Benefits of Cardiac Rehabilitation and Exercise Training Programs in Elderly Coronary Patients

The authors review several studies from the Ochsner Heart and Vascular Institute showing the benefits of formal phase II cardiac rehabilitation and exercise training programs in elderly patients with coronary artery disease, including benefits on plasma lipids, obesity indices, exercise capacity, peak oxygen consumption, behavioral characteristics (especially depression), and quality of life. Marked benefits were noted in elderly women and all elderly patients over the age of 75 years. The authors conclude that the therapy has proved to be safe and effective for elderly coronary patients, and that these individuals should be routinely referred to, and vigorously encouraged to attend, cardiac rehabilitation programs following major coronary events.     

Elderly Cardiac Rehabilitation Patients Show Greater Improvements in Ventilation at Submaximal Levels of Exercise

The minute ventilation (VE) and carbon dioxide output (VCO&sub2;) adaptations to 12 weeks of cardiac rehabilitation were investigated in diagnosis-matched elderly patients (ELD) and younger patients (YNG). Thirty ELD (25 males, 5 females; age equals 69.2?+/-3.9 years) and 30 YNG (27 males, 3 females; age equals 48.3?+/-7.0 years) were exercise tested at program entry (T1) and completion (T2). Peak oxygen uptake (VO&sub2; peak) and ventilatory threshold (VT) (ml kg-1 min-1) were greater for YNG at both T1 and T2 (p is less than 0.01). Both ELD and YNG showed significant T1 to T2 improvements (p is less than 0.01) for VO&sub2; peak (21.1% and 23.4%) and VT (20.1% and 12.4%). The VE/VCO&sub2; ratio was greater (p is less than 0.01) for ELD but approached YNG values after training. The VCO&sub2;/VO&sub2; slope showed a greater T1 to T2 reduction in ELD (12.4% vs 3.4%). There was no relationship (r(2) equals 0.15; NS) between the percentage change in VO&sub2; peak and VE/VCO&sub2; indicating unrelated mechanisms of improvement. We conclude that ELD showed similar improvements in VO&sub2; peak but greater improvements in their ventilatory tolerance for submaximal exercise. These changes indicate improvements in aging-enhanced exercise ventilation, are important for performance of normal activities of daily living, and would have been undetectable without gas exchange analysis.     

帕罗西汀对老年脑卒中后运动康复的影响

目的 探讨帕罗西汀对老年性脑卒中后运动康复的影响.方法 将64例患者按入院顺序随机分为治疗组和对照组各32例.对照组给予脑卒中常规治疗,治疗组在对照组治疗基础上加服帕罗西汀20 mg/d,连续90 d,两组患者同时接受物理治疗.治疗前及治疗后21d、90d进行功能独立性评定量表(FIM)评估.结果 治疗前和治疗后21 d两组FIM评分差异无统计学意义(P>0.05),治疗后90 d治疗组FIM评分值较治疗前显著升高(P<0.01),且高于对照组(P<0.05).结论 帕罗西汀治疗脑卒中后运动功能障碍安全有效,可促进运动功能康复.     

运动锻炼改善急性心肌梗死患者运动能力及心率恢复能力

目的:探讨运动锻炼对急性心肌梗死患者运动能力及心率恢复能力的影响.方法:60例无严重并发症首次发生急性ST段抬高型心肌梗死的患者,随机分为康复运动组(n=30)和对照组(n=30),给予康复运动组有指导的家庭运动锻炼,共随访6个月,于发病后第10～14天(康复运动前)及第6个月(康复运动后)分别进行运动心肺功能测定,测定运动后第一分钟心率恢复能力(HRR)及两组患者HRR降低(sHRR)的比例.结果:①康复运动组和对照组无氧阈时代谢当量和峰值代谢当量基线值差异无统计学意义,随访6个月时两组上述运动指标均较基线值明显增加,差异有统计学意义(P<0.01),但康复运动组较对照组增加显著,差异有统计学意义(P<0.01).②两组患者的基线值运动第一分钟HRR及sHRR的比例差异无统计学意义,随访6个月时,康复运动组HRR较基线值明显提高,差异有统计学意义[(29±11)次/分比(22±10)次/分,P<0.05];康复运动组sHRR的比例较基线值明显下降,差异有统计学意义[0%比75%,P<0.05],与对照组比较差异也有统计学意义[0%比45%,P<0.05].结论:有指导的运动锻炼可以改善急性心肌梗死患者的运动能力及运动后心率恢复能力.     

早期康复对心脏重症患者的作用及安全性分析研究

【摘要】 目的 探讨早期康复对心脏重症患者的短期临床作用和安全性。方法 选择2019年6月至2020年5月间在阜外华中心血管病医院心脏重症监护室(Cardiac Intensive Care Unit, CICU)接受机械通气治疗的患者63例,按患者出生月份单双数随机分为两组：对照组（32例）：进行常规的心脏重症监护与诊治;观察组（31例）：除常规监护与诊治外,进行基于无创心排量评估的早期康复治疗。分别统计两组的机械通气时间、每搏输出量（stroke volume, SV）、心输出量（cardiac output, CO）、心指数（cardiac index, CI）、肺炎发生率和不良事件发生率。结果 通过对比,观察组的机械通气时间明显缩短[(21.48±2.13) vs. (29.09±3.65),p<0.05];肺炎发生率明显下降[3.2% vs. 15.6%,p<0.05];出CICU时每搏输出量（SV）[(56.38±3.36) vs. (53.85±3.89),p<0.05]、心输出量（CO）[(4.82±1.14) vs. (3.90±1.23),p<0.05]和心指数（CI）[(3.62±1.36) vs. (3.01±1.24),p<0.05]均明显提高,差异具有统计学意义;两组间不良事件发生率[1.0% vs. 0,p>0.05]差异无统计学意义。结论 早期康复对心脏重症患者安全有效,促进心脏功能恢复,值得在临床推广。     

Benefits of Cardiac Rehabilitation and Exercise Training in Older Persons

Despite the well-proved benefits of cardiac rehabilitation and exercise training, older persons are frequently not referred to or vigorously encouraged to pursue this therapy after major coronary heart disease (CHD) events. Therefore, we determined the effects of this therapy on plasma lipids, indices of obesity, and exercise capacity in older CHD patients compared with the benefits obtained in a younger cohort. At baseline, the older persons had lower body mass indices (BMI), triglycerides levels, and estimated metabolic equivalent (METs), and the elderly had higher levels of high-density lipoprotein cholesterol (HDL-C). Most other parameters were statistically similar in the older and younger patients. After cardiac rehabilitation, the elderly had significant improvements in METs, BMI, percent body fat, HDL-C, and low-density lipoprotein cholesterol (LDL-C)/HDL-C but not in total cholesterol or LDL-C. However, improvements in all of these parameters were statistically similar in older and younger patients. We conclude that despite baseline differences, improvements in exercise capacity, obesity indices, and lipid levels were statistically similar in older and younger patients enrolled in formal, phase II, cardiac rehabilitation and exercise training programs. Therefore, our data emphasized that the elderly should not be categorically denied the benefits of vigorous secondary CHD prevention, including formal cardiac rehabilitation and exercise training programs.     

Effects of Pulmonary Rehabilitation on Systemic Inflammation and Exercise Capacity in Bronchiectasis: A Randomized Controlled Trial

Introduction

Bronchiectasis is a chronic condition that is becoming a global health concern.

Objective

To examine the effects of pulmonary rehabilitation (PR) on systemic inflammation, exercise capacity, and quality of life in participants with bronchiectasis.

Methods

Participants were randomized to receive PR (outpatient, three weekly sessions for 3 months) or control intervention (usual care?+?airway clearance therapy?+?breathing exercises). Data on laboratory (fibrinogen level) and patient-centered outcomes such as physical fitness [6-min walk test (6MWT)] and quality of life were collected.

Results

A total of 41 participants were evaluated (20 in the intervention group and 21 in the control group). The magnitude of change between baseline and the end of study was greater in the PR group than in the control group—the 6MWT distance increased by a mean of 54 m (54 vs 12 m; p?<?0.01), fibrinogen showed a significant reduction (fibrinogen ? 92.8 versus ? 47.1 mg/dl; p?<?0.01), and quality of life improved according to Saint George’s Respiratory Questionnaire (SGRQ) (? 7.5 vs 3.2; p?<?0.01), which exceeded the minimal clinically important difference of 4 points.

Conclusion

PR effectively improved physical fitness, quality of life, and the degree of systemic inflammation, as reflected by changes in 6 MWT, fibrinogen levels and SGRQ scores. This study supports the inclusion of people with bronchiectasis in supervised PR programs.

     

Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis

Background

Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups.

Psychosocial Factors Associated with Noncardiac Chest Pain and Cardiac Syndrome X

Abstract Cardiac syndrome X, the triad of angina pectoris, positive exercise electrocardiogram (ECG) for myocardial ischemia and angiographically smooth coronary arteries, is associated with increased psychological morbidity, debilitating symptomatology and a poor quality of life. Patients with noncardiac chest pain (NCCP) are often similarly affected. The psychological morbidity noted among this patient population has been linked with a number of psychosocial factors, including impaired social support, traumatic life events, the negative impact of menopause among female sufferers, and an awareness of a family history of coronary heart disease (CHD). Cognitive behavioral therapy (CBT), group support, physical activity and relaxation techniques have been investigated as treatments for psychological morbidity among this patient group with varying degrees of success. While clinicians should be aware of the psychological aspect of patients with NCCP and cardiac syndrome X, further research is needed in order to establish a comprehensive physiological and psychological treatment regimen.