Effects of virtual exercise on cardio-pulmonary performance and depression in cardiac rehabilitation phase I: A randomized control trial.

BACKGROUND: Cardiac rehabilitation is recommended for patients undergoing open-heart surgery (OHS). During the hospital admission, these patients suffer from reduced cardiopulmonary performance and decreased psychological health, leading to poor physical function, depression, and morbidity. To prevent post-operative pulmonary complications, a pre and post-operative physical therapy intervention is recommended for patients undergoing heart surgery. Virtual reality (VR) promotes the health status of healthy individuals and those with health conditions. However, few studies have reported the beneficial effects of VR exercise programs on the pulmonary performance and mental health status of patients undergoing OHS. OBJECTIVES: To determine whether by using training enhanced by VR, patients who have undergone OHS can more effectively attain cardiopulmonary performance and improve depression than through conventional physical therapy. METHOD: 60 participants were randomly assigned to a conventional physical therapy and VR exercise program. Each session was conducted once daily until discharge from the hospital. Cardiorespiratory performance and depression were evaluated before surgery and at the time of discharge from the hospital. A two-way mixed ANOVA was performed to compare within (i.e., pre and post-operation) and between (i.e., VR and conventional physical therapy) groups. RESULTS: No significant cardiopulmonary performance gains were detected in patients receiving the VR exercise program when compared with those who participated in conventional physical therapy prior to post-operative OHS (p > 0.05). However, the conventional physical therapy group showed significantly higher depression scores than the VR group (∆4.00 ± 0.98 vs. ∆1.68 ± 0.92). However, cardiopulmonary performance did not differ in both VR exercise and conventional physical therapy.

A Prospective Study of 73 Patients to Compare Forward Head Angle, Forward Shoulder Angle, Maximal Inspiratory Pressure, and Self-Reported Breathing-Related Symptoms Before and After Open-Heart Surgery.

BACKGROUND Patients who undergo open-heart surgery often experience widespread musculoskeletal and pulmonary complications. These can interfere with their functioning, resulting in soft tissue changes, worsening postural changes, and poor respiratory performance. Therefore, the prospective study aimed to compare forward head angle (FHA) and forward shoulder angle (FSA), maximal inspiratory pressure (MIP), and self-reported breathing dysfunction before and after open-heart surgery. MATERIAL AND METHODS In a prospective observational study of 106 patients, men and women scheduled for open-heart surgery were enrolled. Prior to surgery and before discharge from the hospital, all patients were required to assess FHA and FSA using 2-dimensional motion analysis software, MIP using a respiratory pressure meter, and breathing dysfunction using the 25-item Self Evaluation of Breathing Questionnaire (SEBQ). Paired t test was used to compare differences between before and after surgery. To evaluate associations, logistic regression analysis was performed. RESULTS Of the 106 patients recruited, 73 completed the study. FHA (-Δ6.55±4.77, P.

Anxiety and Depression Symptomatology Related to Inspiratory Muscle Strength and Functional Capacity in Preoperative Cardiac Surgery Patients: A Preliminary Cross-sectional Study.

BACKGROUND: Poor psychological health and cardiorespiratory fitness prior to open heart surgery (OHS) might be predictors of postoperative pulmonary complications that lead to morbidity and mortality. Assessment of physical and psychological conditions should be considered for patients receiving OHS, to possibly prevent these complications. This study investigates how inspiratory muscle strength (IMS) and functional capacity (FC) relate to the psychological health of preoperative cardiac surgery patients. METHOD: A cross-sectional study was designed before OHS; the 6-minute walk test and IMS were performed on patients who were admitted for OHS. All participants were requested to complete Hospital Anxiety and Depression Scale. Pearson correlation and hierarchal regression analysis were performed to determine the relationships between IMS and FC and psychological conditions (anxiety and depression). RESULTS: Overall, 36 males and 28 females aged 56.89±10.23 years were recruited. Significant relationships were observed between IMS and anxiety and depression symptoms (r = -0.33 and r = -0.27, respectively). Anxiety was negatively related to FC (r = -0.25). These relationships remained significant after adjustment for age, sex, and body mass index (BMI) (∆R 2 = 0.11 and ∆R 2 = 0.09). In addition, anxiety was also related to FC after controlling for age, sex, and BMI (∆R 2 = 0.09). CONCLUSION: Among patients undergoing OHS, those with a higher level of depression or anxiety had a lower cardiorespiratory fitness than those with a low level of depression or anxiety.

Sarcopenia in open heart surgery patients: A cohort study.

BACKGROUND: Sarcopenia is a condition characterized by loss of muscle mass, muscle strength, or physical performance. It has been reported that cardiac surgery causes systemic inflammatory response, which leads to sarcopenia. In addition, open-heart surgery (OHS) has been associated with length of hospital stay, prolonged mechanical ventilation, and postoperative pulmonary complications. However, very few studies have explored the association of sarcopenia with OHS. Thus, this study explores the prevalence of sarcopenia in OHS patients as well as their relationship. METHODS: This cohort study included 160 patients; it was designed to assess sarcopenia during preoperative OHS and before patient discharge from the hospital. Sarcopenia was defined according to Asian Working Group for Sarcopenia (AWGS) criteria as low muscle mass plus low muscle strength and/or slow gait speed. Participants were requested to perform exercises to test their handgrip strength, gait speed, and bioelectrical impedance. In addition, their medical history (e.g., duration of hospitalization and mechanical ventilation) was recorded. RESULTS: The prevalence of sarcopenia during preoperative OHS was 26.9%, with affected men comprising 11.9% and affected women comprising 15% of the total sample. Participants with sarcopenia had a significantly lower body mass index (BMI) than those without. Further, patients who had longer stays in the hospital and prolonged mechanical ventilation time showed significantly higher rates of developing sarcopenia. During postoperative OHS, the incidence of sarcopenia rose by 20.92%, increasing the total prevalence of sarcopenia to 46.41%. Moreover, advanced age emerged as one of the most significant risk factors of sarcopenia. Participants in the age group >55 years had an increased risk of sarcopenia (odds ratio [OR]: 3.90). It was also found that patients with a low BMI (<23 kg∗m-2) and a history of diabetes mellitus (DM) had an increased risk of sarcopenia (ORs: 2.11 and 1.47, respectively). Moreover, longer hospital stays and mechanical ventilation times were important risk factors (ORs: 1.58 and 2.07, respectively). CONCLUSION: The prevalence of sarcopenia was observed to be high during postoperative OHS. Participants with sarcopenia who underwent OHS had a history of DM, longer length of hospital stays, and prolonged mechanical ventilation times, compared with patients without sarcopenia. CLINICAL TRIAL REGISTRATION NUMBER: TCTR20190509003.