摘要:

Background.This study examined differences in the perceptions of the importance and timing of sexual counseling in patients with myocardial infarction (MI).Methods.Using a longitudinal descriptive prospective design, subjects were identified from the discharge records of three health-care agencies after having experienced an acute MI in the last 4 to 8 weeks. The Sexual Counseling Needs of MI Patients Survey and a consent form were mailed to patients at 2, 4, and 6 months after MI. Patients (N = 91) rated the importance and timing of 14 sexual counseling items using a Likert scale (1 to 5), and reported the preferred method of education. The possible range for the importance score was 14 to 70.Results.Mean importance ratings for each of the 14 items at each of the data collection periods ranged from 3.28 to 4.59. The mean overall importance score at 2 months (56.96), 4 months (56.52), and 6 months (55.19) reflected the importance of these items for teaching. There was no significant difference between importance scores at each of these time periods. Subjects were divided as to when sexual counseling should occur, in hospital or after discharge, for items related to specific sexual counseling. The most preferred educational method at 2, 4, and 6 months after MI were written materials, followed by individual discussion, and a videotape to watch at home.Conclusions.Patients validated the importance of each of the specific areas for sexual counseling after MI. The timing and educational methods for sexual counseling must be further addressed in future research. Sexual counseling initiated in the acute-care setting and continued throughout the recovery period can impact the quality of life of patients with MI and their partners.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Secondary prevention is an important goal of cardiac rehabilitation in patients with coronary heart disease (CHD). Dyslipidemia is one of the major risk factors that is important to control to reduce the incidence of future ischemic coronary events. The aim of the present study was to assess whether control of dyslipidemia, in secondary prevention, could be improved by a comprehensive cardiac rehabilitation program.Methods.Fifty-two newly diagnosed hyperlipidemic men, who had experienced a recent CHD event, were separated in two equal groups of 26 patients: group CR+, in which patients were included in a 2-month cardiac rehabilitation program including an extensive educational program on cardiovascular risk factors, lipids, and diet, and group CR− without any cardiac rehabilitation. Mean age, body mass index, initial levels of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and LDL/HDL ratio were not significantly different between the 2 groups. In both groups, each patient was referred to a dietitian and to the same lipidologist to start an appropriate hypolipidemic treatment. Treatment of coronary event, type of hyperlipidemia, and hypolipidemic treatment were not different between the two groups.Results.Lipid measurements, performed 3 months after the beginning of the hypolipidemic treatment, showed that patients from the CR+ group, compared with those from the CR− group, had a significantly greater reduction of total cholesterol (23% versus 13%; P < 0.001), of LDL cholesterol (28% versus 12%; P < 0.001), of LDL/HDL ratio (34% versus 13%; P < 0.01) and of triglycerides (33% versus 21%; P = 0.05).Conclusions.Patients with CHD included in a comprehensive cardiac rehabilitation program showed a significantly better response to the hypolipidemic treatment than patients without cardiac rehabilitation. These results could be attributable to the extensive educational program on secondary prevention performed during cardiac rehabilitation, leading to optimized knowledge on lipid-lowering diet and to improved diet and drug adherence. A secondary prevention educational program must be an important part of any comprehensive cardiac rehabilitation program in patients with CHD.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background and Purpose.Older patients with artery disease have higher rates of disability than younger coronary patients, partly based on lower levels of skeletal muscle strength. We compared the effect of a combined resistive-aerobic training program on muscular strength in older and younger coronary patients early after myocardial infarction.Methods.The study population included 45 patients who had recently (4-12 weeks) suffered a myocardial infarction; 19 were age ≥ 62 years (mean 68 ± 3 years) and 25 were <60 years of age (mean 48 ± 7 years). Muscle strength was measured by single repetition maximum lifts for leg extension and bench press, before and after the 12-week conditioning program. Body composition was measured in a subset of 16 patients by dual x-ray absorptiometry.Results.At baseline, the older population demonstrated lower strength measures than the younger patients. With conditioning, both groups improved strength similarly with leg-extension and bench press measures increasing by 35% and 14% respectively in the older patients and 39% and 14% in the younger patients (both P < 0.05, NS between groups). Within the older patient group, the men were significantly stronger than the women at baseline yet the women tended to improve their strength measures to a greater degree than the men, increasing leg strength by 66% and bench press by 29% versus 29% and 10% in older men (P < 0.10 between groups). In the overall study population, body composition measures showed a slight decrease in body weight, a decrease in fat mass, and a maintenance of lean body mass and bone mineral content with no difference in response between older and younger patients.Conclusions.Older coronary patients can effectively increase body strength with a combined resistive-aerobic exercise program in the early post-myocardial infarction period.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.The purpose of this investigation was to compare capillarity and fiber type proportions of the vastus lateralis muscle between patients with chronic obstructive pulmonary disease (COPD) and healthy subjects.Methods.Fifteen male subjects were included in the study (8 COPD: 61.0 ± 1.8 years [mean ± SEM]; forced expiratory volume in 1 second 42.0 ± 2.1% predicted; 7 N: age 54.0 ± 1.1). Subjects were submitted to a symptom-limited maximal exercise test on ergocycle. After a transcutaneous biopsy of the vastus lateralis muscle, sections were cut 8 to 10 μm thick and stained with the Andersen method for capillarity and Stevens method for fiber typing.Results.Patients with COPD had a decrease in peak oxygen consumption compared with healthy subjects (1.2 ± 0.1 versus 3.0 ± 0.2 L/min). Number of capillaries per square millimeter was lower in patients with COPD versus healthy subjects (92.6 ± 16.1 and 213.3 ± 33.5,P< 0.001); percentages of fiber types were 43.5 ± 5.5% type I, 56.5 ± 5.5% type II in COPD, and 56.7 ± 3.4% type I, 43.2 ± 3.4% type II in healthy subjects (P < 0.05). In addition, capillaries/fiber ratio was 0.83 ± 0.05 in COPD, and 1.56 ± 0.10 in healthy subjects (P < 0.001).Conclusion.As expected, patients with COPD showed a decrease in exercise capacity. The muscle analysis results indicate that patients with COPD have a greater proportion of type II fibers and a much lower capillaries/fiber ratio than normal subjects. We conclude that COPD adversely affects fiber type and capillarization of the lower limbs. This could be partly caused by deconditioning in these patients.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Because of recent technological advances, exercise testing laboratories now have the ability to use ramp protocols with treadmill exercise tests. Since the Bruce protocol is the most widely used treadmill protocol in clinical laboratories, a standardized ramp treadmill protocol was developed that corresponds to the speed and grade settings of the Bruce protocol at each 3-minute time interval. The purpose of this study was to evaluate the utility of using subject demographic and exercise test data to predict peak oxygen uptake (VO2peak) for tests conducted with the BSU/Bruce Ramp protocol.Methods.Maximal exercise tests were performed by 698 men and women using the BSU/Bruce Ramp protocol. Peak oxygen uptake was measured during all tests. Stepwise multiple regression analyses were used to predict VO2peak(mL · kg−1· min−1) from maximal treadmill test time and selected variables including age, gender, physical activity habits, and body weight.Results.Maximal test time was found to be the most potent predictor of VO2peak, accounting for 86% of the variance in peak aerobic power, with a standard error of estimate of 3.4 mL kg min−1. A multiple regression equation including age, gender, physical activity habits, and body weight resulted in a slightly improved prediction (R2= 0.88; standard error of estimates = 3.1 mL kg min−1).Conclusions.Peak oxygen uptake values can be predicted with reasonable accuracy from the BSU/Bruce Ramp protocol. The BSU/Bruce Ramp would be an excellent choice for laboratories desiring to use a ramp treadmill protocol because of the design of the protocol with identical workloads at equivalent time periods (3, 6, 9, 12, 15, 18, 21 minutes) as the commonly used Bruce protocol.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Purpose.To find out in a sample of coronary patients at entry into a cardiac rehabilitation program, whether women report a lower level of physical functioning and a higher degree of psychosocial impairment than men.Methods.One hundred and nine male and 122 female patients matched for age with a diagnosis of myocardial infarction, coronary artery bypass grafting, or coronary angioplasty were assessed at entry into a multidisciplinary outpatient rehabilitation program. Information was retrieved from hospital records, a semistructured interview, and several psychological questionnaires. Variables of physical functioning included perceived exercise tolerance, functional complaints, psychosomatic complaints, and sleeping disturbances. Variables of psychosocial impairment included anxiety, depression, vital exhaustion, well-being, feelings of being disabled, displeasure, and social inhibition.Results.At program entry, there were no significant differences in age, coronary risk factors, coronary incident, or medication between genders. However, women reported significantly lower perceived exercise tolerance and significantly more functional and psychosomatic complaints. Moreover, women were significantly more anxious and scored significantly higher on social inhibition and vital exhaustion than men.Conclusions.At entry into rehabilitation, women in this sample report a higher degree of psychosocial impairment and a lower level of physical functioning than men. Women's significantly higher scores on social inhibition and vital exhaustion might partly explain their reported higher drop-out and lower adherence rates in cardiac rehabilitation.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Congestive heart failure (CHF) is associated with increased peripheral vascular resistance. Exercise-induced shear stress may release endothelial relaxing factors, such as nitric oxide (NO), and inhibit the production of vasoconstrictors such as endothelin-1 (ET-1) thereby modulating vascular tone. We examined the effect of intensive training on ET-1 plasma concentrations and NO-metabolite elimination in patients with CHF after acute myocardial infarction.Methods.Seventeen patients with CHF after a myocardial infarction were randomized to an exercise group (n = 9), who performed physical training for 8 weeks, or a control group (n = 8) who received usual care. A physical examination, pulmonary function test, and a maximum exercise test were performed, and 24-hour urinary nitrate elimination and ET-1 in plasma were determined before and at the end of the study period.Results.Maximal oxygen uptake remained unchanged in controls (17.9 ± 1.4 to 18.1 ± 1.5 mL/(kg min) but increased in the exercise group (from 20.4 ± 0.75 to 26.7 ± 1.4 mL/(kg min). After 8 weeks the urinary nitrate elimination in controls was significantly decreased (1.25 ± 0.20 to 1.03 ± 0.22 mmol/24 hours; P < 0.001), while it was unchanged in the exercise group (1.26 ± 0.23 to 1.39 ± 0.28; P = 0.71). Plasma ET-1 levels did not change after 8 weeks (7.87 ± 0.62 versus 7.57 ± 0.75 and 7.13 ± 0.6 versus 7.35 ± 0.7 pg/mL for control and exercise groups, respectively).Conclusion.In patients with CHF after acute myocardial infarction nitrate elimination decreases over the subsequent 2 months. This trend was reversed by training. Because nitrate elimination mirrors endogenous NO production, these results suggest that training may positively influence endothelial vasodilator function.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Purpose.To compare the progress of patients who were exercise tested before or during cardiac rehabilitation versus those patients who were not tested.Methods.Eighty-eight (88) post-myocardial infarction patients and 141 post-bypass surgery patients had a symptom-limited exercise test before or during 12 weeks of cardiac rehabilitation. Another 125 post-myocardial infarction and 146 post-surgery patients were not tested.Results.Caloric expenditure during class increased for the entire group (P < 0.001) from week 1 to week 12. Body weight decreased for the entire group as a result of cardiac rehabilitation (P < 0.001). Tricep skinfolds decreased for the entire group (P < 0.001) while subscapular skinfolds did not change (P = 0.28). The percent change from week 1 to week 12 for both groups was similar for all variables. No problems occurred during cardiac rehabilitation that required emergency medical management.Conclusions.Patients completing a 12-week cardiac rehabilitation program can be safely progressed in terms of their exercise capacity without an entry exercise test. This is desirable in a managed-care setting for reducing costs while maintaining effective patient care. Such factors as staff training and experience, institutional philosophy, patient referral patterns, and facility location must be considered before adopting a no-test policy.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID