Where you live matters: Challenges and opportunities to address the urban-rural divide through innovative secondary cardiac rehabilitation programs

2013 ◽  
Vol 21 (3) ◽  
pp. 170-177 ◽  
Author(s):  
Janice Sangster ◽  
Susan Furber ◽  
Philayrath Phongsavan ◽  
Margaret Allman-Farinelli ◽  
Julie Redfern ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Rehabilitation Programs ◽  
Challenges And Opportunities ◽  
Urban Rural

Hiring Practices of Exercise Physiologist in Cardiac Rehabilitation Programs among Mid-Atlantic States in the United States

2016 ◽  
Vol 5 (3) ◽  
pp. 32-36 ◽  
Author(s):  
Allison Hope Bowersock ◽  
William Alexander Breeding ◽  
Carmel Alexander Sheppard
Keyword(s):  
United States ◽  
Patient Education ◽  
Cardiac Rehabilitation ◽  
Science Curriculum ◽  
Exercise Physiology ◽  
Clinical Skill ◽  
The United States ◽  
Hiring Practices ◽  
Clinical Settings ◽  
Rehabilitation Programs

Purpose: The purpose of this survey was to identify factors that may be influencing the appreciation of exercise physiology as a discipline as demonstrated by hiring practices in regional clinical settings. Methods: A telephone survey was administered to 33 cardiac rehabilitation programs in 5 states in the Mid-Atlantic region of the United States (Kentucky, North Carolina, Tennessee, Virginia, and West Virginia). Results: The distribution of nurses and exercise physiologists (EPs) employed by the 33 facilities varied by state, but overall there were 86 nurses and 55 EPs working among the surveyed facilities. Of the 33 surveyed facilities, 12 (36%) reported a preference for hiring nurses over EPs; only 4 (12%) reported a preference for hiring EPs over nurses. The remaining facilities (n = 17; 52%) reported no preference (n = 12; 36%) or that the decision depends on a variety of factors (n = 5; 15%). Several common themes were identified from respondents. These included that, compared to nurses, EPs have greater expertise in exercise prescription and better understanding of safe exercise progression for patients. However, nurses were believed to possess greater assessment and clinical skill with an emphasis on emergency response preparedness and greater general patient education skills. Conclusion: Academic programs that prepare students for careers as EPs employed in clinical settings may benefit from additional coursework and internship site selection that focus on clinical assessment skills, emergency preparedness, and patient education to reinforce their work in an exercise science curriculum.

scholarly journals Efficacy of cardiac rehabilitation with motion assistance from wearable cyborg hybrid assistive limb in patients with chronic heart failure: a randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Watanabe ◽  
A Koike ◽  
H Kato ◽  
L Wu ◽  
K Hayashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Rehabilitation ◽  
Exercise Therapy ◽  
Knee Extensor ◽  
Control Group ◽  
Cardiac Events ◽  
Rehabilitation Programs ◽  
Sit To Stand ◽  
Knee Extensor Strength

Abstract Background Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking. Purpose We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure. Methods This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated. Results There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group. Conclusion The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

P2513Offer and participation in different European cardiac rehabilitation programs in the elderly after ACS or coronary revascularization. The EU-CaRE study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Pena-Gil ◽  
G Prada-Ramallal ◽  
V Gonzalez-Salvado ◽  
M Sestayo-Fernandez ◽  
O Lado-Baleato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Smoking Status ◽  
Coronary Revascularization ◽  
Travel Distance ◽  
Living Alone ◽  
Coronary Syndrome ◽  
Rehabilitation Programs ◽  
Care Study ◽  
The Eu

Abstract Background Cardiac rehabilitation programs (CRP) are strongly recommended after acute coronary syndrome (ACS) or coronary revascularization (PCI or CABG), but actual offer and participation among elderly patients (age ≥65) have not been well characterised. Purpose To analyse current offer and participation rates in different European CRP in elderly patients. Methods Data from elderly patients recruited for CRP, after ACS, PCI or CABG, in centres from seven European countries participating in the EU-CaRE study (NTR5306), were analysed. Results 3471 patients were screened, of whom 80.9% (n=2806) were offered participation and 68.0% of these (n=1908) agreed to participate in a CRP. Outpatient CRP were offered to 73–92% of screened patients. Among reasons for not offering the program were contraindications and geographical conditions. Patients who were not offered were mainly older, with worse cardiovascular risk profile and comorbidities. In the multivariable analysis main variables related with offering in Copenhagen were age (OR=0.92, CI95% 0.87–0.98), gender (male, OR=2.42, CI95% 1.10–5.31) and previous CABG (OR=0.12, CI95% 0.04–0.36). In Bern, age (OR=0.89, CI95% 0.85–0.93), ACS (OR=1.85, CI95% 1.01–3.54) and smoking status (OR=0.47, CI95% 0.24–0.93). In Zwolle, age (OR=0.89, CI95% 0.91–0.97), CABG (OR=4.34, CI95% 1.37->10), smoking status (OR=0.23, CI95% 0.06–1.11), diabetes mellitus (OR=0.33, CI95% 0.13–0.91) and comorbidities (i.e. obstructive pulmonary disease). In Santiago, age (OR=0.83, CI95% 0.73–0.91), index event PCI (OR=14.21, CI95% 3.68->10) and rheumatoid arthritis. The ratio of participation among those who were offered the program varied from 46% to 94% (46% to 67% in outpatients' programs). Main reasons for not participating were patients considered that it was not useful (366, 10.5%), travel distance (205, 5.8%), transport difficulties (134, 3.8%) and exercises on own initiative (70, 2.0%). In a center-specific analysis we performed predictive models of participation. In Copenhagen (AUC=0.69) the main variables predicting participation were age (OR=0.99, CI95% 0.96–1.03), not living alone (OR=1.53, CI95% 0.96–2.42), CABG (OR=2.69, CI95% 1.51–4.80) and comorbidities. In Bern (AUC=0.81), age (OR=0.92, CI95% 0.89–0.95), ACS (OR=3.99, CI95% 2.56–6.20) and peripheral artery disease. In Zwolle (AUC=0.71), age (OR=0.94, CI95% 0.91–0.98), employment status (OR=0.28, CI95% 0.13–0.60), CABG (OR=3.62, CI95% 2.28–5.77) and previous ACS (OR=0.58, CI95% 0.35–0.95). In Santiago (AUC=0.85), age (OR=0.95, CI95% 0.90–0.99), rural habitat (OR=0.58, CI95% 0.32–1.04), valvulopathy (OR=0.33, CI95% 0.14–0.79) and the index intervention PCI. Conclusions Knowing reasons (travel distance, usefulness of the program understood by patient) and variables (age, living alone or in rural area) that determine if CRP is offered and whether or not patients participate will help redesign CRP to better adapt to actual needs of an elderly European population. Acknowledgement/Funding This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634439

scholarly journals Participation in Cardiac Rehabilitation Programs Among Older Patients After Acute Myocardial Infarction

2015 ◽  
Vol 175 (10) ◽  
pp. 1700 ◽  
Author(s):  
Jacob A. Doll ◽  
Anne Hellkamp ◽  
P. Michael Ho ◽  
Michael C. Kontos ◽  
Mary A. Whooley ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Older Patients ◽  
Rehabilitation Programs

Cardiac rehabilitation during COVID-19 pandemic – new challenges, new opportunities

2021 ◽  
Vol 14 (3) ◽  
pp. 215-221
Author(s):  
Maciej Janiszewski ◽  
Artur Mamcarz
Keyword(s):  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Second Phase ◽  
Mortality And Morbidity ◽  
Rehabilitation Programs ◽  
Rehabilitation Centers ◽  
New Challenges ◽  
Artery Disease

The role of comprehensive cardiac rehabilitation (CCR) is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Many clinical trials demonstrated effectiveness of CCR in improving exercise capacity, quality of life, and in reducing cardiovascular mortality and morbidity. However, even before the era of the COVID-19 pandemic comprehensive cardiac rehabilitation program’s implementation, especially the second phase, had many barriers. One of the main reasons for not attending in second phase of CCR was lack of transportation from patient’s home to rehabilitation centers. Additionally, in recent months COVID-19 pandemic has led to closure of many cardiac rehabilitation centres resulting in many eligible patients unable to participate in the optimisation of secondary prevention. During the coronavirus disease-2019 pandemic, hybrid telerehabilitation has become the leading solution in the cardiac rehabilitation programs. The present paper contains key information about structures, effectives and safety of hybrid telerehabilitation during the COVID-19 era.

scholarly journals Machine Learning Approaches for Supporting Patient:Specific Cardiac Rehabilitation Programs

2016 ◽  
Author(s):  
Danilo Lofaro ◽  
Maria Carmela Groccia ◽  
Rosita Guido ◽  
Domenico Conforti ◽  
Sergio Caroleo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Rehabilitation ◽  
Learning Approaches ◽  
Rehabilitation Programs
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