ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEDose-response relationships between exercise training volume and blood lipid changes suggest that exercise can favorably alter blood lipids at low training volumes, although the effects may not be observable until certain exercise thresholds are met.METHODS AND RESULTSPlasma triglyceride reductions are often observed after exercise training regimens requiring energy expenditures similar to those characterized to increase high-density lipoprotein cholesterol (HDL-C). Thresholds established from cross-sectional and longitudinal exercise training studies indicate that 15 to 20 miles/week of brisk walking or jogging, which elicit between 1200 to 2200 kcals of energy expenditure per week, is associated with triglyceride reductions of 5 to 38 mg/dL and HDL-C increases of 2 to 8 mg/dL. Exercise training seldom alters total cholesterol and low-density lipoprotein cholesterol (LDL-C) unless dietary fat intake is reduced and body weight loss is associated with the exercise training program, or both. Thus, for most individuals, the positive effects of regular exercise are exerted on blood lipids at low training volumes and accrue so that noticeable differences frequently occur with energy expenditures of 1200 to 2200 kcals/week.CONCLUSIONSIt appears that weekly exercise caloric expenditures that meet or exceed the higher end of this range are more likely to produce the desired lipid changes. Regarding hyperlipidemic disorders, the primary means for intervention is pharmacologic, whereas diet modification, weight loss, and exercise, although important, are viewed as adjunctive therapies. Because much is known about the exercise training-induced plasma lipid and lipoprotein modifications as well as the mechanisms responsible for these changes, rehabilitation professionals can better develop a comprehensive medical management plan that optimizes pharmacologic, reduced dietary fat intake, weight loss, and exercise interventions.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEThe authors evaluate the prognostic value of treadmill testing in a large consecutive series of patients with chronic coronary artery disease. Exercise testing is widely performed, but analyses of the prognostic value of test results have largely concentrated on patients referred for the diagnosis of coronary artery disease, patients after an acute coronary event or procedure, or patients with congestive heart failure.METHODSAll patients referred for evaluation at two university-affiliated Veterans Affairs Medical Centers who underwent exercise treadmill tests for clinical indications between 1987 and 2000 were determined to be dead or alive using the Social Security Death Index after a mean 5.8-year follow-up. Patients without established heart disease and those with congestive heart failure were excluded, leaving the target population of those with a history myocardial infarction or coronary intervention. Clinical and exercise test variables were collected prospectively according to standard definitions; testing and data management were performed in a standardized fashion using a computer-assisted protocol. All-cause mortality was used as the endpoint for follow-up. Standard survival analysis was performed including Kaplan Meier curves and the Cox Hazard Model.RESULTSOf the 1473 patients with coronary artery disease who had exercise testing, 273 (19%) patients had a revascularization procedure (Revascularization group); 813 (55%) had a history of myocardial infarction, diagnostic Q waves (MI group), or both; and 387 (26%) had a history of myocardial infarction or Q wave and revascularization (Combined group). Mean age of the patients was 61.8 ± 9 years. A total of 401 deaths occurred during a mean follow-up of 5.8 years with an annual mortality rate of 4.5%. Only two variables, age and maximal exercise capacity, were independently and statistically associated with time to death in all three groups and were the strongest predictors of all cause mortality.CONCLUSIONA simple score based on METs, age, and history of myocardial infarction or diagnostic Q waves can stratify prognosis in patients with chronic coronary artery disease. The score enabled the identification of a group at low risk (32% of the cohort) with an annual mortality rate of 2%, a group at intermediate risk (42% of the cohort) with an annual mortality rate of about 4%, and a group at high risk (26% of the cohort) with an average annual mortality rate of approximately 7%.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSETo examine the effectiveness of cardiac rehabilitation on health status following coronary artery bypass surgery.METHODSA prospective cohort study of patients having coronary artery bypass surgery at 14 centers in the state of Washington. Baseline clinical and demographic data were collected, as was information from the Rand Short Form, 36 (SF-36), the Seattle Angina Questionnaire, and other questions regarding health status before surgery and at 6 and 12 months after surgery. In the 12-month follow-up survey, subjects were asked to complete questions pertaining to their participation in postdischarge cardiac rehabilitation programs.RESULTSA total of 947 subjects from 13 centers received 1-year follow-up surveys, with 75% responding. Of these, 691 (95%) answered questions about participation in cardiac rehabilitation programs. SF-36 and Seattle Angina Questionnaire scores improved significantly after surgery for both cardiac rehabilitation participants and nonparticipants. Although more than 90% of subjects who participated in the cardiac rehabilitation programs stated that they were beneficial, for eight SF-36 domains and five Seattle Angina Questionnaire domains, no significant associations were found with participation in cardiac rehabilitation. When the participation status was defined as only those participants who completed at least 8 weeks of cardiac rehabilitation, only 1 of 13 health status domains favored cardiac rehabilitation. Responses to a series of questions about perceptions of change in general and cardiac-specific health did not differ among participants and nonparticipants.CONCLUSIONSAlthough patients report favorable impressions of cardiac rehabilitation after coronary artery bypass surgery, it does not appear to provide a measurable benefit in self-reported health status beyond that achieved from the revascularization procedure itself.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEDepressive symptoms, physiologic function, and cognition were examined in patients with chronic obstructive pulmonary disease (COPD) after 3 weeks of rehabilitation.METHODSPatients with COPD completed measures of depression, neuropsychological function, exercise, and spirometry before and after a 3-week rehabilitation program. The 30 rehabilitation patients with COPD were compared with 29 untreated patients with COPD and 21 healthy controls similar in age, education, and gender.RESULTSA significant group by time interaction effect was found on the Beck Depression Inventory (BDI). A significant interaction effect was also found on the 6-minute walk. Patients in the COPD rehabilitation program had decreased depressive symptoms and increased 6-minute walk distance compared with the untreated groups. Across the 3 groups, no significant interaction effects were found on neuropsychological tests. However, clinically significant improvement in sustained visual attention, verbal retention, and visuospatial ability were reported in the most impaired patients with COPD in the rehabilitation group.CONCLUSIONCompared with control groups, decline in depressive symptoms and increased exercise capacity occurred in patients with COPD after brief rehabilitation. Clinical improvement in visual attention, verbal memory, and visuospatial functions occurred in the impaired patients with COPD participating in treatment. Neurobehavioral improvements after such a brief rehabilitation intervention are relevant for clinical care and warrant continued investigation in well-designed clinical trials.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID