[Sports and rehabilitation in old age]. / Sport und Rehabilitation im Alter.

Cardiac rehabilitation of older patients aims at restoring physical aptitude as well as possible and at preserving independence. Prognostic aspects are less important than symptomatic relief. A formal rehabilitation program is indicated in adjunction to revascularization procedures and in cases, where a closer medical supervision is warranted. Exercise guidelines for persons older than 65 years should include prescriptions for endurance training of moderate intensity and an exercise program to enhance flexibility and coordination. Weight training at 40 to 60% of maximal voluntary contraction to support muscle-strength is feasible and useful even in frail persons, whereas sports with high impact of technical skills and speed are not advisable. Such training prescriptions will allow to maintain physiological and psychological function and will thus enhance the quality of life of older patients.

[Heart patient and sports]. / Herzpatient und Sport.

Patients with heart disease may benefit from scheduled exercising in different ways. Exercise tolerance is increased, risk factors are controlled, and even progression and regression of coronary artery disease can be influenced by training and diet. Psychological effects include lessened depression and reduced anxiety. Overall, regular physical activity is important for maintenance of health and may lead to a better quality of life. In order to minimize the risk of training, the patients should be provided with guidelines for exercising by the physician. Activities should include dynamic endurance exercises and properly selected calisthenics (without a need for high technical skills). Circuit weight training of moderate intensity is helpful for promoting muscle strength. Training has to be followed not less than 2 to 3 hours per week in at least three sessions at an intensity corresponding to 60 to 85% of the maximum heart rate achieved in a symptom-limited maximum exercise-test. Cardiac patients at high risk (decreased left ventricular function, persisting ischaemia, low exercise capacity, severe symptoms, older age) should exercise at lower intensities.

[Regression of coronary atherosclerosis: possible--and clinically relevant?]. / Regression der Koronaratheromatose: Möglich--und von praktischer Bedeutung?

Several recent clinical trials have shown that in male patients with stable coronary heart disease, progression of atherosclerosis can be delayed even in short time. The interventions to bring about less progression and even a regression of coronary artery lesions mainly consisted in lowering high lipid levels, either with drugs, partial ileal bypass surgery or comprehensive lifestyle changes. The results of trials using calcium antagonists were less consistent and failed to show clear-cut slowing or prevention of progression. Some questions, however, arise and are discussed: i.e. the shortcomings of quantitative angiography to assess the extent of atherosclerotic lesions and the clinical importance of the observed changes in luminal diameter, which tended to be small. Despite these intriguing issues, the reported studies provided the additional information that the angiographically demonstrated benefits were paralleled by a reduction of clinical vascular events and an improvement of the short-term clinical outcome.

[Intramural rehabilitation following infarction]. / Die stationäre Rehabilitation nach Infarkt.

Major objectives of a comprehensive cardiac rehabilitation include not only an increased functional capacity by physical training with aerobic exercise as a cornerstone, a reduction in morbidity and mortality by secondary preventive measures and a rapid return to work, but also an improvement in subsequent quality of life. Different forms of rehabilitation programs may be equally successful: a four-week institutional rehabilitation course or an outpatient rehabilitation program with 2 to 3 weekly training sessions for 3 to 6 months. If the guidelines for graduated activity are respected, the training bears a low risk. Patients with low exercise capacity for cardiac, vascular or other reasons, as those otherwise handicapped, should not join a formal rehabilitation program, but should be followed on an individual basis. In those patients as well as in many others the home physician plays a crucial role in the long-time supervision and counseling.

[Physical activity and coronary heart disease]. / Körperliche Aktivität und koronare Herzkrankheit.

Epidemiological data suggest that in middle aged men a regular physical activity, occupational or in leisure time, may protect against a first coronary event. Randomized clinical trial of cardiac rehabilitation after myocardial infarction, including physical training, has shown a positive trend for reduced rates of all-cause death and coronary death in the intervention group. Although not statistically significant, physical training in coronary patients is recommended because the benefits of training include an improved exercise tolerance and risk factor profile. Furthermore, supervised cardiac exercise programmes appear to be safe for the average patient, with the possible exception of some patients with large anterior wall infarctions who might deteriorate and have, therefore, to be closely controlled during rehabilitation.

[The alcoholic patient in rehabilitation]. / Der Alkoholkranke in der Rehabilitation.

Alcoholics are in general not the ideal candidates for a cardiac rehabilitation programme, mainly because the rehabilitation demands a high degree of cooperation and motivation by the patients to be successful. Therefore, only stable patients with some self-esteem and strong enough to withstand the temptation of the available alcohol, patients without symptoms and signs of neuro-psychiatric deficit and with a relative intact social network, have a chance to benefit from the therapy which is based mainly on a physical training programme beside the usual medical care, but without the possibility of intensive care.

[Health aims of patients following myocardial infarct and heart surgery: are the goals realistic?]. / Untersuchungen zum Gesundheitsverhalten von Patienten nach Herzinfarkt und nach Herzoperation: werden die Ziele verwirklicht?

134 patients (11 females and 123 males, mean age 52 years) taking part in our rehabilitation program after myocardial infarction or bypass surgery were asked to say what they were aiming for as far as exercise, smoking habits and body weight are concerned. Follow-up was carried out by a questionnaire 6 months later. 120 patients (90%) were prepared to engage in some exercise on a regular basis. 112 (86%) of the 130 patients surviving actually met the criteria at follow-up. On admission 15 patients were smokers and at discharge still 12; 9 of whom intended to stop smoking. This would have left a smoking fraction of 2%. At the key date, however, 19% were either still smokers or had become smokers again. Only 43 patients were able to lose as much weight as they intended. Yet during the follow-up period the average weight of all patients remained constant. In short, the aims of our coronary patients are pitched extraordinarily high. Regular exercise is achieved easily, but with regard to smoking habits and required loss of weight the intentions are obviously somewhat too optimistic.

[Can factors of prognostic significance be identified during rehabilitation of cardiac infarct patients?]. / Lassen sich während der Rehabilitation von Herzinfarktpatienten prognostisch bedeutsame Faktoren erfassen?

In a follow-up study of myocardial infarction patients who had followed the rehabilitation program at this clinic, a cardiac mortality rate of 3.8% (35 out of 930 patients) and a reinfarction rate of 2.3% (21 out of 930 patients) were observed in the 16.6 months after infarction. The relationship between 15 variables and these cardiac events was examined by cross-tabulation and then by Fischer's test of independence. No prognostic factors for reinfarction were found. However, there were 4-risk-indicators which were predictive of early mortality: diabetes, severe complications during the hospital course, congestive heart failure and exercise-induced, complex ventricular arrhythmias. While a single risk-indicator was of little prognostic significance, a combination of two or more identified patients at high risk of subsequent mortality.

[Outcome after hospital rehabilitation of patients with myocardial infarct]. / Verlauf nach der stationären Rehabilitation von Herzinfarktpatienten.

A series of follow-ups were carried out in 947 patients who had 12 to 28 months previously (average 16.6 months) undergone a period of rehabilitation at this clinic in Gais . 17 patients were not traced, but from the remaining 930 patients, 35 (3.8%) had died of cardiac disorders, 21 had had nonfatal infarctions, and 51 patients had undergone aortocoronary bypass operation by the follow-up period. The prevalence and grade of angina pectoris (NYHA functional classification) in 816 patients from whom data was obtained remained unchanged. Even after exclusion of all patients with reinfarction or bypass surgery, there was no increase in the severity of angina pectoris in the remaining 752 patients. 705 patients had returned to work, 555 of whom were still in full employment and 118 part-time , while 32 remained active housewives. From the remaining 112 patients who were not working, 55 had retired. In conclusion, a stable course and high grade of employment were observed during the first year after infarction in patients who had undergone a course of rehabilitation at this clinic.

[Are swimming and sauna hazardous in the rehabilitation of heart patients?]. / Sind Schwimmen und Sauna bei der Rehabilitation von Herzpatienten gefährlich?

The incidence of cardiac arrhythmias and ischemic episodes (I) during swimming and sauna as compared to other types of physical exercise was studied in 18 patients with coronary disease and in 18 controls without heart disease (mean age 46 and 48 years respectively). Maximum achieved heart rates during swimming and sauna were lower by at least 10% than those achieved during bicycle ergometry. Angina and/or ST segment displacement greater than or equal to 1 mm and frequent (greater than 1/min), multiform or repetitive VPB's occurred more frequently in coronary patients than in controls (I: 50 vs 11%, VPB's: 72 vs 28%, both p less than 0.005). VPB's were observed in 13/18 coronary patients, 6 of whom had these VPB's during swimming or sauna. Repetitive VPB's did not occur during swimming, but occurred during sauna in 2 coronary patients in whom they were also present during rest and walking. Ischemic episodes were noted in 9/18 coronary patients in 5 of whom they occurred during swimming. No ischemias were noted during sauna. It is concluded that swimming and sauna may safely be recommended during rehabilitation of coronary patients provided a submaximal exercise test and possibly a 24-h Holter ECG are performed on entry to exclude patients at risk.

[Rhythm disorders in the rehabilitation phase after myocardial infarct]. / Rhythmusstörungen in der Rehabilitations phase nach Herzinfarkt.

45 patients with uncomplicated myocardial infarction and on no cardiac drugs underwent an exercise test and 24-hour monitoring 53 (range 22-80) days after the acute event before entering a 4-week rehabilitation program. These same tests were repeated 21 days later. Severe ventricular arrhythmias were registered in 14 patients (31%) while monitored on tape, in only 1 patient during exercise. Arrhythmias were more common in patients with ST-depression during exercise (38%) and in patients with reduced work capacity (42%). Non-smokers had no severe arrhythmias. The rehabilitation program had no influence on these findings. Arrhythmias after myocardial infarction correlate with work capacity and myocardial ischemia.

[Results of in-patient rehabilitation after myocardial infarction]. / Ergebnisse der stationären Rehabilitation nach Myokardinfarkt.

431 of 435 patients with recent myocardial infarction completed our clinic's 4-week rehabilitation program in 1979. 235 presented with post-infarction angina pectoris (a.p.). Of these patients, 152 achieved a decrease of one or more a.p. functional classes, 70 remained in the same class and in 12 the symptoms worsened by one or more classes. The mean physical work capacity under maximal bicycle-stress test increased by 19 Watt. Overall ventricular arrhythmia frequency under stress remained unchanged from beginning to end of our program. Individual arrhythmia frequency, however, varied widely with or without antiarrhythmic drug therapy. During exercise training, 3 nonfatal cardiac events occurred. There were no fatalities. It is concluded that our training program can be performed relatively safely and that physical work capacity can be increased during the rehabilitation program.

[Endocavitary electric exploration in the study of auricular dysrhythmias]. / Contribution de l'exploration électrique endocavitaire à l'étude de la dysrythmie auriculaire

His bundle recording combined with atrial pacing permit to evaluate atrio-ventricular conduction and the function of the sinus node by measuring the corrected sinus recovering time (CSRT). Three groups of 10 patients are included in this study: -- Group I is composed of control patients; the CSRT varies between 30 and 450 msec (mean value : 320 msec +/- 123.3). Neither atrio-ventricular nor intraventricular block was observed during His bundle recording combined with atrial pacing. -- Group II, composed of patients with atrial dysrhythmia has a CSRT varying from 720 to 5.900 msec (mean value: 2.750 msec +/- 184.5). Six of these patients have atrio-ventricular conduction disturbances. -- In group III all patients had atrio-ventricular or intraventricular conduction defects without atrial dysrhythmia. CSRT varies between 205 and 510 msec (mean value: 310 +/- 88.6). The authors conclude that atrial dysrhythmia is probably an original degenerative disease which is different from the "Lenègre" disease, by his incidence, the location of the lesions and the clinical issue. This conclusion is made by comparing the results of the authors with the analysis by James of the embryogenesis of the sinus node and of atrial and atrio-ventricular pathways.

[Percutaneous selective coronarography. Apropos of 600 cases]. / La coronarographie sélective percutanée. A propos de 600 examens

600 selective coronary angiographies were performed in 559 patients, using Judkins preformed transfemoral catheters. One fatality was deplored (mortality: 0,17 p. 100). 15 cardiac complications were observed 2,5 p. 100), 10 of which were severe but rapidly corrected arrhythmias. Among these 559 patients 495 were clinically cases suffering from probable or certain coronary heart disease. 88 p. 100 of this group were men. Selective coronary angiography revealed stenosis with decrease of at least 50 p. 100 of the lumen in over 80 p. 100 of the cases. The anterior descending was the most frequent site of stenosis. In the majority of cases, and especially in men, two or several vessels were diseased. There is some relationship between the development of collateral circulation and the extension of coronary disease. In one third of the cases, ventricular function, assessed by measurement of the ejection fraction was impaired.