Cardiac rehabilitation in patients with peripheral arterial disease after revascularization.

OBJECTIVES: To evaluate safety, feasibility, and benefit of cardiac rehabilitation (CR) in patients with peripheral arterial disease (PAD) who undergo revascularization. METHODS: We conducted a prospective, non-randomized, pilot study to assess the feasibility, safety, and benefit of CR in PAD patients after revascularization compared to standard of care (controls). CR feasibility was assessed by the ability to complete 36 sessions. Safety was defined as the absence of adverse cardiovascular events during CR. Quality of life (QoL) assessment was performed using SF-36 form (Medical Outcomes Study 36-Item Short-Form Health Survey) and PAD-specific quality of life questionnaire (VascuQOL6). Other endpoints included incidence of claudication during 6-minute walk test (6MWT), mean distance, and number of laps walked. All outcome data were collected before and after CR completion. Standard statistical tests were used for comparisons. RESULTS: This study enrolled 20 subjects (CR group = 10). Mean age was 60.70 (±7.13) and 63.1 (±9.17) years in CR and controls, respectively (p-value > 0.05). Fifty percent and 60% were female in CR and control group, respectively. All subjects completed 36 CR sessions without adverse events. The increase in mean distance walked during 6MWT was higher in the CR group compared to control group (63.7 m vs. 10.5 m, p = 0.043). Change in mean number of laps walked was higher in the CR group (3.5 vs. -1.1; p < 0.01). Scores on 6 of 8 scales of SF-36 and VascuQOL6 were higher in the CR group, though not statistically significant. CONCLUSION: CR is safe, feasible, and improves walking ability in ambulatory patients with PAD after arterial revascularization.

Validity of a Submaximal 6-min Recumbent Stepper Test for Cardiac Rehabilitation.

PURPOSE: Submaximal exercise tests, such as the 6-min walk test (6MWT), are used to assess and determine changes in cardiorespiratory fitness in cardiopulmonary rehabilitation (CR) programs. However, other modalities such as recumbent steppers are frequently utilized in rehabilitation settings and suit individuals of all ability levels; yet, no self-paced submaximal test has been developed for this exercise modality. The aim of this study was to produce a self-paced, submaximal 6-min recumbent stepper test (6MRST) that is comparable with the 6MWT and can be used as pre- and post-CR assessments. METHODS: Seventy subjects participating in CR performed a 6WMT and a 6MRST at the beginning and end of their CR program. Distance exercised, blood pressure, heart rate, and perceived exertion were measured to determine whether the 6MRST was comparable with the 6MWT. RESULTS: Significant correlations were found between the distance exercised in the 6MWT and the 6MRST during both pre- and post-CR testing (r = 0.540 and r = 0.700, respectively; P < .001). The distance for the 6MRST increased from 1599 to 2101 ft after CR. Heart rate and rating of perceived exertion showed strong correlations between the 6MWT and the 6MRST at both testing time points. CONCLUSIONS: The 6MRST was found to produce similar results to that of the 6MWT in a CR setting. The 6MRST could therefore serve as an alternative to the 6MWT in those patients who cannot adequately perform a 6MWT, in a facility where space may be too limited, and a walking track is not available or simply due to patient or staff preference.

Variability of Objectively Measured Sedentary Behavior.

INTRODUCTION: The primary purpose of this study was to evaluate variability of sedentary behavior (SB) throughout a 7-d measurement period and to determine if <7 d of SB measurement would be comparable with the typical 7-d measurement period. METHODS: Retrospective data from Ball State University's Clinical Exercise Physiology Laboratory on 293 participants (99 men, 55 ± 14 yr, body mass index = 29 ± 5 kg·m(-2); 194 women, 51 ± 12 yr, body mass index = 27 ± 7 kg·m(-2)) with seven consecutive days of data collected with ActiGraph accelerometers were analyzed (ActiGraph, Fort Walton Beach, FL). Time spent in SB (either <100 counts per minute or <150 counts per minute) and breaks in SB were compared between days and by sex using a two-way repeated-measures ANOVA. Stepwise regression was performed to determine if <7 d of SB measurement were comparable with the 7-d method, using an adjusted R2 of ≥0.9 as a criterion for equivalence. RESULTS: There were no differences in daily time spent in SB between the 7 d for all participants. However, there was a significant interaction between sex and days, with women spending less time in SB on both Saturdays and Sundays than men when using the 100 counts per minute cut-point. Stepwise regression showed using any 4 d would be comparable with a 7-d measurement (R2 > 0.90). CONCLUSIONS: When assessed over a 7-d measurement period, SB appears to be very stable from day to day, although there may be some small differences in time spent in SB and breaks in SB between men and women, particularly on weekend days. The stepwise regression analysis suggests that a measurement period as short as 4 d could provide comparable data (91% of variance) with a 1-wk assessment. Shorter assessment periods would reduce both researcher and subject burden in data collection.