Correlates of exercise among coronary heart disease patients: review, implications and future directions.

Despite the well-documented benefits of exercise, adherence among patients with coronary heart disease (CHD) has been low during and after cardiac rehabilitation (CR) as well as among patients not attending CR. Therefore, an understanding of the factors that influence exercise in this population is crucial to assist in the development of effective interventions. The goal of this review was to document the correlates of exercise of CHD patients in all CR contexts from a social-ecological perspective that addresses multiple levels of influence on exercise. The search strategy included PubMed, PsychINFO and Web of Science databases. In all, 121 studies, examining 32 different correlates of exercise, with a total of 25 217 participants were included. Across all CR contexts, six variables were consistently related to exercise (self-regulatory self-efficacy, health status, intention, perceived control, beliefs/benefits and previous physical activity). Several variables were also related to exercise in three of four contexts (e.g. task self-efficacy, perceived barriers, attitude, action planning, sex and employment status). Many of the variables consistently related to exercise may be amenable to change through the development and implementation of appropriate interventions. Specific suggestions are made for each relevant variable to assist CR staff and other healthcare practitioners in 32 promoting exercise among CHD patients. Current gaps in literature such as a lack of prospective studies and research examining broader (e.g. policy level) correlates are also discussed.

Visual field and optic disc progression in patients with different types of optic disc damage: a longitudinal prospective study.

OBJECTIVE: To evaluate the incidence of visual field and optic disc progression in glaucoma patients with distinct patterns of optic disc damage. DESIGN: Prospective, observational case series. PARTICIPANTS: One hundred five patients with open-angle glaucoma. METHODS: Baseline optic disc photographs of 105 study eyes of 105 patients were reviewed by 2 masked observers and classified according to patterns of disc damage into the following categories: focal, myopic, senile sclerotic, and generalized disc damage. Patients were followed up every 6 months with standard automated perimetry (SAP), high-pass resolution perimetry (HRP), and scanning laser tomography (SLT) with the Heidelberg Retina Tomograph. MAIN OUTCOME MEASURES: Visual field (SAP and HRP) and optic disc (SLT) progression were determined according to predefined criteria. RESULTS: Twenty-four eyes were classified into the focal, 8 into the myopic, 12 into the senile sclerotic, and 28 into the generalized group. Eyes from 33 patients could not be classified by the observers into any of these groups and were excluded from further analysis. Although intraocular pressure during follow-up was similar among the four groups, some differences in frequency of progression were observed. Patients with senile sclerotic discs had the lowest rates of visual field progression (both with SAP and HRP) and optic disc progression, although the differences were significant only for optic disc progression (P = 0.05). CONCLUSIONS: Patients with senile sclerotic discs showed a tendency towards less visual field and optic disc progression when compared with patients with other types of disc damage.

Responses of rural family physicians and their colleague and coworker raters to a multi-source feedback process: a pilot study.

PURPOSE: To describe responses of family physicians, their medical colleagues, and coworker raters to a multisource feedback assessment process. METHOD: Data collection tools included multisource feedback self-assessment and medical colleague, coworker, and patient rating forms; and program evaluation physician and rater questionnaires. RESULTS: The pilot study included 142 physicians and their raters, with 113 (80%) physicians completing evaluations. Positive correlations were found between familiarity scores and medical colleague and coworker mean ratings. Peer medical colleagues were significantly more familiar with physicians than were consultants. Consultants were unable to rate items most frequently. Physicians disagreed with colleague feedback more frequently. Agreement was positively correlated with scores. CONCLUSIONS: Familiarity, ability to observe physicians appropriately to rate them, and physicians' responses to feedback are factors to consider when multisource feedback is used.

Effects of cold-induced vasospasm in glaucoma: the role of endothelin-1.

PURPOSE: Vasospasm has been associated with glaucoma, but its mechanisms have not been elucidated. The present study was designed to evaluate the role of endothelin (ET)-1, a potent endogenous vasoconstrictor, in the genesis of vasospasm in glaucoma. METHODS: Our sample contained patients with open-angle glaucoma (n = 43) and subjects with normal nonglaucomatous eyes and without acral vasospasm (n = 27). After the eligibility visit, all subjects underwent a provocative cooling test, consisting of wearing for 30 minutes a head-vest cooling garment containing coolant fluid. Blood was collected before and after cooling, and plasma ET-1 was determined by immunoassay. In addition, visual fields and retinal blood flow, measured with a confocal scanning laser and Doppler flowmeter, were measured before and after cooling. Peripheral finger flow, skin temperature, and blood pressure were monitored during the experiment. A recovery visit was performed within 1 month, when visual field and retinal blood flow measurements were repeated. RESULTS: Baseline plasma ET-1 levels were similar between patients with glaucoma and control subjects (mean +/- SD: 2.81 +/- 1.29 and 2.56 +/- 1.36 pg/mL, respectively, P = 0.465). Patients with glaucoma, however, had a significant increase in plasma ET-1 after cooling (mean +/- SD increase of 34% +/- 52%, P = 0.001), not observed in control subjects (mean +/- SD increase of 7% +/- 43%, P = 0.750). No significant change in visual fields or retinal blood flow was observed after cooling in either group. Patients with glaucoma who had evidence of acral vasospasm, however, were more likely to show deterioration in visual fields after cooling than patients without acral vasospasm (P = 0.007). CONCLUSIONS: Patients with glaucoma have an abnormal increase in plasma ET-1 after the body cools. It is possible that at least in some patients, increased levels of ET-1 in response to vasospastic stimuli may be involved in the pathogenesis of glaucomatous damage.