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Eser P, Pini M, Vetsch T, Marcin T, Berni S, Burri R, Casanova F, Huber S, Gurschler F, Boeni C, Hubli M, Herwegh N, Zimmermann A, Hess L, Schmutz S, Wilhelm M. Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study. Eur J Prev Cardiol 2025:zwaf107. [PMID: 40184412 DOI: 10.1093/eurjpc/zwaf107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/23/2025] [Accepted: 02/23/2025] [Indexed: 04/06/2025]
Abstract
AIMS Data on self-selected modes of delivery of cardiac rehabilitation (CR) are limited. This study compared centre-based CR (cbCR) with hybrid cardiac telerehabilitation (hCTR) in terms of patient characteristics, change in physical and mental functioning, and achievement of guideline-directed treatment targets. METHODS AND RESULTS From May 2022 to December 2023, consecutive patients with cardiovascular diseases were enrolled at a tertiary centre into a 3 month cbCR or hCTR programme based on shared decision-making. Changes in exercise capacity, anxiety, depression, and health-related quality of life (hrQoL) scores from admission to the discharge visit were compared between CR modalities. The achievement of two-step blood pressure and LDL-cholesterol (LDL-C) goals, as well as the HbA1c goal in patients with diabetes at the discharge visit, was compared between CR modalities. Out of 1292 patients screened, 406 (21% females, age 60.4 ± 12.7 years) were eligible and completed the study. Of those, 72% chose cbCR and 28% chose hCTR. Patients in hCTR were 3 years younger and exhibited higher baseline peak VO2 (91 vs. 80% of predicted), better hrQoL, and lower depression and anxiety scores. No significant differences were found in improvements in physical or mental functioning or in meeting blood pressure and HbA1c targets between the two groups. A smaller proportion of hCTR participants achieved the LDL-C Step I target (56 vs. 69% in cbCR). CONCLUSION Overall, hCTR attracted slightly younger patients with better baseline health, but both modalities showed similar effects on most health outcomes. Centre-based cardiac rehabilitation was associated with tighter lipid control, which could be related to more intense counselling or patient preference.
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Affiliation(s)
- Prisca Eser
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Matteo Pini
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Thomas Vetsch
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Thimo Marcin
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Seraina Berni
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Regula Burri
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Flurina Casanova
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Sarina Huber
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Franziska Gurschler
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Claudia Boeni
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Michael Hubli
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Nico Herwegh
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Andreas Zimmermann
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Laura Hess
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Sven Schmutz
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern CH-3010, Switzerland
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Racodon M, Vanhove P, Fabre C, Malanda F, Secq A. Comparison between hybrid cardiac rehabilitation and center-based cardiac rehabilitation: a noninferiority randomized controlled trial. Int J Rehabil Res 2025; 48:25-30. [PMID: 39841814 DOI: 10.1097/mrr.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025]
Abstract
Cardiac rehabilitation (CR) is a cornerstone of heart disease (HD) management, enhancing functional capacity and quality of life. Hybrid cardiac rehabilitation (hCR), combining supervised center-based sessions with synchronous, real-time telerehabilitation at home, offers an alternative to conventional CR to overcome logistical barriers such as facility limitations, distance, and pandemic-related disruptions. This randomized controlled trial evaluated the noninferiority of hCR compared to standard CR in improving functional capacity in patients with chronic heart disease, including those with stable coronary artery disease. Seventy-five participants were randomized into two groups: the CR group, with exclusively center-based sessions, and the hCR group, with synchronous tele-rehabilitation sessions at home complemented by center-based sessions. Functional capacity was assessed using cardiopulmonary exercise testing, the six-minute walk test, and the wall squat test. Both groups showed significant improvements in functional outcomes, including walking distance (six-minute walk test), strength capacity (wall squat test), and cardiopulmonary exercise testing performance ( P < 0.001). The improvements in the hCR group were statistically noninferior to those in the CR group. These findings demonstrate that hCR provides an effective alternative to conventional CR while addressing practical challenges in access to care. The hCR protocol represents a viable solution for expanding rehabilitation options without compromising outcomes, particularly for patients facing logistical constraints or during emergencies such as pandemics.
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Affiliation(s)
- Michaël Racodon
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
- Univ. Lille, ULR 4354-CIREL-Centre interuniversitaire de recherche en éducation deLille, F-59000 Lille, France
| | - Pierre Vanhove
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
| | - Claudine Fabre
- Université de Lille, Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, Lille, France
| | | | - Amandine Secq
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
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Rawstorn JC, Subedi N, Koorts H, Evans L, Cartledge S, Wallen MP, Grace FM, Islam SMS, Maddison R. Stakeholder perceptions of factors contributing to effective implementation of exercise cardiac telerehabilitation in clinical practice. Eur J Cardiovasc Nurs 2025; 24:116-125. [PMID: 39352400 DOI: 10.1093/eurjcn/zvae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/29/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024]
Abstract
AIMS Cardiac exercise telerehabilitation is effective and can be cost-effective for managing ischaemic heart disease, but implementation of evidence-based interventions in clinical practice remains a challenge. We aimed to identify factors that cardiac rehabilitation stakeholders perceived could influence the effectiveness of implementing an evidence-based, real-time remotely monitored cardiac exercise telerehabilitation intervention (REMOTE-CR). METHODS AND RESULTS Online interviews and focus groups were conducted with cardiac rehabilitation consumers (n = 16, 5 female, 61.1 ± 10.0 years), practitioners (n = 20, 14 female; 36.6 ± 11.8 years), and health service managers (n = 11, 7 female; 46.2 ± 9.2 years) recruited from one metropolitan and three inner-regional healthcare services in Western Victoria, Australia. Discussions were guided by two theoretical frameworks (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability; Consolidated Framework for Implementation Research), and analysed thematically. Factors perceived to influence effective implementation of REMOTE-CR spanned all domains of the theoretical frameworks, related to six major themes (resources, change management, stakeholder targeting, knowledge, intervention design, security) and were largely consistent across study sites; however, the relative importance of each factor may vary between sites. CONCLUSION Effective implementation of exercise telerehabilitation interventions like REMOTE-CR will require a coordinated context-specific approach that considers factors across all levels of the healthcare system and implementation science frameworks. Key requirements include prioritizing resources, managing change, selecting target stakeholders, developing digital health capabilities, and selecting fit-for-purpose technologies that enable programme delivery objectives.
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Affiliation(s)
- Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Narayan Subedi
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Luke Evans
- Allied Health, Grampians Health, Ballarat, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Institute of Health and Wellbeing, Federation University, Mt Helen, Australia
| | - Fergal M Grace
- Institute of Health and Wellbeing, Federation University, Mt Helen, Australia
- Future Regions Research Centre, Federation University, Mt Helen, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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Ntovoli A, Mitropoulos A, Anifanti M, Koukouvou G, Kouidi E, Alexandris K. Can Online Exercise Using Wearable Devices Improve Perceived Well-Being? A Study Among Patients with Coronary Artery Disease. SENSORS (BASEL, SWITZERLAND) 2025; 25:698. [PMID: 39943336 PMCID: PMC11821072 DOI: 10.3390/s25030698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/18/2024] [Accepted: 01/21/2025] [Indexed: 02/16/2025]
Abstract
Today, cardiovascular diseases contribute to approximately 17.9 million deaths annually worldwide. With reference to Europe, coronary artery disease (CAD) causes about 3.9 million deaths annually. Considering the positive physical and psychological outcomes of on-site exercise for CAD patients, this study aimed to expand the literature by examining the effects of a 6-month online exercise training program using wearable devices on CAD patients' perceived well-being, measured with the PERMA profiler. Individual well-being is considered today as an important prerequisite for healthy societies. Thirty patients with a recent myocardial infarction (i.e., <4 weeks) were randomly assigned to either the online home-based or the community-based exercise group. Both groups followed the same 24-week exercise-based cardiac rehabilitation program three times per week. Each session consisted of a 30-min aerobic, followed by a 15-min strength workout, and then a 15-min balance and flexibility training. The results of the Mann-Whitney U tests and the z scores indicated that the Meaning of Life, Health, Accomplishment, Engagement, and Positive Relationship dimensions of the PERMA were statistically improved, and Negative Emotions were decreased. These findings support the importance of cardiac telerehabilitation for patients' psychological health, demonstrating that online exercise using wearable devices can be a meaningful alternative to on-site exercise for patients with recent myocardial infarction. These results have policy implications as they provide arguments for providing online exercise for CAD patients as an alternative means for improving their psychological health.
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Affiliation(s)
- Apostolia Ntovoli
- Department of Physical Education and Sports Sciences, Frederick University, Nicosia 3080, Cyprus;
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Alexandros Mitropoulos
- Lifestyle, Exercise and Nutritional Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK;
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (M.A.); (G.K.); (E.K.)
| | - Maria Anifanti
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (M.A.); (G.K.); (E.K.)
| | - Georgia Koukouvou
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (M.A.); (G.K.); (E.K.)
| | - Evangelia Kouidi
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece; (M.A.); (G.K.); (E.K.)
| | - Kostas Alexandris
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
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Dehghani M, Cheraghi M, Shakarami A, Dehghani M, Namdari M. Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial. Ann Med Surg (Lond) 2024; 86:6537-6545. [PMID: 39525786 PMCID: PMC11543172 DOI: 10.1097/ms9.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/02/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose This study aimed to assess the effects of a home-based cardiac telerehabilitation (HBCT) on cardiac hemodynamic and functional responses and health-related quality (HRQOL) of the patients undergoing percutaneous coronary intervention (PCI). Materials and methods In this randomized controlled clinical trial, single-blinded. One hundred-fifty-five patients (mean age: 50.41±7.3 years, 41 women and 39 men) who underwent PCI were randomized into the two groups of intervention and control. The HBCT program included supervised exercise training, walking, phone calls, and a pedometer for 8 weeks. Hemodynamic changes, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), resting heart rate (HRrest), maximum heart rate (HRmax), ejection fraction (EF), and rate pressure product (RPP), and functional parameters including the distance walked and metabolic equivalents (METS), also HRQOL were measured in all patients before and after the 8-week HBCT program. Results Our results showed significant reductions in SBPrest (126.82±9.17 vs. 131.27±10.24; P =0.044), DBPrest (87.4±5.39 vs. 89.17±7.33; P=0.027), HRrest (76.15±3.01 vs. 77.65±4.16; P=0.041), HRmax (143.1±5.24 vs. 147.57±8.63; P=0.011), and RPP (9.64±0.81 vs. 10.07±0.99; P=0.007) and significant elevations in (45.75±4.31 vs. 43.5±5.21; P=0.039), distance walked (514.95±214.5 vs. 368.04±221.43; P=0.019), Mets (7.41±0.84 vs. 6.89±1.28; P=0.018), as well as HRQOL in the MCS (50.62±10.45 vs. 46.25±7.74; P=0.037), and HRQOL in the PCS (46.75±8.73 vs. 42.37±9.99; P=0.040) in the intervention group compared to the control group. Conclusion An HBCT program consisting of supervised exercise training significantly improved hemodynamic response, exercise performance capacity, and HRQOL in patients following PCI.
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Affiliation(s)
- Mostafa Dehghani
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
| | - Mostafa Cheraghi
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
| | - Amir Shakarami
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
| | - Morteza Dehghani
- Department of Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Namdari
- Department of Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Science, Khorramabad, Iran
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Zulianello dos Santos R, Scheafer Korbes A, Batista Bonin CD, Marques Vieira A, Karsten M, Benetti M, Oh P, Ghisi GLDM. Preliminary Effects of a Structured Educational Program in Cardiac Patients at Different Stages of Enrollment in Cardiovascular Rehabilitation. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:365-376. [PMID: 38817096 PMCID: PMC11143761 DOI: 10.1177/0272684x221080119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
This quasi-experimental study investigated the preliminary effects of a structured education intervention in a pooled sample of cardiovascular rehabilitation (CR) patients in Brazil. Recently enrolled (RE) and long-term enrolled (LTE) patients attended 12 weekly education sessions in addition to three weekly exercise sessions. Patients completed surveys assessing disease-related knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was assessed by the 6-minutes walking test. All outcomes were assessed at pre-,post-CR, and 6-months follow-up. Bonferroni correction was applied. In total, 69 (69.7%) patients completed all three assessments. There were significant improvements in knowledge pre-to post-test in both subgroups (p < 0.001), and in functional capacity (p ≤ 0.001) and food intake (p ≤ 0.001) pre-to post-test in the RE subgroup. Post-test knowledge was correlated to physical activity, functional capacity and health literacy. This preliminary study suggests the importance of structured education for CR patients. A larger study using a randomized controlled design is needed to determine efficacy.
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Affiliation(s)
| | - Andrea Scheafer Korbes
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Christiani D. Batista Bonin
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Ariany Marques Vieira
- Montreal Behavioural Medicine Centre, Hôpital Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Marlus Karsten
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Magnus Benetti
- Cardio Oncology and Exercise Medicine Nucleus (NCME), University of Santa Catarina State, Santa Catarina, Brazil
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Paramita N, Santoso DIS, Nusdwinuringtyas N, Rasmin M, Kartinah NT, Jusman SWA, Abdullah M, Tinduh D, Widjanantie SC, Harini M, Sianipar IR, Nugraha B, Gutenbrunner C, Widaty S. The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID. Int J Telerehabil 2024; 16:e6610. [PMID: 39022434 PMCID: PMC11249837 DOI: 10.5195/ijt.2024.6610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.
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Affiliation(s)
- Nurul Paramita
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dewi Irawati Soeria Santoso
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nury Nusdwinuringtyas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Menaldi Rasmin
- Department of Pulmonology and Respiratory Medicine, Persahabatan National Respiratory Referral Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Neng Tine Kartinah
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sri Widia A. Jusman
- Department of Biochemistry and Molecular Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Damayanti Tinduh
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Department of Physical Medicine and Medical Rehabilitation, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Siti Chandra Widjanantie
- Department of Physical Medicine and Rehabilitation, Persahabatan National Respiratory Referral Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Melinda Harini
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Imelda Rosalyn Sianipar
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Boya Nugraha
- Department of Rehabilitation and Sport Medicine, Hannover Medical School, 30625 Hannover, Germany
- Hannover Rehabilitation Services & Science Consulting, 30627 Hannover, Germany
| | - Christoph Gutenbrunner
- Department of Rehabilitation and Sport Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Sandra Widaty
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Mitropoulos A, Anifanti M, Koukouvou G, Ntovoli A, Alexandris K, Kouidi E. Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial. Front Cardiovasc Med 2024; 11:1410616. [PMID: 38903965 PMCID: PMC11188591 DOI: 10.3389/fcvm.2024.1410616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined. Methods A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed. Results The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study. Conclusion Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.
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Affiliation(s)
- A. Mitropoulos
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Lifestyle, Exercise and Nutritional Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | - M. Anifanti
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G. Koukouvou
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Ntovoli
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physical Education, Sports Sciences Frederick University, Nicosia, Cyprus
| | - K. Alexandris
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E. Kouidi
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kotelnikova EV, Gridnev VI, Posnenkova OM, Senchikhin VN. Feasibility Study of Using the Integrated Telemedicine Platform “IS-cardio” for Outpatient Cardiological Rehabilitation: Single-Centered Cohort Study. BULLETIN OF REHABILITATION MEDICINE 2024; 23:56-65. [DOI: 10.38025/2078-1962-2024-23-1-56-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
INTRODUCTION. The implementation of remote cardiac rehabilitation (RCR) technology based on telemedicine platforms (TMP) requires a preliminary assessment of the feasibility of use.
AIM. A preliminary study of the feasibility of using the integrated TMP “IS-cardio” to perform RCR in patients with cardiovascular diseases (CVD) in the context of need, feasibility and acceptability.
MATERIALS AND METHODS. Single-center cohort study of patients (n = 33; 75 % men; mean age 56 ± 8 years) with CVD. Testing of the TMP «IS-cardio» was carried out during 12-week physical training (PT) programs with an intensity of 55 %. Feasibility was assessed according to the following criteria: need, feasibility, acceptability. Data on need and acceptability were obtained from a patient survey. Feasibility was assessed as the proportion of patients completing RCR. Remote monitoring was performed using heart rate, blood pressure, electrocardiogram and mobile application recorders. Feedback was provided in the form of electronic reports and delayed consultation. Patient satisfaction was assessed in points.
RESULTS. 79.2 % of respondents were interested in telemedicine monitoring. 100 % of patients completed RCR; 12 patients (39.6 %) fully completed the PT program. The patients’ activity amounted to 2.4 ± 0.7 PT sessions per week; the average duration of PT was 56.5 ± 29.8 min/week. With a total satisfaction of 29.0 ± 3 points, the level of RCR was highly rated (3.85 ± 0.16 points) as a real solution to the problem associated with the presence of CVD (3.67 ± 0.34 points).
DISCUSSION. The medical-technological solution TMP “IS-cardio”, combining the principles of traditional cardiac rehabilitation with telecardiology tools (monitoring based on digital recorders, automatic data transfer and feedback) met the criteria for the feasibility of using TMP with a similar concept.
CONCLUSION. The high demand for remote monitoring, feasibility, and patient satisfaction of RCR may indicate the feasibility of its use for implementation of its programs.
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Gallegos-Rejas VM, Rawstorn JC, Gallagher R, Mahoney R, Thomas EE. Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:208-218. [PMID: 38774382 PMCID: PMC11104477 DOI: 10.1093/ehjdh/ztad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 05/24/2024]
Abstract
Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Ray Mahoney
- CSIRO Health & Biosecurity, Australian e-Health Research Centre, Surgical, Treatment and Rehabilitation Service—STARS Level 7, 296 Herston Rd, Herston 4029, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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11
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Gamble CJ, van Haastregt JCM, van Dam van Isselt EF, Zwakhalen SMG, Schols JMGA. Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil 2024; 38:457-477. [PMID: 38013415 PMCID: PMC10898211 DOI: 10.1177/02692155231217411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. DATA SOURCES Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. REVIEW METHODS Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. RESULTS A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. CONCLUSION The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.
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Affiliation(s)
- CJ Gamble
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
- Stichting Valkenhof, Valkenswaard, The Netherlands
| | - JCM van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - EF van Dam van Isselt
- University Network for the Care sector Zuid-Holland, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - SMG Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - JMGA Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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12
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NIKAIDO A. Collaboration with Community Pharmacy and Use of Online Communication in Cardiac Rehabilitation. RINSHO YAKURI/JAPANESE JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS 2024; 55:49-55. [DOI: 10.3999/jscpt.55.1_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Akira NIKAIDO
- Hachioji Minamino Cardiac Rehabilitation Clinic, Tokyo, Japan
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13
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Antoniou V, Kapreli E, Davos CH, Batalik L, Pepera G. Safety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: A systematic review. Digit Health 2024; 10:20552076241237661. [PMID: 38533308 PMCID: PMC10964460 DOI: 10.1177/20552076241237661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Objective To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubmed, Scopus, Cochrane Central Register of Controlled Trials in the Cochrane Library, Cinahl and Web of Science) were reviewed from January 2012 up to August 2023. Inclusion criteria were: (a) randomized controlled trials, (b) RDCR implementation of at least 12 weeks duration, (c) assessment of safety, rates of serious adverse events (SAEs) and re-hospitalization incidences at endpoints more than 6 months. Three reviewers independently performed data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool. Results 14 studies were identified involving 2012 participants and a range of RDCR duration between 3 months to 1 year. The incidence rate of exercise-related SAEs was estimated at 1 per 53,770 patient-hours of RDCR exercise. A non-statistically significant reduction in the re-hospitalization rates and the days lost due to hospitalization was noticed in the RDCR groups. There were no exercise-related deaths. The overall study quality was of low risk. Conclusions RDCR can act as a safe alternative delivery mode of cardiac rehabilitation (CR). The low long-term rates of reported SAEs and re-hospitalization incidences of the RDCR could enhance the uptake rates of CR interventions. However, further investigation is needed in larger populations and longer assessment points.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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14
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Nemani RRS, Gade BS, Panchumarthi D, Bathula BVSR, Pendli G, Panjiyar BK. Role of Cardiac Rehabilitation in Improving Outcomes After Myocardial Infarction. Cureus 2023; 15:e50886. [PMID: 38249185 PMCID: PMC10799544 DOI: 10.7759/cureus.50886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Myocardial infarction, an integral part of acute coronary syndrome (ACS), occurs due to atherosclerotic narrowing of the coronary (heart) blood vessels. Acute coronary syndrome, being one of the major cardiovascular diseases (CVDs), has led to a significant amount of mortality and morbidity, the majority of it due to MI. Over a long period following an MI, the physical, psychological, social, emotional, and occupational well-being are greatly impacted. Cardiac rehabilitation (CR) can address the above and help improve long-term well-being and overall quality of life. The benefits of CR include enhanced exercise capacity, risk factor reduction, improved quality of life (QOL), reduced mortality, and hospital readmissions. We used a systematic literature review (SLR) approach in this article to provide a global overview of cutting-edge CR in the post-MI phase. We reviewed 45 articles from journals of good repute published between 2013 and December 1st, 2023, focusing on seven selected papers for in-depth analysis. The analysis was focused on factors such as the positive outcomes of CR and the effects of CR post-MI. There are only a few statistically significant studies in a few domains of CR benefits, namely decreased mortality, cardiac events, depression, depression-associated mortality, hospital readmissions, increased left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic volume (LVESV), metabolic equivalent of task (MET), maximal oxygen consumption (VO2max), and the six-minute walk test (6MWT), and as a result, increased physical performance. Further research is needed to enhance the understanding of its mechanisms and statistically prove its effectiveness in all other domains. As CR continues to evolve, referral and participation in CR should be increased as it improves overall health and well-being.
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Affiliation(s)
| | | | | | | | - Ganesh Pendli
- Medicine, PES Institue of Medical Sciences and Research, Kuppam, IND
| | - Binay K Panjiyar
- Research, Texas Tech University Health Sciences Center, Odessa, USA
- Internal Medicine, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Puri SN, Lalwani L. A Comparison Between Cardiac Telerehabilitation Program and Outpatient Hospital-Based Cardiac Rehabilitation Program for Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Review. Cureus 2023; 15:e48488. [PMID: 38073989 PMCID: PMC10704402 DOI: 10.7759/cureus.48488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/08/2023] [Indexed: 06/09/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent and possibly fatal cardiovascular ailment, and it is treated surgically by coronary artery bypass grafting (CABG). The coronary arteries, which supply the heart with oxygen and nutrients, are the most commonly affected. Even though CABG is a frequently employed procedure to restore cardiac blood flow, prolonged rehabilitation is necessary for long-term success. For patients with heart disease, cardiac rehabilitation (CR) involves a comprehensive therapeutic approach. It consists of risk mitigation, regular exercise, health education, and efficient stress management. Information and communication technology is used in telerehabilitation (TR), a rehabilitation service that offers a flexible choice that improves self-management. This study examined novel approaches and effective intervention elements while comparing cardiac TR with center-based programs in terms of risk factor management, patient commitment, and satisfaction.
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Affiliation(s)
- Saurabh N Puri
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
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16
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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17
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Kinsara AJ, Aljehani R, Wolszakiewicz J, Staron A, Alsulaimy MA. The Prevention and Cardiac Rehabilitation Group of the Saudi Heart Association Recommendations Regarding Establishing a Cardiac Rehabilitation Service. J Saudi Heart Assoc 2023; 35:205-213. [PMID: 37700757 PMCID: PMC10495045 DOI: 10.37616/2212-5043.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Cardiac rehabilitation (CR) is a cornerstone in the secondary prevention of cardiovascular disease (CVD). Comprehensive cardiac rehabilitation has obtained the highest class of recommendation and the level of evidence for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndromes, and in patients with heart failure (HF). Comprehensive cardiac rehabilitation should be implemented as soon as possible, be multi-phasic, and adjusted to the individual needs of the patient. CR is still suboptimally used, and many cardiac centers do not have such services (2). The provision of CR services should be based on standards and key performance indicators, and guidelines containing a minimum standard of cardiac rehabilitation utilization should be published to improve the quality of the CR program. This document presents an expert opinion that summarizes the current medical knowledge concerning the goals, target population, organization, clinical indications, and implementation methods of the CR program in the Kingdom of Saudi Arabia.
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Affiliation(s)
- Abdulhalim J. Kinsara
- Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, Jeddah,
Saudi Arabia
| | | | | | - Adam Staron
- Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
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18
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Racodon M, Vanhove P, Bolpaire R, Masson P, Porrovecchio A, Secq A. Is hybrid cardiac rehabilitation superior to traditional cardiac rehabilitation? Acta Cardiol 2023; 78:773-777. [PMID: 37294005 DOI: 10.1080/00015385.2023.2215610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/29/2022] [Accepted: 04/18/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The current COVID-19 pandemic imposes changes in the management of cardiac pathologies. Cardiac rehabilitation needs to define new protocols to welcome patients back. In connection with the observations of the European Association of Preventive Cardiology, the choice of cardiac tele-rehabilitation appeared to be unavoidable. AIM This retrospective research based on data from the Program for the Medicalisation of Information Systems (PMSI) and the electronic medical record analyzes the effect of Hybrid Cardiac Rehabilitation. METHODS One hundred and ninety-two patients (29 females and 163 males) with an average of 56.9 years old (±10.3) were able to benefit from a Hybrid Cardiac Rehabilitation program. The data concerning the Stress Test and the Wall Squat Test were collected. RESULTS We have noticed that patients had improved their cardiorespiratory capacity on the initial and final Stress Test 6.6 (±1.8) MET to 8.2 (±1.9) MET (p < 0.0001). We also found that patients improved lower limb muscle strength 75.1 (±44.8) seconds to 105.7 (±49.7) seconds (p < 0.0001). CONCLUSIONS Hybrid Cardiac Rehabilitation protocols can be set up in this pandemic situation. The programme effectiveness appears to be comparable to the traditional model. However, additional studies are needed to determine the effectiveness of this programme in the long term.
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Affiliation(s)
- Michaël Racodon
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Pierre Vanhove
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
| | | | | | - Alessandro Porrovecchio
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Amandine Secq
- Clinique la Mitterie, cardiac rehabilitation, Lille, France
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19
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Chimura M, Koba S, Sakata Y, Ise T, Miura H, Murai R, Suzuki H, Maekawa E, Kida K, Matsuo K, Kondo H, Takabayashi K, Fujimoto W, Tamura Y, Imai S, Miura SI, Origuchi H, Goda A, Saita R, Kikuchi A, Taniguchi T. Evaluation of the efficacy and safety of an integrated telerehabilitation platform for home-based cardiac REHABilitation in patients with heart failure (E-REHAB): protocol for a randomised controlled trial. BMJ Open 2023; 13:e073846. [PMID: 37620273 PMCID: PMC10450078 DOI: 10.1136/bmjopen-2023-073846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is strongly recommended as a medical treatment to improve the prognosis and quality of life of patients with heart failure (HF); however, participation rates in CR are low compared with other evidence-based treatments. One reason for this is the geographical distance between patients' homes and hospitals. To address this issue, we developed an integrated telerehabilitation platform, RH-01, for home-based CR. We hypothesised that using the RH-01 platform for home-based CR would demonstrate non-inferiority compared with traditional centre-based CR. METHODS AND ANALYSIS The E-REHAB trial aims to evaluate the efficacy and safety of RH-01 for home-based CR compared with traditional centre-based CR for patients with HF. This clinical trial will be conducted under a prospective, randomised, controlled and non-inferiority design with a primary focus on HF patients. Further, to assess the generalisability of the results in HF to other cardiovascular disease (CVD), the study will also include patients with other CVDs. The trial will enrol 108 patients with HF and 20 patients with other CVD. Eligible HF patients will be randomly assigned to either traditional centre-based CR or home-based CR in a 1:1 fashion. Patients with other CVDs will not be randomised, as safety assessment will be the primary focus. The intervention group will receive a 12-week programme conducted two or three times per week consisting of a remotely supervised home-based CR programme using RH-01, while the control group will receive a traditional centre-based CR programme. The primary endpoint of this trial is change in 6 min walk distance. ETHICS AND DISSEMINATION The conduct of the study has been approved by an institutional review board at each participating site, and all patients will provide written informed consent before entry. The report of the study will be disseminated via scientific fora, including peer-reviewed publications and presentations at conferences. TRIAL REGISTRATION NUMBER jRCT:2052200064.
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Affiliation(s)
- Misato Chimura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinji Koba
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Suzuki
- Department of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koki Matsuo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | | | | | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shunsuke Imai
- Department of Cardiology, Shinrakuen Hospital, Niigata, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hideki Origuchi
- Department of Cardiology, Japan Community Hearlthcare Organization, Kyushu Hospital, Kitakyushu, Japan
| | - Akiko Goda
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center, Nishinomiya, Japan
| | - Ryotaro Saita
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Remohab Inc, Osaka, Japan
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20
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Hayn D, Sareban M, Höfer S, Wiesmüller F, Mayr K, Mürzl N, Porodko M, Puelacher C, Moser LM, Philippi M, Traninger H, Niebauer J. Effect of digital tools in outpatient cardiac rehabilitation including home training-results of the EPICURE study. Front Digit Health 2023; 5:1150444. [PMID: 37519897 PMCID: PMC10382682 DOI: 10.3389/fdgth.2023.1150444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Cardiovascular diseases are the leading cause of death worldwide and are partly caused by modifiable risk factors. Cardiac rehabilitation addresses several of these modifiable risk factors, such as physical inactivity and reduced exercise capacity. However, despite its proven short-term merits, long-term adherence to healthy lifestyle changes is disappointing. With regards to exercise training, it has been shown that rehabilitation supplemented by a) home-based exercise training and b) supportive digital tools can improve adherence. Methods In our multi-center study (ClincalTrials.gov Identifier: NCT04458727), we analyzed the effect of supportive digital tools like digital diaries and/or wearables such as smart watches, activity trackers, etc. on exercise capacity during cardiac rehabilitation. Patients after completion of phase III out-patient cardiac rehabilitation, which included a 3 to 6-months lasting home-training phase, were recruited in five cardiac rehabilitation centers in Austria. Retrospective rehabilitation data were analyzed, and additional data were generated via patient questionnaires. Results 107 patients who did not use supportive tools and 50 patients using supportive tools were recruited. Already prior to phase III rehabilitation, patients with supportive tools showed higher exercise capacity (Pmax = 186 ± 53 W) as compared to patients without supportive tools (142 ± 41 W, p < 0.001). Both groups improved their Pmax, significantly during phase III rehabilitation, and despite higher baseline Pmax of patients with supportive tools their Pmax improved significantly more (ΔPmax = 19 ± 18 W) than patients without supportive tools (ΔPmax = 9 ± 17 W, p < 0.005). However, after adjusting for baseline differences, the difference in ΔPmax did no longer reach statistical significance. Discussion Therefore, our data did not support the hypothesis that the additional use of digital tools like digital diaries and/or wearables during home training leads to further improvement in Pmax during and after phase III cardiac rehabilitation. Further studies with larger sample size, follow-up examinations and a randomized, controlled design are required to assess merits of digital interventions during cardiac rehabilitation.
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Affiliation(s)
- Dieter Hayn
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Graz, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Mahdi Sareban
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Höfer
- Department of Psychiatry II, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Fabian Wiesmüller
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Graz, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Karl Mayr
- CARDIOMED Kardiologisches Rehabilitationszentrum GmbH, Linz, Austria
| | - Norbert Mürzl
- Institut für Präventiv- und Rehabilitationsmedizin, Cardio Vital Wels, Wels, Austria
| | - Michael Porodko
- Institut für Präventiv- und Rehabilitationsmedizin, Cardio Vital Wels, Wels, Austria
| | | | | | | | - Heimo Traninger
- ZARG Zentrum für ambulante Rehabilitation GmbH, Graz,Austria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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21
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Dafny HA, Champion S, Gebremichael LG, Pearson V, Hendriks JM, Clark RA, Pinero de Plaza MA, Gulyani A, Hines S, Beleigoli A. Cardiac rehabilitation, physical activity, and the effectiveness of activity monitoring devices on cardiovascular patients: an umbrella review of systematic reviews. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:323-330. [PMID: 36690341 PMCID: PMC10284262 DOI: 10.1093/ehjqcco/qcad005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
AIMS To consolidate the evidence on the effectiveness of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease who attended cardiac rehabilitation (CR) programmes. METHODS AND RESULTS An umbrella review of published randomized controlled trials, systematic reviews, and meta-analyses was conducted. Nine databases were searched from inception to 9 February 2022. Search and data extraction followed the JBI methodology for umbrella reviews and PRISMA guidelines. Nine systematic reviews met the inclusion criteria, comparing outcomes of participants in CR programmes utilizing devices/applications, to patients without access to CR with devices/applications. A wide range of physical, clinical, and behavioural outcomes were reported, with results from 18 712 participants. Meta-analyses reported improvements in physical activity, minutes/week [standardized mean difference (SMD) 0.23, 95% confidence interval (CI) 0.10-0.35] and activity levels (SMD 0.29, 95% CI 0.07-0.51), and a reduction in sedentariness [risk ratio (RR) 0.54, 95% CI 0.39-0.75] in CR participants, compared with usual care. Of clinical outcomes, the risk of re-hospitalization reduced significantly (RR 0.49, 95% CI 0.27-0.89), and there was reduction (non-significant) in mortality (RR 0.27, 95% CI 0.05-1.54). From the behavioural outcomes, reviews reported improvements in smoking behaviour (RR 0.87, 95% CI 0.67-1.13) and total diet quality intake (RR 0.79, 95% CI 0.66-0.94) among CR patients. CONCLUSIONS The use of devices/applications was associated with increase in activity, healthy behaviours, and reductions in clinical indicators. Although most effect sizes indicate limited clinical benefits, the broad consistency of the narrative suggests devices/applications are effective at improving CR patients' outcomes.
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Affiliation(s)
- Hila Ariela Dafny
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
| | - Stephanie Champion
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
| | - Lemlem G Gebremichael
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
| | - Vincent Pearson
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Aarti Gulyani
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
- Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Alice Springs, NT, Australia
| | - Alline Beleigoli
- Caring Futures Institute (CFI), College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, Northern Territory 0871, Australia
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Batalik L, Filakova K, Sladeckova M, Dosbaba F, Su J, Pepera G. The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review. Eur J Phys Rehabil Med 2023; 59:248-258. [PMID: 36692413 PMCID: PMC10167703 DOI: 10.23736/s1973-9087.23.07773-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR. EVIDENCE ACQUISITION PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531). EVIDENCE SYNTHESIS Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR. CONCLUSIONS Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic -
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic -
| | - Katerina Filakova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Michaela Sladeckova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, University Hospital of Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Jingjing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Garyfallia Pepera
- School of Health Sciences, Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
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23
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Filakova K, Janikova A, Felsoci M, Dosbaba F, Su JJ, Pepera G, Batalik L. Home-based cardio-oncology rehabilitation using a telerehabilitation platform in hematological cancer survivors: a feasibility study. BMC Sports Sci Med Rehabil 2023; 15:38. [PMID: 36959613 PMCID: PMC10034898 DOI: 10.1186/s13102-023-00650-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
Purpose Cardiovascular disease is a competing mortality cause in hematological cancer survivors due to toxic oncological treatment, accumulation of risk factors, and decline of cardiorespiratory fitness. Cardio-oncology rehabilitation (CORE) is an emerging treatment model to optimize the prognosis of hematological cancer patients and survivors; however, its accessibility during the COVID-19 pandemic is poor. The study aimed to evaluate the feasibility, safety, and effect of a 12-week home-based CORE intervention in telerehabilitation approach among hematological cancer survivors. Methods A prospective single-arm interventional study was conducted at a faculty hospital in Brno, Czech Republic. This study provided 12 weeks of the home-based CORE using a telerehabilitation approach that allows remote supervision by a clinician from a medical facility. The telerehabilitation approach consists of three components: a heart rate sensor (PolarM430, Kempele, Finland), a web platform compatible with the sensor, and telesupervising via telephone call (1 call per week). To improve adherence, a physiotherapist called participants to assess or address adverse effects, exercise feedback, and participant-related concerns. The anthropometry, body composition, and cardiorespiratory fitness were measured immediately after the intervention. Results Eleven hematological cancer survivors with an average age of 60.3 ± 10 years participated in the study. Most participants were diagnosed with Follicular lymphoma and received maintenance treatment. Participants had a significant (p < 0.05) increase in cardiorespiratory fitness by 2.6 ml/kg/min; and in peak workload, from 143.3 ± 60.6 W to 158.6 ± 67.5 W (p < 0.05). Improvement in anthropometry and body composition was observed but yielded no statistical significance. Most (80%) participants completed the three times/per week telesupervising exercise session for 12 weeks.No adverse event was identified. Conclusion Findings from this study suggest that home-based CORE may provide hematological cancer survivors with an increase in CRF during the rehabilitation period after hospital discharge. The telerehabilitation CORE model is effective, feasible, safe, and has demonstrated good adherence. Further randomized controlled efficacy study with larger sample size is needed before clinical implementation. Clinical trial registration Clinical trial registration number NCT04822389 (30/03/2021). Supplementary Information The online version contains supplementary material available at 10.1186/s13102-023-00650-2.
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Affiliation(s)
- Katerina Filakova
- grid.412554.30000 0004 0609 2751Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- grid.4491.80000 0004 1937 116XDepartment of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Andrea Janikova
- grid.412554.30000 0004 0609 2751Department of Internal Medicine–Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Marian Felsoci
- grid.412554.30000 0004 0609 2751Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Filip Dosbaba
- grid.412554.30000 0004 0609 2751Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Jing Jing Su
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Garyfallia Pepera
- grid.410558.d0000 0001 0035 6670Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ladislav Batalik
- grid.412554.30000 0004 0609 2751Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- grid.10267.320000 0001 2194 0956Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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MacEachern E, Giacomantonio N, Theou O, Quach J, Firth W, Abel-Adegbite I, Kehler DS. Comparing Virtual and Center-Based Cardiac Rehabilitation on Changes in Frailty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1554. [PMID: 36674308 PMCID: PMC9865753 DOI: 10.3390/ijerph20021554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Many patients with cardiovascular disease (CVD) are frail. Center-based cardiac rehabilitation (CR) can improve frailty; however, whether virtual CR provides similar frailty improvements has not been examined. To answer this question, we (1) compared the effect of virtual and accelerated center-based CR on frailty and (2) determined if admission frailty affected frailty change and CVD biomarkers. The virtual and accelerated center-based CR programs provided exercise and education on nutrition, medication, exercise safety, and CVD. Frailty was measured with a 65-item frailty index. The primary outcome, frailty change, was analyzed with a two-way mixed ANOVA. Simple slopes analysis determined whether admission frailty affected frailty and CVD biomarker change by CR model type. Our results showed that admission frailty was higher in center-based versus virtual participants. However, we observed no main effect of CR model on frailty change. Results also revealed that participants who were frailer at CR admission observed greater frailty improvements and reductions in triglyceride and cholesterol levels when completing virtual versus accelerated center-based CR. Even though both program models did not change frailty, higher admission frailty was associated with greater frailty reductions and change to some CVD biomarkers in virtual CR.
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Affiliation(s)
- Evan MacEachern
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Wanda Firth
- Hearts and Health in Motion, Nova Scotia Health, Halifax, NS B3L 0B7, Canada
| | | | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
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25
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Su JJ, Paguio J, Baratedi WM, Abu-Odah H, Batalik L. Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial. Heart Lung 2023; 57:214-221. [PMID: 36265371 DOI: 10.1016/j.hrtlng.2022.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/24/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits. OBJECTIVE The study aimed to explore the experiences of patients who participated in the NeCR program. METHODS A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors. RESULTS Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers. CONCLUSIONS Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.
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Affiliation(s)
- Jing Jing Su
- WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, A127 Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Jenniffer Paguio
- WHO Collaborating Center (WHO CC) for Leadership in Nursing Development, College of Nursing, the University of the Philippines - Manila, Manila, Philippines
| | | | - Hammoda Abu-Odah
- Centre for Advancing Patient Health Outcomes: A Joanna Briggs Institute, School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Lee AYL, Wong AKC, Hung TTM, Yan J, Yang S. Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40364. [PMID: 36322107 PMCID: PMC9669889 DOI: 10.2196/40364] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode. OBJECTIVE This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases. METHODS A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots. RESULTS A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate. CONCLUSIONS This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases. TRIAL REGISTRATION International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.
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Affiliation(s)
- Athena Yin Lam Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Tommy Tsz Man Hung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Yan
- Zhejiang Hospital, Zhejiang, China
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27
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Stefanakis M, Batalik L, Antoniou V, Pepera G. Safety of home-based cardiac rehabilitation: A systematic review. Heart Lung 2022; 55:117-126. [PMID: 35533492 DOI: 10.1016/j.hrtlng.2022.04.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR. OBJECTIVES To examine the incidence and severity of adverse events of HBCR. METHODS The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome. RESULTS Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise. CONCLUSION The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.
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Affiliation(s)
- Marios Stefanakis
- Physiotherapy Department, University of West Attica, Egaleo, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital, Jihlavska 20, Brno 62500, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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Batalik L, Pepera G, Su JJ. Cardiac telerehabilitation improves lipid profile in the long term: Insights and implications. Int J Cardiol 2022; 367:117-118. [PMID: 36055472 DOI: 10.1016/j.ijcard.2022.08.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Kim C, Kwak HB, Sung J, Han JY, Lee JW, Lee JH, Kim WS, Bang HJ, Baek S, Joa KL, Kim AR, Lee SY, Kim J, Kim CR, Kwon OP, Sohn MK, Moon CW, Lee JI, Jee S. A survey of the perceptions of barriers to and facilitators of cardiac rehabilitation in healthcare providers and policy stakeholders. BMC Health Serv Res 2022; 22:999. [PMID: 35932056 PMCID: PMC9356496 DOI: 10.1186/s12913-022-08298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea. Methods We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed. Results Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations. Conclusions Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08298-3.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hae-Bin Kwak
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Young Han
- Department of Physical Medicine and Rehabilitation, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University, College of Medicine, Cheongju, South Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Kyung Lim Joa
- Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Wonkwang University Hospital, Wonkwang University Medical School, Iksan, South Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Oh Pum Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Chang-Won Moon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Jae-In Lee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Chungnam National Univeristy College of Medicine, Daejeon, South Korea.
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DE Lima AP, Pereira DG, Nascimento IO, Martins TH, Oliveira AC, Nogueira TS, Britto RR. Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial. Eur J Phys Rehabil Med 2022; 58:598-605. [PMID: 35634888 PMCID: PMC9980526 DOI: 10.23736/s1973-9087.22.07340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN Single-blind randomized control trial. SETTING A university hospital. POPULATION Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.
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Affiliation(s)
- Ana P DE Lima
- University Center of Belo Horizonte (Uni-BH), Belo Horizonte, Brazil
| | - Danielle G Pereira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil -
| | - Isabella O Nascimento
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thiago H Martins
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Anne C Oliveira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Tiago S Nogueira
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Raquel R Britto
- Department of Physiotherapy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Antoniou V, Davos CH, Kapreli E, Batalik L, Panagiotakos DB, Pepera G. Effectiveness of Home-Based Cardiac Rehabilitation, Using Wearable Sensors, as a Multicomponent, Cutting-Edge Intervention: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11133772. [PMID: 35807055 PMCID: PMC9267864 DOI: 10.3390/jcm11133772] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 12/19/2022] Open
Abstract
Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients’ health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model, further investigation is needed. This systematic review and meta-analysis aimed to evaluate the effectiveness of wearable sensors-assisted HBCR in improving the CVD patients’ cardiorespiratory fitness (CRF) and health profile. PubMed, Scopus, Cinahl, Cochrane Library, and PsycINFO were searched from 2010 to January 2022, using relevant keywords. A total of 14 randomized controlled trials, written in English, comparing wearable sensors-assisted HBCR to center-based cardiac rehabilitation (CBCR) or usual care (UC), were included. Wearable sensors-assisted HBCR significantly improved CRF when compared to CBCR (Hedges’ g = 0.22, 95% CI 0.06, 0.39; I2 = 0%; p = 0.01), whilst comparison of HBCR to UC revealed a nonsignificant effect (Hedges’ g = 0.87, 95% CI −0.87, 1.85; I2 = 96.41%; p = 0.08). Effects on physical activity, quality of life, depression levels, modification of cardiovascular risk factors/laboratory parameters, and adherence were synthesized narratively. No significant differences were noted. Technology tools are growing fast in the cardiac rehabilitation era and promote exercise-based interventions into a more home-based setting. Wearable-assisted HBCR presents the potential to act as an adjunct or an alternative to CBCR.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
| | - Constantinos H. Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece;
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic;
- Department of Public Health, Masaryk University Brno, Zerotinovo nam. 617/9, 601 77 Brno, Czech Republic
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 176 71 Kallithea, Greece;
- Faculty of Health, University of Canberra, Bruce 2617, Australia
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
- Correspondence:
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Antoniou V, Xanthopoulos A, Giamouzis G, Davos C, Batalik L, Stavrou V, Gourgoulianis KI, Kapreli E, Skoularigis J, Pepera G. Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol. BMJ Open 2022; 12:e059945. [PMID: 35738643 PMCID: PMC9226468 DOI: 10.1136/bmjopen-2021-059945] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05019157.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | | | - Gregory Giamouzis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Constantinos Davos
- Cardiovascular Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Masaryk University Brno, Brno, Czech Republic
| | - Vasileios Stavrou
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | - John Skoularigis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
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(Home-based remote cardiovascular rehabilitation in a patient after coronary intervention during COVID-19 pandemic - a case study). COR ET VASA 2022. [DOI: 10.33678/cor.2021.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fonseca-Pinto R, Ferreira F, Alves J, Januario F, Antunes A. Impact of the COVID-19 Pandemic on Adherence to Exercise Prescription: The case of Cardiac Rehabilitation Programs. 2022 45TH JUBILEE INTERNATIONAL CONVENTION ON INFORMATION, COMMUNICATION AND ELECTRONIC TECHNOLOGY (MIPRO) 2022:374-377. [DOI: 10.23919/mipro55190.2022.9803456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Rui Fonseca-Pinto
- Polytechnic of Leiria,ciTechCare – Center for Innovative Care and Health Technology,Portugal
| | - Fabio Ferreira
- Polytechnic of Leiria,ciTechCare – Center for Innovative Care and Health Technology,Portugal
| | - Joao Alves
- Polytechnic of Leiria,ciTechCare – Center for Innovative Care and Health Technology,Portugal
| | | | - Alexandre Antunes
- Polytechnic of Leiria,ciTechCare – Center for Innovative Care and Health Technology,Portugal
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Efficacy and Safety of Hybrid Cardiac Telerehabilitation in Patients with Hypertrophic Cardiomyopathy without Left Ventricular Outflow Tract Obstruction and Preserved Ejection Fraction—A Study Design. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common congenital disease increasing the risk of sudden cardiac death. For many years, HCM patients were excluded from exercise training. However, there are data showing that patients with HCM undergoing supervised exercise training could improve physical performance without serious adverse events. A project was designed as a randomized clinical trial to assess the effectiveness and safety of hybrid cardiac rehabilitation (HCR)—a combination of hospital-based cardiac rehabilitation (1 month) with a new form of home-based telemonitored cardiac rehabilitation (2 months) in HCM patients without left ventricular (LV) outflow tract obstruction and preserved systolic function. Sixty patients who fulfil the inclusion criteria have been randomly assigned (1:1) to either HCR plus usual care (training group) or usual care only (control group). The primary endpoint is a functional capacity evaluated by peak oxygen uptake (pVO2). Secondary endpoints include workload time during the cardiopulmonary exercise testing, a six-minute walk test distance, NT-pro BNP level, echocardiographic parameters of the left ventricular diastolic function (E/A, E/e’, myocardial strain rate), right ventricular systolic pressure, a gradient in the LV outflow tract, and quality of life. The tertiary analysis includes safety, acceptance and adherence to the HCR program. Our research will provide innovative data on the effectiveness and safety of hybrid cardiac rehabilitation in HCM patients without LV outflow tract obstruction and preserved systolic function. Clinical trials registry: ClinicalTrials.gov Identifier NCT03178357.
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Pepera G, Sandercock GRH. Incremental shuttle walking test to assess functional capacity in cardiac rehabilitation: a narrative review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022; 29:1-10. [DOI: 10.12968/ijtr.2021.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Background/AimsLow functional capacity has been recognised to be the most important predictor of overall mortality compared to all other cardiovascular risk factors in patients with cardiovascular disease. Walk tests, such as the incremental shuttle walking test and the 6-Minute Walk Test, are used to assess functional capacity in patients, the effectiveness of a cardiac rehabilitation programme and the prognosis of cardiovascular diseases. The aim of this review was to provide a narrative review of the literature and identify the key features of the incremental shuttle walking test as a measure of functional capacity testing in cardiac rehabilitation patients.MethodsThe PubMed, MEDLINE, Elsevier and Google Scholar databases were searched for relevant scientific articles published up to March 2021 with no restriction on start day. The key words defined by researchers were ‘incremental shuttle walking test’, ‘exercise test’, ‘functional capacity’, ‘cardiovascular disease’, ‘cardiac rehabilitation’, ‘reliability’ ‘prediction; ‘walk tests’. A final set of 31 articles was included in this narrative review.ResultsEvidence-based findings suggest that the incremental shuttle walking test is a valid, reliable, sensitive, useful tool for detecting and predict cardiorespiratory capacity.ConclusionsClinicians can be confident that they can use the incremental shuttle walking test to monitor changes in functional capacity in patients with cardiovascular disease.
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Affiliation(s)
- Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Gavin RH Sandercock
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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Irgens I, Midelfart-Hoff J, Jelnes R, Alexander M, Stanghelle JK, Thoresen M, Rekand T. Videoconferencing in Pressure Injury: Randomized Controlled Telemedicine Trial in Patients With Spinal Cord Injury. JMIR Form Res 2022; 6:e27692. [PMID: 35438645 PMCID: PMC9066320 DOI: 10.2196/27692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/04/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023] Open
Abstract
Background Geographical, financial and travel-related barriers may impact access to necessary health care for people in need of long-term follow-up. Objective The goal of the research was to perform a nonblinded, randomized, controlled trial on health-related quality of life (HRQoL), healing, interaction, and satisfaction of patients with spinal cord injury (SCI) and PI receiving multidisciplinary videoconference consultations from a wound clinic to the participant’s home versus regular outpatient care. The multidisciplinary team consisted of a medical doctor, a wound nurse, and an occupational therapist. In both groups, district nurses attended the consultations at the participant’s home. Methods A total of 56 participants, 28 in each group, were randomized to a videoconference group (VCG) or a regular care group (RCG). Validated questionnaires were used to measure and compare the follow-up effect on HRQoL. Percentage reduction of wound volume was measured at end of the follow-up. A Likert scale was used to measure the satisfaction of the patients and district nurses regarding the interaction between different modalities of care in the 2 groups. Results The HRQoL did not show significant differences between the 2 groups (P values ranging from .09 to .88) or the rate of PI healing, experienced interaction, and satisfaction in the groups. A total of 67% (37/55) of all PIs healed, 64% (18/28) in the VCG and 70% (19/27) in the RCG. Mean reduction in ulcer volume was 79% in the VCG and 85% in the RCG (P=.32). A Kaplan-Meier plot with a logrank test regarding time to healing did not show any significant difference between the 2 groups. Conclusions Videoconference-based care seems to be a safe and efficient way to manage PIs in terms of HRQoL, healing, interaction, and satisfaction compared to conventional care for people with SCI. This should be considered when planning for future care. SCI has a huge impact on the individual, the family, and the health care system. There is an urgent need to improve systems of care so that individuals who live far from specialists and require long-term follow-up for conditions such as PI can get optimal treatment. Trial Registration ClinicalTrials.gov NCT02800915; https://clinicaltrials.gov/ct2/show/NCT02800915 and Current Research Information System in Norway (CRISTIN) 545284; https://app.cristin.no/projects/show.jsf?id=545284
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Affiliation(s)
- Ingebjørg Irgens
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jana Midelfart-Hoff
- Spinal Cord Unit, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Faculty of Health, VID Specialized University, Bergen, Norway
| | - Rolf Jelnes
- Medical Center, Hospital Sønderjylland, Aabenraa, Denmark
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, Birmingham School of Medicine, University of Alabama, Birmingham, AL, United States.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard School of Medicine, Boston, MA, United States.,Sustain Our Abilities, Birmingham, AL, United States
| | | | - Magne Thoresen
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Tiina Rekand
- Spinal Cord Unit, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Sahlgrenska Academy and Institute for Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Piao JJ, Wan B, Zhao H, Shang Z, Yan L, Hao Z, Wang Y, Zhang Y, Gu Y. Effects of different brisk walking intensities on adherence and cardiorespiratory endurance of cardiac rehabilitation among patients with CHD after PCI: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055437. [PMID: 35418429 PMCID: PMC9013999 DOI: 10.1136/bmjopen-2021-055437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is a critical treatment for patients with coronary heart disease after percutaneous coronary intervention. Unfortunately, participation and adherence of CR are unexpectedly poor. This study aims to test whether low-intensity or medium-intensity brisk walking is more helpful in improving early attendance, adherence and physical results. METHODS AND ANALYSIS This randomised controlled study will compare the effects of low-intensity and medium-intensity brisk walking to improve adherence and cardiopulmonary endurance. Participants will be randomly allocated to low-intensity or medium-intensity groups and will be followed-up for 8 weeks. Primary and secondary outcome data will be collected at baseline and at 2, 4 and 8 weeks. Primary outcomes measure changes in oxygen consumption (VO2) peak value (mL/kg/min), as well as adherence. Secondary outcomes include changes in body mass index, oxygen pulse, maximal metabolic equivalent, breathing reserve, vital capacity, ratio of forced expiratory volume in 1 s to forced vital capacity, Δoxygen consumption/Δwork rate (ΔVO2/ΔWR), minute ventilation/carbon dioxide production and self-efficacy. ETHICS AND DISSEMINATION Ethical approval and informed consent form have been obtained from the Ethics Committee of Hebei General Hospital (approval number: NA-2021-03). The study background and main objective, as well as potential benefits and risks, will be fully explained to the participants and their families. Findings from this study will be published on academic journals in Chinese or in English for widespread dissemination of the results TRIAL REGISTRATION NUMBER: ChiCTR2100047568.
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Affiliation(s)
- Jing Jing Piao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Boya Wan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Hebei General Hospital, Shijiazhuang, China
| | - Haomei Zhao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhiyang Shang
- Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Lingjun Yan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- The Third Hospital Of Shijiazhuang, Shijiazhuang, China
| | - Zhina Hao
- Hospital of Stomatology Hebei Medical University, Shijiazhuang, China
| | - Yonghong Wang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanqing Zhang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanmei Gu
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Key Laboratory for HealthCare with Chinese Medicine of Hebei Province, Shijiazhuang, China
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Nso N, Nassar M, Mbome Y, Emmanuel KE, Lyonga Ngonge A, Badejoko S, Akbar S, Landry I, Alfishawy M, Munira M, Rizzo V. Comparative Assessment of the Long-Term Efficacy of Home-Based Versus Center-Based Cardiac Rehabilitation. Cureus 2022; 14:e23485. [PMID: 35475109 PMCID: PMC9035293 DOI: 10.7759/cureus.23485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
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Giacalone A, Marin L, Febbi M, Franchi T, Tovani-Palone MR. eHealth, telehealth, and telemedicine in the management of the COVID-19 pandemic and beyond: Lessons learned and future perspectives. World J Clin Cases 2022; 10:2363-2368. [PMID: 35434056 PMCID: PMC8968610 DOI: 10.12998/wjcc.v10.i8.2363] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/11/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
In this article, we discuss evidence supporting the effective implementation of eHealth, telehealth, and telemedicine during the coronavirus disease 2019 pandemic, with a view towards its permanent future integration in healthcare. We performed a literature search for articles describing the use of telehealth/ telemedicine in the pandemic context using five databases. The articles selected describe the use of telemedicine as its advantages in terms of practicality and cost-effectiveness. This synthesis of articles is applicable to high-, middle- and low-income countries. Some of the notable benefits include breaking down geographical and time barriers, reducing waiting lists and crowding in healthcare facilities, and saving on national healthcare expenditure. However, there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns. Moreover, it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence. Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them. In the current socio-economic climate, it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare, as well as leading to an improvement in the quality of life of patients, whilst optimising existing resources and reducing costs. In that regard, the adoption of eHealth, telehealth, and telemedicine services should be considered highly timely, despite current existing limitations.
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Affiliation(s)
- Andrea Giacalone
- Department of Industrial Engineering, Technologies for Sports Medicine and Rehabilitation, University of Rome Tor Vergata, Rome 00133, Italy
| | - Luca Marin
- Department of Research, Asomi College of Sciences, Marsa MRS 19112, Malta
| | - Massimiliano Febbi
- Department of Research, Asomi College of Sciences , Marsa MRS 19112, Malta
| | - Thomas Franchi
- The Medical School, The University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
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Fraser MJ, Leslie SJ, Gorely T, Foster E, Walters R. Barriers and facilitators to participating in cardiac rehabilitation and physical activity: A cross-sectional survey. World J Cardiol 2022; 14:83-95. [PMID: 35316976 PMCID: PMC8900522 DOI: 10.4330/wjc.v14.i2.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) have been shown to be the greatest cause of death worldwide and rates continue to increase. It is recommended that CVD patients attend cardiac rehabilitation (CR) following a cardiac event to reduce mortality, improve recovery and positively influence behaviour around CVD risk factors. Despite the recognised benefits and international recommendations for exercise-based CR, uptake and attendance remain suboptimal. A greater understanding of CR barriers and facilitators is required, not least to inform service development. Through understanding current cardiac patients’ attitudes and opinions around CR and physical activity (PA) could inform patient-led improvements. Moreover, through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.
AIM To investigate participants’ attitudes and opinions around CR and PA.
METHODS This study employed a cross-sectional survey design on 567 cardiac patients. Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands, from May 2016 to May 2017 were sampled. As part of a larger survey, the current study analysed the free-text responses to 5 open-ended questions included within the wider survey. Questions were related to the participants’ experience of CR, reasons for non-attendance, ideas to increase attendance and their opinions on PA. Qualitative data were analysed using a 6-step, reflexive thematic analysis.
RESULTS Two main topic areas were explored: “Cardiac rehabilitation experience” and “physical activity”. Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered. Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs. Moreover, responses demonstrated a lack of information and communication around the classes. Respondents highlighted that the provision of more classes and classes being held out with working hours, in addition to a greater variety would increase attendance. In terms of PA, respondents viewed this as different to the CR experience. Responses demonstrated increased freedom when conducting PA with regards to the location, time and type of exercise conducted.
CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.
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Affiliation(s)
- Matthew James Fraser
- Division of Biomedical Science, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
| | - Stephen J Leslie
- Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
| | - Emma Foster
- Cardiac Unit NHSH, NHS Highland, Inverness IV2 3JH, United Kingdom
| | - Ronie Walters
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
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Papathanasiou J, Kashilska Y, Bozov H, Petrov I, Masiero S. The outbreak of the SARS-CoV-2 Omicron variant make imperative the adoption of telerehabilitation in the Bulgarian health care system. Eur J Transl Myol 2022; 32. [PMID: 35107088 PMCID: PMC8992671 DOI: 10.4081/ejtm.2022.10355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 02/08/2023] Open
Abstract
The rapid spread of the highly contagious Omicron variant of SARS-CoV-2 globally will challenge the accessibility and the delivery of physical and rehabilitation medicine (PRM) services. Many health care systems throughout the world performed effective reforms such as the transition to telerehabilitation (TR). In Bulgaria, TR is still not regulated by law, and terms such as teleconsultation and tele-education have not yet been introduced. The adoption of TR in the Bulgarian health care system will undoubtedly increase the accessibility to rehabilitation treatment for a larger group of Bulgarian patients with various neurological, cardiorespiratory, musculoskeletal, and oncological conditions and will significantly contribute to the PRM services modernization in Bulgaria.
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Affiliation(s)
- Jannis Papathanasiou
- Department of Kinesitherapy, Faculty of Public Health "Prof. Dr. Tzecomir Vodenicharov, DSc" , Medical University of Sofia, Bulgaria; Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv.
| | - Yana Kashilska
- Medical Center for Outpatient Rehabilitation and Sport Medicine, Plovdiv, Bulgaria; (4) Complex Oncologic Center of Burgas, Faculty of Public Health and Health Care, University prof. Assen Zlatarov, Burgas.
| | - Hristo Bozov
- Complex Oncologic Center of Burgas, Faculty of Public Health and Health Care, University prof. Assen Zlatarov, Burgas.
| | - Ivo Petrov
- Clinic of Cardiology and Angiology, Acibadem City Clinic Cardiovascular Center University Hospital, Sofia.
| | - Stefano Masiero
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, University of Padua, Padua.
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Xu YX, Yu Y, Huang Y, Wan YH, Su PY, Tao FB, Sun Y. Exposure to bedroom light pollution and cardiometabolic risk: A cohort study from Chinese young adults. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 294:118628. [PMID: 34883146 DOI: 10.1016/j.envpol.2021.118628] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 06/13/2023]
Abstract
Indoor light environment has altered dramatically and exposure to light at night (LAN) potential leads to the progression of cardiometabolic conditions. However, few studies have investigated the effect of bedroom LAN exposure on cardiometabolic risk. To estimate the associations between multi-period bedroom LAN exposure with cardiometabolic risk among Chinese young adults. We objectively measured multi-period bedroom LAN intensity using portable illuminance meter in an ongoing prospective cohort (n = 484). At one-year follow-up, 230 young adults provided fasting blood samples for quantification of cardiometabolic parameters. Cardiometabolic (CM)-risk score was derived as the sum of standardized sex-specific z-scores for waist circumference (WC), mean arterial pressure (MAP), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) and homeostasis model assessment for insulin resistance (HOMA-IR), with HDL-C multiplied by - 1. Multivariate and univariable linear regression models were used to examine associations of multi-period bedroom LAN exposure with cardiometabolic risk. Exposure to higher bedroom LAN intensity is associated with 1.47-unit increase in CM-risk score (95% CI: 0.69-2.25; P < 0.001). Besides, post-bedtime light exposure was associated with elevated fasting insulin (PBL-1h: β = 0.06, 95% CI: 0.01-0.10; PBL-4h: β = 0.33, 95% CI: 0.19-0.47) and HOMA-IR (PBL-1h: β = 0.013, 95% CI: 0-0.03; PBL-4h: β = 0.07, 95% CI: 0.04-0.11) while pre-awake light exposure was associated with elevated total cholesterol (PAL-1h: β = 0.03, 95% CI: 0.02-0.04; PAL-2h: β = 0.02, 95% CI: 0.01-0.03), triglyceride (PAL-1h: β = 0.015, 95% CI: 0.01-0.02; PAL-2h: β = 0.01, 95% CI: 0-0.02) and low-density lipoprotein cholesterol (PAL-1h: β = 0.02, 95% CI: 0.01-0.03; PAL-2h: β = 0.02, 95% CI: 0.01-0.03). Among young adults, bedroom LAN exposure was significantly associated with higher cardiometabolic risk. Furthermore, different periods of bedroom light exposure have time-dependent effect on cardiometabolic risk. Further research is needed to confirm our findings and to elucidate potential mechanisms.
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Affiliation(s)
- Yu-Xiang Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yang Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yan Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yu-Hui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Anghel R, Adam CA, Marcu DTM, Mitu O, Mitu F. Cardiac Rehabilitation in Patients with Peripheral Artery Disease-A Literature Review in COVID-19 Era. J Clin Med 2022; 11:416. [PMID: 35054109 PMCID: PMC8778009 DOI: 10.3390/jcm11020416] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiac rehabilitation (CR) is an integral part of the management of various cardiovascular disease such as coronary artery disease (CAD), peripheral artery disease (PAD), or chronic heart failure (CHF), with proven morbidity and mortality benefits. This article aims to review and summarize the scientific literature related to cardiac rehabilitation programs for patients with PAD and how they were adapted during the COVID-19 pandemic. The implementation of CR programs has been problematic since the COVID-19 pandemic due to social distancing and work-related restrictions. One of the main challenges for physicians and health systems alike has been the management of PAD patients. COVID-19 predisposes to coagulation disorders that can lead to severe thrombotic events. Home-based walking exercises are more accessible and easier to accept than supervised exercise programs. Cycling or other forms of exercise are more entertaining or challenging alternatives to exercise therapy. Besides treadmill exercises, upper- and lower-extremity ergometry also has great functional benefits, especially regarding walking endurance. Supervised exercise therapy has a positive impact on both functional capacity and also on the quality of life of such patients. The most effective manner to acquire this seems to be by combining revascularization therapy and supervised exercise. Rehabilitation programs proved to be a mandatory part of the integrative approach in these cases, increasing quality of life, and decreasing stress levels, depression, and anxiety.
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Affiliation(s)
- Razvan Anghel
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iasi, Romania; (R.A.); (C.A.A.); (F.M.)
| | - Cristina Andreea Adam
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iasi, Romania; (R.A.); (C.A.A.); (F.M.)
| | - Dragos Traian Marius Marcu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iasi, Romania;
- “Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iasi, Romania
| | - Florin Mitu
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iasi, Romania; (R.A.); (C.A.A.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iasi, Romania;
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45
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Bonneux C, Hansen D, Dendale P, Coninx K. The SharedHeart Approach: Technology-Supported Shared Decision Making to Increase Physical Activity in Cardiac Patients. LECTURE NOTES OF THE INSTITUTE FOR COMPUTER SCIENCES, SOCIAL INFORMATICS AND TELECOMMUNICATIONS ENGINEERING 2022:469-488. [DOI: 10.1007/978-3-030-99194-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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46
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Kondratova I, Fournier H. Virtual Cardiac Rehabilitation in a Pandemic Scenario: A Review of HCI Design Features, User Acceptance and Barriers. LECTURE NOTES IN COMPUTER SCIENCE 2022:485-499. [DOI: 10.1007/978-3-031-05581-2_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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47
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Pogosova NV, Badtieva VA, Ovchinnikova AI, Sokolova OY. [New treatments and technologies in cardiac rehabilitation programs]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:50-57. [PMID: 35700376 DOI: 10.17116/kurort20229903150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article presents a review of literature data reflecting the relevance and modern views on the effectiveness and expediency of using various options for rehabilitation programs for cardiovascular diseases. The issues of the history of the development of cardiac rehabilitation both abroad and in Russia are consecrated. The article also presents alternative models for conducting cardiac rehabilitation, in particular, using remote and telemedicine technologies. The widespread use of smartphones and high-speed Internet access contributed to the further introduction and use of telemedicine technologies in cardiac rehabilitation. The article discusses the possibilities of telerehabilitation of cardiological patients and shows its comparable effectiveness with traditional cardiac rehabilitation.
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Affiliation(s)
- N V Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - V A Badtieva
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - A I Ovchinnikova
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - O Yu Sokolova
- National Medical Research Center of Cardiology, Moscow, Russia
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Besnier F, Dupuy EG, Gagnon C, Vincent T, Grégoire CA, Blanchette CA, Saillant K, Bouabdallaoui N, Grau JI, Bérubé B, Olmand M, Marin MF, Belleville S, Juneau M, Vitali P, Gayda M, Nigam A, Bherer L. Investigation of the Effects of Home-Based Exercise and Cognitive Training on Cognitive and Physical Functions in Cardiac Patients: The COVEPICARDIO Study Protocol of a Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:740834. [PMID: 34938780 PMCID: PMC8685268 DOI: 10.3389/fcvm.2021.740834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: During the COVID-19 pandemic, confinement measures are likely to produce collateral damage to health (stress, confusion, anxiety), especially in frail individuals and those living with cardiovascular disease (CVD). In cardiac patients in particular, these measures dramatically increase the level of physical inactivity and sedentary lifestyle, which can decrease cardiorespiratory capacity and increase the risk of acute events, rehospitalization, and depressive syndromes. Maintaining a minimum level of physical activity and cognitive stimulation during the COVID-19 crisis is essential for cardiac patients. This study is designed to document the effects of 6 months of home-based physical exercise alone or combined with cognitive training on cognitive and physical functions in patients with CVD over 50 years old. Methods and Analysis: 122 patients (>50 years old) with stable CVD and no contraindication to perform physical exercise training will be recruited and randomly assigned to one of the 2 following arms: (1) Home-based physical exercise alone, (2) Home-based physical exercise combined with cognitive training. The intervention lasts 6 months, with remote assessments performed prior to, mid and post-training. A follow-up 6 months after the end of the intervention (12 month) is also proposed. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as performances on measures of executive functions, processing speed, and episodic memory. The secondary outcome is physical performance, including balance, gait and mobility, leg muscle strength and estimated cardiorespiratory fitness. Tertiary outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported online questionnaires. Discussion: With the COVID-19 crisis, there is a critical need for remote exercise and cognitive training, and to further investigate this topic, in particular for cardiac patients. The present context can be viewed as an opportunity to perform a major shift from center-based programs to home-based physical exercise. This is especially important to reach out to older adults living in remote areas, where access to such interventions is limited. ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT04661189], NCT04661189.
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Affiliation(s)
- Florent Besnier
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Emma Gabrielle Dupuy
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada
| | - Thomas Vincent
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada
| | | | - Caroll-Ann Blanchette
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Kathia Saillant
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Nadia Bouabdallaoui
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Josep Iglésies Grau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Béatrice Bérubé
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Miloudza Olmand
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Marie-France Marin
- Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada.,Research Center of the Montreal Mental Health University Institute, Montréal, QC, Canada
| | - Sylvie Belleville
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Martin Juneau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Paolo Vitali
- McGill University Research Centre for Studies on Aging, Montréal, QC, Canada.,McGill University Department of Neurology and Neurosurgery, Faculty of Medicine, Montréal, QC, Canada
| | - Mathieu Gayda
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anil Nigam
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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Jouini S, Milleron O, Eliahou L, Jondeau G, Vitiello D. Effects of a personalized home-based training program among patients suffering from Marfan syndrome: a pilot randomized and controlled study. Intractable Rare Dis Res 2021; 10:263-268. [PMID: 34877238 PMCID: PMC8630458 DOI: 10.5582/irdr.2021.01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Marfan syndrome (MFS) is an autosomal hereditary pathology affecting 1:5000 peoples. Alteration of the fibrillin 1 gene (FBN1) results in haplo-insufficiency of the FBN1 protein mainly altering the vascular system. International recommendations have gradually allowed MFS patients to perform training programs because of its potential benefits. However, to date, there are no data on the effect of a long training period in these patients. The aim of the present study is to investigate the effect of a 3-month personalized home-based training on quality of life (QoL) of patients suffering from MFS. At least 50 MFS patients were included in the study. They were randomly placed into 4 groups: control group; endurance; resistance and endurance + resistance training groups. The training program lasted 3 months and is performed at patients' home. There were 2 training sessions per week telemonitored by a specialist of physical activity and cardiology. Pre and post-training evaluations were performed at the Bichat-Paris Hospital, France. They consisted of assessing psychometrics based on self-administered questionnaires (FiRST, GPAQ, ISP-25, MOS SF-36) and physiological parameters such as the peak oxygen consumption, aorta diameter, cardiac ventricle function and skeletal muscle power at rest and during exercise. Our preliminary results showed an improvement of 50% in QoL, cardiorespiratory fitness and skeletal muscle power in a patient who completed the combined training program. This experimental approach might be a new alternative way for MFS patients' care that may improve their QoL, cardiorespiratory fitness and skeletal muscle power.
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Affiliation(s)
- Steeve Jouini
- Institute of Sport and Health Sciences of Paris, Université de Paris, Paris, France
| | - Olivier Milleron
- Laboratory for Vascular Translational Science, Hôpital Bichat-Claude-Bernard, Université de Paris, Paris, France
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Ludivine Eliahou
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Guillaume Jondeau
- Laboratory for Vascular Translational Science, Hôpital Bichat-Claude-Bernard, Université de Paris, Paris, France
- Centre national de référence pour le syndrome de Marfan et pathologies apparentés, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Service de Cardiologie, Centre National de Référence Pour le Syndrome de Marfan et Apparentés, AP-HP, Hôpital Bichat, Paris, France
| | - Damien Vitiello
- Institute of Sport and Health Sciences of Paris, Université de Paris, Paris, France
- Address correspondence to:Damien Vitiello, URP 3625-Institute of Sport and Health Sciences of Paris (I3SP), Université de Paris, Paris 75015, France. E-mail:
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Batalik L, Dosbaba F, Hartman M, Konecny V, Batalikova K, Spinar J. Long-term exercise effects after cardiac telerehabilitation in patients with coronary artery disease: 1-year follow-up results of the randomized study. Eur J Phys Rehabil Med 2021; 57:807-814. [PMID: 33619944 DOI: 10.23736/s1973-9087.21.06653-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Home-based cardiac telerehabilitation (HBCT) is a feasible and effective alternative to traditional center-based cardiac rehabilitation (CBCR). Currently, there are only limited studies focusing on a long-term effect of HBCT, which means it is essential to do more research in this study field. AIM This study aimed at investigating a 1-year effect of a randomized controlled study using Cardiac Rehabilitation through the Global Position System (CR-GPS) compared to outpatient cardiac rehabilitation. Study focused on cardiorespiratory fitness (CRF) and health-related quality of life (HRQL) in patients with coronary heart disease (CAD). DESIGN A long-term follow-up of a randomized study. SETTING Patients were enrolled, and the intervention was performed in an outpatient or home-based model. The results were obtained and evaluated in a hospital. POPULATION Patients who participated in the CR-GPS study were diagnosed with CAD with low to moderate cardiovascular risk. METHODS Patients enrolled in the study were eligible participants who had previously completed a 12-week HBCT program using a wrist heart rate (HR) monitor or attended a traditional CBCR. Primary outcome was the change in CRF expressed in peak oxygen uptake (pVO<inf>2</inf>), and the secondary outcomes were self-reported HRQL, objectively measured anthropometric characteristics, and mortality and hospitalization rates. RESULTS Forty-four patients (76%) completed the long-term follow-up. The average peak of pVO<inf>2</inf> was higher after 1-year follow-up in the telerehabilitation group (HBCT 25.5 mL/kg/min compared to the active control group CBCR 23.6 mL/kg/min P=0.047). No statistically significant difference between the two groups was found after long-term follow-up for the parameter HRQL. For both groups, there was a significant improvement in the range of perceptions of general health. There was no death case and no difference in hospitalization rate between the groups. CONCLUSIONS This study supports the HBCT model. It has been demonstrated that it induces satisfactory long-term effects in pVO<inf>2</inf>, exercise performance, and perceived general health in CAD patients with low to moderate cardiovascular risk. CLINICAL REHABILITATION IMPACT Cardiovascular telerehabilitation using wrist HR monitors is a feasible and effective rehabilitation method that can help patients eliminate barriers that prevent them from using CBCR programs. Especially in the current global situation with the COVID-19 pandemic, this topic is becoming increasingly important.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic -
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic -
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic
| | - Martin Hartman
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic
| | - Vladimir Konecny
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic
| | - Katerina Batalikova
- Department of Rehabilitation, University Hospital of Brno, Brno, Czech Republic
| | - Jindrich Spinar
- First Department of Internal Medicine and Cardioangiology, Institutions shared with St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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