Effectiveness of a real-life program (DIAfit) to promote physical activity in patients with type 2 diabetes: a pragmatic cluster randomized clinical trial.

Introduction: The aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes. Research design and methods: This was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile. Results: All 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program. Conclusions: Both frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible. Clinical trial registration: clinicaltrials.gov, identifier NCT01289587.

[A He(art) museum for an existential rebirth after a myocardial infarction]. / HeART museum : soigner son cœur au musée après un infarctus du myocarde.

Rebuilding one's life after a myocardial infarction requires mobilizing each and every resource available during a difficult period. Medical treatments, physical training and patient education (PE) help to initiate this process. Associating healthcare with art and culture is known to favour an existential « rebirth ¼ and positive biological effects. Since 2019, we propose an initiation to museotherapy (museum in health) to patients in our cardiac rehabilitation program. This article summarizes the evidence about museotherapy benefits in cardiovascular diseases and describes the experience gathered by the cardiology service of the HUG since museotherapy was initiated in 2019.

Reconstruire sa vie, une santé et une identité acceptables après un infarctus du myocarde nécessite de mobiliser toutes ses ressources dans un moment perturbé. Traitements médicamenteux, réentraînement physique et éducation thérapeutique du patient (ETP) engagent ce processus. On sait de longue date qu'incorporer l'art et la culture aux soins favorise une « renaissance ¼ existentielle et des effets biologiques positifs. Depuis 2019, nous proposons aux patients une initiation à la muséothérapie intégrée à notre programme de réadaptation cardiovasculaire (RCV) ambulatoire. Cet article a pour but de résumer les évidences concernant les bénéfices de la muséothérapie dans les maladies cardiovasculaires et de décrire l'expérience débutée en 2019 par le Service de cardiologie des HUG dans ce domaine.

[Cardiac rehabilitation : a multidisciplinary program of cardiovascular prevention of essential importance]. / La réadaptation cardiaque : un programme multidisciplinaire de prévention cardiovasculaire indispensable.

Cardiovascular diseases and especially coronary artery disease remain the first cause of mortality in Switzerland. Comprehensive cardiac rehabilitation is a validated multidisciplinary intervention, which represents the most appropriate strategy of implementing an effective secondary cardiovascular prevention to reduce the impact of cardiovascular diseases. However, less than half of patients after a myocardial infarction and a tiny proportion of patients with heart failure participate in a rehabilitation program in our country. This article summarizes the current state of cardiac rehabilitation in Switzerland, as well as future developments of cardiac tele-rehabilitation that have accelerated due to the COVID-19 pandemic.

Les maladies cardiovasculaires, et en premier lieu la maladie coronarienne, restent la première cause de mortalité en Suisse. La réadaptation cardiaque intégrée est une intervention multidisciplinaire validée représentant le meilleur moyen de mettre en place une stratégie de prévention cardiovasculaire secondaire efficace pour réduire l'impact des maladies cardiovasculaires. Pourtant, moins de la moitié des patients victimes d'un infarctus du myocarde et une proportion infime de patients atteints d'une insuffisance cardiaque participent à un programme de réadaptation cardiaque dans notre pays. Cet article résume l'état actuel de la réadaptation cardiaque en Suisse ainsi que les futurs développements de téléréadaptation cardiaque qui se sont accélérés dans le contexte de la pandémie de Covid-19.

[Arteriofit: a supervised exercise training program, recommended as a first-line treatment in intermittent claudication]. / Artériofit : un programme recommandé en première intention pour le traitement de la claudication intermittente.

Lower extremities arterial disease (LEAD) is the third most common manifestation of atherosclerosis. The number of cardiovascular events in this population is similar to that of coronary artery disease. Management consists mainly of strict control of cardiovascular risk factors, optimal pharmacological treatment and supervised exercise training. Supervised exercise training is superior to other exercise modalities in terms of increased walking time, maximum walking distance, pain-free walking distance and quality of life scores. In association with revascularization, the benefits are enhanced. In Switzerland, federal programs have been created on this basis and exist in many cities. They are little known and yet essential.

L'insuffisance artérielle des membres inférieurs est la troisième manifestation la plus fréquente de l'athérosclérose. Le nombre d'événements cardiovasculaires dans cette population est similaire à celui des malades coronariens. La prise en charge consiste en un contrôle strict des facteurs de risque cardiovasculaires, un traitement pharmacologique optimal et l'entraînement supervisé à la marche. L'entraînement supervisé est supérieur aux autres modalités d'exercices en termes d'augmentation du temps de marche, de la distance maximale de marche, de la distance de marche sans douleur et des scores de qualité de vie. En association avec une revascularisation, les bénéfices sont majorés. En Suisse, des programmes fédéraux ont été créés sur ces bases et existent dans de nombreuses villes. Ils sont méconnus et pourtant essentiels.

[Physical inactivity behavior: is this an adaptive answer that is normal and inappropriate to public health in the 21st century?]. / Comportement d'inactivité physique: une réponse adaptative inappropriée au maintien de la santé dans nos sociétés?

Physical inactivity or sedentary behavior is more and more widespread, a fairly recent worldwide health phenomenon. It currently takes the shape of a chronic illness with dire consequences. Its factors are influenced by personal motivation and the social and physical environments in which people live. Screening for physical inactivity or sedentary behavior enables patients and caregivers to become fully aware of its risks. The health benefits of simply adding walking to our everyday activities or adding low-impact movement in oureveryday lives would improve the health, the quality of life and longevity for most adults. Caregivers can successfully assist patients in changing their behavior. For certain patients suffering from diseases or complex cases, interdisciplinary specialized surveillance care is useful. There is a need to put this issue at the forefront of public health and adopt a positive stance towards strategies in our places of work, our schools, our means of transportation and overall urban planning and development.