/20 to 30/ 03/22, of which 1043 patients (98%) had an initial assessment. Of these, 407 wore a Fitbit device (33% provided by programme, 6% own Fitbit) and synchronised to OHOM Fitbit dashboard (39% uptake). 6% had their own non-Fitbit smartwatch. 55% declined Fitbit (5% didn't own a smartphone for app download or access the internet, 3% weren't interested in technology, 2% medical reasons, 2% didn't collect, 43% weren't interested in virtual monitoring). Physical activity outcomes pre and post programme are shown in table 1. Conclusion Fitbit (and other) smartwatches coupled with centralised monitoring provided a viable alternative to supervised exercise classes in approximately half of those attending cardiac rehabilitation with evidence of increased physical activity.
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Background The Duke Activity Status Index (DASI) questionnaire assesses functional capacity of patients with cardiovascular disease (CVD[1]figure 1.). DASI derives a total score and corresponding METs level. We utilised this questionnaire during COVID-19 when face to face (F2F) functional capacity testing was an unavailable outcome measure for cardiac rehabilitation (CR). Aim To evaluate the correlation between DASI METs and the incremental shuttle walk test (ISWT)and establish if it is a reliable tool to estimate functional capacity in patients with cardiovascular disease (CVD). Methods DASI questionnaire was completed over the phone as part of a subjective assessment. Two ISWTs were performed at a F2F appointment prior to starting class, best of two, taken. Measures were repeated post-CR completion. Results 93 patients, 64.5% male, mean age (SD) 65.3 (9.6) years, assessed at baseline. Patients' presentation: 27% NSTEMI, 24% STEMI, 16% Angina, 13% Heart failure and 20% other. Outcomes pre to post CR are shown in table 1. Correlation between DASI METs and the ISWT at baseline was r= 0.32 [weak positive (p<0.05)] and post-CR was r= 0.67[strong positive (p<0.01)]. The ISWT change was similar to the minimum important difference (MID) 70m in the CHD population. There is no MID for the DASI Conclusions Patients attending CR post-pandemic made significant improvements in both the DASI and ISWT. Correlations became stronger post programme, indicating patients may better self-evaluate physical performance after taking part in CR. DASI questionnaire may be a useful alternative outcome measure when F2F exercise testing is not an option. Future work could explore how to prescribe an exercise programme from this and what might represent a meaningful change in this outcome following CR (Table Presented).
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Introduction: The COVID-19 pandemic has impaired hospitals, i.e. cardiac departments by cancellation of acute interventions and reduction of bed num-bers. Cardiac rehabilitation clinics were affected up to partial or complete shut-down. This investigation was performed in order to obtain how the pandemic in 2020 had affected the cardiac rehabilitation institutions. Method(s): Via an online survey, which the DGPR performs yearly in its member institutions in order to get data of the performance numbers, data re-lating to the pandemic situation 2020 were collected between May and November 2021. Result(s): At 30th of November 2021, 74 rehabilitation institutions (rate 71 %) provided data of 94.668 patients. In more than 50 % short time was int-roduced (for physicians in 52,7 %, for other persons in 63,5 %). 67 institutions (93,1 %) reported a decrease of alloca-tion of patients, on average for 32 weeks duration. 30 institutions (41,1 %) reported a COVID-19 onset, which in 10 % resulted in a shutdown of the institution. Discussion(s): The survey substantia-tes the drastic consequences of the CO-VID-19 pandemic for cardiac rehabilitation institutions in 2020, this becomes clear by the reduction of allocations and the shutdown of institutions - and this in the light of an increasing need for rehabilitation i.e. due to numerous suffe-rers with post / long COVID syndrome.Copyright © 2022, Verlag Kirchheim and Co. GmbH. All rights reserved.
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Background Despite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID- 19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR selfmanagement programme. The SCOT:REACH-HF study was designed to provide the understanding of real-world implementation needed for NHS-wide roll-out in a Scottish context. Aim To 1) compare outcome improvements and delivery costs with those identified in the RCT;and 2) identify facilitators of and barriers to real-world implementation. Methods A mixed-method implementation study of REACHHF delivery across six NHS Scotland areas in 2021-22. Health professionals were trained to facilitate delivery of the 12-week programme. We assessed patient- and caregiverreported outcomes (including health-related quality of life, psychological wellbeing) pre-and post-REACH-HF participation. Primary Outcome: Minnesota Living with Heart Failure Questionnaire (MLHF). 136 adults with reduced ejection fraction HF (HFrEF) were recruited, and 101 completed follow-up. 54 participants nominated caregivers, 26 of whom completed follow- up. Qualitative interviews with 20 key health professionals (primarily REACH-HF facilitators) were subject to thematic analysis to explore barriers to and facilitators of implementation. Fidelity, contextual, and economic data were also collected. Results REACH-HF participation resulted in significant gains in health-related quality of life, as assessed by the MLHF, PROM-CR+, and EQ-5D-5L, and Self-Care of Heart Failure Index (SCHFI). MLHF improvements were both statistically significant and met the minimum clinically important difference in 63% of participants (see figure 1). Interviewees were largely positive about REACH-HF - considering it to have 'filled a gap' when no other CR was available - and key issues to support future roll-out were identified. Conclusion Our findings support the scaled roll-out of REACH-HF. This would offer people with HFrEF, and their families and friends, an accessible alternative to centre-based CR. (Figure Presented).
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Background Cardiac rehabilitation (CR) has shown clinical benefit in heart transplant (HT) recipients. However, variable adherence with CR has been reported. We aimed to describe adherence and factors associated with CR cessation. Methods We performed a retrospective chart review of HT recipients who attended at least one CR session at a tertiary medical center (2013-2021). Complete adherence was defined as participation in all 36 CR sessions. We extracted participant age, sex, race, BMI, diabetes, creatinine clearance, post-operative complications (reoperation, major bleeding, infection, or need for dialysis), hospital length of stay, and METs on baseline exercise tolerance test prior to CR. We computed the proportion of HT recipients who did not complete CR, and then compared their characteristics to those of HT recipients with complete adherence using Kruskal Wallis tests and Fisher's Exact tests for continuous and categorical variables, respectively. Primary reasons for cessation were extracted from the electronic health record. Results There were 55 HT recipients (median age 55.9 years, 67.3% male) who attended CR;25 (45.5%) had complete adherence. Thirty did not complete CR (14 patients attended 1-12 sessions, 12 patients attended 13-24 sessions, and 4 patients attended 25-35 sessions) and participated in a median of 13 sessions (IQR 9-21). Within this group, 46.7% reported medical reasons for cessation, 20.0% for personal reasons, 13.3% for COVID-19 pandemic, 6.7% for insurance expense, 3.3% for relocation, and 3.3% for return to work or school. Patients who did not complete CR experienced more post-operative complications after HT (63.3% vs 32.0%, p = 0.03) but there were no other differences in characteristics between groups. Conclusion Nearly half of HT recipients in our sample had complete adherence to CR. Among those who did not complete CR, medical reasons were most commonly cited. Postoperative complications predicted CR cessation, but there were no other differences between groups, albeit with a relatively small sample size.Copyright © 2023 American College of Cardiology Foundation
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The proceedings contain 63 papers. The topics discussed include: the CAT is significantly correlated to DLCO and 6-minute walk test in patients with long-COVID;cardiac and non-cardiac pain and sleep in patients participating in outpatient cardiac rehabilitation;the PEM/PESE activity questionnaire: a novel health-related quality of life measure for post-exertional disablement;comparison of AM-PAC and FSS-ICU in patients recovering from open heart surgery in ICU;assessment of physical therapy students' self-efficacy and accuracy measuring blood pressure using a task trainer;functional improvements observed in long-covid patients following participation in pulmonary rehabilitation;effects of a virtually-delivered program on breathing strength and lung function - a retrospective study;the influence of kinesiology tape on posture and breathing mechanics in healthy individuals;is there a role for increasing daily lifestyle walking bouts in asymptomatic peripheral arterial disease?;and impact of standard vs. modified sternal precautions on function following median sternotomy: a systematic review.
ABSTRACT
The proceedings contain 63 papers. The topics discussed include: the CAT is significantly correlated to DLCO and 6-minute walk test in patients with long-COVID;cardiac and non-cardiac pain and sleep in patients participating in outpatient cardiac rehabilitation;the PEM/PESE activity questionnaire: a novel health-related quality of life measure for post-exertional disablement;comparison of AM-PAC and FSS-ICU in patients recovering from open heart surgery in ICU;assessment of physical therapy students' self-efficacy and accuracy measuring blood pressure using a task trainer;functional improvements observed in long-covid patients following participation in pulmonary rehabilitation;effects of a virtually-delivered program on breathing strength and lung function - a retrospective study;the influence of kinesiology tape on posture and breathing mechanics in healthy individuals;is there a role for increasing daily lifestyle walking bouts in asymptomatic peripheral arterial disease?;and impact of standard vs. modified sternal precautions on function following median sternotomy: a systematic review.
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Introduction: COVID-19 significantly affected outpatient cardiac rehabilitation which is a central resource for patients recovering from cardiovascular disease. The aim of the study was to examine the impact of COVID-19 on Cardiac Rehabilitation (CR) Phase II clinical outcomes. Method(s): A single-site retrospective chart review of CR Phase II patients who completed 12 or more visits during 2019 (pre-COVID) and 2020 (COVID) was performed. Depression was measured using the PHQ-9, functional capacity was measured by the 6-minute walk in distance (ft) and metabolic equivalents (METs), and quality of life (QOL) was measured by the Ferrans and Powers Index. Descriptive and linear mixed methods were used to analyze the data. Result(s): A total of 212 patients who were predominately male 67% and 66.5 (SD=10.8) years old were included. PHQ-9 results showed a significant interaction COVID*pre-post scores F(1, 119.66) = 4.66, p = 0.03. For the remaining scores, all results showed significant improvements in pre-post: distance F(1, 151.90) = 226.92, p <.001;METs F(1, 180.13) = 138.7, p <.001;and QOL F(1, 145.32) = 5.89, p =0.02. Interactions were not significant for the three variables. QOL results showed significant differences in the COVID group with F(1, 239.12) = 6.13, p = 0.01. Conclusion(s): All four outcomes improved significantly in the pre-COVID and COVID sample. COVID significantly impacted depression PHQ-9 score change, with a pre-post improvement of 0.62 points in the pre-COVID group and 2.08 points during COVID. Finally, the mean overall QOL score was significantly lower in the COVID group than the pre-COVID group.
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Background: Cardiac Rehabilitation (CR) is a multidisciplinary approach involving exercise training and health-related education routinely available to cardiac patients, but rarely offered to people with stroke. We have shown people with stroke can be integrated into centre-based CR, but due to access difficulties, opportunities for people with stroke to participate in centre-based CR are limited. Home-based CR is well-established for people with heart disease and offers an alternative for people with stroke who are unable to access centre-based rehabilitation. Aim(s): Investigate the safety and feasibility of home-based, telehealthdelivered, stroke-adapted CR. Method(s): A single-site, prospective-cohort safety and feasibility trial. People with ischaemic stroke were screened for eligibility and invited to participate in a six-week program of exercise and education delivered via telehealth to the participant in their own home following discharge from inpatient rehabilitation (i.e. <6-weeks post-stroke). Safety and feasibility were assessed by incidence of adverse events and measures of participant recruitment, retention, and adherence. Result(s): Ninety-five people with stroke were screened, 67 (70%) were eligible to participate, and 19 (28%) consented. Of the 28 that were ineligible to participate, the main reasons for exclusion were haemorrhagic stroke (53%), nil medical clearance (18%), and nil acute stroke (14%). Of the 48 eligible participants that did not consent, 45% were not included due to the impact of COVID-19, 20% were discharged prior to being approached to participate, and 12% did not consent due to a lack of time. Three participants dropped out of the study prior to commencing the outpatient intervention. The remaining 16 participants completed the six-week intervention. Positive written and verbal feedback was received from participants on the appropriateness of the intervention. Conclusion(s): COVID-19 significantly impacted our capacity to recruit participants to this trial. Preliminary data suggests home-based, telehealthdelivered, stroke-adapted CR is safe and potentially feasible in early subacute stroke.
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Background: The COVID-19 pandemic resulted in a necessary transition from centre-based cardiac rehabilitation to virtual cardiac rehabilitation (VCR) to continue delivery of effective and high-quality care. To enhance risk stratification, an extended duration electrocardiographic (ECG) patch monitor was added to the intake protocol for patient's enrolled in a virtual only cardiac rehabilitation program. Method(s): The objectives of this study were to assess the diagnostic yield of extended ECG patch monitoring (DR400 3-channel monitor, NorthEast Monitoring, Inc., Maynard MA;5-day duration) and the effect on clinical management in a tertiary cardiac rehabilitation population. A retrospective analysis of consecutive patients enrolled in VCR at a single site was performed. All patients who were enrolled in VCR and underwent extended ECG patch monitoring as part of their intake assessment were included. Risk was defined by the AACVPR 2020 risk categorization. Extended patch monitor diagnoses were reviewed for accuracy and classified as a new or known diagnosis. Impact on clinical management was defined as any medication adjustment, procedure requirement/recommendation, or exercise prescription modification. Patient characteristics, cardiac testing results, and risk categorization were described using basic descriptive methods including frequency distributions, and means and SDs. Result(s): Two-hundred and sixty-nine patients [mean age 61.7 years (SD 12.0) 63% male] out of 286 patients enrolled in VCR between August 13, 2020 and October 26, 2021 met inclusion criteria (Table 1). Two percent of patients were classified as high risk, 41% as moderate risk, and 57% as low risk. Thirty (11%) new arrythmia diagnoses were obtained from extended ECG patch monitoring. Diagnoses included one patient with atrial flutter and high-grade AV block, one patient with paroxysmal atrial fibrillation, and 28 patients with non-sustained ventricular tachycardia (NSVT) (4-48 beats;11% symptomatic). Fifty-seven percent (n=17) of diagnoses were evident on the first 24-hours of monitoring and 43% (n=13) required extended duration monitoring for diagnosis. Thirteen patients with known atrial fibrillation or flutter were noted to have this arrhythmia present. Of those with a new diagnosis, 6 (20%) resulted in a change in clinical management (Figure 1). Conclusion(s): Extended duration ECG patch monitoring appears diagnostically and clinically useful when utilized as a component of intake evaluation for VCR. Furthermore, added benefit of extended (i.e., 5 day) versus the initial 24-hour period of monitoring was observed. Further evaluation is required to determine the optimal duration and clinical utility of asynchronous ECG monitoring as a component of risk stratification for VCR programs.
ABSTRACT
Background: Cardiac Rehabilitation (CR) is a supervised exercise and risk factor modification program for patients with cardiac conditions. Endothelial dysfunction is often present and is associated with worsening cardiac prognosis, and several studies have indicated that standard onsite CR has improved endothelial function in heart disease patients. However, during the COVID-19 pandemic, many CR programs transitioned to a virtual or hybrid model of care to increase safety of CR programs. Objective(s): The objective of this study was to determine vascular function of patients with coronary artery disease (CAD) measured before and after 4 months of outpatient CR using a virtual model of care. Method(s): Virtual CR included 1 virtual group session/week by videoconferencing and hybrid CR included 1 session/week (4 on-site and 12 virtual group sessions) for a total of 16 weeks. CAD patients (6 females, 4 males) mean age 68.1+/-7.5 years rested in a supine position to measure 1) brachial artery flow-mediated dilation (FMD), 2) microvascular function, and 3) augmentation index (AI) using ultrasound sonography (n=8) and an EndoPAT 2000 (n=9). Two patients completed virtual CR and the rest underwent hybrid CR. These measurements were obtained concurrently using an ultrasound transducer at the brachial artery proximal to a blood pressure cuff on the forearm with EndoPAT cuffs on the index fingers during 5-minute intervals of baseline, occlusion, and recovery. FMD results were analyzed using automated Cardiovascular Suite software. AI and Reactive Hyperemia Index (LnRHI) were determined using automatic analysis via the EndoPAT 2000. Anthropometrics, blood pressure, and food intake were recorded at each visit. Patients were advised to refrain from strenuous exercise, alcohol, caffeine, and highly saturated foods at least 12 hours prior to the study appointment. One tailed paired t-tests were conducted between baseline and completion. Result(s): Adherence to CR averaged 10.3+/-3.2 out of 16 sessions. FMD improved from (2.75+/-1.71% to 5.63+/-4.37%, p=0.048) while there was no improvement in AI (14.2+/-18.8 to 13.2+/-19.6, p=0.45) or LnRHI (0.56+/-0.12 to 0.52+/-0.20, p=0.24). Conclusion(s): While there was no improvement in LnRHI or AI after CR, FMD improved in CAD patients after 4 months of adapted CR. Our results indicate that while virtual and hybrid models of CR may not be sufficient for improving microvascular function and aortic stiffness in CAD, there is an improvement of endothelial function. Future studies should examine the effects of adherence, duration and exercise intensity within these alternative models of CR on aortic and microvascular improvements.