Physical exercise rehabilitation: Long-term dropout rate in cardiac patients

The long-term dropout rate was examined in a physical exercise rehabilitation program in which 203 cardiac patients were followed for 40 months. The dropout curve was found to be downward-sloping and negatively accelerated with most of the dropouts occurring during the first 3 months. This dropout rate appeared to resemble the group relapse curve previously found in the treatment of addictive behaviors. Implications of the present findings are discussed in terms of the development of strategies to facilitate long-term compliance.Preparation of this paper was supported in part by National Heart, Lung and Blood Institute Grants 5T32HL07332 and HL24233.     

Self-efficacy for exercise in cardiac rehabilitation: review and recommendations

Despite the numerous physical and psychosocial benefits of exercise for coronary heart disease survivors, non-adherence to cardiac rehabilitation (CR) exercise is a major problem. Adherence to the lifestyle behavior change associated with CR involves both physical and self-regulatory skills. While self-regulatory efficacy is clearly linked to exercise adherence and adjustment, the literature on the relationship between self-efficacy and exercise among CR participants has not been systematically reviewed. A search of relevant databases identified 41 CR studies. Few studies measured self-regulatory efficacy for actions that facilitate adherence. Most studies examined self-efficacy during the intensive center-based phase of CR, with little attention to long-term maintenance. The CR literature could benefit by examining (a) self-efficacy as a major rehabilitation outcome, (b) measurement of self-regulatory efficacy for behavior change, (c) suspected moderators of self-efficacy (i.e. gender, age), and (d) self-efficacy relative to maintenance.     

Eliciting exercise preferences in cardiac rehabilitation: initial evaluation of a new strategy.

Cardiac rehabilitation (CR) programs may be more effective in promoting long-term exercise if participants are helped to devise exercise programs that are individually tailored to their exercise preferences. This paper describes an initial evaluation of 'CHOICE' (Creating better Health Orientation by Improving Communication about Exercise experiences), an instrument designed to elicit cardiac patients' exercise preferences. In individual interviews with 16 women, CHOICE was used to help participants select exercise features that were important to them for maintaining long-term exercise. Exercise preferences were then summarized on individual preference forms. Study participants in this pilot study had no problems in selecting exercise features contributing to exercise maintenance and could easily discriminate between their relative importance. Further, there were large variations in the importance participants placed on different exercise features. This suggests the need for eliciting patients' exercise preferences so exercise programs can be individually designed. In conclusion, CHOICE is an applicable instrument for eliciting exercise preferences.     

Predictors of self-reported antidepressant adherence

The authors' objectives of this research were: (1) to assess levels of selfreported antidepressant adherence and reasons for nonadherence and (2) to investigate determinants of nonadherence. A group of general hospital and community psychiatry practice mood disorder outpatients (n=80) took a self-report questionnaire that assessed beliefs about antidepressants, self-efficacy, and reasons for nonadherence. High levels of adherence were reported: 58 patients (73%) indicated they took their medication as directed more than 80% of the time. Practical issues (e.g., simply forgetting or a change in routine) were the most frequently identified reasons for nonadherence. Patients were more likely to report nonadherence if they experienced a sexual side effect, had lower self-efficacy, were female, and had not completed post-secondary education. Clinicians should be cognizant of this complexity and address not only issues related to medication efficacy and tolerability, but also social mediators and health beliefs when prescribing antidepressants.     

Predictors of protocol adherence in a pediatric asthma clinical trial

BACKGROUND: Declining protocol adherence can threaten the validity of a clinical trial. OBJECTIVE: We sought to explore patient and family factors important for protocol adherence in the 133 patients followed at one of the 8 Childhood Asthma Management Program (CAMP) clinical centers. Difficulties with timely return of diary cards (diary card problem), with keeping or frequently rescheduling appointments (appointment problem), and with commitment to all aspects of the trial (commitment problem) were tracked prospectively during the treatment phase of CAMP, which ranged from 20 to 40 months at the time of the analysis. METHODS: We performed a cross-sectional analysis. RESULTS: During the course of this investigation, no St Louis CAMP patients dropped out of the study, although signs of eroding participation were observed in 44% of patients. For this cross-sectional analysis, the percentage of patients exhibiting protocol-adherence problems was greater the longer patients had been in the trial: 33.3% at 20 to 25 months, 39.5% at 26 to 30 months, 51.4% at 31 to 35 months, and 69.2% at 36 to 40 months (P <.01). The diary card problem was present in 22.2% of the patients enrolled in the trial for 20 to 25 months compared with 66.7% for patients enrolled for 36 to 40 months (P <.005). Appointment and commitment problems were present in smaller percentages of patients and did not change by time in the trial (P =.41 and.22, respectively). A logistic regression analysis of demographic characteristics indicated that age at randomization and time in the trial were significant factors: for every 2-year increase in age, a child was twice as likely to have a commitment problem (odds ratio [OR], 1.96; 95% CI, 1.50-2.57), and for each additional 5 months of participation in the study, a child was twice as likely to have a diary card problem (OR, 1.91; 95% CI, 1.76-2.07). There was no influence of family income, patient race, or patient sex on the occurrence of any of the 3 protocol-adherence problems. A similar analysis of psychologic characteristics of the child and family indicated (1) a 2-fold increase in the risk of a diary card problem with a 10% increase in the percentage of total commissions on the attention scale of the Gordon Diagnostic Study (OR, 2.18; 95% CI, 2.02-2.35), (2) a 2-fold decrease in the risk of an appointment problem with a 10-unit increase in the Child Manifest Anxiety Scale (OR, 0.46; 95% CI, 0.44-0.49), (3) a 2-fold decrease in risk of an appointment problem with a 10-unit increase in the cohesion subscale of the Family Environment Scale (OR, 0.58; 95% CI, 0.55-0.60), and (4) a 5-fold decrease in the risk of a commitment problem with a 10-unit increase in the Child Depression Index score (OR, 0.21; 95% CI, 0.18-0.24). CONCLUSIONS: Adherence and retention problems commonly occur in longer clinical trials. CAMP patients and families were selected in part on the basis of likelihood of being able to participate in the trial to enhance the conclusions of the trial. Despite this selection process, adherence problems were noted. Problems increased with duration of participation, increasing child age, and the presence of less family cohesion or attention problems in the child. In contrast, the presence of mild emotional distress (anxiety and depression) in the child was associated with fewer protocol-adherence problems. Incorporating procedures that help anticipate and identify adherence problems early might improve continued participation in all aspects of a trial and even retention in long-term clinical trials.     

An examination of psychosocial correlates of exercise tolerance in cardiac rehabilitation participants

This study explored the influence of psychosocial factors on an important prognostic indictor among heart patients, exercise tolerance (ET). Prior to attending cardiac rehabilitation (CR), 100 men and 24 women completed a survey assessing social support and self-efficacy for exercise in CR followed by an ET test (ETT) measured in metabolic equivalents (METS) 1 month later. Regression analyses showed that age was the strongest predictor of METS, but that income and the psychosocial variables also significantly impacted on METS. Overall, 50% of the variance in METS was explained by the predictor variables. These results show that psychosocial factors affect the ET of heart patients. Future research should examine the prognostic role of these psychosocial factors as they affect ET as well as their influence on behavioral mechanisms such as exercise.     

The effect of participation in an exercise training program on cardiovascular reactivity in sedentary middle-aged males.

Exaggerated cardiovascular reactivity to mental stressors may be a risk factor for cardiovascular disease. To determine if participation in a moderate intensity aerobic exercise training program reduces cardiovascular reactivity to laboratory stressors, 40 sedentary middle-aged males were randomly assigned: training group (n = 25) and control group (n = 15). Cardiovascular reactivity during and after three mental stressors (passive responding, push-button Stroop and verbal Stroop) and mild exercise (bicycle ergometer) was assessed before and after an 8-week intervention. VO2(peak) was determined using the Balke protocol. Among 19 subjects who completed the training, VO2(peak) increased 13.7%. Also, trained compared to untrained subjects showed significant reductions in baseline and absolute heart rate responses to all stressors. Baseline adjusted heart rates were significantly lower during push-button Stroop recovery and during verbal Stroop. Blood pressure, T-wave amplitude, finger pulse amplitude and pulse transit time responses were unaffected by exercise training. It was concluded that participation in a short-term, moderate intensity aerobic exercise training program may have a cardioprotective effect by significantly reducing absolute and baseline-adjusted heart rate responses to stressors.     

Predictors of adherence to antiretroviral therapy in rural Zambia

BACKGROUND/OBJECTIVE: Antiretroviral therapy (ART) adherence levels of >or=95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices. METHODS: We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients' home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients' medical and pharmacy records. RESULTS: At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; P = 0.002). CONCLUSIONS: Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.     

Acid hydrolase activities in mouse cardiac and skeletal muscle following exhaustive exercise

Summary Acid hydrolase activities in skeletal and cardiac muscle were studied 5,10, and 20 days after exhaustive intermittent running by untrained and endurance-trained mice. Exhaustion increased the activities of cathepsin D, -glucuronidase and ribonuclease, but not that of p-nitrophenylphos-phatase in skeletal muscle of untrained mice. Activities were highest on the fifth day after exhaustion and decreased during the following two weeks. More intensive loading produced no changes in acid hydrolytic capacity in skeletal muscle of endurance-trained mice. Acid hydrolase activities in cardiac muscle of both untrained and trained mice were unaffected by exhaustive running. It is suggested that exhaustive running causes both lethal and sublethal hypoxic fiber injuries in the skeletal muscle of untrained mice but not in that of endurance-trained mice or in the cardiac muscle of animals of either group. These injuries manifest themselves as fiber necrosis (lethal) and as increased acid hydrolytic capacity in surviving fibers (sublethal).This study was financially supported by the Academy of Finland and the Finnish Research Council for Physical Education and Sport (Ministry of Education)     

Predictors of participation and attrition in a health promotion study involving psychiatric outpatients

Participant selection biases can reduce the generalizability of research findings and lead to misestimates of intervention effectiveness. The authors examined factors associated with study participation and attrition among psychiatric outpatients recruited for the initial phase of a health promotion trial. Medical records were reviewed to obtain HIV-risk and substance abuse data, as well as psychiatric and demographic characteristics of potential participants. Of 895 eligible outpatients, 67% (n = 601) consented to participate, among whom 69% (n = 415) completed all baseline appointments. Compared with nonconsenters, consenters were more likely to be at risk for drug problems and to receive care from clinics serving more impaired patients. Study completion was associated with older age, a psychiatric diagnosis other than adjustment disorder, and a recent sexually transmitted disease diagnosis. These findings suggest that patients who could most benefit from risk reduction interventions are more likely to participate.     

Predictors of medication adherence: fact or artifact

Numerous studies have examined socio-demographic, psychosocial, and other factors as potential contributors to poor adherence. Variability exists in the strength and consistency of findings. We speculated that the method of measuring adherence might be a factor in the variability in identification of predictor variables. We examined the identification of predictors of adherence by method of measurement in two randomized, controlled trials of adherence interventions. Both studies used the Aardex Medication Event Monitor and the Morisky Self-Report Scale. Twenty-one days of baseline data from 698 subjects were examined in relation to measures of depression, functional status, perceived therapeutic efficacy, number of co-morbidities, and socio-demographic indices. Analysis included Spearman rho, Pearson r, and multiple logistic regression. Differences in the identification of predictors between adherence measurement methods were identified. These data support the hypothesis that different measurement methods yield different predictors of adherence.     

A rehabilitation exercise program to remediate skeletal muscle atrophy in an estrogen-deficient organism may be ineffective

To determine rehabilitation exercise program effects under hormone deficient (ovariectomy or OVX) and hormone supplemented [OVX + 17-beta estradiol (E2)] conditions. Mature female rats (n = 123) were assigned to OVX or OVX + E2-supplemented groups. OVX and OVX + E2 groups were allocated to one of four conditions: (1) control, (2) hindlimb unweighted (HLU) for 4 weeks to induce muscle atrophy, (3) cage Recovery for 2 weeks after HLU, and (4) Recovery with 2 weeks of rehabilitation exercise program after 4 weeks of HLU. Atrophy following HLU was comparable for OVX and OVX + E2-supplemented rats and was significant in all muscles examined (soleus, tibialis anterior, plantaris, gastrocnemius, quadriceps). Also significant with HLU was the decline in muscle force (P < 0.05) in soleus, plantaris, gastrocnemius and tibialis anterior (quadriceps not tested). There were trends toward return of muscle mass in Recovery OVX and Recovery OVX + E2 groups but only the E2 supplemented OVX rats had return of muscle mass (4/5 muscles studied) with exercise. Peak tetanic tension (Po) returned to control values in the E2 supplemented Exercise rats but not in the unsupplemented Exercise group. For example, gastrocnemius Po for OVX HLU, OVX Recovery and OVX-Exercise groups was 82%*, 82%* and 76%* of control. Gastrocnemius Po for E2 supplemented HLU, Recovery and Exercise groups was 72%*, 95% and 106% of control (*P < 0.05 compared to control). H&E cross-sections from OVX-Exercise rats showed central nuclei. In conclusion, a rehabilitation exercise program to remediate acute atrophy in females appears more effective if E2 is present.     

Evaluation of a training program for improving adherence promotion skills

A workshop for improving the adherence counseling skills of health professionals was developed and evaluated. Target audiences have included medical students, nursing students, dietetic interns, and practising nurses and dietitians. Four categories of skills are taught: relationship building, interviewing, problem diagnosis, and behavioral intervention. Teaching methods include faculty demonstration, participant rehearsal, and group and individual feedback. The Adherence Promotion Training (APT) workshop has been offered as a 3- to 5-day intensive course and as a semester-long elective. A reliable coding system was developed to assess these skills from videotaped provider-patient interactions. A standardized patient task was given to 60 subjects before and after participation in the adherence counseling skills workshop. Videotapes were coded by trained raters, who were masked to whether the tape came from before or after the workshop. Significant short-term improvements were observed in all four core skills. This uncontrolled evaluation suggests that the Adherence Promotion Training program is a promising way to enhance the ability of health professionals to care for nonadherent patients.     

基于胰高血糖素样肽1受体及其下游信号探讨有氧运动对小鼠心梗模型心功能康复的影响

目的:探讨有氧运动训练(AET)对心肌梗死(MI)小鼠的心脏保护作用,并阐明其作用机制是否与胰高血糖素样肽1受体(GLP-1R)激活有关.方法:在实验1(研究AET对MI小鼠的心脏保护作用及对心脏组织中GLP-1R表达的影响)中,67只小鼠分为3组:假手术(sham)组(n=14)、MI组(n=28)和MI+AET组(...