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:

PURPOSEThis study aimed to examine demographic, psychosocial, and clinical variables as predictors of smoking cessation in patients with coronary artery disease.METHODSSmoking status and psychosocial variables were obtained at baseline. Participants were followed up at 3 months then annually up to 6 years for smoking status. Participants were recruited from the population of patients undergoing coronary angiography from 1986 through 1990. Patients were included in the study if they reported smoking at baseline and had valid data for demographic and clinical measures of interest. Depending on the psychosocial measure analyzed, sample size ranged from 525 to 303. Age, gender, education, marital status, disease severity, cardiac procedure, hostility, and four ratings of distress were evaluated as predictors of smoking cessation.RESULTSOf the full sample, 40% (n = 210) quit smoking without relapse. Education (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.44–0.84;P< .003), disease severity (OR 0.58; 95% CI 0.40–0.84;P< .004), and coronary artery bypass surgery (OR 0.60; 95% CI 0.43–0.85;P< .004) were associated with a lower likelihood of relapse. Higher levels of hostility (OR 2.36; 95% CI 1.46–3.84;P< .001), concern about health (OR 1.90; 95% CI 1.33–2.74;P< .001), tension (OR 1.60; 95% CI 1.12–2.30;P< .012), and depressive feelings (OR 1.60; 95% CI 1.12–2.27;P< .010) were associated with a higher risk of continuing to smoke.CONCLUSIONSThese findings describe demographic, clinical, and psychological mechanisms that might underlie successful smoking cessation and also may guide the identification of patients in need of special intervention.

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:

BACKGROUNDMost patients with coronary heart disease are overweight. However, only minimal weight loss occurs with participation in a standard cardiac rehabilitation (CR) program.METHODSThe study investigated 82 patients with coronary heart disease who entered an outpatient CR program and completed 36 sessions of exercise over a 12-week period. The effects of a structured, nurse-coordinated, weight loss intervention during phase 2 CR were compared with those observed in a CR control group receiving usual care.RESULTSThe intervention group lost an average of 4.3 ± 2.8 kg (P< .0001), as compared with a weight loss of 1.7 ± 2.6 kg (P< .001) in the control group (P< .005 between groups). The effect of the weight loss intervention on total cholesterol (172 ± 34 to 166 ± 29 mg/dL) differed from the response in a control group receiving usual care (180 ± 30 to 187 ± 28 mg/dL) (P< .05 between groups). The weight loss group experienced a significantly greater improvement (P< .05) than the control group in the physical function score on the Medical Outcomes Study SF-36 questionnaire. A significant correlation was found between the number of weight loss sessions an individual attended and the amount of weight loss experienced (R = 0.39;P< .05).CONCLUSIONSThe current study demonstrated that a behavioral weight loss intervention is effective in reducing body weight in a CR setting. Participants in the intervention group experienced significantly greater improvements in body weight, body mass index, and total cholesterol than a control group. Additionally, participants in the weight loss program reported greater improvements in their physical function score than the control patients.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEPrevious work has established that the Heart Fit Rx Diet Habits Survey (HFD), formerly the Food Frequency Assessment Tool, compares favorably (r= 0.78;P< .01) with the Oregon Health Sciences University Diet Habit Survey. The purpose of this study was to assess the validity and reliability of the HFD in estimating fat intake as a percentage of calories.METHODSThe validity study assessed 137 patients undergoing cardiac rehabilitation (age, 60.7 ± 11.3 years) who completed the HFD (29 questions, 11 of which were dietary fat related [fat subscore]) and a 3-day food record. A regression equation was obtained using HFD subscores to estimate fat intake as a percentage of calories. The regression equation was tested using 50 patients not included in the original cohort. Reliability was assessed using a third group of 31 patients in a 4-week test-retest analysis.RESULTSThe correlation coefficient between the 3-day record and the HFD fat subscore was 0.65 (P< .01). The correlation coefficient for women (r= 0.77) was slightly higher than for men (r= 0.62). The regression equation derived from the HFD fat subscore was as follows: percentage of dietary fat = 50.65 − 0.736 (HFD fat subscore). The correlation coefficient for actual and predicted values was 0.58 (P< .01). Differences between estimated fat intake, as determined by the 3-day record and the HFD, ranged from 0% to 25% and were within 5% for 26 of the 50 subjects (52%), and within 10% for 41 of the 50 subjects (82%). The mean difference between the two measures was 1.5% (P= .17). Test-retest reliability was high for both the HFD total score (r= 0.95) and the HFD fat subscore (r= 0.85;P< .01).CONCLUSIONSThe HFD is an inexpensive, valid, and reliable clinical instrument for assessing dietary fat. It can be a viable alternative to other time-consuming methods, including computerized analysis.

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:

PURPOSEResistance training has become an accepted part of cardiac rehabilitation programs. Because of the potential for a high afterload to have a negative impact on left ventricular function, there has been concern regarding the safety of resistance training for patients with congestive heart failure.METHODSThis study addressed this concern by studying 12 healthy volunteers, 12 patients with stable coronary artery disease, and 12 patients with stable congestive heart failure during upright cycling at 90% of ventilatory threshold, and during one set of 10 repeated leg presses, shoulder presses, and biceps curls at 60% to 70% of 1-repetition maximum. Left ventricular function was measured by echocardiography.RESULTSThe pattern of changes in heart rate, blood pressure, left ventricular ejection fraction, wall thickness, and left ventricular internal diameters was similar across all three groups of subjects, although there were large differences in absolute values. Despite elevations in diastolic and mean arterial pressures during resistance exercise, there was no evidence of significant rest-to-exercise deterioration in left ventricular function during leg press (ejection fraction, 60%–59%, 56%–55%, and 38%–37%), shoulder press (66%–65%, 59%–53%, and 38%–35%), or biceps curls (63%–58%, 53%–54%, and 35%–36%), as compared with cycle ergometry (63%–69%, 51%–57%, and 35%–42%) in the healthy control subjects, the patients with coronary artery disease, and the patients with congestive heart failure, respectively.CONCLUSIONSLeft ventricular function remains stable during moderate-intensity resistance exercise, even in patients with congestive heart failure, suggesting that this form of exercise therapy can be used safely in rehabilitation programs.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEExaggerated blood pressure (BP) response during physical exertion is associated with increased risk for cardiovascular events. Furthermore, it may be the predisposing factor for myocardial infarction triggered by physical exertion. The authors have shown that systolic BP achieved after 6 minutes of exercise is the strongest predictor of left ventricular hypertrophy. Furthermore, a 37 mm Hg increase in systolic BP above resting BP at 6 minutes of exercise was the threshold for left ventricular hypertrophy. The purpose of this study was to determine predictors of exercise BP response in normotensive and hypertensive women.METHODSAn exercise tolerance test (Bruce) was performed by 1411 normotensive (resting BP < 140/90 mm Hg) and hypertensive (resting BP ≥ 140/90 mm Hg) women. These women were faculty, students, and staff at the University of Maryland, College Park, Maryland, and the George Washington University Medical Center, as well as patients undergoing a routine exercise tolerance test at West Coast Cardiology, Pinellas Park, Florida. Two fitness categories (low-fit and high-fit) were established on the basis of treadmill time to exhaustion adjusted for age.RESULTSSignificant associations were observed among the 6-minute exercise BP and age, body mass index, resting systolic and diastolic BP, heart rate, and exercise time to exhaustion. In a stepwise multiple-regression analysis, the determinants of BP after 6 minutes of exercise were resting systolic BP and treadmill time to exhaustion (R2= 0.36) for normotensive women and treadmill time to exhaustion and resting systolic BP (R2= 0.30) for hypertensive women. When fitness categories were contrasted, low-fit women in both the normotensive and hypertensive categories had higher BP and rate-pressure product after 6 minutes of exercise than the high-fit women (P< .05).CONCLUSIONSResting systolic BP and cardiorespiratory fitness are determinants of a submaximal exercise BP response for both hypertensive and normotensive women. Low cardiorespiratory fitness is associated with a higher BP response during submaximal exercise, suggesting that increased fitness may attenuate this abnormal rise in BP. Thus, low- to moderate-intensity physical activities for most days of the week should be encouraged for all women to increase cardiorespiratory fitness. This is likely to attenuate an abnormal rise in systolic BP that may occur during routine daily activities and protect against the associated health consequences.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSEThis study aimed to establish the reliability, validity, and sensitivity of the Cardiovascular Limitations and Symptoms Profile (CLASP) in a group of patients with chronic stable angina.METHODSAfter 226 patients with angina had been recruited, they were randomly allocated to one of three groups: a 10-week hospital-based angina management program (n = 75; men = 56; age = 60 ± 8 years), routine care (n = 74; men = 52; age = 61 ± 7 years), and exercise therapy (n = 77; men = 60; age = 60 ± 7 years). All the patients were assessed with CLASP on two occasions: at baseline and at 10 weeks. The Sickness Impact Profile (SIP), the Hospital Anxiety and Depression Scale (HADS), and the Sleep Problems Questionnaire (SPQ) also were administered at the same time.RESULTSSignificant positive correlations between the actual number of angina episodes and the CLASP angina subscale scores (r= .60,P< .001) were observed. The CLASP subscale scores for shortness of breath (r= −.36;P< .001) and ankle swelling (r= −.24;P< .001) were significantly correlated with the total treadmill time. The CLASP tiredness subscale score showed a significant positive correlation with the SPQ score (r= .48;P< .001). The CLASP subscale scores were significantly correlated with their corresponding SIP subscale scores: the tiredness score with the sleep and rest score (r= .49;P< .001), the social and leisure score with the recreation and pastimes score (r= .41;P< .001), the home score with the home management score (r= .45;P< .001), and the mobility score with the mobility (r= .37;P< .001) and total treadmill time scores (r= −.49;P< .001).CONCLUSIONSThe findings show CLASP to be a reliable, valid, sensitive measure of health-related quality of life in patients with chronic stable angina. Before it can be recommended for all patients with heart disorders, similar data will be required from other diagnostic groups such as patients with heart failure or those who have sustained an acute myocardial infarction.

ISSN:0883-9212    

出版商:OVID    

年代:2002

数据来源: OVID