Cardiac rehabilitation without exercise tests for post-myocardial infarction and post-bypass surgery patients.

PURPOSE: To compare the progress of patients who were exercise tested before or during cardiac rehabilitation versus those patients who were not tested. METHODS: Eighty-eight (88) post-myocardial infarction patients and 141 post-bypass surgery patients had a symptom-limited exercise test before or during 12 weeks of cardiac rehabilitation. Another 125 post-myocardial infarction and 146 post-surgery patients were not tested. RESULTS: Caloric expenditure during class increased for the entire group (P < 0.001) from week 1 to week 12. Body weight decreased for the entire group as a result of cardiac rehabilitation (P < 0.001). Tricep skinfolds decreased for the entire group (P < 0.001) while subscapular skinfolds did not change (P = 0.28). The percent change from week 1 to week 12 for both groups was similar for all variables. No problems occurred during cardiac rehabilitation that required emergency medical management. CONCLUSIONS: Patients completing a 12-week cardiac rehabilitation program can be safely progressed in terms of their exercise capacity without an entry exercise test. This is desirable in a managed-care setting for reducing costs while maintaining effective patient care. Such factors as staff training and experience, institutional philosophy, patient referral patterns, and facility location must be considered before adopting a no-test policy.

Early developmental progress of preterm twins discordant for birthweight and risk.

Studies of developmental progress in high-risk twins have disparate findings. In this study, we report the outcome of 45 twin pairs born between 26 and 37 weeks gestation, and whose birthweights ranged from 840 to 2000 g. No significant differences were found for weight, risk and birth order. However, earlier preterm infants were found to have significantly lower mental scores on the Bayley Scales of Infant Development at 24 months, and lower IQ scores on the Stanford Binet Intelligence Scale at 36 months. These findings imply that gestational age is a powerful variable in determining developmental outcome.